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PubMed2000

A prospective study on condom slippage and breakage among female brothel-based sex workers in Singapore.

BACKGROUND: Concerns about the effectiveness of condoms in preventing sexually transmitted diseases have been raised. Data are lacking on condom failure and its associated factors among sex workers in Southeast Asia. GOAL: To assess factors associated with condom breakage and slippage. STUDY DESIGN: A prospective study on condom breakage and slippage over a 1-day period was conducted among 219 female brothel-based sex workers in Singapore in 1997. RESULTS: Condom breakage and slippage rates among 1,885 episodes of condom use were 1.2% (95% CI, 0.7-1.8) and 2.1% (95% CI, 1.2-3.0), respectively. After adjusting for intracluster effects and confounders, condom breakage and slippage were significantly associated with duration of sex work and spontaneity of clients to use condoms. CONCLUSION: Condom use among sex workers should be promoted in view of the low failure rates. Strategies to reduce condom breakage and slippage should be directed at sex workers with increased risk of condom failure.

Adult↗
PubMed1992

Condom use in multi-ethnic neighborhoods of San Francisco: the population-based AMEN (AIDS in Multi-Ethnic Neighborhoods) Study.

We examined the prevalence and correlates of condom use in a community-based sample of unmarried heterosexual and gay/bisexual Whites, Blacks, and Hispanics (aged 20 to 44 years) in San Francisco (n = 1229). Only 9% of heterosexual males reported always using condoms, and fewer of those with multiple sexual partners (6%) reported always using condoms compared with those in monogamous relationships (12%). Much higher proportions of gay/bisexual men reported always using condoms (48%). Racial differences in condom use were observed only among women. Sexual communication and the sexual enjoyment value of condoms were consistent correlates of condom use across gender and sexual orientation, while other condom-related beliefs were significant predictors of condom use only for men. In general, condom promotion programs should build sexual communication skills, teach people how to enhance enjoyment with condoms, and reduce psychological barriers to condom acquisition and use.

Adult↗
PubMedDate not supplied

Inappropriate lubricant use with condoms by homosexual men.

Use of condoms has been advocated as an important method of reducing the risk of human immunodeficiency virus (HIV) transmission among high-risk groups such as homosexual and bisexual men, prostitutes, intravenous drug users, adolescents, and hemophiliacs. Despite risk-reduction education campaigns directed to gay men since the early 1980s, evidence shows continued deficits in condom-use skills and knowledge among gay men. Because most failures in the use of condoms are attributed to errors in use, increasing knowledge and skills in condom use is important in preventing HIV infection. Two groups of homosexual and bisexual men were sampled, those entering a risk-reduction education program and participants in a Gay Pride event. They were surveyed on their current sex practices and their efforts to reduce their risk of HIV infection. They were asked about their numbers of sex partners, specific sexual behaviors, use of condoms, types of condoms used, and lubricants used for genital-anal sex. The characteristics of those surveyed were similar to those of respondents in other studies of risk reduction among gay men. The use of an oil-based lubricant with condoms has been shown to weaken latex and to increase the likelihood of condom breakage, which use of water-based lubricants does not. Among respondents who reported having genital-anal sex, 60 percent reported use of an oil-based lubricant with a condom at least once during the year before the survey. Gay men in sexually exclusive relationships engaged in less consistent use of condoms for receptive genital-anal sex than did single gay men. The duration of their relationship with a partner was unrelated to the consistency of risk reducing behaviors practiced by men in sexually exclusive relationships. Gay Pride participants engaged in sexual behavior that was relatively more risky for HIV transmission than did the other group. Gay Pride participants used condoms less consistently for genital-anal sex than did the risk-reduction program entrants.The findings indicate the need for better risk reduction education efforts directed to gay men. Continued improvement in these efforts will require assessing the effectiveness and consistency of risk reduction efforts, determining the potential for gay men to relapse into more risky behavior, and identifying gaps in the knowledge of risk-reduction efforts among gay and bisexual men. Risk reduction programs need to emphasize motivational factors, provide basic information on how one determines the content of lubricants, explain why water-based lubricants only should be used, and teach how to use condoms properly. Active outreach is needed to gay and bisexual men who are unlikely to voluntarily enroll in risk-reduction programs.

Adult↗
PubMed1992

Determinants of condom use among junior high school students in a minority, inner-city school district.

