SciELO - Scientific Electronic Library Online

vol.15 issue1Assessment of the English literacy level of patients in primary health care services in Tshwane, Gauteng province: Part 2Retaining professional nurses in South Africa: Nurse managers' perspectives author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand



Related links

  • On index processCited by Google
  • On index processSimilars in Google


Health SA Gesondheid (Online)

On-line version ISSN 2071-9736
Print version ISSN 1025-9848

Health SA Gesondheid (Online) vol.15 n.1 Cape Town  2010




'No condom, no sex': Easy to say, but not possible for all South African women



Johanna E. Maree

Adelaide Tambo School of Nursing Science, Tshwane University of Technology, South Africa





Cervical cancer is the most common cancer in South African women. The human papillomavirus (HPV) is the biggest risk factor for developing this cancer. However, condom use protects against HPV transmission. The purpose of the study was to investigate whether Black women living in Tshwane, South Africa, were able to protect themselves against cervical cancer by insisting on condom use. The study was exploratory, qualitative and contextual, and a convenience snowball sampling method was used. The sample size was determined through data saturation (n = 20). Self-reported data were gathered by means of interviews, and analysed using Tesch's approach. Four themes emerged, (1) knowledge of cervical cancer, (2) sexual behaviour, (3) social problems and (4) emotions. The study provided evidence that women were not able to protect themselves from cervical cancer by insisting on condom use. Women lacked knowledge of cervical cancer and did not associate condom use with self-protection against this disease. Most of their sex partners refused to use condoms. Poverty, physical abuse, helplessness and fear prevented women from insisting on the use of condoms. Primary prevention strategies should focus on empowering women to protect themselves from cervical cancer and not leave this important issue to someone who might refuse it.

Keywords: cancer prevention strategies; condom use; fear of sexually transmitted infections; risk perception; self-protection in sexual relationships


Servikskarsinoom is die mees algemene kanker in Suid-Afrikaanse vroue. Die menslike papiloom virus (MPV) is die grootse oorsaak van hierdie kanker. Oordraging van die virus kan egter met kondoomgebruik voorkom word. Die doel van die studie was om te bepaal of Swart vroue woonagtig in Tshwane, Suid-Afrika, hulself teen die virus kan beskerm deur op kondoomgebruik aan te dring. Die studie was eksploratief, kwalitatief en kontekstueel en 'n gerieflikheids sneeubal metode het die steekproef gerig. Die steekproefgrootte is deur dataversadiging bepaal (n = 20). Data is ingesamel deur middel van onderhoude en die data is met behulp van Tesch se metode geanaliseer. Vier temas is geïdentifiseer, (1) kennis van servikskarsinoom, (2) seksuele gedrag, (3) sosiale probleme en (4) emosies. Die studie het bevind dat vroue hulle nie self teen servikskarsinoom kan beskerm deur op kondome aan te dring nie. Kennis van die siekte was so gebrekkig dat vroue nie kondoomgebruik met servikskarsinoom vereenselwig het nie. Die meeste van hul seksmaats het geweier om kondome te gebruik. Armmoede, fisiese geweld, hulpeloosheid en vrees het vroue weerhou om op die gebruik van kondome aan te dring. Primêre voorkomingstrategië behoort op selfbemagtiging van vroue te konsentreer. Dit sal voorkom dat vroue van mans, wat hulle die reg kan weier, afhanklik is vir beskerming teen servikskarsinoom.



“Full text available only in PDF format”




Abdool-Karim, Q., 2001, 'Barriers to preventing Human Immunodeficiency Virus in women: Experiences from KwaZulu-Natal, South Africa', Journal of the American Medical Women's Association 56(4), 193-196.         [ Links ]

Abdullah, A., Fielding, R., Hedley, A., Ebrahim, S. & Kuk, Y., 2002, 'Reasons for not using condoms among the Hong Kong Chinese population: Implications for HIV and STD prevention', Sexually Transmitted Infections 78, 180-184.         [ Links ]

Abu-Baker, K., 2005, 'The impact of social values on the psychology of gender among Arab couples: A review from psychotherapy', The Israel Journal of Psychiatry and Related Science 42(2), 106-115.         [ Links ]

Adesoji, A., 2005, 'Education: An antidote for the spread of HIV/ AIDS', Journal of the Association of Nurses in AIDS Care 16(2), 40-48.         [ Links ]

Agha, S., Kusanthan, T., Longfield, K., Klein, M. & Berman, J., 2002, 'Reasons for non-use of condoms in eight countries in sub-Saharan Africa', viewed 29 January 2009, from http//        [ Links ]

Albertyn, C., 2003, 'Contesting democracy: HIV/AIDS and the achievement of gender equality in South Africa', Feminist studies 29(3), 595-615.         [ Links ]

