The Relationship Between Past Condom Use and Condom Use Intention Among Male Construction Worker Clients of Sex Workers in the Western Cape, South Africa: A Parallel Multiple Mediator Model

Abstract

Male clients of sex workers in South Africa are at high risk for HIV, yet limited research has examined the psychological factors influencing their condom use intentions. This study addressed this gap by assessing the mediating roles of positive attitudes towards condom use, condom use self-efficacy, and perceived norms in the relationship between past condom use and intentions to use condoms. A cross-sectional survey was used to obtain data from male construction workers who reported sexual intercourse with a sex worker in the past three months. Using a parallel multiple mediator model, the analysis revealed that condom use self-efficacy (β = 0.060, 95% CI [0.021, 0.107]) and positive attitudes towards condom use (β = 0.027, 95% CI [0.004, 0.058]) significantly mediated the relationship between past condom use and condom use intention, while perceived norms did not (β = − 0.001, 95% CI [− 0.007, 0.007]). These findings underscore the importance of targeting instrumental and affective attitudes and enhancing self-efficacy to promote consistent condom use in this population. Although perceived norms were not determined to be statistically significant in this study, their potential role as a mediator merits further exploration, particularly in light of the study limitations. This research highlights the need for tailored interventions to reduce HIV risk among male clients of sex workers in South Africa.