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PubMed2001

Protective role of health values in adolescents' future intentions to use condoms.

PURPOSE: To examine the protective role of health values in adolescents' intentions to use condoms. METHODS: Two hundred thirty-six sexually active adolescents who were attending a municipal sexually transmitted diseases clinic were interviewed, using standardized and constructed instruments, regarding their previous condom use, health values, condom attitudes, social norms regarding condoms, self-efficacy regarding condoms, and intentions to use condoms in the future. Correlations and hierarchical multiple regression analyses were conducted to examine the direct and indirect effects of health values on intentions to use condoms. RESULTS: Health values were significantly correlated with intentions to use condoms with main and casual sexual partners, and accounted for a significant amount of variance in intentions to use condoms with casual sexual partners, after controlling for demographic variables, past condom use, and constructs from the Theory of Planned Behavior. Health values were also found to moderate the relationship between condom attitudes and intentions to use condoms with casual partners. CONCLUSIONS: Efforts to include health values as a protective factor in health behavior theory and risk-reduction interventions are warranted.

Adolescent↗
PubMed2004

The availability of socially marketed condoms in urban Tanzania, 1997-99.

The objective of this study was to evaluate trends in the availability of socially marketed condoms in urban Tanzania, and to assess the effect of changes in the social marketing programme's strategy for distributing condoms to retail outlets. Three retail outlet surveys conducted in urban Tanzania in 1996/97, 1998 and 1999 were analysed. Multiple Classification Analysis (MCA) was used to determine changes in availability of condoms, after adjusting for differences in the composition of the samples. Consistent with the changes in the condom social marketing distribution system, the proportion of condom outlets that were supplied by wholesalers increased from 42% in 1997 to 60% in 1999. The increasing use of wholesalers allowed sales agents to devote more time to opening new outlets. Hence, the percentage of outlets that had been solicited to sell condoms by social marketing condom sales persons increased from 14% in 1997 to 25% in 1999. Following these changes in the distribution system, the percentage of outlets selling socially marketed condoms increased from 25% to 32% between 1997 and 1998, and stabilized at that level. More detailed examination showed that availability of socially marketed condoms increased significantly in most non-traditional outlets, and in all regions of the country. In conclusion, distribution survey data indicate that changes in the distribution system increased the role of wholesalers, and enabled sales teams to allocate more time to soliciting new condom outlets. Concurrent with these changes, the availability of socially marketed condoms in non-traditional retail outlets increased significantly. Regular monitoring of condom availability can ensure that any emerging supply problems are identified and remedied quickly.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Identification of strategies for promoting condom use: a prospective analysis of high-risk African American female teens.

Condom promotion strategies for adolescents typically include provision of STD/HIV-associated knowledge, fostering favorable attitudes toward condom use, promoting positive peer norms regarding condom use, improving condom-related communication skills and self-efficacy, and overcoming barriers to condom use. The purpose of this study was to identify which of these constructs were prospectively associated with condom use among a high-risk sample of African American adolescent females reporting sexual activity with a steady male partner. Adolescents, 14-18 years old, were recruited from schools and health clinics. Adolescents completed an in-depth survey and interview at baseline and again 6 months later. Analyses were limited to adolescents with steady partners who reported sexual activity between the baseline and 6-month follow-up assessment periods (N = 179). At baseline, five-scale measures and a single-item measure were used to assess predictive constructs. At follow-up, adolescents were asked about their frequency of condom use over various periods of recall. Multivariate models were created to control for the confounding influence of pregnancy status. The findings were remarkably distinct. The evidence strongly supported the predictive role of perceived barriers toward condom use and peer norms. The measure of sexual communication achieved significance for two of the six assessed outcomes. Alternatively, measures of attitudes toward condom use, condom negotiation self-efficacy, and knowledge about STD/HIV-prevention were consistently nonsignificant. The findings suggest that to improve effectiveness of individual-level STD/HIV prevention programs, designed for this population, program emphasis should be on reducing barriers to condom use, teaching partner communication skills, and fostering positive peer norms relevant to condom use.