Ankrah, E., 1995, 'Let their voices be heard: Empowering women in the fight against AIDS', Aidscaptions 2(3), 4-7.         [ Links ]

Brandhorst Krumboltz, H. & Shapiro, J., 1979, 'Counseling women in behavioral self-direction', Personnel and Guidance Journal April, 415-418.         [ Links ]

Burchell, A., Rachel, L., De Sanjose, S. & Franco, E., 2006, 'Chapter 6: Epidemiology and transmission dynamics of genital HPV infection', Vaccine 24S3, S3/52-S3/61.         [ Links ]

Burns, N. & Grove, S., 2005, The practice of nursing research: Conduct, critique, and utilization, St. Louis, Elsevier.         [ Links ]

CANSA, 2005, Cervical cancer, viewed 10 May 2007, from         [ Links ]

Carter, M., Kraft, J., Koppenhaver, T., Galavotti, C., Roels, T., Kilmarx, P. & Fidzani, B., 2007, 'A bull cannot be contained in a single kraal: Concurrent sexual partnerships in Botswana', AIDS Behaviour 11(6), 822-830.         [ Links ]

Chimbiri, A., 2007, 'The condom is an "intruder" in marriage: Evidence from rural Malawi, Social Science and Medicine 64, 1102-1115.         [ Links ]

Cothran, M. & White, J., 2002, 'Adolescents' behavior and sexually transmitted diseases: The dilemma of human papillomavirus', Health Care Women International 23, 306-319.         [ Links ]

Cresswell, J., 1994, Qualitative inquiry and research design: Choosing among five traditions, Sage, Thousand Oaks.         [ Links ]

Dennis, P., 2006, 'The crisis of marriage in contemporary South Africa', Grace and Truth. A Journal of Catholic Reflection for Southern Africa 23(1), 3-8.         [ Links ]

Denny, L., Quinn, M. & Sankaranarayanan, R., 2006, 'Chapter 8: Screening for cervical cancer in developing countries', Vaccine 24(S3), S3/71-S73/77.         [ Links ]

Dangor, Z., Hoff, L. & Scott, R., 1998, 'Woman abuse in South Africa: An exploratory study', Violence Against Women 4, 125-152.         [ Links ]

Drumright, L., Gorbach, P. & Holmes, K., 2004, 'Do people really know their sex partners? Concurrency, knowledge of partner behavior, and sexually transmitted infections within partnerships', Sexually Transmitted Diseases 31(7), 437-424.         [ Links ]

Dunkle, K., Jewkes, R., Nduna, M., Jama, N., Levin, J., Sikweyiya, Y. & Koss, M. 2007, 'Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: Prevalence, predictors, and associations with gender-based violence', Social Science and Medicine 65, 1235-1248.         [ Links ]

Epstein, R., 2005, 'Primary prevention of human papillomavirus-neoplasia: No condom, no sex', European Journal of Cancer 41, 2595-6000.         [ Links ]

Fischbach, R. & Herbert B., 1997, 'Domestic violence and mental health: Correlates and conundrums within and across cultures', Social Science and Medicine 45(8), 1161-1176.         [ Links ]

Frega, A., Stentella, P., De Ioris, A., Piazze, J., Frambini, M., Marchionni, M. & Cosmi, E., 2003, 'Young women, cervical intraepithelial neoplasia and human papillomavirus: risk factors for persistence and recurrence', Cancer Letters 196, 127-134.         [ Links ]

Gauteng Tourism Authority, SA, n.d., Did you know? Interesting facts about Gauteng, viewed 28 September 2009, from hppt://        [ Links ]

Gavey, N., McPhillips, K. & Doherty, M., 2001, 'If it's not on, it's not on - or is it?', Gender & Society 15(6), 917-934.         [ Links ]

Goetz, A., Shackleford, T., Romeroa, G., Kaighobadi, F. & Miner, E., 2008, 'Punishment, proprietariness, and paternity: Men's violence against women from an evolutionary perspective', Aggression and Violent Behavior 13, 481-489.         [ Links ]

Gomo, E., Ndamba, J., Nhandara, C., Murahwa, S. & Nyansema, N., 1997, 'Prevalence of gonorrhoea and knowledge of sexually transmitted infections in a farming community in Zimbabwe', The Central African Journal of Medicine 43(7), 192-195.         [ Links ]

Hattori, M. & Dodoo, F., 2007, 'Cohabitation, marriage and "sexual monogamy" in Nairobi's slums', Social Science and Medicine 64, 1067-1078.         [ Links ]

Hawken, M., Melis, R., Ngombo, D., Mandaliya, K., Nganga, L., Price, J., Dallabetta, G. & Temmerman, M., 2002, 'Sexual behaviour, knowledge and prevalence of sexually transmitted infections in a suburban community in Kenya', International Conference on AIDS, Barcelona, Spain, July 07-12, 2002, n.p.         [ Links ]