Condoms reduce the risk of human immunodeficiency virus (HIV) transmission; however, their use among adolescents has been inconsistent. Little is known about factors which motivate consistent condom use, particularly among younger adolescents. In a study designed to identify such factors, 1899 inner-city junior high school students were surveyed. In June 1988, students completed an anonymous self-report questionnaire assessing HIV-related knowledge, attitudes, and behaviors. Among sexually active students (N = 403), logistic regression analysis evaluated the influence of demographic, psychosocial, and behavioral factors on frequency of condom use. Respondents who believe condoms are effective in preventing HIV transmission were 2.2 times more likely to report using condoms consistently during sexual intercourse; those with low perceived costs associated with condom use were 1.9 times more likely to be consistent users. Number of lifetime sexual partners was inversely related to frequency of condom use. Respondents with a history of three or more sex partners were half as likely to use condoms consistently. Factors not associated with consistent condom use include age, age at sexual debut, ethnicity, HIV knowledge, perceived efficacy to avoid HIV infection, and alcohol and drug use. School- and community-based HIV prevention programs will have to go beyond the didactic transfer of factual information and include more interactive teaching strategies to improve adolescents' attitudes toward condoms are self-efficacy to increase condom use and to counter negative peer influences and adolescents' perceptions of invulnerability. Physicians are an underutilized source of HIV prevention information. They have an important role in counseling adolescents about effective HIV-prevention methods and dispelling misperceptions which hinder consistent condom use.

Acquired Immunodeficiency Syndrome↗
PubMed1992

The why, when and whether of condom use among female and male drug users.

Eight focus groups consisting of all male, all female and mixed male and female drug users were conducted to gain an in-depth understanding of beliefs and behavior regarding the use of family planning services and contraceptives, particularly condom use in an effort to reduce the perinatal transmission of HIV. While participants often supported the use of condoms because of STDs and AIDS, their unplanned pregnancies and STD histories indicated in-consistent use, depending on the partner and the circumstances. The vast majority of both men and women did not like to use condoms because it interfered with the spontaneity and pleasure of sexual relations, though women seemed more willing to use condoms than their partners. Participants varied in their knowledge about the benefits of using a condom, in how and when to put it on, in the associations they made between condom use and trust and commitment, in the type of partner and conditions under which they would use condoms and in their willingness to consider condom use as an integral part of their lives. Issues of trust, commitment and condom use did not seem to have been resolved in the drug using community, particularly among younger people who appeared to have more difficulty in negotiating condom use. Promoting the use of condoms needs to be considered as part of a larger, multifaceted behavior change effort.

Condoms↗
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↗
PubMed1996

Reported condom use is not associated with incidence of sexually transmitted diseases in Malawi.

OBJECTIVES: To establish frequency of reported condom use and validate reliability of self-reporting among urban women in Malawi. DESIGN: Cross-sectional survey in antenatal women in 1989 and 1993. Prospective study in cohort first surveyed in 1989. METHODS: A total of 6561 women in 1989 and 2460 women in 1993 answered questions about condom use and sexual activity, had a physical examination and were screened for HIV. A subset of women from the 1989 screening were administered a questionnaire and tested for syphilis, Neisseria gonorrhoeae and Trichomonas vaginalis infections every 6 months. RESULTS: Although between the two cross-sectional studies intermittent condom use increased from 6 to 15% (P < 0.001) with no difference according to HIV infection, consistent use was reported by less than 1%. In the prospective study, women reported a higher condom use at any visit than either group assessed cross-sectionally. Consistent condom use peaked at 62% in the first 6 months, but declined to as low as 8% in the second year of follow-up. Condom use at each visit, either intermittent or consistent, was higher in HIV-seropositive than HIV-seronegative women. Overall, the incidence of gonorrhea, trichomoniasis and syphilis did not decline in women reporting consistent condom use. CONCLUSIONS: In prospectively followed women reports of consistent condom use was substantially higher than in cross-sectional surveys, but rapidly decreased over time, irrespective of HIV status. The presence of new sexually transmitted diseases suggests that this population of urban women overreports condom use or underreports sexual activity, or both. Intensive and sustained education is needed to achieve consistent condom use. Biologic markers of sexual activity are useful in interpreting reported condom use.

Adult↗
PubMedDate not supplied

Patterns of condom use and sexual behavior among never-married women.