Adolescent↗
PubMedDate not supplied

Gender differences related to heterosexual condom use: the influence of negotiation styles.

The present study had three primary goals. The first was to identify gender differences related to negotiation styles associated with condom use. We hypothesized that women would report engaging in more negotiation behaviors associated with condom use than men. The second goal was to determine whether the relationships between intentions to use condoms and past condom use for women and men were moderated by negotiation behaviors. The third goal was to examine gender differences in responses to an open-ended question inquiring why participants did not use condoms. Male and female college students (N = 219) anonymously completed a series of measures. The results indicated that women and men have unique roles in the negotiation process; women play a more active role in negotiation of condom use, while men play a more reactive role. The relationship between intentions to use condoms and past condom use increased for men when their partners were more active in the process of deciding whether to use condoms. Responses to the open-ended item revealed that women identified perceptions of low risk as the most common reason for not using condoms, while men identified the inconvenience or unavailability of condoms as the most common reason. The implications of these results are discussed as they relate to health efforts to increase condom use.

Adolescent↗
PubMed2001

Understanding constraints to adolescent condom procurement: the case of urban Botswana.

Even when condoms are widely available and affordable, adolescents may be reluctant to obtain them. Hence, programme managers need to understand what determines youths' perceptions of access to condoms. This paper analyzes focus group and survey data on condom access conducted among male and female adolescents in urban Botswana. Although a majority of sexually experienced adolescents have purchased condoms from retail outlets, only about 50% have obtained condoms from health facilities, even though the latter distribute free condoms. This study shows that many adolescents perceive that access to condoms is more difficult from public sector outlets than for private sector outlets, because the public sector providers tend to question the adolescents' behaviour while the latter do not. To bypass this problem, males tend to obtain condoms from friends. However, females are reluctant to ask their friends for condoms because they fear that their friends may gossip about them. The results of this study indicate that adolescents' access to condoms can be improved by interventions that improve the quality of interaction between public sector providers and adolescents, destigmatize condom use, expand private sector condom distribution, and that use peer sales agents and educators.

Adolescent↗
PubMed2004

Identifying the psychosocial correlates of condom use by female sex workers in Hong Kong.

This study examined factors affecting condom use by Hong Kong female sex workers when they have sex with their clients and steady partners. Our respondents consisted of 109 active female sex workers, mainly streetwalkers or sex workers who worked in villas. During a 30-minute interview, respondents were interviewed individually and were asked questions regarding their condom use practice. These questions were designed to measure various factors affecting their condom use practice, including attitudes toward condom use, normative pressure, perceived behavioural control, perceived AIDS risks, past condom use behaviour, and future condom use intentions with respect to the two types of partners. Multiple regression analyses reveal that perceived behavioural control is the most important factor associated with these respondents' future condom use across the two types of partners. Perceived AIDS risk is the additional predictor for condom use with clients, while normative pressure is the additional predictor for condom use with steady partners. Past condom use behaviour also provided significant additional prediction for both types of partners, implying the habitual nature of condom use among our respondents. These results have significant implications for designing intervention programmes targeting at increasing condom use by female sex workers in Hong Kong.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Safety and acceptability of the Reality condom for anal sex among men who have sex with men.

OBJECTIVES: To assess safety and acceptability of Reality condoms for anal sex among men who have sex with men. METHODS: Crossover study among HIV-seroconcordant (33 HIV-negative and 5 HIV-positive) monogamous male couples, randomized to latex male and Reality condom use with anal sex. RESULTS: Slippage with removal was reported more frequently with Reality than male latex condoms [odds ratio (OR), 2.7; 95% confidence interval (CI), 1.2-5.8 for receptive partners and OR, 34.1; 95% CI, 13.8-84.1 for insertive partners]. Receptive partners more frequently reported pain or discomfort (OR, 5.0; 95% CI, 2.6-9.4) and rectal bleeding (OR, 1.9; 95% CI, 0.9-4.1) with Reality condoms than male condoms. Over 20% reported willingness to use the Reality condom in the future with a partner of unknown HIV status; willingness was associated with past problems with male condoms and no problems with Reality condoms among receptive partners, and with past use of Reality condoms and HIV seropositivity among insertive partners. CONCLUSIONS: Men reported more frequent problems with Reality condoms than male latex condoms used for anal intercourse, particularly slippage, discomfort, and rectal bleeding. Design modifications, training, and research on the clinical significance of safety outcomes are needed for use of Reality condoms with anal sex.

