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PubMed2001

HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda.

OBJECTIVE: Evidence of condom effectiveness for HIV and sexually transmitted disease (STD) prevention is based primarily on high-risk populations. We examined condom effectiveness in a general population with high HIV prevalence in rural Africa. METHODS: Data were from a randomized community trial in Rakai, Uganda. Condom usage information was obtained prospectively from 17,264 sexually active individuals aged 15-59 years over a period of 30 months. HIV incidence and STD prevalence was determined for consistent and irregular condom users, compared to non-users. Adjusted rate ratios (RR) of HIV acquisition were estimated by Poisson multivariate regression, and odds ratios of STDs estimated by logistic regression. RESULTS: Only 4.4% reported consistent condom use and 16.5% reported inconsistent use during the prior year. Condom use was higher among males, and younger, unmarried and better educated individuals, and those reporting multiple sex partners or extramarital relationships. Consistent condom use significantly reduced HIV incidence [RR, 0.37; 95% confidence interval (CI), 0.15-0.88], syphilis [odds ratio (OR), 0.71; 95% CI, 0.53-0.94] and gonorrhea/Chlamydia (OR, 0.50; 95% CI, 0.25-0.97) after adjustment for socio-demographic and behavioral characteristics. Irregular condom use was not protective against HIV or STD and was associated with increased gonorrhea/Chlamydia risk (OR, 1.44; 95% CI, 1.06-1.99). The population attributable fraction of consistent use for prevention of HIV was -4.5% (95% CI, -8.3 to 0.0), due to the low prevalence of consistent use in the population. CONCLUSIONS: Consistent condom use provides protection from HIV and STDs, whereas inconsistent use is not protective. Programs must emphasize consistent condom use for HIV and STD prevention.

Adolescent↗
PubMed2004

HIV risk and condom use in the adult heterosexual population in France between 1992 and 2001: return to the starting point?

OBJECTIVE: The aim of this paper is to measure changes in protection behaviours from 1992 to 2001, in assessing trends in condom use over time in the heterosexual adult population. DESIGN: These changes are measured through repeated AIDS KABP surveys comparing, over time, condom use during the 12 months prior to the surveys and condom use at first sexual intercourse before and after the beginning of the AIDS epidemic. METHOD: National telephone surveys were conducted in 1992, 1994, 1998 and 2001. A total sample of 7026 heterosexual individuals, aged 18-54 years, was obtained. RESULTS: Two temporal phases are highlighted in condom use. The first shows an increase in both condom use at first sexual intercourse from 1985 to 1998, and in condom use during the 12 months prior to the surveys between 1992 and 1998, suggesting that sexual health promotion messages may have increased HIV/AIDS preventive behaviours. The second phase shows a decrease in condom use. Compared with 1998, condom use at first sexual intercourse in the 2001 survey still remains high; however, condom use in the 12 months prior to the survey is clearly decreasing, particularly among those with multiple sexual partners during the past 12 months. CONCLUSIONS: Reasons for this relapse in condom use in the general population include changes in social and individual representation due to the introduction of highly active antiretroviral therapy, the difficulties in sustaining long-term preventive behaviours, and a high level of awareness in the population and/or the decrease of large HIV prevention campaigns.

Adolescent↗
PubMed2005

Increasing condom use without reducing HIV risk: results of a controlled community trial in Uganda.

BACKGROUND: Although consistent condom use is effective in reducing individual risk for HIV infection, the public health impact of condom promotion in a generalized epidemic is less clear. We assess the change in condom uptake and number of sex partners after a condom promotion trial in Kampala, Uganda. METHODS: Two similar poor urban communities near Kampala were randomized. One received a condom promotion program that taught condom technical use skills in workshops for men aged 18 to 30 years (n = 297) and encouraged condom use. Men in the control community (n = 201) received a brief informational presentation about AIDS. Participants received coupons redeemable for free condoms from distributors in both communities and completed questionnaires at baseline and 6 months later. RESULTS: Six-month follow-up was completed for 213 men (71.7%) in the intervention group and for 165 (82.1%) men in the control group. Men in the intervention group redeemed significantly more condom coupons than men in the control group (on average, 110 vs. 13 each; P = 0.002). Men in the intervention group increased their number of sex partners by 0.31 compared with a decrease of 0.17 partners in the control group (P = 0.004). Other measures did not support a net reduction in sexual risk in the intervention community compared with the control community and, in fact, showed trends in the opposite direction. CONCLUSIONS: In this study, gains in condom use seem to have been offset by increases in the number of sex partners. Prevention interventions in generalized epidemics need to promote all aspects of sexual risk reduction to slow HIV transmission.