BACKGROUND AND OBJECTIVES: Use of condoms is one of the main methods sexually active persons may choose to prevent infection with sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). Little is known about patterns of condom use among women in the United States. We provide a conceptualization of patterns of condom use and factors associated with these patterns. GOAL OF THIS STUDY: To examine patterns of condom use and associated characteristics among sexually active, never-married women in the United States. STUDY DESIGN: Analysis of data from the 1988 National Survey of Family Growth, which is a nationally representative sample of women in their childbearing years. RESULTS: Only a minority of sexually active, never-married women report using condoms, and even fewer report using them consistently. Women with characteristics traditionally associated with increased risk of infection with STD and HIV appear to be less likely to report using condoms and to report using them consistently. Women who report use of condoms to prevent STDs are more likely to report consistent condom use; less likely to cease using condoms; and more likely to initiate consistent condom use. CONCLUSION: Findings suggest the need for innovative programming targeted for specific sexually active populations to promote both initiation and maintenance of use of condoms.

Adolescent↗
PubMed1997

An in vitro evaluation of condoms as barriers to a small virus.

BACKGROUND: Because of the possible presence of small holes, the effectiveness of condoms as barriers to virus transmission is controversial. GOALS: To determine the proportion of condoms that allow virus penetration and the amounts of virus that penetrate. STUDY DESIGN: A sensitive, static test was used to evaluate different condom types as barriers to a small virus, including brand with or without lubrication and ones of different materials. The test included some physiologic-based parameters and some parameters that exaggerated expected actual use conditions. RESULTS: Under test conditions, 2.6% (12 of 470) of the latex condoms allowed some virus penetration; the median level of penetration was 7 x 10(-4) ml. Lubricated condoms performed similarly to nonlubricated ones. Polyurethane condoms yielded results higher than but not statistically different from those for latex condoms. CONCLUSIONS: Few condoms allowed any virus penetration. The median amount of penetration for latex condoms when extrapolated to expected actual use conditions was 1 x 10(-5) ml (volume of semen). Thus, even for the few condoms that do allow virus penetration, the typical level of exposure to semen would be several orders of magnitude lower than for no condom at all.

Bacteriophage phi X 174↗
PubMed1999

Implications of laboratory tests of condom integrity.

BACKGROUND: There is sufficient evidence from Food and Drug Administration laboratory experiments and clinical studies to draw conclusions about the relative importance of holes and breakage to condoms. The laboratory test methods determined penetration of viruses or virus-size microspheres through holes in condoms under conditions that simulated or exaggerated those expected in actual use, and determined the frequency with which condoms might pass virus or microspheres and the amounts of passage in each case. GOALS: To summarize and comment on the significance of test results on latex, polyurethane, and natural membrane condoms as barriers to virus passage. STUDY DESIGN: Published and unpublished data addressing three distinct concerns were analyzed: (1) passage of virus or microspheres through small holes or pores inherent in the material of "intact" condoms which are undetectable by the standard water leak quality assurance test, (2) passage of virus or microspheres through larger holes in "leaker" condoms detectable by the water leak test but marketed because of the finite acceptable quality level (AQL) of the test, and (3) passage of virus through condoms that break during use. RESULTS: Extrapolating to the passage of semen expected during actual use allowed an analysis of the relative importance of breakage and water-leak-detectable or water-leak-undetectable holes. CONCLUSIONS: The relative importance of breaks and holes is related to the volume of semen that contains an "infectious dose" of a sexually transmitted disease (STD). When 0.1 mL to 1.0 mL exposures to semen are necessary for disease transmission, the risk during latex condom use primarily results not from holes, but from breakage of condoms. For smaller volumes of semen exposure (0.00001 mL and less), the presence of holes can be as important as breaks. The same qualitative argument pertains to a comparison of "leaker" condoms to the large majority of "intact" condoms.

Biocompatible Materials↗
PubMed1999

Condom use in young blacks and Hispanics in public STD clinics.

