Introduction

In Mozambique, the ability to negotiate condom use is vitally important in combating the high rates of HIV and unintended pregnancies, particularly among adolescent girls and young women (AGYW). While many studies have focused on the necessity of condom use itself, few have delved deeply into the negotiation process that precedes it—a crucial yet often overlooked aspect. This report sheds light on the factors influencing condom use negotiation among AGYW, drawing from comprehensive data from the 2022-2023 Mozambique Demographic and Health Survey (MZDHS).

Methodology

The analysis included data gathered from 2,624 sexually active AGYW aged 15-24 years across Mozambique. Their ability to negotiate condom use—defined as the capacity to request a partner to use a condom—was cataloged as a binary variable. Various influencing factors were assessed, including education level, wealth status, age, and personal experiences such as HIV testing. Advanced statistical techniques were used to discern significant predictors of successful negotiation across the demographic spectrum.

Findings

Only 35.11% of the surveyed AGYW reported feeling equipped to negotiate condom use. The study revealed that women with secondary or higher levels of education were over twice as likely to engage in effective negotiation (adjusted Odds ratio [aOR] = 2.17). Those hailing from wealthier households also exhibited a higher likelihood of negotiating condom use (aOR = 2.51). Additionally, AGYW who had undergone HIV testing were 39% more likely to negotiate condom use successfully, underlining the role of health education and awareness.

Conversely, the research highlighted a concerning trend: AGYW who held inequitable gender attitudes—believing that male dominance in relationships is acceptable—were less likely to negotiate condom use (aOR = 0.62). Alarmingly, young women aged 15-19 with such attitudes were found to have the lowest likelihood of effective negotiation.

Understanding the Context

Mozambique faces one of the highest HIV prevalence rates globally, affecting 12.4% of individuals aged 15-49, with young women being the most at-risk group. Further complicating these issues, approximately 88% of pregnancies among women aged 15-49 in Mozambique are unintended. The implications of inconsistent condom use are severe, perpetuating cycles of poverty and health risks that disproportionately affect women.

Insights from Behavioral Theory

The Theory of Planned Behaviour (TPB) provides a useful lens through which to understand the complex dynamics of condom use negotiation. According to this theory, attitudes towards condom use, perceived social pressures, and an individual’s confidence in negotiating contribute significantly to their ability to advocate for safer sex practices. Positive educational experiences and supportive social norms can enhance negotiation skills, while negative attitudes and inequitable gender roles can serve as formidable barriers.

Recommendations for Policy and Interventions

To address the identified gaps and empower AGYW in Mozambique, targeted public health initiatives are needed. Programs should aim to:

1. Enhance Educational Opportunities: Increase access to secondary education for girls, emphasizing sexual health education as a crucial component of the curriculum to equip them with necessary negotiation skills.

2. Promote Economic Empowerment: Develop economic initiatives aimed at improving the financial independence of young women, ensuring they have the resources to negotiate their sexual health effectively.

3. Encourage HIV Testing and Counseling: Integrate HIV testing with comprehensive sexual health education, creating platforms for open discussions about condom use and strategies for negotiation.

4. Challenge Inequitable Gender Norms: Engage both women and men in discussions about gender attitudes to foster healthier, more equitable relationships that support women's negotiation power.

Conclusion

The findings of this research highlight the critical interplay of education, economic status, health awareness, and gender attitudes in improving the ability of AGYW to negotiate condom use in Mozambique. By addressing these factors comprehensively through well-structured policies and community engagement strategies, stakeholders can make significant strides in mitigating the HIV epidemic and reducing unintended pregnancies among young women in the country.

Understanding and empowering young women's rights to negotiate safer sex is not just a health issue but a fundamental step towards achieving gender equality and improving overall societal well-being.

Call to Action

Join the fight to support adolescent girls and young women in Mozambique! Advocate for policies that promote education, economic independence, and comprehensive health services today!