Adult↗
PubMed2003

A tailored minimal self-help intervention to promote condom use in young women: results from a randomized trial.

OBJECTIVE: To evaluate the efficacy of a theory-based tailored minimal self-help intervention to increase condom use among young women at risk for HIV/sexually transmitted disease (STD). DESIGN: Randomized controlled trial on an intent-to-treat basis in two managed care plans, in Washington state and North Carolina, with follow-up at 3 and 6 months. PARTICIPANTS: A proactively recruited sample of 1210 heterosexually active, non-monogamous, non-pregnant women, aged 18-24 years recruited June 1999-April 2000; 85% completed the 6-month follow-up. METHOD: Arm 1 received usual care. Arm 2 received a mailed computer-generated self-help magazine, individually tailored on survey items including stage of readiness to use condoms, barriers to condom use, partner type; condom samples and a condom-carrying case were included in the packet; this was followed 3 months later by a tailored 'booster' newsletter. The a priori 6-month main outcomes were percentage of women using condoms during the previous 3 months (overall and by partner type) and proportion of total episodes of intercourse during which condoms were used in the previous 3 months. RESULTS: Relative to usual care, intervention group women reported significantly more condom use overall [adjusted odds ratio (OR), 1.86; 95% confidence interval (CI), 1.32-2.65; P = 0.0005] and with recent primary partners (OR, 1.97; 95% CI, 1.37-2.86; P = 0.0003). They also reported using condoms for a higher proportion of intercourse episodes (52.7% versus 47.9%; P = 0.05). Significantly more intervention women carried condoms, discussed condoms with partners, and had higher self-efficacy to use condoms with primary partners. CONCLUSIONS: Tailored cognitive/behavioral minimal self-help interventions hold promise as HIV/STD prevention strategies for diverse populations of young at-risk women.

Adult↗
PubMedDate not supplied

Virus leakage through natural membrane condoms.

The authors determined virus leakage from condoms made from processed sheep caecum using two viral probes simultaneously. They poured a mixture of two viruses, the bacteriophage, phi X174 (4 X 10(7) pfu/ml), and the human pathogen, herpes simplex virus (about 1 X 10(6) pfu/ml), in a buffered solution into condoms, which were suspended into beakers also containing buffered solution. The authors then assayed aliquots from the beakers to measure the extent of virus leakage from the condoms. With one brand of condom, 10 out of 24 samples leaked small amounts of phi X174; with the other brand of condom, 13 out of 24 samples gave similar leakage. The extent of leakage varied over two orders of magnitude from condom to condom within each brand. Of the 23 condoms that leaked the smaller virus, phi X174 (27 nm in diameter), only two also leaked the larger herpesvirus (120-150 nm in diameter). These data demonstrate that (1) large and small viruses can leak from natural membrane condoms; (2) there is considerable variation from condom to condom in allowing leakage of the viruses; and (3) leakage of a small virus does not necessarily indicate that a larger virus will leak from that particular condom. The authors explain some inconsistencies in the published literature.

Animals↗
PubMed2003

Patterns and predictors of female condom use among ethnically diverse women attending family planning clinics.

