SWAZILAND: Tackling low condom use dramatically
MANZINI, 20 May 2008 (PlusNews) - Why are condoms so unpopular? This question has baffled and discouraged health experts for a decade, but in Swaziland the mystery of why men and women refuse to use condoms is slowly being unravelled by a project that is getting Swazi men to open up about their condom use, or lack thereof.
Much has been said and written about the myths and misconceptions inhibiting condom use, but little has been done to reflect these realities in existing HIV/AIDS awareness and prevention campaigns.
Now, an initiative led by AIDS activist and health motivator Hannie Dlamini, and the National Emergency Council on HIV/AIDS (NERCHA), a government body that distributes grants to AIDS organisations, is hoping to change this by getting to the bottom of men's attitudes towards sexual health.
Swaziland's first Demographic Health Survey, in 2007, found that 26 percent of sexually active Swazis were infected with HIV. Although almost 99 percent of survey participants said they knew about the disease, nearly half admitted having multiple sex partners and having sex without condoms.
"Men in Swaziland do not use condoms. They are distributed all over, but they are not used," Dlamini told IRIN/PlusNews.
For the past three years, the NERCHA project has covered two of Swaziland's four regions: the populous central Manzini, the country's commercial hub, and Hhohho region in the north, where the capital, Mbabane, is located. Next on the itinerary are Shiselweni in the south and Lubombo in the east.
The programme has adopted a traditional communications approach, rather than the standard method of using questionnaires, to amass data. To get the men talking, Dlamini and dramatist Modison Magagula looked to traditional Swazi customs that are still largely observed by Swazi men in rural areas, and understood by all Swazi men.
"We recreated the sihonco. This is the enclosure, like a small kraal [cattle pen], where the men go to roast meat, smoke traditional weeds, and discuss things. Women do not enter the sihonco, just as by custom men do not enter the women's special huts. We call the AIDS awareness programme 'kudliwe inhloko' and that is the SiSwati term that means when men sit around and talk amongst themselves," Dlamini explained.
 Men in Swaziland do not use condoms. They are distributed all over, but they are not used. | Magagula's drama troupe performs a playlet covering a specific issue, like men involved with under-age girls, which is the starting point for the discussion that follows.
About 8,000 men have participated thus far, but the organisers intend to make this an ongoing project that would eventually reach all Swazi men, to inform them about the facts on AIDS and counter peer pressure and the prevailing myths about the disease.
Hannie Dlamini commented that such word-of-mouth misinformation often served to fill the vacuum of factual knowledge, because there were almost no health educators out there regularly meeting with communities, especially in remote rural areas.
What do men really think?
"What has resulted thus far from this project is not statistics but understanding: why men behave the way they do, what their beliefs are," said Wiseman Dlamini, a NERCHA project officer in the Manzini region.
Hannie Dlamini said the anecdotes showed a striking pattern of similarity. "The men give many reasons for not using condoms, but these are excuses. The problem is that condoms were never properly introduced to men."
As a result, Swazi men are eager to embrace anti-condom myths as a reason to reject what they consider a foreign and unnatural intrusion into their sex lives.
"One myth we hear a lot is that condoms were made to destroy African manhood; then they say they heard that the gels in condoms shorten the size and duration of erections," Dlamini reported.
Allergic reactions to condoms were another common excuse. "Some men are developing rashes and other problems. It is really happening to them. But other men see this and they decide condoms are dangerous. If one man gets a rash, that means the whole community will not use them," said Dlamini.
"We tell men that if they have trouble with the rubber latex condoms, they must use a female condom, which is made of plastic. But even Swazi women are afraid of using their condoms. The men are ashamed of the suggestion. If women don't use them, men don't want anything to do with them," he noted.
Bored and married
Extramarital affairs were also a topic of discussion in the men's enclosure. According to many men who participated, sleeping with one woman all the time caused them to lose interest in sex. "They don't get erections because every day they sleep together, so the men find excitement with other girls," Dlamini said.
Renewing excitement in a marriage is a challenge for couples worldwide, and although marriage counselling is not what Dlamini's project is about, AIDS prevention measures will have to take these findings into account.
"In the past, polygamy was the Swazi man's way to avoid sexual boredom. For financial reasons that is not the option it once was, so there is a need to keep the spark going between a married man and his wife to keep him from straying," said AIDS counsellor Patricia Dube.
Will this project make a difference? Dlamini is frank and realistic in his assessment: "It's true that people listen, but after two days they think otherwise. They forget; they are influenced by their friends. Men listen to you when you talk to them, tomorrow they will go on as they did before," said Dlamini.
He said it would take regular education campaigns in communities if progress was to be made.
NERCHA, the Ministry of Health and Social Welfare, and AIDS non-governmental organisations will analyse the findings for possible ways of bringing about behavioural change. Dlamini feels that if the views and concerns of ordinary people had been taken into consideration from the inception of the AIDS crisis, more effective solutions might have been found, perhaps even achieving the elusive goal of convincing people to change their behaviour.
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