BACKGROUND AND OBJECTIVES: Young blacks and Hispanics are an emerging risk group for contracting HIV. The goal of this study was to assess the most salient correlates of condom use for young Hispanics and blacks in Los Angeles county sexually transmitted diseases (STD) clinics as a first step toward designing a short clinic-based intervention. STUDY DESIGN: Face-to-face interviews were conducted with 376 patients younger than the age of 27 years at six STD clinics operated by the Los Angeles County Department of Health Services. Assessment included several attitudinal variables and AIDS risk behaviors. RESULTS: Condom use at last intercourse ranged from 40% among Hispanic females to 48% among black males. Among females, condom users were more likely to report high self-efficacy regarding condom use, peer norms supporting condom use, and more sexual communication than respondents who did not use a condom at last intercourse. Among males, no relationship was found between condom use at last intercourse and these attitudinal variables, except for sexual communication. The most important correlate of condom use among males and females was the frequency of carrying condoms. CONCLUSIONS: Our findings suggest that offering educational group sessions and attractive means for carrying condoms to patients in STD clinics may have the potential to increase condom use. The efficacy of these intervention strategies should be explored in future studies.

Adult↗
PubMed1997

Promoting condom-only brothels through solidarity and support for brothel managers.

Brothel workers in Thailand are at high risk of HIV infection but they alone do not have adequate bargaining power to insist on condom use with all clients. Brothel managers, on the other hand, are a source of influence over both clients and their workers and can promote universal condom use in their establishments. To test whether brothel managers in Khon Kaen City would adopt and successfully implement a condom-only policy in their establishments, all 24 brothel managers in Khon Kaen City attended a meeting on the dangers of HIV and benefits of an all-condom policy. Ideas on how to implement the policy were discussed. Follow-up visits were made once a month to brothels to resupply condoms, provide reinforcement and to collect data. All brothel managers approved of the condom-only in principle and are now implementing the policy. Results of the evaluation of condom use and degree of solidarity in these 24 brothels are available for the AIDS prevention programme. However, a condom-only policy in brothels can only succeed if managers and brothel workers show solidarity in rejecting all non-condom using clients. Laws to promote condom use may not be needed if brothels are given the opportunity to implement a condom-only policy using their own resourcefulness and determination.

Adult↗
PubMed1997

Condom use with main partners by sterilized and non-sterilized women.

This study examined condom use with main partners by surgically sterilized and non-sterilized women at risk for HIV infection. Data were obtained from 379 African American women residing in low-income urban communities. Sterilized women were one-fifth as likely as non-sterilized women to use condoms. Multivariate logistic regression indicated that for both groups of women, higher perceived benefits of condom use for disease prevention were associated with condom use. In addition, younger age, self-efficacy for condom use, peer support for condom use, and whether condoms were ever used for pregnancy prevention were associated with condom use among non-sterilized women. Results of this study indicate the role of fertility status in condom use and the value of developing targeted prevention programs that reach women at high risk for HIV infection. Risk reduction programs need to emphasize the role of condoms in disease prevention and address attitudes towards condom use.

Adolescent↗
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↗
PubMedDate not supplied

Relationship dynamics, ethnicity and condom use among low-income women.

CONTEXT: Women's protection against HIV and sexually transmitted diseases (STDs) depends upon their ability to negotiate safer sex. It is important to know how cultural norms and gender roles, which vary by ethnicity, may either constrain or encourage negotiation of condom use. METHODS: Questionnaires were completed by 393 low-income non-Hispanic black, Hispanic and non-Hispanic white women who were sexually active and attending family planning and STD clinics and other public health and social service centers in Miami in 1994 and 1995. Multivariate logit techniques were used to identify ethnic differences in relationship dynamics and to determine couple- and individual-level factors associated with consistent use, occasional use or nonuse of condoms. RESULTS: Black and Hispanic women reported higher levels of consistent condom use (15-17%) than did white women (4%). Nearly all black and white women (90-95%) said that they were extremely or somewhat comfortable talking about condoms with their partner, whereas 76% of Hispanic women did so. A larger proportion of Hispanic women (55%) reported joint contraceptive decision-making than did black women (26%) or white women (31%). Among women who reported that their partner made contraceptive decisions, 28% used condoms consistently or occasionally, compared with 24% among women who made the decision themselves. When the couple made the decision jointly, 41% of them were condom users. Hispanic women scored the lowest on a scale of condom-related self-efficacy, yet also reported the highest levels of confidence in their condom negotiating skills. Multivariate analysis indicated that, compared with white women, black and Hispanic women were more likely to be consistent condom users than nonusers (odds ratios, 10.2 and 18.9, respectively). Women who shared financial decision-making with their partner were almost 80% less likely to be a consistent condom user, and women who did not participate in financial decisions were more than 90% less likely to do so, than were women who made monetary decisions independently. CONCLUSIONS: HIV prevention and intervention programs should emphasize birth control discussion between partners and the development of condom-related self-efficacy and negotiation skills, and these programs also should customize prevention messages according to ethnicity and social context.

