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PubMed2000

A randomized trial of hierarchical counseling in a short, clinic-based intervention to reduce the risk of sexually transmitted diseases in women.

INTRODUCTION: Effective public health interventions to reduce the incidence of sexually transmitted disease (STD), including HIV, among women are urgently needed. METHODS: A randomized trial among STD clinic patients of two types of counseling regarding methods to reduce disease transmission: a 'hierarchical' message (HP), with counseling on male condoms, female condoms, diaphragms, cervical caps, and spermicides (three formulations) and a single method message (SM) covering male condoms only or female condoms only. For this analysis, 1591 subjects received one of three educational messages at the central public STD clinic in Philadelphia. Disease incidence data for up to 6 months following the index visit were extracted from the clinic's electronic database. The primary outcome was STD reinfection: laboratory-confirmed trichomonas infection and/or clinical diagnoses of at least one of four STD. Rates were based on the full sample of randomized women (full sample) and on the subset who spontaneously returned between 22 days and 183 days following their initial visit (returners). RESULTS: Rates of trichomonas infection (SM 2.5% full sample and 12.9% returners versus HP 2.4% full sample and 11.5% returners) and clinical diagnoses (SM 6.3% full sample and 39.7% returners versus HP 6.9% full sample and 41.2% returners) did not differ across the two arms of the randomized trial, both as a straight percentage and in survival analysis (P = .81). CONCLUSION: At least in this single-session intervention trial, increasing choices in protection for women did not produce a change in disease risk compared with single-method approaches.

Adult↗
PubMed2005

Barrier method preferences and perceptions among Zimbabwean women and their partners.

In Zimbabwe, adult HIV prevalence is over 25% and acceptable prevention methods are urgently needed. Sixty-eight Zimbabwean women who had completed a barrier-methods study and 34 of their male partners participated in focus group discussions and in-depth interviews to qualitatively explore acceptability of male condoms, female condoms and diaphragms. Most men and about half of women preferred diaphragms because they are female-controlled and do not detract from sexual pleasure or carry stigma. Unknown efficacy and reuse were concerns and some women reported feeling unclean when leaving the diaphragm in for six hours following sex. Nearly half of women and some men preferred male condoms because they are effective and limit women's exposure to semen, although they reportedly detract from sexual pleasure and carry social stigma. Female condoms were least preferred because of obviousness and partial coverage of outer-genitalia that interfered with sexual pleasure.

Adolescent↗
PubMed2002

Continuation and compliance of contraceptive use.

Choosing a method of contraception is an important decision as regards user satisfaction, continuation of use and compliance. The issues of continuation of and compliance with contraceptive use are presented. The continuation rate of a method of contraception is the indicator of the acceptability of that method. The highest continuation rates at the end of the first year are recorded for subdermal implants, intrauterine devices (IUD), the pill and Depo-Provera. Lower continuation rates are found for periodic abstinence, male condom, female condom, diaphragm and spermicides. Continuation rates are highest for methods not affected by compliance. Compliance indicates the degree to which the patient adheres to a prescribed regimen. Lack of compliance can lead to adverse effects of contraceptive use (unintended pregnancy, side-effects, diminished non-contraceptive health benefits) and to discontinuation of the contraceptive method. Also, differences between method effectiveness and user effectiveness can largely be attributed to compliance with the prescribed contraceptive regimens. Health-care professionals have to empower the patient to increase compliance with the existing methods. In addition, the development and use of new contraceptive methods, which take into account the issues of non-compliance, should be encouraged.

Contraception↗
PubMed1999

Brief behavioural skills building intervention for female controlled methods of STD-HIV prevention: outcomes of a randomized clinical field trial.

The need for female controlled methods for preventing HIV infection is well recognized and women have been found to accept the female condom for these purposes. Women (n = 105) were randomly assigned to receive either (a) a 3-h behavioural skills building intervention that concentrated on educating women about the female condom, motivating female condom use, and building behavioural skills relevant to using the female condom, or (b) a time-matched broadly defined women's health education intervention. Women who received the female controlled skills building intervention used the female condom to a greater extent than did women in the health education condition. Importantly, the effects of the behavioural skills intervention were most pronounced for women who reported only one male sex partner in the previous 6 months compared to women with multiple sex partners. However, female condom use was modest, with only one in 5 vaginal intercourse acts being protected by female condoms among women with one partner who received skills training. Interventions are needed to further enhance use of the female condom and new female controlled methods are needed for the majority of women at risk who did not adopt the female condom.

Adult↗
PubMedDate not supplied

Family planning providers' perspectives on dual protection.

CONTEXT: Family planning providers can play an important role in helping women to identify their risk of HIV and other sexually transmitted diseases (STDs) and to adopt preventive measures. In-depth investigation of providers' attitudes about approaches to STD risk assessment, contraceptive counseling and dual protection--concurrent protection from STDs and unintended pregnancy--has been limited. METHODS: In semistructured interviews conducted in 1998, 22 health care providers from a large New York City agency offering contraceptive and STD services described how they balanced STD and pregnancy concerns, viewed risk assessment and assessed various contraceptive methods. RESULTS: STD prevention was seen as an integral part of family planning counseling, and most providers believed that risk assessment should be conducted universally. Providers viewed dual protection as use of condoms along with an effective contraceptive; few advocated use of the male or female condom alone. The female condom was believed to be a disease prevention method of last resort and was considered appropriate only for specific groups of women. Although providers lacked understanding about the effectiveness of the female condom and how to counsel clients concerning its use, they expressed interest in learning more. CONCLUSIONS: Training is needed to reduce providers' negative perceptions of the female condom and to reinforce the importance of individualized counseling tailored to women's specific circumstances. Studies are needed on how to encourage family planning providers to promote male and female condoms as effective contraceptive methods.

