The paper examined the associations between patterns of condom use, and gender relations attitudes, and violence against intimate and non-partners and risky sexual practices. In the study setting, consistent condom use is an unconventional sexual practice with half of the men having never used condoms in the past year and inconsistent condom use being twice as likely as consistent use. Men who reported inconsistent condom use reported similar socio-economic background to consistent users but were more sexually risky and more violent compared to both never and consistent condom users.
The paper shows a tendency for clustering of young men’s characteristics around gender relations ideology, violent practices, sexual risk and socio-economic status by condom use group (see Table 2). We observed in the analysis an emergence of three male positions which distinguished the men from one another on the basis of gender attitudes and sexual/relationship practices. Never and consistent condom users were very similar with respect to violence perpetration and sexual risk taking, yet never condom users were markedly different from consistent users as they held very conservative attitudes towards gender relations and male control over female partners. Inconsistent users were very much more violent and sexually risky than the other groups, and held a middle position on gender attitudes. Whilst the gender attitudes of consistent users were not significantly different from inconsistent, this was a less violent and sexually risky masculinity. Given that the research was undertaken in what was mostly a deep rural area it is not surprising that there was little evidence of a very gender equitable masculinity as defined by Barker , but a recent rural South African study on male care work indicates that there is an emergence of a less domineering masculinity that is also conservative . This analysis points to the need for nuance in understanding the non-linear relationship between violent and sexually risky men’s practices and attitudes towards gender equity and gender relations.
Inconsistent condom use is a risky sexual practice and places one at increased risk of HIV infection . Similar tendencies to be violent are observed in another South African study where men who used condoms inconsistently were more likely to perpetrate physical/sexual intimate partner violence . On its own, having many partners may also pose a difficulty in ensuring consistency of condom use with different partners, as authors have already shown the contradictions that may exists as to which partner condom use is more appropriate [14, 15]. Thus, the current paper suggests that inconsistent condom use is part of a continuum of expressions of male heterosexuality which innately emphasize sexual conquest as a sign of a strong masculine image , and endorse the ideology pertaining to use of violence to control women . This high reporting of such behaviours can be attributable to a heightened desire to embody a hegemonic masculinity described in Jewkes and Morrell . Participants may not desire to be infected with HIV per se, but could be facing a composite challenge and contradictions that are posed by the notions of an ideal man as invincible, sexually virile and tough. Connell  refers to these contradictions as based on complicity with certain notions of manhood that are symbolic, familiar, manageable and also widely acceptable to a sector of men with whom one identifies. It appears that these young men who subscribe to such male violent and hypersexual ideals, including being lax about condom use, are indeed at greater risk of HIV infection and need to change their assumptions about who they are as men.
Never condom users portray a masculine position that is very conservative and yet less risky and violent, that is, very traditional but in some respects more ‘benign’ men. This suggests that such a masculinity may be in existence as mentioned in Jewkes and Morrell’s qualitative study: a female participant compared her two male partners, with one described as a very ‘traditional person’ who was very controlling but also allowed her some degree of freedom to socialise with her friends unlike her other partner who was expressly disapproving and controlling in the relationship . The ‘never users’ were also much poorer than condom users. It’s hard to know whether they had fewer partners than inconsistent users because they lacked the money to entice women, or whether they simply did not aspire to be such men. Their lack of condom use could have been influenced by traditional ideas about sex, less exposure to more modern ideas and concerns about health and HIV risk, or it may be from assumptions of masculine invincibility . Views about HIV invincibility may also underlie lower perceived HIV risk reported in other studies . Never and consistent users were similar in terms of being benign towards women in their practices than inconsistent users, but differed in terms of gender attitudes. This may suggest that an important point for interventions may be to challenge traditional notions of masculinity by encouraging healthy sexual practices and men’s accessing of sexual and reproductive health services, thereby influencing a change in gender attitudes among men who are resistant to condom use.
Consistent users upheld more progressive gender relations attitudes but only in the bivariate analysis, and this is in direct opposite to never users who were similarly less sexually risky and less violent. The findings suggest that being more liberal on gender and relationships makes it permissible for men to intensify risk reduction strategies. The multinomial model showed that consistent condom users were less likely to be violent and had fewer sexual partners. Thus they appeared to represent another male position which is more benign, for example, being less violent towards an intimate partner and having fewer sexual partners are indicators of respectful and harmonious relationships . A small proportion of men were gender equitable overall, however, the findings imply that gender equity is present in other practices such as observed in the consistent group thus supporting the notion that condom use is one of the male behaviours that could be considered when evaluating ideals of manhood, and being a consistent user does imply a progressive and healthy masculine position.
The findings draw into question an assumption that never condom users are the ‘riskiest’ group. The very high prevalence of risky sexual practices among inconsistent condom users indeed suggests that they may have been the ‘most vulnerable’ to HIV infection. Their higher levels of violent and sexually risk practices, as well as their relative conservatism, suggest that these men are an important target group for an intervention that seeks to change negative ideas about masculinity such as use of violence, having multiple concurrent partners and a precarious commitment to safer sex. Such interventions exist in South Africa, and these have shown success in engaging men at local and national levels, for example, Men as Partners . However, there is uncertainty about the sustainability of these kinds of campaigns in rural settings but suggest that testing and subsequent wide up-scaling of such programmes in poor rural communities of South Africa can have far-reaching effects in curbing the incidence of HIV over time. The Brother’s for Life initiative mainly targets men over the age of 30 years on collectively addressing risky sexual behavior, gender based violence and promoting HIV prevention and male health seeking and participation through multimedia, and presents a model that could be adapted for a younger age group of men.
The sample was largely homogeneous in terms of demographic and socioeconomic factors. Since this data analysed for this paper is cross-sectional, we cannot draw any causal inferences from our findings, but can point to observed clustering of practices which has been discussed elsewhere . The study setting and participants were not randomly selected which limits generalisability. This may not affect the association between variables and associations found have often confirmed those of other authors, and therefore we have confidence that the findings of this study have validity. The consistent condom group is much smaller than the other groups and this will have widened confidence intervals, but this does not cast doubt on the reliability of the findings as the standard and rigorous statistical measures were used, to establish and test the associations of variables with condom user group. A longitudinal study to investigate the role of masculine gender ideologies on men’s condom use and other sexually risky practices may be valuable. The study relied on self-reported behaviour, which is prone to desirability bias. This may have been minimised by using just a few interviewers (56% of the interviews were done by 2 men) who received intensive initial and on-going training and support and were similar of age group, sex and background to the study sample .