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PubMed1994

Sexual behavior and condom use among urban, low-income, African-American and Hispanic youth.

Low income, urban, African-American, and Hispanic youth have been identified as a group for which there is concern about the spread of HIV. Using data from a household probability sample of 1,435 minority youth aged 15 to 24 in Detroit, this paper evaluates levels of sexual activity, condom use, and reasons for condom use and non-use. Comparisons with national samples of minority youth indicated that Detroit low-income youth have similar patterns of sexual behavior to national samples, although males and African-American females began their sexual experiences earlier and were less likely to have used condoms or other protection from pregnancy or sexually transmitted diseases (STDs) at first intercourse. Recent levels of condom use also left many Detroit youth unprotected from STDs. Less than half used a condom at least intercourse in the last year with nonmarital partners that they "knew well." In addition, condom use with partners that they "did not know well" was very low for Hispanic youth: Among those who had at least one casual partner in the last year, only 30% to 33% had ever used a condom with that partner. Analysis of reasons for use indicate that both pregnancy prevention and disease prevention were important motivations for condom use. However, many youth did not use condoms for reasons such as unavailability of condoms or unplanned sex.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Impact of a high school condom availability program on sexual attitudes and behaviors.

CONTEXT: While making condoms available in high schools has provoked much debate, evidence on the actual effects of such programs on students' attitudes and behavior is sparse. METHODS: Prior to implementation of a condom availability program in a Los Angeles County high school, 1,945 students in grades 9-12 (98% of eligible students) completed a self-administered anonymous survey on their sexual behavior and on related knowledge and attitudes; one year later, 1,110 students (59% of eligible students) completed a follow-up survey. RESULTS: There was no significant change over time in the percentage of males or females who had ever had vaginal intercourse or who had had vaginal intercourse during the year prior to the survey. The percentage of males who reported using condoms every time they engaged in vaginal intercourse during the past year increased significantly, from 37% to 50%, and the percentage of males who reported condom use at recently initiated first vaginal intercourse increased from 65% to 80%. On the other hand, female respondents showed no significant change in their condom use. The self-reported likelihood of using a condom for vaginal intercourse during the following year did not change significantly for students who had had vaginal intercourse, but it increased dramatically for those who, had never had vaginal intercourse. The students' attitudes toward sex and condom use either remained the same between surveys or changed in a direction favoring less sexual behavior and greater risk prevention. CONCLUSIONS: The condom availability program appears not to have produced an increase in sexual activity among high school students, and it appears to have led to improved condom use among males. The apparent strong effect on students' intention to use condoms and on males' use at first vaginal intercourse suggests that such programs may have a particular impact on the least sexually experienced adolescents.

Adolescent↗
PubMedDate not supplied

Condom use among women choosing long-term hormonal contraception.

CONTEXT: Women who rely on long-term hormonal contraception may neglect to use condoms, and thus increase their risk of contracting sexually transmitted diseases, including AIDS. METHODS: Data from a prospective, multisite study were collected to examine the probability of condom use among 1,073 new users of either the contraceptive implant or injectable; users were interviewed when they accepted their method and again six months to one year later. Multivariate logistic regression analyses identified factors that significantly predicted the likelihood of dual method use. RESULTS: Condom use dropped markedly among women who adopted long-term hormonal contraception. The proportion who always used condoms in the previous three months fell from 21% at the time of adoption to 11% at follow-up. Among women with one sexual partner, this decrease was from 20% to 10%; however, among those with more than one partner, use increased from 25% to 31%. The factors significantly predicting dual method use included previous condom use (odds ratio of 2.5), receipt of AIDS-specific counseling (odds ratio of 1.6), the perception of being at some risk of AIDS at baseline (odds ratio of 1.4) and having had more than one sexual partner over the study period (odds ratio of 5.4). In addition, injectable users, teenagers and black women were more likely than other women to use condoms with their hormonal method. CONCLUSIONS: Although condom use among all women declined markedly once they initiated long-term hormonal contraception, frequency of condom use varied by subgroup and was associated with several factors. Most importantly, women with more than one sexual partner and those who received a message during counseling on the need to continue using condoms were more likely than others to use condoms in conjunction with the implant or injectable.

Adolescent↗
PubMed1998

Effect of HIV counseling and testing on sexually transmitted diseases and condom use in an urban adolescent population.

