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1 Research Division Population Services International th Street, NW, Suite 600 Washington DC Patterns of Use of the Female Condom in Urban Zimbabwe Dominique Meekers PSI Research Division Working Paper No Dr. Meekers is Research Director, Population Services International, Washington D.C., and Associate, Department of Population and Family Health Sciences, School of Hygiene and Public Health, Johns Hopkins University, Baltimore.

2 Acknowledgements This analysis was funded though financial support by UNAIDS. Data collection was cofunded by Horizons/Population Council and UNAIDS. Additional support was provided by PSI, which has core support from the British Department for International Development (DFID). The author is grateful to Muyiwa Oladosu for comments and suggestions and to Karen Toll for editing the paper.

3 Abstract In 1996, Zimbabwean women petitioned the government to make the female condom widely available as an alternative means of HIV protection. The female condom has now been mass-marketed for a little more than one year. This study uses data from exit surveys with a random sample of 1,753 consumers at retail outlets to assess patterns in awareness and use of the female condom, and to examine to what extent discussion and use of the female condom varies by type of partner. The results indicate that awareness of the female condom is very high (80%). Female condoms appear most appealing to consumers who have a regular non-marital partner. One out of four consumers have discussed using the female condom with their regular partner. By contrast, consumers are much less likely to have discussed using it with their spouse (15%), or with their casual partners (9%). Thus far, user-prevalence of the female condom has remained low at 2.3% of all consumers. Use is higher with regular partners (3.0%) than with spouses (1.4%) or casual partners (1.0%). Unlike the case for the male condom, use of the female condom does not increase with the number of sexual partners or with HIV risk perception. Comparison of the characteristics of users of male and female condoms shows that users of female condoms are more likely to be female, to have a slightly higher socio-economic status and education, to be monogamous, and to have a lower HIV risk perception. These findings suggest that the female condom is not being used for protection in high-risk situations, but rather for protection in relatively low risk acts. In the long run this may prove important, given that HIV prevalence is very high and that use of the male condom has remained very low in stable relationships.

4 Patterns of Use of the Female Condom in Urban Zimbabwe The female condom has been heralded as a promising method to make it easier for women to protect themselves from STD/HIV infection. Compared to the male condom, it is easier for women to initiate use of the female condom because it can be inserted hours before intercourse (AIDS Weekly Plus 1997c). Perfect use of the female condom can reduce the annual risk of becoming HIV positive by over 90%, a level similar to that of the male condom (Cecil, Perry, Seal, and Pinkerton 1998; Trussell, Sturgen, Strickler, and Dominik 1994; Young 1997). A study of prostitutes in Thailand found a 34% decrease in STD incidence when female condoms were made available, and a 25% decline in unprotected sex acts (AIDS Weekly Plus 1998). Hence, the introduction of the female condom has led to high expectations. This study examines the achievements after one year of social marketing the female condom in urban Zimbabwe. Early female condom programs mostly targeted high-risk persons, such as commercial sex workers, because the high production costs made the product too expensive for the general public. However, in regions where HIV prevalence is high, persons in monogamous stable relationships may also be at risk if their partners are promiscuous (De Zoysa, Sweat, and Denison 1996; Young 1997). In 1997, UNAIDS negotiated a multi-year deal with the manufacturer of the female condom (The Female Health Company) to sell the female condom to UN member states at a global public sector price of about one dollar, less than half the market price (AIDS Weekly Plus 1997c). This reduced price allowed the female condom to be mass marketed in several developing countries, including Zimbabwe. In Zimbabwe, the female condom has been mass-marketed in urban areas through a combination of free public sector distribution and social marketing. The Zimbabwean case is of particular interest because there appears to be such a large interest in the female condom. Even though HIV prevalence is very high and male 1