Hegarty, K. & Roberts, G., 2008, 'How common is domestic violence against women? The definition of partner abuse in prevalence studies', Australian and New Zealand Journal of Public Health 22(1), 49-52.         [ Links ]

Heysteck, M., De Jonge, E., Meyer, H. & Lindeque, B., 1995, 'Screening for cervical neoplasia in Mamelodi -lessons from an unscreened population', South African Medical Journal 86(4), 1180-1182.         [ Links ]

Holloway, I. & Wheeler, S., 2002, Qualitative research in nursing, 2nd edn., Blackwell, Oxford.         [ Links ]

Hou, W-L., Wang, H-H. & Chung, H-H., 2003, 'Post-traumatic responses of abused women to marital violence', Kaohsiung Journal of Medical Sciences 19, 352-357.         [ Links ]

Hou, W-L., Wang, H-H. & Chung, H-H., 2005, 'Domestic violence against women in Taiwan: their life-threatening situations, post-traumatic responses, and psycho-physiological symptoms. An interview study', International Journal of Nursing Studies 42(6), 629-636.         [ Links ]

Hughes, G., Hoyo, C. & Puonane, T., 2006, 'Fear of sexually transmitted infections among women with male migrant partners - relationship to oscillatory migration pattern and risk-avoidance behavior', South African Medical Journal 96(5), 434-438.         [ Links ]

Hutton, H. & McCaul, M., 2008, 'The relationship between recent alcohol use and sexual behaviors: gender differences among sexually transmitted disease clinics partners', Alcoholism: Clinical and Experimental Research 32(11), 208-2011.         [ Links ], S.A., Seven red flags of abuse, viewed 06 February 2009, from        [ Links ], 2008, 'Understanding infidelity in Africa', viewed 29 January 2009, from        [ Links ]

Jewkes, R., Levin, R. & Renn-Kekana, L., 2002, 'Risk factors for domestic violence: findings from a South African cross-sectional study', Social Science & Medicine 55(9), 1603-1617.         [ Links ]

Kalichman, S., Simbayi, L., Cain, D., Cherry, C., Jooste, S. & Mathiti, V., 2006, 'Alcohol use and sexual risks for HIV/ AIDS in sub-Saharan Africa: systematic review of empirical findings', Prevention Science: the official journal of the Society for Prevention Research 8(2), 141-151.         [ Links ]

Keeling, J., 2004, 'A community-based perspective of living with domestic violence', Nursing Times 100(11), 28-29.         [ Links ]

Kim, J. & Pronyk, P., 2008, 'Exploring the role of economic empowerment in HIV prevention', AIDS, suppl. 4, S57-S71.         [ Links ]

Krefting, L., 1991, 'Rigor in qualitative research: the assessment of trustworthiness', American Journal of Occupational Therapy 45, 214-222.         [ Links ]

LoBiondo-Wood, G. & Harber J., 2006, Nursing research: methods and critical appraisal for evidence-based practice, St Louis, Mosby.         [ Links ]

Maharaj, P., 2001, 'Obstacles to negotiating dual protection: perspective of men and women', African Journal of Reproductive Health 5(3), 150-161.         [ Links ]

Maharaj, P. & Cleland, J., 2005, 'Risk perception and condom use among married and cohabiting couples in KwaZulu-Natal, South Africa', International Family Planning Perspectives 31(1), 24-29.         [ Links ]

Mahon, S., 2009, 'Cancer epidemiology. Implications for prevention, early detection, and treatment', in S. Newton, M. Hickey & J. Marrs (eds.), Mosby's oncology nursing advisor. A comprehensive guide to clinical practice, n.p., Mosby, St Louis.         [ Links ]

Makua, T., 2008, 'Knowledge, hygiene and sexual practices of men contributing to the development of cervical cancer', Masters dissertation, Tshwane University of Technology.         [ Links ]

Maree, J. & Wright, S., 2007, 'Sexual and menstrual practices: risks for cervix cancer', Health SA Gesondheid 12(3), 55-65.         [ Links ]

Mason, L., 2005, 'Knowledge of sexually transmitted infections and sources of information amongst men', The Journal of the Royal Society for the Promotion of Health 125(6), 266-271.         [ Links ]

Mitchell, G., 2006, 'Parse's theory of human becoming in nursing practice', in M. Alligood & A. Tomey (eds.), Nursing theory, utilization & application, n.p., Mosby, St Louis.         [ Links ]

Mnbaga, E., Leyna, G., Mnyika, K. & Klepp, K., 2008 'Sexually transmitted infection knowledge and its impact in the practice of risky sexual behaviours and HIV serostatus: results from rural Kilimanjaro, Tanzania', Sexually Transmitted Infections 84, 224-226.         [ Links ]