Adult↗
PubMed2001

Condom use during a community intervention trial in Kenya.

We conducted a cluster-randomized community intervention trial at Kenyan agricultural sites to measure the impact of female condom introduction on sexually transmitted infection (STI) prevalence. We present male and female condom use data here. Six Intervention sites received a community risk-reduction campaign and distribution of female condoms and male condoms, while 6 Control sites received the same campaign with male condoms only. Male and female condom distribution increased throughout follow-up. Self-reported male condom use increased substantially during follow-up to over 60% of the participants. The proportion of consistent male condom users at Control sites was higher than at Intervention sites, 23% vs 14% at 6 months and 24% vs 22% at 12 months. At Intervention sites, 11% and 7% of women used the female condoms all the time at 6 and 12 months, respectively, while the percentage of female condom non-users grew. Male and female condom use was hindered by male partner objections; suspicion of the study and the devices among residents; and bias against condoms by clinic service providers. A large proportion of coital acts remained unprotected during the trial. Our female condom intervention did not reduce STI prevalence, compared with male condom promotion only.

Adult↗
PubMed2002

[Community based intervention and reduction of women's vulnerability to STD/AIDS in Brazil].

OBJECTIVES: Despite the growing number of AIDS cases in women reported, community-based interventions, which are essential in this context, are scarce and rarely evaluated. The aim of this study was to carry out a community-based research intervention, to develop and evaluate a set of STD/ AIDS prevention actions targeting the vulnerability of low income women population. METHODS: The study was carried out in Monte Azul slum in the city of São Paulo, SP, Brazil, in the period 1998-1999. The following actions were put in place: training of health professionals from the local outpatient clinic, availability of prevention resources (male and female condoms), educational groups, educational materials and community radio programs. For evaluating intervention, data from four different research instruments were assessed: pre and post training testing of health professionals, monitoring of condom supply, direct observation of community activities, and record of health professionals and target population's voluntary statements during activities. RESULTS: It was observed an increase in demand for male condom and an interest in female condoms. There were relevant gender and age differences in adhering to proposed activities. Although there were good results regarding sensitization and training of health professionals, their involvement in prevention activities was limited. CONCLUSIONS: Strategies relating to codes, demands and specific interests of the local society, especially those related to gender roles, have successfully performed as preventive actions. Health professionals' overwork at the local outpatient clinic proved to be an important limitation for maintaining preventive actions.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Female-initiated barrier methods for the prevention of STI/HIV: where are we now? Where should we go?

The female condom has been on the US market for over 8 years and was hailed as a method that would allow women greater control in protecting themselves against unwanted pregnancy and sexually transmitted infections. However, since its launch, promotion of the female condom has met with challenges that vary from provider bias against the device, concerns about efficacy, and doubts about whether it will be used. While daunting, many of these challenges are not unique to the female condom. In fact, they parallel those of the tampon when it was first promoted in the US for menstrual hygiene in the early 1930s. Many providers were initially opposed to the tampon; early users found the tampon inadequate. Ten years after the introduction of the tampon and despite mass marketing, acceptability was mixed and use was modest (25% prevalence in a 26-city survey). Similar to female condom use observed in current-day prospective studies, users did not use the tampon exclusively or even predominantly. The story of the tampon demonstrates that a method does not have to be adopted by all users immediately to play an important role, and that even initially controversial methods can become widely accepted as mainstream. The early history of the tampon sheds perspective, and hope, on where we stand with the female condom. While much-needed work is under way to develop microbicides, we should take advantage of the fact that the female condom is already available and promote it to those in need now.

Advertising↗
PubMed2000

Use of female controlled microbicidal products for HIV risk reduction.

Many over-the-counter microbicidal contraceptive methods reduce the risk of acquiring sexually transmitted diseases. This pilot project compared the use of female controlled barrier methods in an extremely high-risk population of low-income drug abusing women following an intervention designed to promote HIV risk reduction and barrier use. An HIV transmission risk reduction interactive intervention emphasizing self-esteem, assertiveness and sexual negotiation was offered to 41 drug dependent women. Participants were randomly assigned to one of two conditions, a male and female condom condition or a male and female condom plus N-9 products (vaginal suppositories, film, gel) condition. Results from the three-month follow-up period suggest that there may be a synergistic effect of availability of multiple protective methods on the overall rate of protective behaviours. The use of the male condom for penile/vaginal sex increased from 19% at study entry to 27% during the three-month follow-up period. The total protected sexual episode rate, calculated to include use of the other protective barriers distributed, was 60%. Thus, the condom use rate was not found to decrease because of the availability of alternative methods of protection. Future research should address the use of microbicidal products to empower women to prevent STD/HIV transmission.

Adult↗
PubMed2005

Introducing diaphragms into the mix: what happens to male condom use patterns?

The objective of this analysis was to assess the effect of introducing the diaphragm on condom use patterns. Participants included one hundred eighty-nine women attending family planning clinics in Harare, Zimbabwe who reported less than 100% condom use. The proportion of acts where at least one method was used significantly increased over using follow-up; male condom use remained stable. A diaphragm was used with 50% to 54% of acts; male condoms were also used about 50% of the time. The proportion of acts where a female condom was used decreased. Women who used both male and female condoms were more likely to use diaphragms than those who reported not using female condoms. Introducing the diaphragm increased the overall proportion of protected acts. The proportion of acts where a male condom was used did not change. Female condoms use declined because concurrent use with the diaphragm is not possible.

Adolescent↗