5 promiscuity common, condom use has remained fairly low, especially in stable relationships. Thus, men who have unprotected sex with multiple partners may transmit the infection to their spouse or regular partner. Since it is culturally unacceptable for women to refuse to have sex with their husband, they have no way of protecting themselves from infection if he refuses to use a male condom. In this context, the female condom may provide an acceptable solution (AIDS Weekly Plus 1996). Acceptability studies in Zimbabwe showed that the female condom was nearly universally liked among women, and that the large majority of males liked the female condom. In fact, most women, as well as their partners, preferred the female condom over the male condom (Ray et al. 1995; Ray and Maposhere 1997). Men liked the product because it does not interrupt the sexual act and because it reduces their responsibility for protection. More importantly, over 30,000 women petitioned the government to make female condoms widely available, in order to give them greater protection against sexually transmitted diseases (AIDS Weekly Plus 1996; AIDS Weekly Plus 1997b). The female condom has now been mass marketed in urban areas of Zimbabwe for a little over one year, enabling an assessment of this startup period. This study uses data from an exit survey among 1,753 randomly selected consumers at retail outlets in urban Zimbabwe to describe patterns of awareness and use of the female condom. Specifically, we examine awareness of the female condom, compare levels of use of the male condom and the female condom, and compare the characteristics of users of the male condom and of the female condom. We also examine to what extent discussion about using the female condom and actual use of the female condom vary by partner type. Advertising, Promotion, and Sales of the Female Condom Population Services International (PSI) started social marketing subsidized female condoms in July 1997, on behalf of the National AIDS Coordination Program and the Zimbabwe National Family Planning Council, as part of the larger male condom social 2

6 marketing program (Population Services International 1998). Funding for the social marketing program was provided by the U.S Agency for International Development (USAID) and the British Department for International Development (DFID). Operations research on the female condom was funded by UNAIDS and Horizons/The Population Council. To avoid the stigma associated with STD prevention, the female condom was marketed for family planning purposes, under the brand name Care. To dissociate the product from the male condom, it is marketed as a contraceptive sheath, rather than a condom. The image of the product is supported using the slogans the Care contraceptive sheath is for caring couples and for women and men who Care (Tsopotsa 1998). The use of Care is promoted through an extensive communications campaign, including newspapers, magazines, posters, and radio advertisements. Given that Care is marketed as a contraceptive product, rather than a disease-prevention product, the campaign targets women in long-term relationships. Initially, Care was only sold only through selected pharmacies and clinics. Distribution has since expanded to other outlets, including large supermarkets and convenience stores. (By contrast, the social marketed Prudence Plus condoms are also available in a wide variety of non-traditional outlets, including service stations, tuck shops, bars, and hotels.) The product is sold at a retail price of US$0.24 (Z$3 each) for a box of two female condoms. The government also obtained funding to procure 400,000 female condoms for free distribution at hospitals, family planning clinics, and other public health institutions (AIDS Weekly Plus 1997a; Winter 1997b). PSI forecasted sales of 4,000 female condoms a month (Winter 1997a; Winter 1997b). However, during the first 4 months of the program, 95,000 condoms were sold (Population Services International 1998). While this novelty use has since diminished, sales have been higher than expected. Care sales totaled 120,720 in 1997 (June through 3

7 December), 119,650 in 1998, and 89,879 for January through July 1999 (Population Services International 1999). Data and Methods This analysis is based on a survey of a representative sample of 1,753 consumers in urban Zimbabwe who were visiting outlets that sell male or female condoms. Respondents who did not have intercourse in the year before the survey were excluded from the analysis, reducing the sample size to 1,740. Separate questionnaires were used for users of the female condom, users of the male condom, and non-users. Each questionnaire collected information on the respondent s background and socio-economic status, sexual behavior, and perceptions about HIV risk. The female condom questionnaire includes sections on exposure to Care advertising, discussion and use of male and female condoms, previous contraceptive methods, purchasing preferences, and reasons for discontinuation. The male condom questionnaire collects information about exposure to Protector Plus advertising, brand knowledge and brand switching, and condom use. The non-user questionnaire includes information on media exposure, discussion about use of male and female condoms, reasons for not using male and female condoms, brand knowledge, and exposure to Protector Plus and Care advertising. Sampling Procedures The sampling methodology was designed to obtain a sample representative of the population of consumers (who constitute the maximum target population for social marketing condoms). The survey covers Harare, Bulawayo, Chitungwiza, Gweru, KweKwe, Mutare, Masvingo, and several small towns. 1 Sampling was conducted in two stages. Stage 1 selects the outlets included in the study. Four outlet types were included: pharmacies, supermarkets, other traditional outlets (e.g., small stores), and non-traditional 1 The study was also conducted in rural areas. However, as female condoms are only sold in urban areas, the results presented here are restricted to the urban areas. 4