Adolescent↗
PubMed2004

Lack of recent condom use among detained adolescent males: a multilevel investigation.

OBJECTIVE: To investigate multiple levels of influence with respect to the lack of recent condom use among a high risk sample of adolescent males recruited from short term detention facilities. METHODS: A cross sectional survey of 231 adolescent males serving, predominantly, short term detention sentences. Assessments were conducted using audiocomputer assisted self interviewing. Condom use during the most recent sexual event was assessed as well as 20 potential correlates of not using condoms. Correlates were assessed within five levels of causation: personal, relational, peer affiliation, family, and societal. RESULTS: Nine correlates achieved bivariate significance (p<0.05). Of these, the personal level correlates were particularly important in a multivariate model. The motivation subscale from the Condom Barriers Scale was the strongest multivariate correlate of recent condom use. Adolescents scoring below the median were about 3.4 times more likely to report lack of recent condom use (p=0.0006). Adolescents indicating they had ever caused a pregnancy were about 2.5 times more likely to report lack of condom use (p=0.02). Finally, those reporting their peers did not use condoms were about twice as likely to report lack of use (p=0.048). CONCLUSION: Upon investigating multiple levels of potential influence on condom use, the multivariate findings suggest that personal level factors may be the most important determinant of non-use among adolescent males in short term detention facilities. Although structural changes may be needed to influence some forms of safer sex behaviour, direct intervention with adolescent males may be justified to favourably alter determinants of condom use.

Adolescent↗
PubMed1997

Anogenital warts and condom use--a survey of information giving.

OBJECTIVE: To examine information giving by genitourinary medicine (GUM) consultants about the use of condoms for patients with anogenital warts (AGW). METHOD: 228 GUM consultants in the UK and Ireland were sent a questionnaire concerning the information about condom use which they usually discuss with patients with AGW. The survey was carried out in 1994. RESULTS: There was a 46% response rate. Most consultants indicated giving information specifically with regard to the prevention of transmission of human papilloma virus (HPV), and not only in the context of safe sex. With regard to current AGW, consultants were more likely to discuss, than not to discuss, use of condoms with patients with regular sexual partners in terms of benefit, uncertain benefit, or no benefit. However, no significant difference in the likelihood of discussing, or not discussing, these issues was found for current AGW for patients without regular partners. For both groups, benefit of using condoms for current AGW was more likely to be discussed than no benefit. The majority of consultants indicated that they would discuss condom use after disappearance of AGW as being of uncertain benefit. However, many consultants also indicated discussing use of condoms for a specific period or an indefinite period of time, including many of those who specific discussing uncertain beneficial use of condoms after disappearance of AGW. The most common duration of condom use chosen for discussion was until 3 months after disappearance of AGW. CONCLUSION: GUM consultants vary in the information they give about condom use specifically to prevent transmission of HPV. This survey suggests a need for evaluation by GUM physicians of management guidelines relating to information given about condom use for AGW, including utilising the available scientific evidence as well as dealing with issues of uncertainty.

Condoms↗
PubMedDate not supplied

The impact of lubricants on latex condoms during vaginal intercourse.

