Enhancing Adolescent Sexual Health Education and Condom Use in Harare: Addressing Attitudes and Practices Amongst Adolescents on Antiretroviral Therapy
Authors: Kuture Nancy , Mataure Priscilla , Mutanana Ngonidzashe 
Published: April 2024

Background: This study is coming against the backdrop of the attitudes and practices portrayed by sexually active adolescents on antiretroviral therapy (ART) concerning preventing STIs through condoms as a practice for safe sexual relations. Aim: The study aims to explore the attitudes that adolescents on ART have towards the use of condoms as a preventive measure for the spread of sexually transmitted infections (STIs). Method: The research presents a comprehensive examination of adolescent knowledge and attitudes towards antiretroviral therapy (ART) and sexual health education in Harare, employing a mixed-method approach. Quantitative data were gathered through semi-structured questionnaires, capturing participants’ understanding of ART and their views on sexual health services. Qualitative data were obtained through structured interviews with purposely selected groups of adolescents, reflecting their lived experiences and perceptions. The sample was designed to reflect the diversity of the urban setting, with ten groups of participants representing various demographics. Data analysis encompassed univariate statistics, bivariate associations using Pearson’s Chi-square, and multivariate relationships between variables and consistent condom usage, all with a 95% confidence level. This integrated approach provides a nuanced understanding of the complex factors influencing adolescent behavior in relation to ART and sexual health services, contributing valuable insights for public health interventions in Harare. Results: This study investigated the attitudes and practices of condom use among 202 adolescents aged 10-19 years. The study found that several factors were significantly associated with a positive attitude towards condom use. Adolescents with older partners were more likely to have a positive attitude towards condom use (AOR=2.43, CI=1.16-5.10). This means that for every one year increase in the age of the sexual partner, the odds of having a positive attitude towards condom use increased. This could be attributed as adolescents perceive older partners as having more sexual experience and therefore consider condom use as a necessary precaution. Adolescents who reported a better understanding of STIs were more likely to have a positive attitude towards condom use (AOR=3.31, CI=1.07-1.79). This means that adolescents who understood STIs better were 3.31 times more likely to have a positive attitude towards condom use than those who did not understand STIs as well. Research showed that adolescents express concerns about contracting STIs and the negative impact it can have on their health and future relationships. This increased awareness of risk motivated them to adopt positive attitudes towards condom use as a preventive measure. Adolescents with more knowledge about condoms were more likely to have a positive attitude towards condom use (AOR=1.51, CI=0.10-3.45). This means that adolescents who had more knowledge about condoms were 150% more likely to have a positive attitude towards condom use than those who did not have as much knowledge about condoms. The conversations carried with the adolescents revealed that those with more knowledge about condoms have a better understanding of their efficacy, contributed to positive attitudes towards condom use. Others expressed a sense of self-assurance in their knowledge of how to properly wear and use condoms, which enhanced positive attitudes towards condom use. These findings suggest that interventions aimed at increasing condom use among adolescents should focus on educating them about the risks of STIs, the benefits of condom use, and safe sex practices. Conclusion: In light of the study’s findings, it is evident that adolescents’ attitudes towards condom use are influenced by various factors, including their own sexual maturation and the perceived experience of their sexual partners. The study underscores the importance of comprehensive sexual health education that addresses both the biological aspects of STIs and the social and psychological implications of sexual activity. As adolescents continue to navigate their sexual identities and relationships, interventions that enhance their knowledge and understanding of condom use as a tool for preventing STIs are crucial. Additionally, considering the broader context of adolescent sexual and reproductive health in developing countries, these findings contribute to a growing body of evidence that supports the need for tailored, culturally sensitive, and age-appropriate programs to support adolescents on antiretroviral therapy (ART) in making informed decisions about their sexual health.