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PubMed2001

Awareness and use of untested barrier methods by HIV-seropositive gay and bisexual men.

Little is known about HIV-seropositive men's awareness and use of untested barrier methods during anal intercourse. A sample of 240 HIV-seropositive men (69.2% men of color) completed a self-administered survey that included items on nonoxynol-9 (N-9), female condoms, and the simultaneous use of two male condoms (double bagging). Most participants (79.6%) had heard of N-9 being used to prevent HIV transmission during anal intercourse. Of these, 20.0% rated N-9 as more effective than condoms, and 14.6% had used N-9 instead of condoms. Fewer men (35.4%) were aware of female condoms being used during anal intercourse. Overall, few respondents (5.4%) had used female condoms; 53.8% of whom rated the device as more pleasurable than male condoms. Most men (69.6%) had heard of double bagging, and 35.2% had engaged in this practice. Of these, 45.1% rated the practice as less pleasurable than using a single condom. Few associations were observed between participant characteristics and the awareness or use of these barrier methods. The widespread use of these untested methods emphasizes the urgent need to further educate HIV-seropositive men about the potential risks of N-9 use and to test the effectiveness of other strategies that may serve as alternatives to male condom use.

Bisexuality↗
PubMed2001

Constraints faced by sex workers in use of female and male condoms for safer sex in urban zimbabwe.

We investigated whether female condoms are acceptable to sex workers in Harare and whether improved access to male and female condoms increases the proportion of protected sex episodes with clients and boyfriends. Sex workers were randomly placed in groups to receive either male and female condoms (group A, n = 99) or male condoms only (group B, n = 50) and were followed prospectively for about 3 months each. We found a considerable burden of human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) in our cohort at enrollment (86% tested HIV positive and 34% had at least one STI). Consistent male condom use with clients increased from 0% to 52% in group A and from 0% to 82% in group B between enrollment and first follow-up 2 weeks later and remained high throughout the study. Few women in group A reported using female condoms with clients consistently (3%-9%), and use of either condom was less common with boyfriends than with clients throughout the study (8%-39% for different study groups, visits, and types of condom). Unprotected sex still took place, as evidenced by an STI incidence of 16 episodes per 100 woman-months of follow-up. Our questionnaire data indicated high self-reported acceptability of female condoms, but focus group discussions revealed that a main obstacle to female condom use was client distrust of unfamiliar methods. This study shows that a simple intervention of improving access to condoms can lead to more protected sex episodes between sex workers and clients. However, more work is needed to help sex workers achieve safer sex in noncommercial relationships.

Adult↗
PubMed1999

Safer sex strategies for women: the hierarchical model in methadone treatment clinics.

Women clients of a methadone maintenance treatment clinic were targeted for an intervention aimed to reduce unsafe sex. The hierarchical model was the basis of the single intervention session, tested among 63 volunteers. This model requires the educator to discuss and demonstrate a full range of barriers that women might use for protection, ranking these in the order of their known efficacy. The model stresses that no one should go without protection. Two objections, both untested, have been voiced against the model. One is that, because of its complexity, women will have difficulty comprehending the message. The second is that, by demonstrating alternative strategies to the male condom, the educator is offering women a way out from persisting with the male condom, so that instead they will use an easier, but less effective, method of protection. The present research aimed at testing both objections in a high-risk and disadvantaged group of women. By comparing before and after performance on a knowledge test, it was established that, at least among these women, the complex message was well understood. By comparing baseline and follow-up reports of barriers used by sexually active women before and after intervention, a reduction in reports of unsafe sexual encounters was demonstrated. The reduction could be attributed directly to adoption of the female condom. Although some women who had used male condoms previously adopted the female condom, most of those who did so had not used the male condom previously. Since neither theoretical objection to the hierarchical model is sustained in this population, fresh weight is given to emphasizing choice of barriers, especially to women who are at high risk and relatively disempowered. As experience with the female condom grows and its unfamiliarity decreases, it would seem appropriate to encourage women who do not succeed with the male condom to try to use the female condom, over which they have more control.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Barriers to condom use and barrier method preferences among low-income African-American women.