The objective was to evaluate the impact of additional lubricant on condom breakage and slippage. Two hundred and sixty-eight couples used 6 new and 6 aged condoms during vaginal intercourse and were instructed to use 2 of each type with either water-based lubricant, oil-based lubricant or no additional lubricant. The use of either oil-based or water-based lubricant increased slippage rates of new and aged condoms, although only one pairwise comparison (oil-based lubricant vs. no additional lubricant) was statistically significant (8.5% vs. 3.8%, P = 0.004). The use of oil-based lubricant increased breakage, although not statistically significantly, in both new and aged condoms. Water-based lubricant did not impact the breakage rate of the new condoms and decreased the breakage rate of the aged condoms (no additional lubricant 4.5% vs. water-based lubricant 2.1%, P = 0.029). From a functional perspective, this study suggests that condom users should be told not to use oil-based lubricants. The negative impact of water-based lubricant on slippage may be outweighted by the protective influence on breakage, especially for aged condoms. Over three-quarters of the couples (76%) had at least some incorrect knowledge, according to current condom instructions, of the type of lubricant that should be used with condoms.

Adult↗
PubMed2000

Longitudinal pathways to condom use: a psychosocial study of male IDUs.

This longitudinal study examined the psychosocial risk and protective factors involved in condom use among 265 male IDUs. Subjects were individually interviewed at two points in time using a structured questionnaire, which included psychosocial measures and questions about drug use and condom use. Data were analyzed using Pearson correlations and hierarchical regression analyses. T1 condom use was the most powerful predictor of T2 condom use, with or without control on other variables. T1 family support for condom use, friends' support for condom use, adaptive coping with AIDS or the threat of AIDS, and planning to use condoms were significantly related to T2 condom use. Protective father factors enhanced the effects of other protective psychosocial factors, increasing T2 condom use. The results suggest several approaches for changing risk-taking sexual behavior in male IDUs: enhancing coping abilities, selecting peers who take fewer risks, and planning to use condoms.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Condom use and the accuracy of AIDS knowledge in Côte d'Ivoire.

CONTEXT: Condom use remains low in Côte d'Ivoire, despite an increasing prevalence of HIV and widespread awareness of how the virus is transmitted. Information is needed about characteristics that predict condom use and about the role of AIDS knowledge and sex differences in the use of condoms. METHODS: Data from the 1994 Côte d'Ivoire Demographic and Health Survey were analyzed for respondents who had had sex in the two months before the survey. Logistic regressions were performed separately by sex to determine whether the accuracy of men's and women's knowledge about AIDS predicted condom use at their most recent sexual intercourse. RESULTS: Accuracy of knowledge about AIDS did not significantly predict condom use. For male respondents, the odds of condom use at last intercourse were significantly lower among those aged 35 or older than among those aged 15-19 (odds ratios, 0.3-0.5). The odds were also lower among married men (0.4) and those who reported friends, family or neighbors as their only source of AIDS knowledge (0.5). Compared with uneducated men, men with secondary or higher education were significantly more likely to report condom use (1.7). Among women, those aged 25 or older had significantly lower odds of condom use at last intercourse than those aged 15-19 (0.2-0.6). The odds of use were significantly reduced among women who were married (0.2) and those who had learned about AIDS from family, friends or neighbors or from television or radio (0.3-0.6); however, the odds were significantly higher for women with secondary or higher education than for uneducated women (2.2). CONCLUSION: The level of accuracy of AIDS knowledge did not predict the likelihood of recent condom use in this sample. Efforts to increase educational attainment in Côte d'Ivoire may be more effective in increasing condom use than a focus on improving the accuracy of AIDS knowledge.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Correlates of partner-specific condom use intentions among incarcerated women in Rhode Island.

