'Why don't you just use a condom? ': understanding the motivational tensions in the minds of South African women
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Background: HIV/AIDS makes the largest contribution to the burden of disease in South Africa and consistent condom use is considered a key component of HIV-prevention efforts. Health workers see condoms as a straightforward technical solution to prevent transmission of the disease and are often frustrated when their simple advice is not followed. Objectives: To better understand the complexity of the decision that women must make when they are asked to negotiate condom use with their partner. Method: A literature review. Results: A key theme that emerged included unequal power in sexual decision making, with men dominating and women being disempowered. Women may want to please their partner, who might believe that condoms will reduce sexual pleasure. The use of condoms was associated with a perceived lack of ‘real’ love, intimacy and trust. Other factors included the fear of losing one’s reputation, being seen as ‘loose’ and of violence or rejection by one’s partner. For many women, condom usage was forbidden by their religious beliefs. The article presents a conceptual framework to make sense of the motivational dilemma in the mind of a woman who is asked to use a condom. Conclusion: Understanding this ambivalence, respecting it and helping women to resolve it may be more helpful than simply telling women to use a condom. A prevention worker who fails to recognise this dilemma and instructs women to ‘simply’ use a condom, may well encounter resistance.