Condom Use Among Unmarried Adolescents and Young Adults in Zambia

Background and Purpose: Heterosexually transmitted HIV infection rates have been on the rise among Zambian youth in recent years (8% in 2014). Despite universal HIV knowledge among this group, reported condom use is low. Existing research examining factors that hinder condom use amongst youth in Zambia is limited. With a predominantly young population and high HIV prevalence rates nationally, preventative interventions targeted at young people in Zambia are vital. This study sought to identify predictors of condom use among Zambian youth.

Method: We used data from the 2013-2014 Zambia Demographic and Health Survey (ZDHS). The survey utilized a two-stage stratified cluster sample design and is representative at the national and provincial level. All women age 15-49 and men age 15-59 in a household were eligible for an interview. We restricted our analytic sample to men and women age 15-24 who have never been married, report having had sex, and are not missing on our variables. We used logistic regression to estimate odds ratios of condom use at first sex (n = 5,021) and condom use at most recent sex during the past year (n = 3,349). We included a number of predictors in our models such as biological sex, age at first sex, household wealth, religion, rural or urban residence, and region/province. All analyses are weighted.

Results: Findings indicate 37% of unmarried Zambian youth used a condom at first sex and 45% used a condom at most recent sex in past year. Our multivariate analyses indicate older age at first sex is a significant predictor of condom use. Each additional year first sex is delayed is associated with a 26% increase in the odds of condom use at first sex. This has enduring effects, with each additional year in age at first sex being associated with a 4% increase in the odds of recent condom use. Youth from wealthier households have the highest odds of condom use at first and most recent sex. Those who report having access to condoms are 49% more likely to use a condom at most recent sex than those who report no access. Those with a child are 51% less likely to use condoms at most recent sex than those without a child. Women are 55% more likely than men to use a condom at first sex but we don’t see differences by biological sex in recent condom use after adjusting for controls. The Copperbelt, Luapula, and Northern provinces have among the lowest odds of condom use.

Conclusions and Implications: Our findings suggest the need to focus on delaying the age of first sex among youth in Zambia. We suggest policies and interventions target efforts on youth in poor households since Zambian youth in poor households tend to have sex for the first time at earlier ages than youth in wealthier households. Further investigation examining the link between socioeconomic changes and youth condom use from a longitudinal perspective is recommended.

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