CONTEXT: Few studies of incarcerated women have examined potential associations between risky sexual behavior and relationship context factors; thus, little is known about the correlates of intentions to use condoms with main and casual partners in this underserved population. METHODS: A sample of 221 women incarcerated in a Rhode Island Department of Corrections facility in 2002-2003 were interviewed. Multiple linear regression analysis was performed to assess associations between selected demographic, psychosocial and behavioral variables and participants' reported intentions to use condoms with main and casual sexual partners in the first six months after their release. RESULTS: Condom use at last sex with a main partner, sexually transmitted disease (STD) history, no strong desire to currently be pregnant, belief that others influence one's health and perceived STD risk were positively associated with women's intention to use condoms with main partners. Pregnancy history was negatively associated with intention to use condoms with a main partner. Condom use at last sex with a casual partner was positively associated with intention to use condoms with casual partners, whereas binge drinking and believing in the role of chance in determining one's health were negatively associated with intention to use condoms with casual partners. CONCLUSIONS: Whether incarcerated women define a partner as main or casual may influence their decisions about the need to protect themselves by using condoms. Programs that focus on the importance of condom use with all partners could greatly benefit incarcerated women and the communities to which they return.

Adult↗
PubMedDate not supplied

Gender differences in the factors influencing consistent condom use among young people in Tanzania.

AIDS has become a major cause of death in Tanzania and young people represent the most vulnerable group. Recent HIV prevalence data showed that young women are more likely than young men to become infected. This paper examined commonalties and differences in the sociodemographic and ideational predictors of condom use among young men and women in Tanzania. The data derive from a 2004 sample survey among young people aged 15-24 years in five regions of Tanzania. The sample on which the analyses were based included 1,523 single women and 1,200 single men. An ideation framework guided the analyses of the predictors of consistent condom use. Logistic regression was the main analytic method used and separate models were estimated for men and women. The most significant correlates of consistent condom use for men included perceived self-efficacy for correct condom use, discussing condom use with friends, and perceived self-efficacy for using condoms with a long-term partner. Discussing condom use with a sex partner and the perceived self-efficacy to refuse sex if the sex partner refused to use a condom were the most significant predictors for women. One implication of the findings is that for men, effective interventions should emphasize correct condom use know-how and address the issue of negative peer pressure and group norms around condom use. For women, interventions should focus on sexual empowerment.

Adolescent↗
PubMed2001

Gender-related psychosocial and cultural factors associated with condom use among Chinese married women.

The present study explored the interplay of psychosocial, gender, and cultural factors on Chinese married women's condom use. A total of 433 Chinese married women residing in Hong Kong participated in the study. Correlation results showed that participants' conservative gender attitudes toward sexuality and sexual decision making were related to less accurate HIV/AIDS knowledge and less concern about contacting the disease from their husbands. About 34.4% of the sexually active participants never used condoms in the past 6 months, and current condom use was associated with egalitarian gender attitudes, positive feelings about condom use, and concerns about contacting HIV/AIDS from their husbands. Among all participants, 32.5% reported that they would not use condoms in their future sexual encounters. Future condom use was related to shorter duration of marriage, accurate HIV/AIDS knowledge, egalitarian gender attitudes, current condom use, and positive feelings about condom use. Results from the logistic regression analyses showed that egalitarian gender attitudes toward sexuality and positive feelings about condom use were the most salient predictors for current and future condom use.

Adult↗
PubMed1995

Condom use among female commercial sex workers in Nevada's legal brothels.

OBJECTIVES: The purpose of this study was to evaluate condom use and the incidence of breakage and slippage during vaginal intercourse among female prostitutes in legal Nevada brothels, where use of condoms is required by law. METHODS: Forty-one licensed prostitutes in three brothels were enrolled in a prospective trial in August 1993. Used condoms were collected to verify reported breaks visually. Retrospective breakage and slippage rates were obtained in a standardized interview. RESULTS: Condoms were used for every act of vaginal intercourse with a brothel client during the study period, as well as in the previous year. In the prospective study phase, condoms were used in 353 acts of vaginal intercourse with clients. No condoms broke, and none fell off the penis during intercourse. Only twice (0.6%) did condoms completely fall off during withdrawal. Twelve times (3.4%) during intercourse and 15 times (4.3%) during withdrawal, condoms slipped down the penis but did not fall off. CONCLUSIONS: These findings, among the lowest breakage and slippage rates published, suggest that regular condom use may lead to condom mastery and the development of techniques to reduce the likelihood of breakage and slippage.