8 outlets. Outlets were selected systematically from a list of all outlets that sell Protector Plus condoms or the Care female condom. Outlets that did not have any female condom sales in the past 3 months were excluded. Fieldwork hours for each region (Harare, Bulawayo, other urban) and outlet type (pharmacies, supermarkets, other traditional, nontraditional) were allocated proportional to the sales volume of Care and Protector Plus condoms (Trigg 1999). The second sampling stage selects the consumers. Respondents were selected using a screening questionnaire, which asked if they had ever used the female condom, and if not, if they had used a male condom in the past year. All patrons who ever used the female condom were selected for the female condom sample. Among the remaining patrons, one in ten male condom users and one in ten non-users were systematically selected for interviewing. After target sample size for the male condom user and non-user samples were reached, interviewing continued with female condom users only. Same-sex interviewers conducted the interviews. Interviewers also collected data on the total volume of consumers. Weighting procedures The data are weighted to correct for the over-sampling of female condom users, and for the differential sampling probability across types of outlets. The first weight equals 10 for consumers who used the male condom (but not the female condom) and for non-users. For female condom users this weight equals 273/492, to account for the fact that 219 female condom users were interviewed after the interviewing and screening of the other two groups had stopped. The second weight equals the ratio of the total number of consumers to the number of contacted consumers. Sample Characteristics The characteristics of the unweighted sample are shown in Appendix 1. The majority of the consumers are in their twenties (30% are aged and 28% aged 25-29). Few 5

9 consumers are teenagers (6%), perhaps reflecting the fact that the sample was restricted to sexually experienced consumers. A little more than half of the consumers in the sample are males (55%), and a majority (60%) are either married or living in a consensual union. The sample is highly educated. Over two thirds of consumers (72%) have secondary school education, and an additional 10% have university or polytechnic education. Using our index of SES, which was designed to split the sample in three groups of roughly equal size, 34% are classified as having a low SES, 41% as medium SES, and 26% as high SES. The findings were expected, as the population of consumers tends to have a higher education and SES than the general population (Meekers and Ogada. E. 1999). Before weighting, 28% of all respondents had used the female condom, 37% had used the male condom (but not the female condom), and 35% had used neither. Note that female condom users may also have used male condoms. Weighting the sample adjusts for this over-sampling of female condom users. After weighting, 2.3% have used the female condom, 47% have used the male condom only, and 51% have used neither type of condom. Weighting has little effect on the distribution of the control variables. Results Awareness of the Female Condom The percentage of consumers who had ever heard of the Care contraceptive sheath or the female condom is shown in Table 1. Overall, 81% of the weighted sample had heard about the female condom. Breakdown by age group shows that female condom awareness is highest among consumers aged and (86% and 92%, respectively). Awareness is lowest among teenagers (67%) and to a lesser extent among those aged (73%). The percentage who heard about the female condom does not vary by gender. 6

10 Awareness of the female condom increases with level of education, from 73% for consumers with less than secondary education, to 81% for those with secondary education, to 98% for those with higher education. Breakdown by SES reveals a similar pattern. Table 1 shows that there is no noticeable difference in the percentage of consumers who heard about the female condom by either marital status or fertility preference. Breakdown by number of sexual partners or personal risk perception does not reveal a consistent pattern. However, consumers who know a person living with AIDS have higher awareness of the female condom than those who do not (82% vs. 73%). Table 1 about here Levels of Use of the Male Condom and the Female Condom Table 2 shows the percentage of consumers who used the female condom and the male condom in the year before the survey. After approximately one year of social marketing the female condom, 2.3% of all consumers (i.e. one out of every 43) have used the female condom. While it is anticipated that this percentage will gradually increase, it is important to note that the female condom is not expected to replace the male condom. Rather, the female condom is expected to appeal mostly to those consumers who are unable or unwilling to use the male condom. Given the low prevalence of female condom use, we observe little variation across subgroups. There are only minor age differences, with those under age 25 having lower use of the female condom (about 2%) than those aged (2.5% or more). It is noteworthy that females report slightly higher use than do males (2.6% vs. 2.0%). The most notable pattern is the increase in female condom use with education and SES. The percentage who used the female condom ranges from 1.8% for those who don t have secondary education, to 2.1% for those with secondary education, and 5.0% for those with higher education. Likewise, the percentage 7