BACKGROUND: The female condom is a viable option for women to protect themselves from HIV infection and other sexually transmitted diseases. GOAL: The goal was to examine the level of female condom use and factors associated with frequency of use among US women living in San Francisco and Oakland, California. STUDY DESIGN: Of 238 women recruited from family planning clinics from July 1998 to April 1999, 206 were interviewed at both baseline and 3-month follow-up (a 92% retention rate). RESULTS: We observed a significant increase in vaginal sexual acts protected by the female condom during the study but no reduction in male condom use. Overall, 82% of women reported using a female condom at least once, but the proportion of sexual acts protected by the female condom was only 17%. Multivariate analyses showed that female condom use was associated with suggesting female condom use to one's partner, less concern about device appearance, and a partner's positive attitude about the female condom. CONCLUSION: Our data indicate that female condom use supplements male condom use and leads to an increase in protected sex. The results also suggest that attitudinal and communication factors can increase female condom use.

Adolescent↗
PubMed2006

A prospective study assessing the effects of introducing the female condom in a sex worker population in Mombasa, Kenya.

OBJECTIVE: To assess the impact and costs of adding female condoms to a male condom promotion and distribution peer education programme for sex workers in Mombasa, Kenya. DESIGN: A 12 month, prospective study of 210 female sex workers. METHODS: We interviewed participants about their sexual behaviour every 2 months for a total of seven times and introduced female condoms after the third interview. We also collected cost data and calculated the cost and cost effectiveness of adding the female condom component to the existing programme. RESULTS: Introduction of the female condom in an HIV/AIDS prevention project targeting sex workers led to small, but significant, increases in consistent condom use with all sexual partners. However, there was a high degree of substitution of the female condom for male condoms. The cost per additional consistent condom user at a programme level is estimated to be 2160 dollars (1169 pounds sterling, 1711 euros) (95% CI: 1338 to 11 179). CONCLUSIONS: The female condom has some potential for reducing unprotected sex among sex workers. However, given its high cost, and the marginal improvements seen here, governments should limit promotion of the female condom in populations that are already successfully using the male condom. More research is needed to identify effective methods of encouraging sex workers to practise safer sex with their boyfriends.

Single-Use Internal Condom↗
PubMed2006

Men with broken condoms: who and why?

OBJECTIVES: To identify (1) the prevalence of condom breakage, and demographic and sexuality-related differences among young men who have sex with women reporting and not reporting this event; (2) condom-specific behaviours associated with breakage. METHODS: Young men (n = 278) attending a clinic for treatment of sexually transmitted infections (STIs) responded to an anonymous questionnaire aided by a CD recording of the questions. The samples were screened to include only men who had used a condom during penile-vaginal sex at least three times in the past 3 months. Condom-specific behaviours (including breakage) were assessed using these last three acts of condom use as the recall period. Correlates achieving bivariate significance were subjected to multivariate analysis. RESULTS: Nearly one third (31.3%) of the men reported recent breakage. The breakage rate was 15%. Three correlates significantly distinguished between men who did and did not report breakage. Men who had past STIs were more likely to report breakage (adjusted odds ratio (AOR) 2.08), as were men who also reported condom slippage (AOR 2.72). Less self-efficacy for correct condom use was also significantly associated with breakage (AOR 1.07). Further, three condom-specific behaviours were significantly associated with breakage: allowing condoms to contact sharp objects (AOR 2.6), experiencing problems with the "fit or feel" of condoms (AOR 2.3) and not squeezing air from the receptacle tip (AOR 2.0). CONCLUSIONS: Breakage may be common and may occur in a larger context of difficulties with condoms. STI clinics could potentially benefit some men by providing instructions on the correct use of condoms.

Adult↗
PubMed2000

Factors associated with female condom use among HIV-seropositive women.

