Differences in condom access and use and associated factors between persons with and without disabilities receiving social cash transfers in Luapula province, Zambia-A cross-sectional study

PLoS One. 2024 Jun 6;19(6):e0302182. doi: 10.1371/journal.pone.0302182. eCollection 2024.

Abstract

Persons with disabilities are disadvantaged in accessing sexual and reproductive health services, including condoms. In this study, we investigated whether condom access and use and their associated factors differed between persons with and without disabilities. We used data from adults in households receiving the Government of Zambia social cash transfers (SCT) in four districts of Luapula province. Condom access and use was the outcome. Disability, defined by the Washington Group Short Set Questions on Disability, was the main predictor. We performed logistic regression analyses to determine the associations between condom access and use and disability. In multivariable analyses, we controlled for covariates including age, sex, marital status, poverty status, HIV testing, and receiving the SCT. The sample comprised 1,143 people aged 16-49, with a median age of 21 years (interquartile range 18-28); 57.4% (n = 656) were female, 86.5% (n = 989) accessed and used condoms, and 17.9% (n = 205) were disabled, rating themselves with a 3 or a 4 on a scale of 1 = "not limited" to 4 = "cannot at all" in performing any of the six daily functions (seeing, hearing, walking, cognition, self-care, or communicating). Nearly sixty percent(58.5% (n = 120)) of persons with disabilities were female, 79.5% (n = 163) reported being very poor, 87.8% (n = 180) reported receiving SCT, and 86.3% (n = 177) reported accessing and using condoms. Condom access and use did not differ between persons with and without disabilities (adjusted odds ratio: 1.09; 95% confidence interval [CI]: 0.60-1.98]). We found no differences between persons with and without disabilities in condom access and use. We established that individual-level factors such as age, sex, marital status, and knowledge of being HIV positive might play a more important role in condom access and use than disability. Condom promotion interventions should account for these factors.

MeSH terms

  • Adolescent
  • Adult
  • Condoms* / statistics & numerical data
  • Cross-Sectional Studies
  • Disabled Persons* / statistics & numerical data
  • Female
  • HIV Infections / economics
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control
  • Health Services Accessibility / economics
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Young Adult
  • Zambia

Grants and funding

This study received financial support from the United Kingdom Research in Innovation (UKRI) Global Challenges Research Fund (GCRF) Accelerating Achievement for Africa’s Adolescents Hub (Principal Investigator Prof. Lucie Cluver) (Grant Ref: ES/S008101/1). Olivia Keiser was supported by the Swiss National Science Foundation (grant no 202660). Elona Toska was supported by CIPHER grant from International AIDS Society (2018/625-TOS), and Fogarty International Center, National Institute on Mental Health, National Institutes of Health (Award Number K43TW011434). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.