11 who used the female condom increases from 1.2% for those with a low SES, to 2.7% for medium SES, to 3.6% for high SES. Table 2 about here As anticipated, Table 2 shows that use of the male condom is considerably higher. Overall, 49% of consumers used a male condom in the year before the survey. Since the female condom is not intended to replace the male condom, high levels of condom use indicate a smaller target market for the female condom. Levels of use of the male condom are higher among younger consumers, with the sole exception of teenagers. The percentage of consumers who used the male condom increases steadily from 32% for ages to 56% for ages Among teenagers, though, only 42% report that they used the male condom. Males report much higher levels of male condom use than do females (60% vs. 37%). This latter finding is in sharp contrast with the female condom, which showed slightly higher use for females than males. As for the female condom, use of the male condom increases with level of education and SES. The percentage reporting male condom use increases from 37% for those who did not have secondary education, to 50% for those with secondary education, to 61% for those with higher education. Similarly, the percentage increases from 43% for the low SES group, to 51% for the medium SES group, to 55% for the high SES group. Use of the male condom is nearly twice as high among unmarried consumers than among those who are married or cohabiting (69% vs. 38%). However, use of the male condom does not vary by fertility preferences. This indicates that the male condom is used predominantly to avoid HIV and other sexually transmitted diseases. It provides relatively little protection for those in stable monogamous relationships. This finding is confirmed by the fact that male condom use increases rapidly with the number of sexual partners. The percentage reporting use of the male condom increases from 32% for those 8

12 who had only one partner in the past year, to 76% for those with two partners, to 83% for those with 3-4 partners, and 98% for those with five or more partners. Male condom use is also above average (64%) for those who think they have a high risk of HIV infection. Consumers who know someone with AIDS have slightly higher levels of male condom use than those who do not know such a person (49% vs. 41%). Profile of Users Due to these variations in use of the male condom and the female condom, the profile of users of the female condom may differ from that of users of the male condom, and from non-users. Comparison of the profiles of each of these three groups, shown in Table 3, indicates that the majority of users of the male condom are males (64%), while the majority of users of the female condom are females (55%). Users of the female condom tend to have a higher level of education and SES than both users of the male condom and non-users. Users of both types of condoms have the same profile in terms of marital status and fertility preferences. Users of the male condom tend to have more sexual partners than users of the female condom, and are more likely to think they have a high HIV risk. Non-users differ from users of both types of condoms, because they tend have a low SES (44%), are married or cohabiting (78%) and are monogamous (91%). Table 3 about here Discussion of the Female Condom with Various Partner Types The percentage of consumers who discussed using the female condom with their spouse, regular partner, or casual partner is shown in Table 4. Overall, 26% had discussed use of the female condom with their regular partner, 15% had discussed it with their spouse, and 9% had discussed it with a casual partner. The percentage who discussed it with their spouse increases steadily from 7% for ages to 22% for ages 30-34, declining afterward. Consumers with higher than 9

13 secondary education and with a high socio-economic status are much more likely than those with lower levels of education or socio-economic status to have discussed using the female condom with their spouse. Breakdown by number of sexual partners and personal risk perception does not reveal consistent differences in the percentage who discussed using the female condom with their spouse. However, consumers who know a person living with AIDS are more likely than those who do not to have discussed using the female condom with their spouse (16% vs. 8%). The percentage who discussed using the female condom with their spouse does not vary by gender, nor by fertility preference. The percentage who report having discussed the female condom with their regular partner does not vary by age, gender, or fertility preference. However, the percentage increases rapidly with level of education, from 17% for consumers with less than secondary education, to 25% for those with secondary education, to 41% for those with higher education. Breakdown by socio-economic status reveals a similar pattern. Discussion of use of the female condom with one s regular partner is higher for respondents who had more sexual partners, but risk perception does not have a consistent effect. Data on discussion on use of the female condom with casual partners reveal a very different pattern. The percentage who discussed using the female condom with one of their casual partners declines from 13% for ages to 3% for ages Among the small group of teenagers who had a casual partner, only 1.5% discussed using the female condom. Contrary to discussion of the female condom with spouses and regular partners, the percentage who discussed the female condom with a casual partner decreases with level of education, from 12% for those with less than secondary education to 6% for those with higher than secondary education. There is no consistent pattern by socio-economic status or gender. The percentage who discussed the female condom with a casual partner increases rapidly with the number of sexual partners, from 0% for those with one partner to 16% for those who had five or more partners. Consumers with a high 10

