Psychosocial and Contextual Determinants of Past and Intended Condom Use among Ethiopian Secondary School Students

Objective: To explore the psychosocial, sexual context, and sociodemographic determinants of past and intended condom use among secondary school students in Ethiopia. Methods: Survey data were collected from 367 sexually active high school students in five major towns using questionnaires. Structural equation modeling techniques were used to examine the role of psychosocial, sexual context, and sociodemographic factors in influencing past and intended condom use. Results: Higher levels of positive attitudes toward and self-efficacy for condom use were associated with higher levels of both past and intended condom use. Knowledge of individuals who live with or have died of HIV/AIDS was also directly related to higher levels of intended condom use. In contrast, involvement in risky sexual behaviors and use of other contraceptive methods predicted higher levels of past condom use. Effects of reproductive health understanding and family socioeconomic status on past and intended condom use were indirect through their positive influence on psychosocial factors, particularly self-efficacy and attitudes. Overall, our psychosocial and contextual model accounted for 40 and 62 percent of the variance in past and intended use, respectively. Conclusion: Findings show that theory-based social psychological and contextual factors are causally linked to patterns of past and intended condom use among Ethiopian secondary school youth. Furthermore, the results provide evidence for the applicability of Western health behavior theories to explain and predict safer sexual behaviors among secondary school students in non-Western settings.