Adult↗
PubMed2001

Intention to use the female condom following a mass-marketing campaign in Lusaka, Zambia.

OBJECTIVES: This report examines intention to use the female condom among men and women in Lusaka, Zambia, who were exposed to mass-marketing of the female condom. METHODS: The study used data from a representative sample of consumers at outlets that sell or distribute the female condom and the male condom. RESULTS: In spite of a high level of awareness of the female condom, use of this method in the last year was considerably lower than use of the male condom. Intention to use the female condom in the future was highest among respondents who had used only the female condom in the last year. CONCLUSIONS: The female condom is likely to be most important for persons who are unable or unwilling to use the male condom.

Adolescent↗
PubMed1999

Double Dutch: looking at the usage of combined pill plus condom in girls under 25.

OBJECTIVE: To establish what proportion of young girls who were prescribed the contraceptive pill at Manchester family planning clinics have first remembered, and second followed, advice also to use the condom for protection from sexually transmitted infection. METHOD: An anonymous self-administered questionnaire was issued to all females up to the age of 25 years, who were already using the pill and who attended one of 20 different clinic locations. Questions included duration of present relationship, frequency of condom use and reasons for use or non-use. RESULTS: The age of respondents ranged from 13 to 25 years, with one-third in the group of 17-19-year-olds. Out of 104 responses, condoms were used most of the time by 29 girls, occasionally by 42 and never by 33. Only 15 of the 104 knew the phrase 'double Dutch'. Dual use most of the time primarily for sexually transmitted disease protection was reported by 23 girls. Previous treatment for sexually transmitted disease was reported by 14 girls, of whom half never used condoms and only three now used condoms most of the time. In the group of girls using condoms occasionally, 70% were using condoms primarily to cover missed pills, antibiotics, etc. Extrapolating from the number of condoms used in the past month and the fact that 80% of girls obtained their condoms from the clinic, the extra cost to the family planning budget is over 14,000 Pounds (over 22,500 Ecu) per year. CONCLUSION: Our result that 22% of young pill users regularly used condoms to protect from sexually transmitted diseases indicates that the message is understood, but the term 'double Dutch' is not.

Adolescent↗
PubMed2004

Commercial sex workers'condom use behavior in Korea.

PURPOSE: With the continuous spread of the AIDS virus and other sexually transmitted diseases (STDs) throughout Asia, it has become imperative for HIV/AIDS prevention outreach programs to stress the need for using prophylactics as one form of protection. This is particularly true for commercial sex workers. This pilot study was conducted to investigate the rate of condom use among the commercial sex workers in Korea and reasons why they frequently do not wear condoms during sexual intercourse. METHODS: Fifty female commercial sex workers who worked in the Yong San area were recruited while outreach was performed and forty eight responses were analyzed due to two incomplete questionnaires. The data were collected on June 28, 2004 as part of an outreach program for condom use promotion. RESULTS: The subjects ranged in age from 21 to 45 years. Nearly half of the subjects (47.9%) did not consistently use condoms. The major reason for not using protection was clients' reluctances for using condoms. When condoms were used, the subjects preferred lubricant-rich and less painful condom during intercourse. CONCLUSION: Due to the inconsistent use of condoms, it is clear that many commercial sex workers and clients are susceptible to sexually transmitted diseases. Therefore, it is important to not only educate commercial sex workers, but also to educate their pimps and clientele about the importance of condom use. In general, it is recommended that practical strategies and a policy for condom use promotion be developed.

Adult↗
PubMed2003

Male condom use in Tanzania: results from a national survey.