14 risk-perception are also most likely to have discussed using the product with a casual partner (15%). Among consumers who know a person with AIDS, 10% have discussed using the female condom with their casual partners, compared to 0% for those who do not know someone with AIDS. Table 4 about here Use of the Female Condom with Various Partner Types Table 5 shows the percentage of consumers who used the female condom with their spouse, regular partner, or casual partner. Overall, 1.4% used the female condom with their spouse, 3.0% used it with their regular partner, and 1.0% used it with their casual partners. Females are more likely than males to have used the female condom with each of these three partner types, especially with regular partners (4.7% vs. 2.1%) and casual partners (2.3% vs. 0.6%). Use of the female condom with spouses and regular partners increases with level of education and socio-economic status. However, education and SES do not have a clear effect on use with casual partners. Use of the female condom with spouses and regular partners also appears to decrease with level of risk perception, while use with casual partners does not vary by risk perception. Knowledge of a person living with AIDS is associated with higher use of the female condom with each of the three partner types. Table 5 about here Conclusion In 1996, Zimbabwean women petitioned the government to make the female condom available as an alternative means of HIV protection. The female condom has now been mass-marketed for a little more than one year. This study uses data from exit surveys with a random sample of 1,753 consumers at retail outlets to assess patterns in awareness 11

15 and use of the female condom, and to examine to what extent discussion and use of the female condom vary by type of partner. The results indicate that awareness of the female condom is very high (81%), even among groups with a low socio-economic status and education (over 70%). However, thus far the prevalence of use of the female condom has remained low, reaching only 2.3 percent of all consumers. User-prevalence increases noticeably with socio-economic status and education, but does not exceed 5% for any subgroup. Interestingly, while use of the male condom increases rapidly with the respondent s number of sexual partners, use of the female condom does not vary by number of sexual partners. Moreover, while use of the male condom increases with risk perception, use of the female condom tends to decline with increased risk perception. This suggests that high-risk groups are already relatively well served by the male condom. Comparison of the characteristics of users of male condoms and female condoms shows that users of female condoms are much more likely to be females and have a slightly higher socio-economic status and education than users of male condoms. Users of female condoms are also more likely to be monogamous and to have a lower risk perception than users of male condoms. Female condoms appear most appealing to consumers who have a regular nonmarital partner. One out of four consumers (26%) have discussed using the female condom with their regular partner. By contrast, only 15% have discussed using it with their spouse, and only 9% have discussed using it with their casual partner. Use of the female condom is higher with regular partners (3.0%) than with spouses (1.4%) or casual partners (1.0%). Unlike the case for the male condom, use of the female condom does not increase with the number of sexual partners or with HIV risk perception. These findings suggest that the female condom is not being used for protection in high-risk situations, but rather for protection in relatively low-risk acts. In the long run, 12

16 this may prove important, given that HIV prevalence is very high, and that use of the male condom is lowest in stable relationships. 13

17 References AIDS Weekly Plus "Zimbabwe Women Petition the State on Female Condom." AIDS Weekly Plus (Dec 23-30): a. "Female Condom Launched in Zimbabwe." AIDS Weekly Plus (July 28): b. "UNAIDS Begins Shipment of Female Condoms." AIDS Weekly Plus (April 21): c. "UNAIDS Promotes Female Condoms in Developing Countries." AIDS Weekly Plus (July 28): "U.N. Promotes Female Condom Against AIDS in Africa." AIDS Weekly Plus (May 4):16. Cecil, H., M. Perry, D. Seal, and S. Pinkerton "The Female Condom: What We Have Learned Thus Far." AIDS and Behavior 2: De Zoysa, I., M. D. Sweat, and J. A. Denison "Faithful but Fearful: Reducing HIV Transmission in Stable Relationships." AIDS 10(Suppl.A):S197-S203. Meekers, D. and Ogada. E "Explaining Discrepancies in Reproductive Health Indicators From Population-Based Surveys and Exit Surveys: A Case Study of Rwanda." PSI Research Division Working Papers 27. Washington, D.C.: Population Services International. Population Services International "Social Marketing With "Care" in Zimbabwe: Female Condom Sparks Early Interest." PSI Profile (March): "Unpublished Sales Statistics (9/1/99)." Washington, D.C.: Population Services International. Ray, S., M. Bassett, C. Maposhere, P. Manangazira, J. Nicolette, R. Machekano, and J. Moyo "Acceptability of the Female Condom in Zimbabwe: Positive but Male-Centered Responses." Reproductive Health Matters (5): Ray, S. and C. Maposhere "Male and Female Condom Use by Sex Workers in Zimbabwe: Acceptability and Obstacles." Reproductive Health Matters : Trigg, Caroline "1999 Zimbabwe Condom Consumer Profile Survey (in Press)." Harare: Target Research Inc. Trussell, J., K. Sturgen, J. Strickler, and R. Dominik "Comparative Contraceptive Efficacy of the Female Condom and Other Barrier Methods." Family Planning Perspectives 26(2):

