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      Sexual communication self-efficacy, hegemonic masculine norms and condom use among heterosexual couples in South Africa


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          Hegemonic masculine norms (HMN), which promote sexual risk-taking among males and the subordination of women, are believed to play a key role in the HIV epidemic among heterosexual couples in South Africa (SA). Sexual communication self-efficacy (SCSE) (i.e. a couple’s confidence in their ability to communicate about HIV prevention) may be a key leverage point for increasing HIV prevention behaviors among this population. We interviewed 163 sexually active heterosexual couples in Soweto, SA to investigate the association between SCSE, HMN and consistent condom use. We collected information on demographics, relationship dynamics and sexual activity. We utilized the SCSE scale to measure couples’ SCSE, and a subscale of the Gender Equitable Men scale to measure HMN among males. We performed bivariate and multivariable analyses to determine the association of consistent condom use with couples’ SCSE as well as the male partner’s endorsement of HMN. We found that couples with higher SCSE have greater odds of consistent condom use (aOR=1.30, 95% CI: 1.15–1.47). Furthermore, male endorsement of HMN was found to be negatively associated with consistent condom use among couples (aOR=0.47, 95% CI: 0.24–0.89). Joint HIV serostatus was not significantly associated with the outcome. Future interventions that equip heterosexual couples with sexual communication skills, while simultaneously promoting more gender equitable norms, may increase consistent condom use and thereby reduce the transmission of HIV among this at-risk population.

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          Author and article information

          AIDS Care
          AIDS Care
          AIDS care
          14 May 2016
          07 September 2015
          01 February 2017
          : 28
          : 2
          : 228-233
          [1 ]Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
          [2 ]Center for AIDS Prevention Studies & Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
          [3 ]Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
          [4 ]Perinatal HIV Research Unit, University of the Witwaterstrand, Soweto, South Africa
          Author notes
          Corresponding Author: Lynae Darbes, Ph.D., Associate Professor of Medicine, Center for AIDS Prevention Studies, UCSF, Mailcode 0886, 550 16 th Street, 3 rd Floor, San Francisco, CA, USA 94158, Tel: +1 (415) 476-6265, lynae.darbes@ 123456ucsf.edu

          Current affiliation: Centers for Disease Control (CDC), Pretoria, South Africa


          Current affiliation: Sanofi Pasteur, Swiftwater, PA, USA

          Anna Leddy, MHS, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA, 21205, Tel: +1 (415)-637-3209, aleddy3@ 123456jhu.edu

          Deepalika Chakravarty, MS, Center for AIDS Prevention Studies, UCSF, Mailcode 0886, 550 16 th Street, 3 rd Floor, San Francisco, CA, USA 94158, Tel: +1 (415)-476-6240, Deepalika.Chakravarty@ 123456ucsf.edu

          Sibongile Dladla, CDC South Africa, 1140 Prospect Street, Hatfiled, Pretoria, South Africa, Tel: +27 12 424 9000, ntilolo41@ 123456gmail.com

          Guy de Bruyn, MBBCh MPH, Sanofi Pasteur, Discovery Drive, Swiftwater, PA, USA, 18370, Tel: +1 (570)-957-0746, gdebruynmd@ 123456gmail.com

          PMC4896738 PMC4896738 4896738 nihpa781041

          South Africa,sexual communication,couples,gender norms,HIV prevention


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