OBJECTIVE: To determine whether human immunodeficiency virus (HIV) counseling and testing has an effect on reducing subsequent risk behaviors in those tested, to evaluate stability in condom use over time, and to determine whether self-reported frequency of condom use relates to the incidence of sexually transmitted diseases (STDs). DESIGN: Cohort study with 2-year follow-up. SETTING: An urban adolescent-medicine clinic. PARTICIPANTS: A random sample of 149 patients (118 female and 31 male adolescents) with a mean (+/- SD) age of 16.4 +/- 1.51 years were selected from a cohort of 500 patients at high risk for HIV infection. The patients had received a risk behavior questionnaire during pretest counseling for HIV testing. They were divided into 3 groups, identified by the letter F, S, or R, based on their self-report of frequency of condom use at enrollment: 24% used condoms frequently/always (F); 40%, sometimes (S); and 36%, rarely/never (R). One hundred twenty-six patients (85%) made return visits. INTERVENTION: HIV counseling and testing. MAIN OUTCOME MEASURES: Medical record documentation of STDs before and after HIV testing, and self-reported condom use frequency. RESULTS: Before HIV testing, all 3 condom use groups had a similar frequency of STD visits per month. The number of STD visits per month did not decrease significantly in the posttest period for either the total group or each of the 3 subgroups. Also, most patients (F, 67%; S, 44%; R, 53%) in each of the 3 subgroups had shifted unfavorably to rarely/never (R) condom use within the month before their follow-up visit. Only 24% (8 patients) of those in the initial frequently/always (F) group reported continued frequent condom use. CONCLUSIONS: As has been found in adult studies, single-dose interventions such as HIV counseling and testing did not seem to reduce HIV risk behaviors in our sample of high-risk adolescent patients. None of the 3 groups showed a significant decrease in STDs after HIV testing and counseling. Also, our adolescent patients reported widely varying condom use frequency over time, yet the incidence of STDs did not correlate with self-reported condom use.

AIDS Serodiagnosis↗
PubMed2005

The effect of correct and consistent condom use on chlamydial and gonococcal infection among urban adolescents.

OBJECTIVE: To evaluate the relationship between self-reported correct and consistent condom use and chlamydial and gonococcal infection. DESIGN: Cross-sectional study. SETTING: An urban adolescent health care clinic. Patients A total of 509 adolescent girls tested for Chlamydia trachomatis and Neisseria gonorrhoeae infection by urine nucleic acid amplification tests. Main Outcome Measure Effect of condom use on infection rates of chlamydia and gonorrhea. Consistent condom use was defined as using condoms for every act of vaginal sex and correct use as consistent use without any of the following: beginning sex without a condom, taking it off before finishing sex, flipping it over, condom breakage, or condom slippage. RESULTS: A total of 95% of the participants were African American, with a mean age of 16.6 years. Chlamydia prevalence was 21% (105/509) and gonorrhea prevalence was 7% (36/509). Condom errors were reported by 316 (71%) of 442 participants who had reported using a condom at least once in the previous 3 months. Consistent use was reported by 176 patients (35%); however, both correct and consistent use was reported by only 80 patients (16%). After adjusting for confounders, correct and consistent use was protective for chlamydia (odds ratio, 0.4; 95% confidence interval, 0.2-1.0) and highly protective for gonorrhea (odds ratio, 0.1; 95% confidence interval, 0-0.7). CONCLUSION: Our findings indicate that assessing both correctness and consistency of use is important for evaluation of condom effectiveness.

Adolescent↗
PubMedDate not supplied

Assessment of condoms as probe covers for transvaginal sonography.

PURPOSE: This prospective study assessed the incidence of transvaginal probe contamination and breakage of condoms used to cover those probes during transvaginal sonography. METHODS: Over a 9-month period, 214 women underwent transvaginal sonography with probes that had been coated with gel and then covered with a latex condom. Condom defects were detected after the scans by inspection, by adding hydrogen peroxide, and by filling the condoms with 500 ml of water. After the condoms were removed, the probe was either wiped with a dry tissue (during the first 18 weeks of the study) or wiped first with a dry tissue and then with a 70% isopropyl alcohol wipe. Probe head contamination was assessed by periodic swab sampling and culturing for bacteria and herpes simplex virus. Samples of the sonographic gel also were tested for bacterial contamination at approximately weekly intervals. RESULTS: A total of 217 condoms were used, 3 of which broke and were discarded while being applied to the probe. Two of the 214 condoms used (0.9%) were found upon visual inspection to have perforations. None of the other 212 condoms leaked upon being filled with water; none of the 204 condoms tested with hydrogen peroxide showed bubbles. Only 1 of the 46 probe swab samples was positive for bacteria (Acinetobacter species); none of the 26 probe swab samples cultured for viruses or the 25 gel samples cultured for bacteria were positive. CONCLUSIONS: Condoms used to cover transvaginal probes showed a low rate of perforation. Disinfection of the probe with isopropyl alcohol wipes further reduced the risk of contamination.

