Gender Differences, HIV Risk Perception and Condom Use

This paper analyzes how different types of HIV-knowledge influence condom use across the sexes. The empirical work is based on a household survey conducted among 1,979 households of a representative group of market persons in Lagos in 2008. Last time condom use is analyzed based on a Probit model while correcting for clustering effects. Next to socioeconomic characteristics, the data includes questions on knowledge of the existence of HIV, HIV prevention, HIV stigma, intended pregnancy, and risk perceptions of engaging in unprotected sex. We observe a large HIV knowledge gap between males and females. Moreover, across the sexes different type of knowledge are important in condom use. Low risk perceptions of engaging in unprotected sex and not knowing that condoms prevent HIV infection appear to be the best predictors for risky sexual behavior among men. The latter is also important in condom use among single females. Both factors, however, do not explain sexual behavior of married women, suggesting a lack of bargaining power in HIV prevention decisions among married females. For females, irrespectively of marital status, stigma leads to lower condom use. Obviously, lack of knowledge on where condoms are available (still 9.4%, 29.1% of the male and female respondents respectively) reduced condom use across both males and females. Our results call for programmatic approaches to differente the focus of HIV prevention campaigns for males and females including a separate focus for the married. Moreover, the large predictive power of high-risk perceptions of engaging in unprotected sex (while correcting for other HIV knowledge indicators) calls for further exploration of influencing these risk perceptions in HIV prevention programs.