Sexual Self-Efficacy and Gender: A Review of Condom Use and Sexual Negotiation Among Young Men and Women in Sub-Saharan Africa

Abstract

Sexual self-efficacy (SSE), one’s perceived control of or confidence in the ability to perform a given sexual outcome, predicts sexual behavior; however, important questions remain regarding whether gender modifies observed associations. In a comprehensive review of peer-reviewed HIV-prevention literature focusing on youth (ages 10 to 25) in sub-Saharan Africa, we measured and assessed the influence of SSE on condom use and sexual refusal, overall and by gender. Our results, after reviewing 63 publications, show that SSE is inconsistently measured. Most studies measured condom use self-efficacy (CUSE) (96.8%) and/or sexual refusal self-efficacy (SRSE) (63.5%). On average, young men had higher CUSE than young women, while young women had higher SRSE than young men. While cross-sectional studies reported an association between high SSE and sexual behaviors, this association was not observed in interventions, particularly among young women who face a disproportionate risk of HIV acquisition. In all, 25% of intervention studies demonstrated that fostering CUSE increased condom use among young men only, and one of two studies demonstrated that higher SRSE led to reduced frequency of sexual activity for both men and women. Future research and HIV-prevention interventions must be gender targeted, consider improving CUSE for young men, and move beyond limited individual-level sexual behavior change frameworks.

Funding and Acknowledgments

The authors thank all of the youth who participated in the studies included in this review. The authors would also like to thank all the partners and others who supported this work, including the staff at the Perinatal HIV Research Unit (PHRU) in Soweto, South Africa; the Maternal Adolescent and Child Health Research Unit (MRU) in Durban, South Africa; and Simon Fraser University and the British Columbia Centre for Excellence in HIV/AIDS in Canada. Also, we thank Heather Mitchell for her editorial support on the manuscript. AK received salary support from the Canada Research Chair program in Global Perspectives on HIV and Sexual and Reproductive Health. The authors have no conflict of interest to declare regarding the publication of this manuscript. All listed authors contributed significantly to the writing and preparation of this manuscript.

Notes

¹ Eggers and colleagues (2017) defined primary abstinence as those who have never initiated sexual activity and secondary abstinence as those who have been sexually active in the past but intended to stay abstinent over the coming year.