Does community clustering mitigate the negative effect of poverty on adolescent condom use in South Africa?

CONTEXT It is important to examine whether youth from disadvantaged households are less likely than others to use a condom at first sex, even after correcting for shared characteristics within communities. METHODS Baseline survey data from the Transitions to Adulthood in the Context of AIDS in South Africa study in KwaZulu-Natal were used. Random effects logistic regression assessed the relationship between poverty and 14-22-year-olds' use of condoms at first sex, correcting for shared characteristics of adolescents within each community. RESULTS Twenty-three percent of young people had used a condom at first sex. Poor and extremely poor females had about one-third the odds of nonpoor females of using a condom at first sex, even after adjusting for community clustering; among males; however, there was no association between poverty and condom use, after adjusting for background factors and community clustering. CONCLUSIONS The importance of community clustering of neighborhood-level characteristics differs by gender in South Africa. Poverty remains a central risk factor for HIV among young women, regardless of the surrounding context, but not among men.