Facilitators and barriers to condom use in Middle East and North Africa: a systematic review.

Abstract

Background: The Middle East and North Africa (MENA) region continues to have the lowest prevalence of HIV (human immunodeficiency virus) in the world, less than 0.1%, yet new transmissions are increasing. Consistent condom use can reduce the probability of transmission by 90–95%, and its use remains as the staple prevention method; however, this isn’t the case for the MENA region, where condom use, knowledge of proper use, and accessibility are limited. Aims: To conduct a systematic review on condom use, its use across different population groups, and its barriers and facilitators in countries that fall under the UNAIDS regional classification of MENA. Methods: This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The search included electronic databases: PubMed/MEDLINE, Academic Search Ultimate, COCHRANE, APA PsycINFO, ScienceDirect, CINAHL Complete, Scopus. There was no date restriction. Results: Of the 471 records retrieved, 45 articles were appraised and included in the analysis. The reported barriers and facilitators are sub-divided into personal, social, and structural factors. Condom accessibility, partner objection, and their perceived ineffectiveness were key barriers, whereas availability, cost, and lack of awareness were rarely mentioned. Concerns of personal health and future financial security, as well as positive peer influence and delayed sexual experience, were identified as motivators. Conclusion: Condom promotion in the region needs to incorporate gender-based power in relationships and the influence of religion, as well as the legal and structural factors. More investment and research are needed for women-initiated contraceptive and digital healthcare initiatives.