Female condoms are an effective option for preventing sexually transmitted diseases (STDs), including HIV transmission. Little is known, however, about female condom use in women living with HIV/AIDS. Ninety HIV-positive women completed measures of demographic characteristics, exposure and use of female condoms, attitudes toward female and male condoms, sexual behaviours, and substance use. Most women (77%) had been exposed to female condoms, however only 30% reported lifetime use, 16% reported recent use, and only 6% of the sample used female condoms as much or more than they used male condoms. The only factors consistently associated with female condom use were positive attitudes toward female condoms. Women who recently used female condoms were also more likely to have multiple male sex partners and reported fewer unprotected intercourse occasions. Female condoms are therefore used by a small number of HIV-infected women, particularly those with more than one male sex partner. Female condom use may be enhanced by removing barriers to their use, increasing cooperation of male partners, and enhancing proficiency of use.

Adult↗
PubMed2001

Predictors of mother-adolescent discussions about condoms: implications for providers who serve youth.

OBJECTIVE: To examine predictors of mother-adolescent communication about condoms. METHODS: Interviews were conducted with 907 mothers of adolescents aged 14 to 17 years in the Bronx, New York; Montgomery, Alabama; and San Juan, Puerto Rico, to determine whether mothers had talked with their adolescent about condoms. RESULTS: By univariate analysis, mother-adolescent communication about condoms was associated with greater knowledge about sexuality and acquired immunodeficiency syndrome, perception of having enough information to discuss condoms, information from a health-related source, less conservative attitudes about adolescent sexuality, perception that the adolescent was at risk for human immunodeficiency virus, greater ability and comfort in discussing condoms, stronger belief that condoms prevent human immunodeficiency virus/acquired immunodeficiency syndrome, and a more favorable endorsement of condoms. In multivariate analyses, mother-adolescent communication about condoms was associated with a less conservative attitude about abstinence until marriage (odds ratio [OR]: 0.73; 95% confidence interval [CI]: 0.54-0.74), greater skill in communicating about sex (OR: 1.13; 95% CI: 1.06-1.20), greater comfort in communicating about sex (OR: 1.31; 95% CI: 1.01-1.69), a more favorable endorsement of condoms (OR: 1.85; 95% CI: 1.17-2.78), and the perception that the adolescent's friends were sexually active (OR: 3.53; 95% CI: 1.97-7.16). CONCLUSION: Parents who communicate effectively about sexuality and safer sex behaviors can influence their adolescents' risk-taking behavior. Health care providers, particularly physicians, can facilitate this communication by providing to parents information about the sexual behavior of adolescents, the risks that adolescents encounter, condom use, condom effectiveness, and how to discuss condoms. They also can make referrals to programs that teach communication skills.

Adolescent↗
PubMed2000

The reported quality of condom use by young adult Zimbabwean males at higher learning centres in Harare.

OBJECTIVE: To examine the level of reported quality of condom use by young adult Zimbabwean males at higher learning institutions. DESIGN: A cross sectional descriptive survey. SETTING: Two technical colleges in Harare, Zimbabwe. SUBJECTS: A sample of 400 subjects (200 from each of the higher learning centres). MAIN OUTCOME MEASURES: Reported quality of condom use. RESULTS: All participants were males who had at least completed 'O' levels, or the equivalent of high school. The majority of the participants were single (78.2%), while a fifth (20.2%) were married and the remaining few were separated or living with a partner. Among those who were married about one fifth had children. The majority 136 (36.8%) were Roman Catholic. The mean age of students surveyed was 24 (SD 3.5) years. The reported quality of condom use in the last 12 months in this sample was measured by four items: 24.6% reported using condoms every time; 27.7% put the condom on every time before the penis entered the vagina for the first time; 29.3% still had an erection every time they withdrew from the vagina and 26.9% held onto the condom every time they withdrew. In this study the results indicated that behaviour specific influences i.e. attitudes towards condom use, use of marijuana, the situational influences of bars, and condom self-efficacy were independently predictive of the reported quality of condom use. CONCLUSION: Using the health promotion model the results indicated that marital status, having been shown how to use condoms, attitudes towards condom use and use of marijuana were all independently predictive of the reported quality of condom use.

Adult↗
PubMedDate not supplied

African-American women who always use condoms: attitudes, knowledge about AIDS, and sexual behavior.