18 Tsopotsa, T "Marketing the Female Condom in Zimbabwe: New Methods and Challenges." Pp in Report From the Meeting on Changing Communication Strategies for Reproductive Health and Rights (Washington, D.C., 10 Dec-10 Dec)Population Council Working Groupo on Reproductive Health and Family Planning. New York: Population Council, Health and Development Policy Project. Winter, J. 1997a. "Female Condom Sales Beat Forecast by 10 Times." AIDS Analysis Africa 7(5): b. "Social Marketing of Condoms (Female, Too) Gets Going (Again). Zimbabwe." AIDS Analysis Africa 7(2):6. Young, A "The Female Condom. A Review." Geneva: World Health Organization. 15

19 Table 1: Percentage of Sexually Active Consumers in Urban Zimbabwe Who Heard of the Female Condom (weighted) Age Sex Female Male Education Less than Secondary Secondary Higher than Secondary Socio-Economic Status Low Medium High Marital Status Not Married Married/Cohabiting Wants Child in Next Two Years Wants Child Does not Want Child Partners in Past Year Personal Risk Perception None/Small Moderate/Don t Know High Knows Person Living with AIDS No Yes % Who Ever Heard of the Female Condom Weighted N of Cases Total

20 Table 2: Percentage of Sexually Active Consumers in Urban Zimbabwe Who Used the Female Condom and the Male Condom in the Past 12 Months (weighted) Age Sex Female Male Education Less than Secondary Secondary Higher than Secondary Socio-Economic Status Low Medium High Marital Status Not Married Married/Cohabiting Wants Child in Next Two Years Wants Child Does not Want Child Partners in Past Year Personal Risk Perception None/Small Moderate/Don t Know High Knows Person Living with AIDS No Yes % of Consumers Who Used Female Male Condom Condom Weighted N of Cases Total

21 Table 3: Profile of Consumers in Urban Zimbabwe Who Used the Female Condom in the Past Year, Who Used the Male Condom, and Who Used Neither (weighted) Type of Condom Used in the Past 12 Months Age Sex Female Male Education Less than Secondary Secondary Higher than Secondary Socio-Economic Status Low Medium High Marital Status Not Married Married/Cohabiting Wants Child in Next Two Years Wants Child Does not Want Child Partners in Past Year Personal Risk Perception None/Small Moderate/Don t Know High Knows Person Living with AIDS No Yes Female Condom Male Condom Neither (a) (e) (b) (e) (c) (e) (d) (e) Total 100% 100% 100% N (Weighted) Note: (a) n=836; (b) n=813; (c) n=811 (d) n=818; (e) n=882. Cases do not add to 100% because categories are not mutually exclusive 18

22 Table 4: Percentage of Sexually Active Consumers Who Discussed Using the Female Condom with their Spouse, Regular Partner, or Casual Partner Spouse Regular Partner Casual Partner % N % N % N Age Sex Female Male Education Less than Secondary Secondary Higher than Secondary Socio-Economic Status Low Medium High Wants Child in Next Two Years Wants Child Does not Want Child Partners in Past Year Personal Risk Perception None/Small Moderate/Don t Know High Knows Person with AIDS No Yes Total Note: Cases do not add to 100% because respondents can have more than one type of partner

23 Table 5: Percentage of Sexually Active Consumers Who Used the Female Condom with their Spouse, Regular Partner, or Casual Partner Spouse Regular Partner Casual Partner % N % N % N Age Sex Female Male Education Less than Secondary Secondary Higher than Secondary Socio-Economic Status Low Medium High Wants Child in Next Two Years Wants Child Does not Want Child Partners in Past Year Personal Risk Perception None/Small Moderate/Don t Know High Knows Person with AIDS No Yes Total Note: Cases do not add to 100% because respondents can have more than one type of partner

24 Appendix 1: Sample Characteristics, urban Zimbabwe (unweighted and weighted) Sample Male Condom User Sample Female Condom User Sample Non-User Sample Age Sex Female Male Marital Status Not Married Married/Cohabiting Education Less than Secondary Secondary Higher than Secondary Socio-Economic Status Low Medium High Unweighted Distribution Weighted Distribution N of Cases