Adult↗
PubMed2003

Nonlatex vs. latex male condoms for contraception: a systematic review of randomized controlled trials.

This systematic review sought to evaluate nonlatex male condoms in comparison with latex condoms in terms of contraceptive efficacy, breakage, slippage, safety and user preferences. We searched computerized databases and contacted manufactures and investigators to find randomized controlled trials of nonlatex vs. latex male condoms. Two reviewers independently abstracted data from the 10 identified trials. While the eZ. on condom did not protect against pregnancy as well as its latex comparison condom, no differences were found in typical-use efficacy between the Avanti and the Standard Tactylon and their latex counterparts. Nonlatex condoms were associated with higher rates of clinical breakage than their latex comparisons, with statistically significant odds ratios of clinical breakage ranging from 2.6 (95% confidence interval [CI]: 1.6-4.3) to 5.0 (95% CI: 3.6-6.8). Few adverse events were reported. Substantial proportions of participants reported preferences for the nonlatex condoms. Despite higher rates of clinical breakage, nonlatex condoms still provide an acceptable alternative for those with allergies, sensitivities or preferences that might prevent the consistent use of latex condoms. The contraceptive efficacy of nonlatex condoms requires more research.

Condoms↗
PubMed2006

Sex, life and the female condom: some views of HIV positive women.

This article offers some insights into the experiences of HIV positive women with the female condom, drawing on my own personal experience and responses of 18 members of the International Community of Women Living with HIV/AIDS to an e-mail survey conducted in 2005. Major barriers reported to female condom use were cost and sporadic or very limited access. All respondents talked about needing to negotiate the use of female condoms with their male sex partners. Most felt more in control and more confident during sex when using the female condom than with the male condom or unprotected sex. Concerns about female condoms appear to be common, especially among women who have never used one; those who had used the female condom for long periods of time said good things about it. Women reclaiming our bodies is a central part of the joy and the challenge of promoting the female condom. For HIV positive women and girls, using a condom is more than protection against pregnancy, but a matter of life and death greater than the risks pregnancy can bring. Female condoms could make a critically important contribution to protecting HIV positive women's sexuality and continued sexual activity, as a fundamental part of our sexual and reproductive rights, if only they were more widely available and affordable.

Attitude to Health↗
PubMed2006

A qualitative study of condom use among married couples in Kampala, Uganda.

Twenty-five years into the HIV/AIDS epidemic, condom use among married/stable couples remains low and under-researched in developing countries, even countries with high HIV prevalence. Introducing condoms into a long-standing relationship, in spite of HIV risk, is likely to be awkward. We conducted a qualitative study in Kampala, Uganda, with 39 couples reporting 100% condom use in the previous three months. The women were recruited from among women in a clinical trial who were using condoms and whose partners also agreed to participate. Twenty-two of the women and six of the men reported having taken the initiative to suggest condom use; the remaining couples disagreed who raised the subject first. Women used insistence, refusal to have sex, persuasion, and condoms for family planning or to protect children, which helped to deflect distrust and get their partner to agree. Some men resisted initially but their reactions were often more positive than expected. Men's reasons for accepting condoms were to please their partner, protect her from HIV, protect their children, protect themselves and, in some cases, continue having other partners. Although condom use is a couple behaviour, an encouraging environment and condom availability are all crucial to increasing condom use by couples in settings like Uganda.

Adolescent↗
PubMedDate not supplied

Predicting intentions and condom use among Latino college students.

To understand the factors that predict Latinos' risk-associated behavior, this study examined whether favorable beliefs about condoms and select moderator variables are related to stronger intentions to use condoms and more reported condom use at most recent vaginal and anal intercourse among Latino college students. Latino students who attended a public university in the northeast United States were mailed a paper-and-pencil questionnaire. Results from completed questionnaires (n = 199) indicated that students who perceived greater partner approval of condom use, perceived greater peer approval of condom use, and expressed confidence in their ability to control themselves reported stronger intentions to used condoms. Perceived partner approval and impulse control was related to self-reported condom use at most recent vaginal intercourse, impulse control was related to self-reported condom use at most recent vaginal intercourse, and impulse control was related to self-reported condom use at most recent anal intercourse. These relations did not significantly differ by Hispanic ethnicity, religiosity, gender, or age. Results suggest that normative beliefs and control beliefs regarding impulse control may be especially salient in both predicting and changing condom use behavior and should be incorporated into nursing assessments and tailored interventions.

Adult↗
PubMedDate not supplied

Knowledge, self-efficacy, coping, and condom use among urban women.

