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PubMed1999

Women's attitudes to condoms and female-controlled means of protection against HIV and STDs in south-western Uganda.

The consistent and correct use of the male condom makes it highly effective in both disease prevention and as a contraceptive method. However, it is also well recognized that its use is under men's control. Because of this vital limitation, there have been frequent calls for female-controlled methods of HIV prevention, particularly from women from sub-Saharan Africa. Here we report on data collected in focus-group discussions (FGDs) with women aged 17-54 in South-Western Uganda. A total of 138 women, from rural villages, urban family planning clinics and a truck-stop town, were recruited to participate in 18 FGDs on the male condom, the female condom and existing formulations of vaginal microbicidal products. Three themes emerged: (i) problems with men's control over the male condom, (ii) the importance of control over and secrecy about protective measures and (iii) sexual pleasure associated with different methods. We found that the female condom, while being perceived as an improvement over the male condom, was recognized as having limited value because of the need to agree its use prior to sex taking place. Other products were considered to be significantly better than the female condom; the sponge, in particular, was perceived as having advantages over every other product. Women like the fact that it could be inserted some time before, and left in place some time after, sexual intercourse, that it was effective for multiple instances of intercourse, and that men would be unaware that it was being employed. Female-controlled methods to prevent sexually transmitted infections, including HIV, and to increase reproductive choice, hold the promise of ceding some control over sexual and reproductive health to women.

Adolescent↗
PubMed2004

Interrupting herpes simplex virus type 2 transmission: the role of condoms and microbicides.

Condoms act as mechanical barriers to genital infection. In vitro models demonstrate that condoms are almost impermeable to viruses. A small amount of virus may cross the condom, but the condom can still reduce the level of virus exposure by several orders of magnitude. However, in vivo factors, such as condom failure during intercourse, can potentially limit their effectiveness. The weight of available evidence suggests that consistent and correct use of the male condom protects against herpes simplex virus (HSV) infection, as well as other sexually transmitted infections. Female condoms should theoretically protect against HSV infection as they cover a large surface area of potentially infected or susceptible tissues, but research is needed to confirm this. The lack of acceptance, or lack of consistent use, of condoms is the biggest barrier to their effectiveness. There is a need for effective counselling of individuals whose sexual behaviour increases their risk of HSV acquisition, such as young adults. Pregnant women are likely to be receptive to counselling due to the risk of neonatal herpes. No commercially available microbicides specifically inhibit HSV, although many inactivate the virus. More potent and specific microbicides are in development, but may be more expensive than those currently available. Although the effectiveness of condom and microbicide use is not completely proven, there is sufficient evidence to support the promotion of their use by healthcare professionals as an important part of safe sex counselling.

Anti-Infective Agents↗
PubMed2003

Determinants of female and male condom use among immigrant women of Central American descent.

This study was designed to determine factors that influence female and male condom use among Central American women, applying the theory of planned behavior. A cross-sectional design was employed and a sample of 175 Central American women, 18-50 years old, was recruited from a community-based clinic in Los Angeles County. Participants in this study were interviewed face-to-face. Attitude, subjective norm, and perceived behavioral control explained 41% and 45% of the variation in the intention to use male and female condoms, respectively. Respondents' friends and mothers influenced their subjective norms. Beliefs regarding sexual sensation and sexually transmitted infection/pregnancy prevention affected respondents' attitudes toward condoms. Trust issues were also a major factor affecting attitudes toward female condoms. Condom use and sex negotiation skills predicted control over condoms. Results of this study can be used to design HIV/AIDS prevention programs that help women feel control over condom use and their sexual behavior.

Adolescent↗
PubMed1998

Current reversible contraceptive methods: a global perspective.