Low-income African-American women (N = 178) entering health clinics completed surveys assessing perceived barriers to condom use for themselves personally and for African-American women generally. Following the survey, each woman received a demonstration of five barrier contraceptive methods and then rated her preference among those methods. The women perceived relatively few personal barriers to use of the male condom but perceived significantly greater barriers for other African-American women (all p < .0001). The male condom was first choice of the largest percentage of women (45%) and last choice of the smallest percentage of women (11%). The male condom was preferred for its convenience, availability, and safety, although the necessity for active cooperation by the male partner was considered a hindrance to using the method. Only 23% of women ranked the female condom as first choice and 35% ranked the female condom as last choice. Reasons for selecting the female condom included preference for a female-controlled method, safety, and protection. However, the female condom was perceived to be uncomfortable, to require the partner's acquiescence, and to interfere with sexual experience. Differences in the women's perceptions of barriers to condom use for themselves and for other African-American women are consistent with Weinstein's theory of optimistic bias. Preferences among barrier methods indicate that further research and product development are needed to develop barrier methods that are female-controlled, do not require the awareness of the male partner, and are safe, comfortable, and convenient.

Adolescent↗
PubMedDate not supplied

Prevention strategies other than male condoms employed by low-income women to prevent HIV infection.

This study sought to determine HIV prevention strategies other than male condom use employed by low-income women who have sex with men (WSM) and to identify variables that predict use of these strategies. A cross-sectional survey of nearly 4,000 women receiving Women, Infants, and Children (WIC) benefits in 21 Missouri counties was conducted. The response rate was 58%, with 2,256 completed questionnaires returned. Women were asked to indicate one or more of nine methods they had ever used to prevent HIV infection. Women were also asked about their use of male condoms, preference for male condoms versus female condoms, and which partner usually made decisions about STD/HIV prevention. Of the 2,256 questionnaires returned, 1,325 WSM indicated use of at least one HIV prevention strategy other than condom use. Strategies were: being tested for HIV (68.2%), partner being tested for HIV (44.1%), asking partner about his sex history (41.1%), using oral contraceptives (18.8%), asking him if he has HIV (13.7%), douching (11.8%), withdrawal (9.4%), and having anal or oral sex (6.6%). Common predictors of these strategies were race, education, history of STD, condom use, and marital status. Basic misunderstandings about HIV prevention are common in specified subpopulations of low-income women. HIV prevention programs for low-income WSM should capitalize on women's efforts to prevent HIV by designing programs to help women replace ineffective prevention strategies with effective prevention strategies.

Adult↗
PubMed2001

Acceptability research on female-controlled barrier methods to prevent heterosexual transmission of HIV: Where have we been? Where are we going?

Acceptability research is an important component of any product development process. As researchers move into a new, accelerated phase of vaginal microbicide development, it is important to take stock of the acceptability research conducted to date and determine future research priorities. In this paper, we review findings from acceptability research conducted to date in four categories: hypothetical product acceptability research, existing product research (spermicide acceptability studies), acceptability research within the context of clinical trials, and postmarketing acceptability research conducted around the female condom. Finally, we highlight areas where additional research is needed in light of recent progress in microbicide development and discuss a possible framework for the introduction and acceptability of new sexually transmitted disease (STD) prevention technologies.

Administration, Intravaginal↗
PubMed2002

Reasons for not using condoms among female sex workers in Indonesia.