In this study, path analysis was used to test a model of the relationships among condom use knowledge, self-efficacy for condom use, coping, and condom use in a sample of 100 urban women. In the final model, the paths between condom use knowledge and self-efficacy, between self-efficacy and condom use, and between self-efficacy and problem-focused coping were significant. In addition, condom use knowledge was indirectly related to condom use through self-efficacy. The final model accounted for 43% of the variance in condom use. Although the women engaged in risky behaviors including having multiple partners, high-risk sexual partners, and unprotected intercourse, they did not worry about or perceive themselves at risk for HIV. To assist women to decrease their risk for sexually transmitted HIV infection, clinicians should conduct individualized assessments of each client's sexual behaviors to identify women at risk. Individualized interventions are recommended to increase both knowledge of how to use condoms and self-efficacy for condom use among women at risk for HIV.

Adaptation, Psychological↗
PubMed1989

Factors influencing selected heterosexual male college students' condom use.

This study assessed selected heterosexual male college students' use of condoms, their reasons for using condoms, and their attitudes toward sexuality and condoms. Three hundred five male subjects completed a questionnaire that assessed class standing, marital status, reasons for using condoms, number of recent sexual partners, intention to use condoms, and attitudes toward sexuality and condoms. Although no relationship between attitudes toward sexuality and attitudes toward condoms was noted, a negative correlation (-.42) was found between attitude toward condoms and intention to use condoms within the next month if the subject were to have intercourse during that time. Recommendations for increasing condom use are presented.

Attitude to Health↗
PubMed2002

Consistent condom use among drug-using youth in a high HIV-risk neighbourhood.

The objectives of this study were to determine predictors of consistent condom use in heterosexual relationships of young adults who use hard drugs in a neighbourhood with widespread drug-use-connected HIV. We interviewed 196 18-24 year olds who injected drugs or used heroin, cocaine or crack in the prior year and lived in the Bushwick neighbourhood of New York City. Interviews covered sociodemographics, substance use and sexual networks. The unit of analysis is the relationship; the dependent variable measures consistent condom use over the prior 30 days in a given relationship. Consistent condom use was reported in 26% of 377 non-commercial relationships and in all of 22 commercial relationships. Using multiple logistic regression, consistent condom use in non-commercial relationships was more likely in relationships that are not 'very close'; for men (but not women) with peers whose norms are more favourable to condom use; and for subjects who had concurrent sex partners in the last 12 months. In conclusion, we found that: (1) the lack of relationship between the peer norms of drug-using women and their condom use suggests they may have little control over condom use in their relationships-programmes should attempt to empower young women drug users and to develop ways for their peers to influence the men in their lives; (2) epidemiologically, the positive association of concurrency to consistent condom use suggests that condom use may be restricting HIV spread through the community-the presence of consistent condom use in all of the commercial sexual relationships also may restrict HIV spread; (3) prevention efforts should attempt to change peer cultures as a way to develop self-sustaining risk reduction. These changes should include changes in gender roles and power relations.

Adult↗
PubMed2001

The promotion of condom use in non-regular sexual partnerships in urban Mozambique.

This study uses data from a representative sample of sexually active adults in urban Mozambique to examine the effectiveness of the JeitO condom social marketing (CSM) project in increasing condom use among men and women at risk of contracting HIV. More specifically, this study tests the hypothesis that exposure to programme interventions (communications and access) increases condom use with non-regular partners. Exposure to the CSM programme is high, and multivariate analyses show that exposure to CSM advertising and communications and knowledge of a condom source are associated with higher reports of condom use with non-regular partners. Analyses of regional differences in condom use show that knowledge and use of condoms with non-regular partners are higher than the national average in all four provinces where the CSM project has been operating for longer (18 months vs. 6 months). Multivariate analyses show that the above-average level of condom use in the capital, Maputo, can be attributed to the higher socioeconomic status of this population, but the above-average level of condom use among men and women in Sofala and Manica provinces is due, in part, to their high level of exposure to the CSM programme. These findings indicate that the JeitO CSM project's behaviour-change communications and condom distribution are effective in encouraging safer sex practices among persons engaged in sex with non-regular partners.

Adolescent↗
PubMed2003

Equity in access to condoms in urban Zambia.