Since the 1960's, there have been important gains in the efforts to make the benefits of family planning accessible to people around the world. However, prevalence of contraceptive use is still low in some areas, especially in sub-Saharan Africa. Making contraceptives accessible through good quality services should be a goal for reproductive health programs. In the absence of an ideal method of contraception which would suit every individual, there is a variety of contraceptive methods with advantages in some aspects and disadvantages in others from which people should be able to choose according to their particular characteristics and needs. Important aspects to take into consideration include effectiveness, convenience, and safety. In general, the most effective methods are more likely to have some side effects and method-related complications. However, when weighing the risks and benefits, the most effective methods have greater benefits on the health of women by protecting them better from the health risks of unwanted pregnancies. Most methods also have non-contraceptive benefits - for instance, combined oral contraceptives (COCs) provide important degrees of protection against endometrial and ovarian cancers, benign breast disease, pelvic inflammatory disease (PID), and ectopic pregnancy. They also reduce menstrual blood loss. Although barrier methods have lower effectiveness against pregnancy, their most important advantage is the protection they can provide against sexually transmitted diseases. The male condom in particular (and probably the female condom) has the special value of providing protection against HIV infection. This paper describes reversible methods of contraception including possible health risks and contraindications. Adequate counseling, however, is essential for people to make an appropriate choice of contraception and to secure safe and effective use of the method.

Choice Behavior↗
PubMed2002

Acquired immunodeficiency syndrome in Brazil.

AIM: To describe the acquired immunodeficiency syndrome (AIDS) epidemic in Brazil and analyze the impact of federal government measures addressing the problem since its onset. METHOD: Retrospective review of AIDS epidemic data from its onset in 1980 up to the last published data in June 2001. RESULTS: AIDS was first reported in Brazil in 1980. By 1988, all 27 Brazilian states had diagnosed cases, and until June 2000 more than half of Brazilian municipalities had recorded at least one case of the disease. The AIDS incidence reached its peak between 1996 and 1997 (14.7 per 100,000 population), and then declined between 1998 and 2000 to 9 per 100,000 population. In the last two decades, the proportion of deaths has been also significantly reduced. These were not random events, but reflected the efficiency of the program implemented by the Brazilian Health Ministry's Coordination on Sexually Transmitted Diseases and AIDS. The program includes an epidemiological surveillance modeling system, which records cases from several regular epidemiological bulletins; national network of diagnosis and monitoring of HIV-infected individuals (ill or not); highly active antiretroviral therapy available free to all patients; mother-infant protection program; educational programs on condom use; the introduction of the female condom; development of AIDS studies in different areas to provide practical solutions; constant preoccupation about drug costs accounting for the patent breaking; and national production of many drugs currently in use. CONCLUSION: Well-planned and implemented national program against AIDS can significantly reduce the burden of this disease to the population.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Retrospective vs. prospective coital frequency and menstrual cycle length in a contraceptive effectiveness trial.

PURPOSE: To determine how well information at enrollment would predict coital frequency and menstrual segment length during a prospective contraceptive effectiveness trial. METHODS: We compared retrospective reports of monthly coital frequency and menstrual segment (cycle) length with prospective information for women participating in a contraceptive trial of the Reality((R)) female condom. RESULTS: Participants reported slightly higher mean monthly coital frequency and slightly longer menstrual segments prior to the study than during the study (12.6 acts vs. 12.0 acts per month and 30.8 days vs. 28.4 days). We examined the actual distribution of differences between the retrospective and prospective measures and found considerable variability. Among the 195 participants studied, parous women were less likely to predict accurately menstrual segment length (OR 0.4; 95% CI 0.3--0.9), while older women were more likely to predict accurately coital frequency (OR 1.9; 95% CI 0.9--3.3). CONCLUSIONS: Coital frequency and menstrual segment length vary considerably over time. Hence, prospective data collection is essential to accurately characterize these variations and to properly interpret results from contraceptive trials and other studies concerned with fecundability and hazards of reproduction.

Adult↗
PubMed1999

An update on contraception for adolescents.

Almost one million American adolescents become pregnant each year. Awareness of up-to-date contraceptive methods allows clinicians to appropriately counsel male and female adolescents, preferably prior to the onset of sexual activity. Abstinence, barrier methods, including the female condom and non-latex male condom, and hormonal methods, including oral contraceptive pills, injectables, and subdermal implants, are all suitable for adolescent use. New oral contraceptive pills with lower estrogen content or multiphasic hormone levels may ameliorate side effects, such as headache or breakthrough bleeding. Frank discussion of confidentiality and of the various contraceptive methods and their side effects allows adolescents to choose the best method for them, thus improving the likelihood of adherence.