The aim of this study was to gather data on condom use among brothel-based female sex workers in Indonesia and to study the reasons for not using condoms in order to provide new and existing condom promotion programs with information to improve their performance. Quantitative data were gathered by KABP surveys (n = 1450) and a condom diary with a sample of 204 female sex workers. Qualitative data were collected by conducting focus group discussions and in-depth interviews among female sex workers and pimps. Around 53% of sexual intercourses were reported to be protected, and 12% of these protected intercourses were preceded by clients' argumentation against it. Only 5.8% of sex workers consistently used condoms for a 2-week period of observation, and this figure decreased to 1.4% for a 4-week period. Reasons for not using condoms from the clients' side, as mentioned by the sex workers, were perceived less pleasure due to the condom and the belief that clients that are acquainted with the sex workers do not need protection against sexually transmitted diseases (STDs) or AIDS. The main reasons of female sex workers for not using condoms were the beliefs that boyfriends, native Indonesians and healthy-looking clients cannot spread STDs. Another reason stated was that sex workers had already taken other preventive measures, like taking antibiotics. The research also showed that pimps were not very supportive of condom use programs in Indonesia. Condom unacceptability is an important reason for not using condoms for both clients and female sex workers, whereas pimps, who are in the best position to encourage condom use, unfortunately consider condom use as a threat to their business. For the successful introduction of consistent condom use, it is necessary to design interventions for both sex workers and clients and to provide appropriate educational materials and preferred brands of condoms. Also, pimps must be involved in intervention programs.

Adolescent↗
PubMed1997

Condom use in a group of aboriginal women.

This exploratory study investigated the attitudes of Aboriginal women in Darwin to the use of condoms to prevent HIV and other sexually transmitted diseases. An Aboriginal research assistant interviewed twelve women regarding their usage of and attitudes to the male condom and their attitude to the possibility of using a female condom. These women, like their ethnic minority counterparts in Africa and North America, had a fair level of knowledge about HIV, a low level of perceived risk of HIV and other sexually transmitted diseases, infrequent usage of male condoms with their partner, and negative attitudes to the male condom. Their attitude to the female condom was more positive. Educational programs and further research into the attitudes of women in remote communities are recommended.

Adult↗
PubMed2005

Effectiveness of female and male condoms in preventing exposure to semen during vaginal intercourse: a randomized trial.

OBJECTIVES: Comparison of male condom (MC) vs. female condom (FC) with respect to self-reported mechanical and acceptability problems and semen exposure using prostate-specific antigen (PSA) as an objective biological marker and evaluation of the effect of an educational intervention on self-reported problems and semen exposure, by condom type. DESIGN: Randomized crossover trial. METHODS: Four hundred women attending a family planning clinic in Brazil were randomized and either received in-clinic instruction or were encouraged to read the condom package insert; all used two FCs and two MCs. We measured the rates of self-reported user problems with MC and FC use and the rates of semen exposure during use (assessed by testing vaginal fluid for PSA). RESULTS: The educational intervention group reported fewer problems with either condom as compared with the control group (p = .0004, stratified by condom type). In both groups, self-reported problems were more frequent with FC use than with MC use (p < .0001, stratified by intervention). The educational intervention did not significantly reduce semen exposure. Overall, semen exposure occurred more frequently with FC use (postcoital PSA, > 1 ng/mL; 22%) than with MC use (15%); the difference, however, was small and nonsignificant for high PSA levels (> or = 150 ng/mL; 5.1% for FC vs. 3.6% for MC). CONCLUSIONS: In this study, the FC was less effective than the MC in preventing semen exposure during use and led more frequently to self-reported user problems. Both devices were highly protective against "high-level" semen exposure, as measured by postcoital PSA levels in vaginal fluid. In-clinic education may reduce user problems and increase acceptability and use of both devices.

Adult↗
PubMedDate not supplied

The acceptability of the female and male condom: a randomized crossover trial.

CONTEXT: Although studies have assessed the acceptability of male and female condoms, comparative trial data are lacking. METHODS: A sample of 108 women in stable relationships recruited from an urban, reproductive health clinic were randomly assigned to use 10 male or female condoms, followed by use of 10 of the other type. A nurse provided instruction in correct method use. Demographic information was collected in a baseline questionnaire; acceptability data were collected in follow-up and exit questionnaires and coital logs. Nonparametric and chi-square statistics were used to analyze measures of the methods' relative acceptability. Bowker's test of symmetry was adapted to test the null hypothesis of no difference in acceptability between condom types. RESULTS: Participants used 678 female and 700 male condoms. Although neither method scored high on user satisfaction measures, the 63 women completing the study protocol preferred the male condom to the female condom for ease of application or insertion, ease of removal, general fit, feel of the condom during intercourse and ease of penetration. Participants reported that their partner also favored the male condom, although women generally appeared to like this method more than their partner did. In a direct comparison between the methods at the end of the study, women generally judged male condoms superior on specified preference criteria. CONCLUSIONS: Across a range of criteria, the female condom was less acceptable than the male condom to most women and their partners. Although both types had low acceptability, they are needed and valid methods of pregnancy and disease prevention. That neither rated high on user satisfaction measures underscores the need for more barrier methods that women and men can use.