OBJECTIVE: This article examines the degree of equity in access to condoms in urban Zambia. METHODOLOGY: This study uses data from representative samples of a). men and women in households in urban Zambia and b). providers at retail outlets in urban Zambia. RESULTS: A substantial proportion of outlets in urban Zambia (39%) stocked social marketing condoms in 1999. More than 30% of groceries and kiosks - outlets commonly found in low-income residential areas - stocked social marketing condoms. Consumer access to condoms (defined as estimated walking time to a condom source) was greater for poorer compared to wealthier respondents: compared to men with 7-13 assets (wealthier men), men with 2-6 assets were 1.5 times as likely and men with up to one asset were 1.8 times as likely to be within 10 minutes walk of a condom source. Multivariate analysis indicated that greater access to condoms among the poor was a function of greater condom availability in poorer neighbourhoods. CONCLUSIONS: Making condoms available in non-traditional outlet types that are commonly found in low-income areas (such as kiosks and groceries) can eliminate socioeconomic inequities in condom access.

Africa↗
PubMed2003

Beliefs as predictors of condom use by injecting drug users in treatment.

This study was conducted to clarify (1) the extent to which health beliefs selected from Protection Motivation Theory can combine to correctly classify 72 injecting drug users (IDUs) as condom users or non-users and (2) which of the beliefs ('vulnerability to a regular partner', 'vulnerability to a casual partner', 'self-efficacy', 'response efficacy', 'response costs' and 'social norms') were most influential in this distinction. Results of a logistic regression indicated that these beliefs were significant predictors of condom use. Overall, 83.3% of participants were correctly classified according to condom use, with condom 'non-users' being more accurately predicted (94.0%) than 'users' (59.1%). 'Vulnerability to a regular partner' and 'social norms' were significant multivariate and univariate predictors of condom use, and 'response costs' were significant univariate predictors. IDUs were confident of their ability to use condoms, considered themselves highly vulnerable to HIV infection from casual partners and were confident in the efficacy of condoms to protect them from AIDS. However, the majority of IDUs were not condom users, particularly with 'regular' partners. Findings suggest that HIV prevention programmes should target beliefs regarding risks from known partners, perceived norms and negative consequences of condom use in order to increase condom use by IDUs in treatment.

Adult↗
PubMed2001

The acceptability of reuse of the female condom among urban South African women.

This study assessed whether reuse of the female condom was acceptable among two groups of women in central Johannesburg, South Africa, who were taking part in two separate studies of female condom reuse. The first group consisted of women (aged 17 to 43 years) attending a family planning/sexually transmitted infections (STIs) clinic who were participating in a cross-sectional survey of the acceptability of female condoms reuse (n = 100). The second group included women (aged 18-40 years) at high risk for STI (80% self-declared sex workers) who were taking part in an ongoing cohort study to investigate the safety of reuse of the female condom through a structural integrity and microbial retention study (n = 50). Among women participating in the acceptability study, 83% said that they would be willing to reuse the female condom, and 91% thought the idea of reuse of the female condom was acceptable. All women taking part in the safety of reuse study and who reused the female condom up to seven times (n = 49) reported that the steps involved in reusing the device were easy to perform and acceptable. All 49 women said they would reuse the female condom at least once, while 45% said they would use it a maximum of seven or eight times. From the results of the interviews with both study groups, it can be concluded that, among women in a South African urban environment who have used a male and/or female condom, the concept of reuse of the female condom is acceptable and thought to be a good idea.

Adolescent↗
PubMed1993

Determinants of condom use in 24,000 prostitute/client contacts in The Gambia.

OBJECTIVE: To determine the factors that influence condom use among prostitutes and their clients in The Gambia. DESIGN: A cohort of 181 prostitutes working in seven bars and several rural markets in The Gambia were monitored daily for 14 months. A sample of 747 clients of these prostitutes was also questioned. MAIN OUTCOME MEASURE: Proportion of sexual contacts for which a condom was used. RESULTS: Data on 24,181 sexual contacts reported by the prostitutes indicated condom use varied according to type of partner (from 84% with clients to only 4% with regular partners). Condom use with clients varied according to location (from 91% in high-class bars to 59% in rural markets), decreased from 91% with the first client of the evening to 37% with the tenth client, and from 75% with clients paying higher charges (> D19) to 52% with those paying lower charges (< D20). Condom use was not related to the socio-demographic characteristics of the prostitutes. Clients reported lower condom use than prostitutes. Clients aged 20-24 years were least likely to use condoms, while white collar workers, traders, and those paying higher charges, were more likely to use condoms. CONCLUSIONS: The level of condom use in this cohort of prostitutes was high but not consistent. Condom use was determined more by the type of establishment and the characteristics of clients, than by any fixed tendency among the prostitutes. Thus, education campaigns should be directed as much to clients as to prostitutes. In The Gambia, 'lower-class' bars and those in rural areas where prostitutes work should be a priority target.

Adolescent↗