Okin, S., 1998, 'Feminism, women's rights and cultural differences', Hypatia 13(2), 32-52.         [ Links ]

Oriel, J., 2005, 'Sexual pleasure as a human right: harmful of helpful to women in the context of HIV/AIDS?' Women's Studies International 28, 392-404.         [ Links ]

Paranjape, A., Bernstein, L., St George, D., Doyle, J., Henderson, S. & Gorbie-Smith, G., 2006 'Effect of relationship factors on safer sex decisions in older inner-city women', Journal of Womens Health 15(1), 90-97.         [ Links ]

Parse, R., 1990, 'Health: a personal commitment', Nursing Science Quarterly 3, 136-140.         [ Links ]

Parse, R., 1992, 'Human becoming: Parse's Theory of Nursing', Nursing Science Quarterly 5(1), 35-42.         [ Links ]

Pillay, A., 2002, 'Rural and urban South African women's awareness of cancer of the breast and cervix', Ethnicity & Health 7(2), 103-114.         [ Links ]

Polit, F. & Beck, C., 2004, Nursing research: principles and methods, Lippincott, Philadelphia.         [ Links ]

Randolph, M., Pinkerton, S., Bogard, l., Cecil, H., & Abrahamson, P., 2007, 'Sexual pleasure and condom use', Archives of Sexual Behavior 36(6), 844-848.         [ Links ]

Schiffman, M., Philip E., Jeronimo J., Rodriques A. & Wacholder S., 2007, 'Human papillomavirus and cervical cancer', Lancet 370, 890-907.         [ Links ]

Senn, T., Carey, M., Vanable, P., Coury-Doniger, P. & Urban, M., 2009, 'Sexual partner concurrency among STI clinic patients with a steady partner: correlates and associations with condom use', Sexually Transmitted Infections 85(5), 343-347.         [ Links ]

Singer, M., Erickson, P., Badiane, L., Diaz, R., Ortiz, D., Abraham, T. & Nicolaysen, A., 2006, 'Syndemics, sex and the city: understanding sexually transmitted disease in social and cultural context', Social Science and Medicine 63(8), 2010-2021.         [ Links ]

South African Medical Research Council, 2008, Our research, viewed 10 May 2006, from        [ Links ]

Stark, A.M. & Hope, A., 2007, 'Aboriginal women's stories of sexually transmissible infection transmission and condom use in remote central Australia', Sexual Health 4(4), 237-242.         [ Links ]

Steiner, M., Cates, W. & Warner, L., 1999, 'The real problem with male condoms is nonuse', Sexually Transmitted Diseases 26(8), 459-462.         [ Links ]

Talbot, L., 1995, Principles and practice of nursing research, Mosby, Boston.         [ Links ]

Turfloop Law Week, 2008, 'Obstacles to gender equity', Limpopo Leader 15, 12-13.         [ Links ]

Verhoeven, V., Baay, M., Colliers, A., Verster, A., Van Royen, P., Avonts, D. & Vermorken, J., 2006, 'The male factor in cervical carcinogenesis: a questionnaire study of men's awareness in primary care', Preventative Medicine 43, 389-393.         [ Links ]

Welman, J. & Kruger, S., 1999, Research methodology for the business and administrative sciences, Oxford University Press, Oxford.         [ Links ]

Weiser, S., Leiter, K., Bangsberg, D., Butler, L., Percy-de Korte, F., Hlanze, Z., Phaladze, N., Iacopino, V. & Heisler, M., 2007, 'Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland', PLOS Medicine 4(10), 1589-1598.         [ Links ]

Williamson, N., Liku, J., McLoughlin, K., Nyamongo, I. & Nakayima, F., 2006, 'A qualitative study of condom use among married couples in Kampala, Uganda', Reproductive Health Matters 14(28), 89-98.         [ Links ]

Wood, K., Jewkes, R. & Abrahams, N., 1997, 'Cleaning the womb: constructions of cervical screening and womb cancer among rural black women in South Africa', Social Science & Medicine 45(2), 283-294.         [ Links ]

Woodsong, C., Koo, H., 1999, 'Two good reasons: women's and men's perspectives on dual contraceptive use', Social Science and Medicine 49(5), 567-580.         [ Links ]

World Health Organization and International Union Against Cancer, 2005, Global action against cancer, WHO and IUAC, Switzerland.         [ Links ]

World Health Organization, 2008, Violence against women, Fact Sheet 239ed, viewed 19 September 2009, from        [ Links ]



Johanna Maree
Adelaide Tambo School of Nursing Science
Private Bag X680
Pretoria 0001
South Africa

Received: 13 Oct. 2009
Accepted: 06 June 2010
Published: 01 Nov. 2010

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License