Adult↗
PubMed2001

A brief sexual barrier intervention for women living with AIDS: acceptability, use, and ethnicity.

Interventions aimed at reducing sexual transmission of human immunodeficiency virus/sexually transmitted diseases (HIV/STDs) have focused primarily on male condom use among seronegative men and women. However, female-controlled sexual barriers (female condoms and vaginal microbicides) offer women living with acquired immunodeficiency syndrome (AIDS) alternative methods to protect themselves and others from disease transmission. A pilot behavioral intervention was conducted to increase sexual barrier use and enhance and assess factors related to acceptability. Participants (N = 178) were drawn from the Stress Management and Relaxation Training with Expressive Supportive Therapy (SMART/EST) Women's Project, a multisite phase III clinical trial for women living with AIDS (Miami, FL; New York City, NY; Newark, NJ). Intervention participants (n = 89) were matched for age and ethnicity with control condition participants (n = 89). Women were African American (52%), Haitian (15%), Hispanic (19%), Caucasian (10%), and other ethnicities (4%). The intervention condition received barrier products (male and female condoms and spermicides based on nonoxynol-9 in the form of vaginal gel, film, and suppositories) during three sessions held over 3 months. Data on barrier use and acceptability were analyzed at baseline and 3 and 9 months postintervention. Use of N-9 spermicides on a trial basis increased significantly by 3 months in the intervention conditions (22%-51%, P <.05). Cultural differences in acceptability were greatest between Haitian women and women in other ethnic groups. Exposure to this pilot behavioral intervention was associated with increased acceptability and use of chemical barriers without decreased use of male condoms.

Acquired Immunodeficiency Syndrome↗
PubMed2002

The POWER campaign for promotion of female and male condoms: audience research and campaign development.

In this study, we conducted and content analyzed 12 focus groups with women aged 15-25 living in inner city Denver as a process of audience research to develop a male and female condom promotion campaign. We recruited 89 women from school and community sites in central Denver neighborhoods to discuss their knowledge, attitudes, and practices regarding both male and female condoms, then solicited opinions about how to increase knowledge about and familiarity with female condoms, increase positive attitudes toward both male and female condoms, and how to increase access to and use of both male and female condoms. Opinions on these topics drove the development of a targeted media campaign promoting condom use in this population. We report here on the general findings from focus groups and provide details about the campaign the participants helped to develop.

Adolescent↗
PubMed2006

Influencing sexual practices among HIV-positive Zambian women.

This study assessed and compared the efficacy of culturally tailored behavioral interventions to increase use and acceptability of sexual barrier products among HIV-positive women in Zambia. It also sought to evaluate cultural preferences as facilitators or impediments to potential use of vaginal chemical barriers for sexual risk reduction within the Zambian context. Women (N=240), recruited from the University Teaching Hospital HIV Voluntary Counseling and Testing Center, were randomized into group or individual intervention arms. Participants attended a baseline assessment, three intervention sessions and follow up assessments at six and 12 months. All participants increased use and acceptability of female condoms and vaginal products and maintained male condom use at six and 12 months. Preliminary data indicated that group participants increased male condom use at six months and trial use and acceptability of female condoms and lubricants predicted their use in the group condition. Results support group interventions to increase sexual barrier use and acceptability in HIV-positive women within the Zambian context. From a public health standpoint, groups may represent a cost-effective and culturally congruent intervention.

Adult↗
PubMed2001

Ourselves, our bodies, our realities: an HIV prevention intervention for women with severe mental illness.