Adult↗
PubMed2000

Factors affecting condom use among South African university students.

OBJECTIVE: To investigate factors affecting condom use among South African university students. DESIGN: Cross-sectional survey. SETTING: Department of Psychology, University of the North, South Africa. PARTICIPANTS: One hundred and forty six female and sixty first year male psychology students, mean age 20.9 years (SD = 3.4), with a range from 17 to 34 years. MAIN OUTCOME MEASURES: Sexual activity and condom use (6 items), A 16-item AIDS Health Belief Scale and a 28-item Condom Use Self-Efficacy Scale. RESULTS: Almost one third (29.2%) of the sample reported never using condoms, 35.4% always, 19.8% regularly and 8.5% irregularly in the past three months. Perceived barriers were associated with increasing age and reduced condom use intentions. In addition, perceived susceptibility was associated with past condom use. The total AIDS Health Belief was not related with age, gender, past condom use and condom use intentions. Self-efficacy of condom use was associated with decreasing age, past condom use and condom use intentions but not with gender. CONCLUSION: Findings have relevant implications and are discussed in the context of developing an educational or intervention programme.

Adolescent↗
PubMed1992

Female condom launched in UK.

The lone-awaited female condom, Femidom, is to be launched at the end of September by manufacturers Chartex. It is being welcomed by the FPA [Family Planning Association] and other family planning experts as a valuable addition to the existing range of contraceptive methods and as an alternative to the male condom in offering effective protection against sexually transmitted diseases including HIV. A lubricated, loose-fitting polyurethane sheath, Femidom is inserted into the vagina at any time before sex. An inner ring holds the condom in place beyond the pubic bone and an outer ring lies flat against the vulva. In addition to extending choice, it is under direct control of the woman. As FPA Director Doreen Massey puts it: "We have to face the fact that some women who want safer sex can't get their partners to use condoms. for the 1st time with Femidom, you can insist that if he won't use a condom, you'll use yours." In trails of self-selected couples, up to 2/3 of women and their partners found the product acceptable. a study at the Institute of Population Studies in Exeter showed that while some couples had initial misgivings about the condom's size and appearance, especially its visibility when in position, these often declined with repeated use. Researcher Dr. Nicholas Ford pointed out that if the female condom makes a woman feel unattractive, her partner's comments may well influence these feelings. Users' experience of insertion and the condom's comfort also improved with repeated use. While there are no large studies showing ranges of effectiveness, it is likely to be as effective as the male condom (about 85%-98%). In a study of 106 women at the margaret Pyke Center in London, there were 7 unplanned pregnancies: 4 were due to inconsistent use of the method and 3 were method failures. Breakages were rare. 1/3 of participants dropped out in the 1st month. Users should continue with their existing contraceptive method until they are sure that they are using Femidom efficiently, recommended the authors. In October the FPA is launching a new free consumer leaflet on male and female condoms. 1/2 million leaflets will be distributed to UK pharmacies in October and November via the Pharmacy Healthcare Scheme as part of a safer sex campaign. a launch event will include the results of a survey asking pharmacists and consumers what they think of condoms.

Behavior↗
PubMedDate not supplied

Condom characteristics: the perceptions and preferences of men in the United States.

Perceptions regarding the consequences of condom use, as well as preferred characteristics of condoms, are examined in a nationally representative sample of 3,321 men aged 20-39. The psychological and interpersonal effect most often cited is that using a condom "shows that you are a concerned and caring person." This is particularly the case among black men and men who are young and have low educational attainments. However, the same men usually agree that using a condom sends unwanted messages to one's partner--for example, that doing so "makes your partner think that you have AIDS" and "shows that you think that your partner has AIDS." In contrast, white men and those who are highly educated tend to cite embarrassment when buying condoms as a frequent consequence of condom use. The device-related consequences cited most often, particularly among black, unmarried, young and poorly educated men, are that using a condom results in reduced sensation, that one must be careful during sex or the condom may break and that one must withdraw quickly after sex or the condom may come off. When purchasing condoms, most men look for those that are easy to put on, have the right amount of lubrication and stay on; these preferences are particularly prevalent among black men. Few men identify color, ribbing and partner's preference for condom type as important.

Acquired Immunodeficiency Syndrome↗