OBJECTIVE: To determine factors associated with male condom use in Tanzania. METHODS: Data from the 1996 Tanzania Demographic and Health Survey (TDHS) was used. In this survey, a national representative sample of sexually active men (N=1898) and women (N=7027) were interviewed to obtain information about potential predictors of sexual practices and condom use. RESULTS: Two hundred and ninety (4.1%) women and 288 (15.2%) men had used condoms during their last sexual encounter. Men aged 20-24 years and women aged 15-19 years reported the highest rate of condom use. In both men and women, condom use increased with increasing level of education. Residents of large urban centers were more likely to have used condoms among both women [adjusted OR=1.8, 95% CI=1.2-2.8] and men (adjusted O=2.0, 95% CI=1.3-3.1). Condom use was significantly increased among women (adjusted OR=6.2, 95% CI=4.4-8.8) and men [adjusted OR-5.9, 95% CI=3.2-8.8) practising high-risk sexual behaviour. Similarly, condom use was significantly increased among men who were never married and in those who had ever tested for AIDS. CONCLUSIONS: Condom promotion activities have been less successful in Tanzania. Additional efforts to increase condom acceptability and use are urgently needed.

Adolescent↗
PubMed2006

Condom and sexual abstinence talk in the Malawi National Assembly.

BACKGROUND: Correct and consistent use of condoms has been reported as effective in the prevention of transmission of HIV. There have been many studies reporting on attitudes (perceptions) of communities on condoms and other aspects of HIV and AIDS and yet there is paucity of data on the perception towards condoms and abstinence by law makers. OBJECTIVE: To determine perceptions of Members of Parliament in Malawi towards condoms. METHODS: A qualitative study utilising parliamentary Hansards to describe the discussions about condoms and abstinence in the National Assembly 1999-2004. Content and discourse analyses were used. RESULTS: In general, Members of Parliament had negative attitudes towards extra- and/or pre-marital sexual intercourse, condom promotion and use. Sexual abstinence amongst non-married persons was preferred as opposed to condom use. Condom use was not perceived as an effective way of controlling the spread of HIV. Some MPs though called for a change in mind-set so as to allow use of condoms in prisons, in order to prevent transmission of infection from prisoners to the general community once the prisoners were released. CONCLUSION: This study confirms that health interventions such as condoms are not perceived neutrally and may be construed as the enemy of society.

Adult↗
PubMed2000

Isolation and identification of male and female DNA on a postcoital condom.

BACKGROUND: Identification of male perpetrators of sexual assault may be made from cells and fluids recovered from postcoital condoms. To date, the focus has been on identifying the person who had worn the condom. OBJECTIVE: To describe a method for scientifically identifying both the male and female participants in a sex act by employing polymerase chain reaction-based technology on swabs taken from the internal and external surfaces of a condom. Fluorescence in situ hybridization may be used to screen for the presence of female cells on a condom. METHODS: Swabs were taken from the internal and external surfaces of a condom 8 hours postcoitus. DNA was isolated from each swab through standard organic extraction. Extracted DNA was amplified for 8 different genetic loci using the Promega PowerPlex kit and the sex identification amelogenin marker. Amplified samples were electrophoresed on precast sequencing gels and analyzed fluorescently using a Hitachi FMBIO 2 fluorescent scanner and software. Each DNA sample obtained from the condom was compared with male and female buccal controls. At the time of collection, air-dried slides were prepared from the swabs for subsequent multicolor fluorescence in situ hybridization using dual X- and Y-chromosome probes with 4'-6-diamidino-2-phenylindole (DAPI) counterstaining. RESULTS: A pure sample of female DNA was isolated from the external surface of the condom as determined by exclusive amplification of the X-chromosome-specific 212-base pair amelogenin marker. Swabs taken from the internal surface yielded DNA originating from the male participant. Identification was conclusive at 8 of 8 genetic loci. Fluorescence in situ hybridization identified pure populations of male epithelial cells from the internal surface of the condom and female cells from the external surface. CONCLUSIONS: Cells shed from a female during sexual intercourse can be retrieved from the external surface of a condom following sexual intercourse. Fluorescence in situ hybridization can be used to screen for the presence of female cells, and positive identification of the female sexual partner can then be made using polymerase chain reaction-based methods. We suggest that swabs taken from both surfaces of a condom used during sexual assault may be used to provide information that will definitively link the victim to the suspect.

Coitus↗