This paper describes a 10-session behavioral intervention introducing female-initiated methods of human immunodeficiency virus (HIV) prevention to reduce vulnerability to HIV infection for women with severe mental illness. In a pilot test of the intervention, 35 women were randomly placed in the experimental intervention group or an HIV education control. Subjective norms, intentions to use, perceived efficacy, and attitudes toward the male condom, female condom, and a microbicide were assessed at baseline, postintervention, and 6-week follow-up. The participants in the treatment group reported a significantly more positive attitude toward the use of female condoms (t = -2.12, P < .05) at 6-week follow-up. Providing women with severe mental illness with choices of protective methods and the knowledge and skills to ensure proper use are among the many crucial ingredients in prevention of acquired immunodeficiency syndrome.

Adult↗
PubMed1996

Increased use of condoms among female university students: a 5-year follow-up of sexual behavior.

OBJECTIVE: To ascertain any changes in sexual behavior and attitudes as an indication of the impact of intensified information activities aiming at decreasing the risk of spread of sexually transmitted diseases among university students. METHODS: In 1989 questionnaires were offered to 275 consecutive female students visiting the Student Health Center. Identical questionnaires were mailed to 200 randomly selected women registered at Uppsala University. The study was repeated in 1994. The study was carried out in Uppsala, a city in Sweden with 27,000 university students. RESULTS: At the Student Health Center 241 (88%) participated in the study in 1989 and 262 (95%) in 1994. Corresponding figures in the postal survey were 137 (69%) in 1989 and 151 (76%) in 1994. Compared with the findings in 1989, in 1994 the sexual behavior was unchanged in terms of mean age at first intercourse (17.6 years), median number of life partners (3-4) and median number of sexual partners during the last 12 months (1), but the awareness of sexually transmitted diseases had increased. Their attitudes to using condoms had become more positive and the actual use of a condom had also increased both at the first intercourse and when changing partner, from 40 to 60%. Concerns about safety of oral contraceptives decreased significantly. CONCLUSIONS: This follow-up shows that awareness of sexually transmitted diseases and condom use had increased between 1989 and 1994, possibly as a result of intensified information efforts.

Adolescent↗
PubMedDate not supplied

HIV prevention outreach in black communities of three rural north Florida counties.

Literature to guide HIV prevention outreach for southeastern rural blacks is limited despite the increasing prevalence of HIV infection in this population. Three men and one woman conducted HIV prevention outreach in three north Florida rural counties in teams of two. The workers received five days of training in additional homework assignments. The workers used HIV/AIDS outreach surveys to guide their 10- to 15-minute outreach visits. Five hundred seventy-four outreach contacts with blacks were made between January and June 2001 (329 in County 1, 176 in County 2, and 69 in County 3) with 347 women and 227 men. Eighty-four percent of the persons contacted accepted literature, 47.5% accepted male condoms, and 31.9% accepted female condoms. More women (99.4%) were knowledgeable about HIV/AIDS than men (92.5%), and they reported taking precautions against infection more often than men (98% vs. 90.3%). Many blacks in rural north Florida were receptive to an HIV prevention outreach program that provided information, literature, and condoms on the street and in homes. These findings suggest that HIV prevention outreach should be expanded to reach more rural blacks, who are increasingly at risk for HIV infection.

Adolescent↗
PubMed2003

Knowledge of, attitudes toward, and stage of change for female and male condoms among Denver inner-city women.

Despite availability for a decade and documented acceptability among some groups of women for the method, female condom use is still rare. We surveyed 198 young women (15-25 years old) living in the inner city of Denver about their knowledge of, attitudes toward, and practices regarding female and male condoms. Most (75%) women had ever considered using male condoms; 32% had ever considered using female condoms; and use of either was sporadic. We examined predictors for being in either precontemplation or a later stage along the change continuum at both the bivariate and multivariate levels. Our findings suggest that African Americans and younger women are more likely to contemplate using female condoms. Both lack of knowledge and positive attitudes toward female condoms in this sample suggest that programs designed to raise awareness and knowledge of female condoms while improving their image are needed.

Adolescent↗