media exposure, education, and residence constant. Of those who said they knew of condoms (including answering affirmatively to prompting), a high proportion could not say where they might be obtained. In the WHO/GPA surveys, a maximum of 38 percent (males, Côte d'Ivoire) knew of a source and lived or worked within 30 minutes of it.

Some surveys have found that people's declared knowledge of condoms depends on the context of the questioning. Messersmith et al. (1994) report that in their study of sexual behavior and condom use in Ile-Ife, Nigeria, condoms were known as a means of family planning by more people of both sexes than as a means of protecting against STD transmission, although more actually used condoms for the latter purpose.

Condom Use

Perhaps the same dynamic is at work with reports of condom use: people asked in the context of STD prevention whether they have ever used condoms may underreport their use as contraceptives. Condom social marketing projects in many African countries have been remarkably successful in the recent past, and the number of condoms sold has increased dramatically (see Chapter 5). Nevertheless, it is clear from all surveys (including the fertility-based DHS series) that use of condoms is still low throughout sub-Saharan Africa (Tables 4-6A and 4-6B).

In multivariate analysis of WHO/GPA data, age is negatively related to condom use, while use rises with both education and level of risk behavior. However, knowing that HIV is transmitted sexually and feeling personally vulnerable to infection16 are not associated with condom use. Messersmith et al. (1994) confirm the negative correlation with age and the positive correlation with risk behavior (including contact with sex workers). They show a linear rise in condom use with the number of lifetime partners. They also show positive associations with knowledge of AIDS and a history of STDs. Using DHS data for Tanzania, Rutenberg et al. (1994) show that although condom use is scanty, it is concentrated among those with multiple partners.

Although around one-quarter of men reporting "commercial" sex in Burundi and Lusaka, Zambia, claim always to use a condom in such encounters, proportions recorded in the other WHO/GPA surveys are far lower. A consistently higher proportion of women than men reporting "commercial" sex said they never used a condom. These women are not likely to be full-time sex workers. A study of just such women in The Gambia (to whom condoms are freely distributed)

16  

 This relationship might be expected to run either way: a person might feel at risk and so be more likely to use condoms, or be more likely to feel at risk as a consequence of not using condoms.



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