Adolescent↗
PubMedDate not supplied

[The prevention of sexually transmitted diseases and AIDS by the use of the condom].

This paper deals with the last literature and examines the most relevant studies of recent years related to condom effectiveness in preventing sexually transmitted diseases (STD), with experimental, epidemiological and seroconversion models. On the basis of these studies, it can be stated that the efficacy of condoms is close to 100 per cent when used correctly and consistently. Condom breakage has been reported in 0.5 per cent of vaginal intercourse and 3.6 to 10 per cent of anal intercourse. Most studies refer low failure rates due to manufacturing defects. Considering all constraints involved in masculine condom use and their implications for women, a female condom has been developed recently. It is not enough to give information or to make condoms available, if all the elements involved in the enhancement or failure of its use are not considered. Sexual education programs are the fundamental strategy in preventing STD and pregnancy.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Helping patients handle accusations of infidelity.

You may have experience with women patients who assume their partners are being unfaithful if they try to use condoms because that behavior could indicate they are trying to prevent potential sexually transmitted diseases (STDs). These same women may believe the same will be assumed of them if they begin to use the new female condom. If women present the device to their partners in the context of a birth control product rather than a device to prevent STDs, men might be more willing to accept it, says sexuality expert Beverly Wipple, PhD, RN, an associate professor at Rutgers State University of New Jersey in Newark and the author of Safe Encounters: How a Woman Can Say Yes to Pleasure and No to Unsafe Sex (Pocketbooks, 1990). Wipple has been a leader in female sexuality research since 1979, having conducted the original research on the "G-spot" (Dell Publishers, 1983). Wipple bases her hypothesis on a presentation about the male condom given at the 1992 annual meeting of the International Society for the Scientific Study of Sex, held in San Diego. The presenter showed that if women were using the male condom as their only form of contraception, then the male was more likely to use it. If the woman was taking oral contraceptives or using another form of contraception--and was only relying on the condom or STD protection--then the male was less likely to use the condom. "I think the same thing might apply to the female condom," Wipple suggests. "If she identifies that this is her method of birth control. I think it is much more likely to be accepted than if she says she is using it to prevent the spread of diseases." Wipple says practitioners should tell women to emphasize the birth control angle and downplay the STD angle. "It may not be the only method they are using, but they don't have to tell him that." she says. "This way, it is not putting an accusation [of infidelity] on him." While she acknowledge and dislikes the lack of honesty inherent in this practice, she says the end justifies the means. "Although it is not addressing the issues that should be addressed, we have to recognize there are people in situations where it is just impossible for them to address the issues," Wipple explains. She says this inability to communicate has led to the spread of STDs.

Attitude↗
PubMed1996

Non-condom use among female nurses in Zambia.

OBJECTIVES: To estimate non-condom user rate and to characterize non-condom users among female nurses. DESIGN: Cross sectional. SETTING: Health institutions. SUBJECTS: Data from 640 (86.5pc) out of 740 consenting female nurses were available for analyses. MAIN OUTCOME MEASURE: Non-condom user rate. RESULTS: Non-condom user rate (per 100) among the female nurses was 73.1pc (95pc CI69.7 to 76.5). Non-condom users tended to be aged above 30 years (OR 1.57; 95pc CI 1.02 to 2.40), midwives (OR 1.56; 95pc CI 1.03 to 2.37), married (OR 2.70; 95pc CI 1.73 to 4.21), not to think that spouse/partner has had sex with other partners (OR 1.72; 95pc CI 1.11 to 2.68) and to have had a sexually transmitted disease (OR 2.61; 95pc CI 1.25 to 5.43). CONCLUSION: There was a surprising high level of non-condom users among female nurses, probably due to the inability for females to initiate or negotiate condom use.

Adult↗
PubMed1997

Sexually transmitted disease prevalence in brothel-based commercial sex workers in Chiang Mai, Thailand: impact of the condom use campaign.

