CONTEXT: High levels of HIV/AIDS and unwanted pregnancy among young people are urgent public health problems in South Africa. Studies among youth have generally focused on protection against one or the other of these risks, but not both. METHODS:Data collected in 2001 from 2,067 sexually active men and women aged 15–24 in KwaZulu-Natal were examined in bivariate and multivariate analyses to assess reasons for condom use, and levels and determinants of use. RESULTS: Overall, 59% of respondents said that they used condoms at last sexual intercourse, including 6% who used them with another method. The main reason for use (cited by 64% of users) was protection against both pregnancy and HIV infection. Two-thirds of respondents thought that becoming or making someone pregnant in the next few weeks would be a big problem; fewer than one in five viewed their risk of HIV infection as medium or high. Among both sexes, young people who would consider a pregnancy highly problematic were more likely to use condoms than
their counterparts who would view a pregnancy as no problem (odds ratios, 1.4–2.3). In sharp contrast, young men and women who perceived themselves as having a medium to high risk of HIV infection were less likely to use condoms than their counterparts who perceived themselves as being at no risk (0.2–0.3). CONCLUSION: Prevention programs could increase condom use in this population by increasing awareness of the twin risks of pregnancy and HIV infection, and by promoting condoms for protection against these dual risks. International Family Planning Perspectives, 2006, 32(1):28–3