HIV Knowledge, Sexual Context, and Contraceptive Use at Sexual Debut among Urban South African Youths

Prior research has been concerned with the small correlation between high levels of HIV prevention awareness and actual contraceptive use among South African youths, suggesting that alternative explanations are needed to explain youths’ contraceptive use in a high HIV-prevalence society. One potential explanation is the ability of youths’ to effectively negotiate contraceptive use, especially among girls. This research uses the Cape Area Panel Study (n=1,380) to examine whether HIV prevention-related knowledge prior to first sexual intercourse and characteristics of youths’ first sex partner predict condom and other contraceptive use at first sex. We find that, similar with prior research, HIV prevention-related knowledge does not predict condom use for either males or females, however among females, having a partner who was two or more years older at first sex decreased the likelihood of using a condom by over 40%. This study extends prior research by using longitudinal data to predict behavior based on HIV knowledge and awareness prior to sexual debut and exploring other potential pathways, such as power dynamics within relationships that may influence the ability of youths to effectively negotiate contraceptive use. These findings have important implications for reproductive and sexual health programs in Sub-Saharan Africa.