One hundred and ninety five (195) brothel-based commercial sex workers (CSW) in Chiang Mai, Thailand, were screened for sexually transmitted disease (STD) between October 1994 and April 1995, prior to their enrollment in a multi-center comparative trial of the effectiveness of two strategies using male and female condoms. These CSW had a mean age of 22.2 (SD 4.3) years. Forty-seven per cent were Thai and 57.4 per cent had no formal education. Median duration of prostitution was 16 months and median cost for sexual service was 50 baht (US$ 2) per client. Ninety-four per cent of CSW reported always using condoms with clients. There were 63 (32.3%) CSW infected with at least one type of the STD screened. The prevalence of STD included chlamydial infection (16.9%), gonococcal infection (14.4%), condyloma accuminata (4.6%), moluscum contagiosum (2.6%) and trichomoniasis (1.0%). There was no statistically significant risk factor for STD found in this study. Despite an active programme for prevention of STD in CSW and the provision of free condoms, STD were diagnosed in one-third of the screened CSW in Chiang Mai. The programme needs to be strengthened by more intensive education and practice in the correct and consistent use of condoms and integrated with other STD prevention programmes.

Adult↗
PubMed2003

HIV prevalence in Zimbabwean women: 54-67% knowledge and perceived risk.

This study examined the level of knowledge of sexually transmitted infections (STI) and HIV, knowledge of symptoms and potential sequelae of STI and perceived personal risks of infection among urban women in Zimbabwe. The women consented to being interviewed, examined, tested and treated for curable diagnosed STIs. Prevalence of both STI and HIV was high 11.4% and 54.5% among women aged 15-19 years, 28.5% and 62.4% among those 20-29 years and was highest among the age group >/=30 years 39.0% and 67.0% respectively. Women aged 15-19 years least perceived their risk of infection. Of the women with the highest rates of STI/HIV infection, less than 30% were aware of their vulnerability to such infections. Knowledge of specific STIs, their symptoms and sequelae was generally low. Women who did not know about syphilis, gonorrhoea, chancroid or warts were more likely to perceive themselves at no risk of infection. Condom use was very low (16.5%). There is an urgent need to improve current education programmes to raise awareness of STIs and the dangers of their long-term sequelae along with behavioural skills building interventions that include equipping women with negotiating skills, making female condoms available at affordable prices and motivating condom use.

Adolescent↗
PubMed2004

Contraception.

HEALTH ISSUE: Contraception choices affect the long-term sexual health and fertility of women and men. Data from the 1998 Canadian Contraception Study and the 2000/2001 Canadian Community Health Survey were assessed for measures of contraceptive use and familiarity with various methods among Canadian women. KEY FINDINGS: The oral contraceptive (OC) pill is the dominant method of contraception for Canadian women. Canadian women demonstrate high awareness of the benefits of condom use, but 75% are unaware of the female condom. Among youth, condom use drops as OC use increases. Contraception use in sexually active females aged 15-17 is fairly high, but use is inconsistent. Sexually active adolescent females report high awareness of emergency contraception but poor knowledge of the time frame within which it is most effective. Women aged 35-44 are more familiar with and likely to choose sterilization than younger women. There has also been a shift away from tubal ligation in favour of vasectomies. DATA GAPS AND RECOMMENDATIONS: National data to guide policy and program development are limited. More data are needed on contraception use among males, and factors affecting accessibility, adherence and negotiation of choice. The importance of dual protection, and correct and consistent use of the chosen contraceptive method must be communicated to younger Canadians, as well as health care providers and educators. All women of reproductive age should be made aware of emergency contraception methods and increased efforts on sexual health promotion and education are required. Further research is essential to develop expanded contraceptive choices.

Journal Article↗
PubMed2005

A strategic assessment of the reproductive health and responsible parenthood programme of Buenos Aires, Argentina.