Given the alarming increase in the incidence of sexually transmitted diseases (STDs), including AIDS, among African-American women, it is apparent that many people are engaging in sexual intercourse without using condoms. The current study examined the interrelationships among attitudes about condom use, knowledge about AIDS, sexual behavior, and drug use among 121 adult African-American women who varied in their intentions to use condoms: 21 (17%) were classified as Steady Users, 75 (62%) did not use condoms but they had High Intentions to, while 25 (21%) did not use condoms and had Low Intentions to use them. Results indicate that the three groups did not differ in their overall knowledge about AIDS or their attitudes toward using condoms as contraceptives. Significant group differences were noted for other scales that assessed attitudes about condoms. Attitudes about the use of condoms were very similar for the Steady Users and the women in the High Intentions group. However, these two groups were significantly (p < .01) different in their belief that condoms are uncomfortable and interrupt sex. Women with Low Intentions to use condoms had significantly (p < .05) more intense angry reactions regarding the negotiation of condom use and significantly more negative attitudes about the use of condoms than women in the other groups. The three groups were not differentiated by drug use, previous treatment for STDs, or their perceived risk for being exposed to AIDS. The present study is cross-sectional in nature and future research using better methodology is needed to establish causal relationships.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Perceived versus actual condom skills among clients at sexually transmitted disease clinics.

The primary aim of this study was to investigate whether individual self-reports of perceived ability to use a condom correctly correlated with the actual ability to do so. Participants in the study were 3,059 clients of a sexually transmitted disease clinic. The findings revealed that the participants' perceived self-efficacy with regard to using a condom effectively was a poor indicator of their clinically demonstrated skills using a penile model as scored on the 6-point Condom Skills Index. Condom skills, in general, were found to be at a moderate level only. Even though 89 percent of the sample were persons who said they were somewhat or very sure that they could put a condom on and take it off correctly, the sample mean score on the Condom Skills Index was only 3.6, or 60 percent correct. Perceived versus demonstrated condom skills showed poor correlations for both the relatively lower-risk group (r = .09; P < .001 and the pooled higher risk groups (r = .12; P < .001). Although men were significantly more likely than women to believe they had adequate condom skills, no significant differences were found between the clinically demonstrated condom skills of males and females. Although condom promotion has included issues of product quality and consistent use, little attention has focused on correct use. Hence, when interventions aimed at reducing risk for HIV focus on developing communication-negotiation skills regarding the consistent use of condoms, attention also should be directed toward developing skills for using condoms effectively.

Adult↗
PubMed1999

Evaluation of prostate-specific antigen as a quantifiable indicator of condom failure in clinical trials.

The ability of condoms to retain all elements of semen during intercourse has been assessed by postcoital visual inspection and in vitro permeability studies. Yet, these observations may not be sufficiently precise or realistic. This pilot study evaluated prostate-specific antigen (PSA) as a semen marker of inapparent failure of the condom barrier under conditions of actual use. Twelve couples collected samples from the vagina and surfaces of the condom using sterile cotton swabs. We obtained precoital and postcoital samples for 24 acts of unprotected intercourse, 54 acts of intercourse using intact condoms, and 40 acts of intercourse using condoms that had been deliberately punctured. We used electrophoresis to determine the amount of PSA present in the samples. PSA was detected in 100% (24/24) of vaginal samples collected immediately after unprotected intercourse and in none of the vaginal samples collected more than 24 h after intercourse (0/90). PSA was also present in 98% (83/85) of the samples collected from the inside of the condom that had failed during intercourse. Excluding uses where the condom failed during intercourse, PSA was detected in 2% (1/47) of the postcoital vaginal samples collected after use of intact condoms and in 41% (14/34) of the samples collected after use of condoms with known 1-mm punctures. We conclude that PSA shows great promise as a semen biomarker in clinical trials of barrier methods. We recommend that future studies further investigate the ability of this biomarker to identify condom failures and quantify the extent of semen exposure associated with various types of condom failures.

Adolescent↗