Since 1991, Argentina has had provincial reproductive health laws, a far-reaching national programme and strong public consensus in support of reproductive health policies. Nevertheless, the challenges of strengthening public services, increasing the number of programme sites and resisting conservative attacks remain. This article describes an assessment of the reproductive health programme of the city of Buenos Aires, passed in 2000, whose objectives are to prevent unwanted pregnancies and sexually transmitted diseases/HIV and to train health personnel. The programme operates in every public hospital and primary health care centre in the city. The assessment was conducted jointly by the Ombudsperson's Office of Buenos Aires and the Centre for the Study of State and Society (CEDES). Hormonal contraceptives, IUDs and male condoms were mostly available, but emergency contraception, female condoms and other barrier methods were not Some health professionals and service users were knowledgeable about the new laws and the reproductive rights recognised under the law. Over 90% were satisfied with quality of care in service delivery but many professionals described excessive workloads, deficient infrastructure, and shortages of supplies and staff. Wanting help to obtain a tubal ligation was the most frequent reason for the claims lodged with the Ombudsperson's Office, followed by HIV, quality of care, and abortion. Information and training for both health care providers and women's and human rights NGOs was carried out.

Adolescent↗
PubMed2000

Culture, sexuality, and women's agency in the prevention of HIV/AIDS in southern Africa.

Using an ethnographic approach, the authors explored the awareness among women in southern Africa of the HIV epidemic and the methods they might use to protect themselves from the virus. The research, conducted from 1992 through 1999, focused specifically on heterosexual transmission in 5 sites that were selected to reflect urban and rural experiences, various populations, and economic and political opportunities for women at different historical moments over the course of the HIV epidemic. The authors found that the female condom and other woman-controlled methods are regarded as culturally appropriate among many men and women in southern Africa and are crucial to the future of HIV/AIDS prevention. The data reported in this article demonstrate that cultural acceptability for such methods among women varies along different axes, both over time and among different populations. For this reason, local circumstances need to be taken into account. Given that women have been clearly asking for protective methods they can use, however, political and economic concerns, combined with historically powerful patterns of gender discrimination and neglect of women's sexuality, must be viewed as the main obstacles to the development and distribution of methods women can control.

Adolescent↗
PubMed1995

Barriers to conception and disease.

For the purpose of this review, ¿barriers¿ are defined as any method used during or after intercourse that physically or chemically isolates semen. Latex condoms for men are the best studied physical barrier and offer high efficacy as both a contraceptive and as protection against several major sexually transmissable diseases (STD), particularly human immunodeficiency virus (HIV). Limited acceptability and dependence on male cooperation limit their ¿use effectiveness¿ in non-commercial sex or when the receptive partner is disempowered. Polyurethane male condoms may improve acceptability and prove stronger and more durable. Female-dependent methods require further study which may net real benefits for containing the spread of STD/HIV infections in the short to medium term. Female condoms and newer non-toxic intravaginal chemicals offer much promise. Similarly, the female diaphragm warrants further investigation and should be given more prominence at least as a second-line measure. Withdrawal and post-coital intravaginal chemical prophylaxis may have been previously underestimated as occasionally useful strategies, particularly for reducing the risk of pregnancy and HIV infection for those that were otherwise unprepared for sex. The only role for vasectomy is as a contraceptive measure, while vaginal or anal douching is contraindicated as a reproductive health measure because of the risk of pelvic inflammatory disease and other ectopic pregnancy. There is ample room for developing a more diverse range of better barrier products as well as better promoting those methods that already exist. We already have the means available to us to halt the spread of HIV. Moral arguments against barrier methods have no scientific basis.

Contraception↗
PubMed2001

Use of contraceptive methods among homeless women for protection against unwanted pregnancies and sexually transmitted diseases: prior use and willingness to use in the future.

Lifetime contraceptive use as reported by a representative sample of 764 homeless women in Los Angeles was examined overall and for different age and ethnic subgroups and contrasted with expressed willingness to use specific methods. Over 80% of the women reported condom use. However, less than 5% had ever used female condoms, although 38% of the overall sample and 73% of the teenagers said they were willing to try them. Similar gaps between reported use and endorsement were found for other particular methods. Native Americans had relatively low use of virtually all contraceptive methods, and over 80% of African-Americans rejected implants. Our findings suggest that age-related factors and ethno-cultural perceptions may deter some homeless women from using contraception. In any case, gaps between realized use and willingness to use may represent missed opportunities to prevent the high rates of unintended pregnancies and sexually transmitted infections found among homeless women.

Adolescent↗