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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↗
PubMed1998

Differences in condom behaviors and beliefs among female drug users recruited from two cities.

This paper examines predictors of condom cognitions and condom use for vaginal sex within women's main and paying partnerships. The sample consisted of active injection drug and crack-using women recruited from two cities with disparate HIV rates. A total of 338 drug-using women who reported vaginal sex with a main and/or paying partner in the prior 30 days were recruited for this study. Recruitment site was a significant predictor for several of the variables examined, for both main and paying partners. Ethnicity and prior HIV test result were also significant predictors, but only for main sex partners. Findings support previous research and suggest that the factors which predict condom beliefs, intention, and behaviors are different for main versus paying partners. Interventions designed to increase condom use must recognize that cognitive factors associated with condom use may vary by partner type, ethnicity, and recruitment site, particularly when important contextual variables, such as local seroprevalence, vary.

Adult↗
PubMedDate not supplied

Contraceptive use and consistency in U.S. teenagers' most recent sexual relationships.

CONTEXT: Most U.S. teenage pregnancies are unintended, partly because of inconsistent or no use of contraceptives. Understanding the factors associated with contraceptive use in teenagers' most recent relationships can help identify strategies to prevent unintended pregnancy. METHODS: Data on 1,468 participants in Waves 1 and 2 of the National Longitudinal Study of Adolescent Health who had had two or more sexual relationships were analyzed to assess factors associated with contraceptive use patterns in teenagers' most recent sexual relationship. Odds ratios were generated through logistic regression. RESULTS: Many relationship and partner characteristics were significant for females but nonsignificant for males. For example, females' odds of ever, rather than never, having used contraception in their most recent relationship increased with the duration of the relationship (odds ratio, 1.1); their odds were reduced if they had not known their partner before dating him (0.2). The odds of consistent use (vs. inconsistent or no use) were higher for females in a "liked" relationship than for those in a romantic relationship (2.6), and for females using a hormonal method instead of condoms (4.5). Females' odds of consistent use decreased if the relationship involved physical violence (0.5). Among teenagers in romantic or "liked" relationships, the odds of ever-use and of consistent use were elevated among females who had discussed contraception with the partner before their first sex together (2.9 and 2.1, respectively), and the odds increased among males as the number of presexual couple-like activities increased (1.2 for each). CONCLUSIONS: Teenagers must use contraception consistently over time and across relationships despite pressure not to. Therefore, they must learn to negotiate sexual and contraceptive decisions in each relationship.

Adolescent↗
PubMed2002

Barriers to safer sex practices among African American college students.

African American college students are among the age group of African Americans with significantly higher heterosexual transmission of HIV. It has been projected that young African Americans of college age will be the next group to be affected by the HIV/AIDS epidemic. The goals of this research were to identify barriers to African American college students engaging in safer sex behaviors; determine whether barriers to safer sex differ for African American men versus African American women; and use the findings to help identify strategies likely to promote safer sex practices among African American college students. The Nominal Group Technique (NGT) was used to collect the information. The results yielded the following themes. For males and females, the combined themes, negative views of condoms were ranked the most important with a score of 70. Trust issues were ranked the second most important with a total score of 47. The third highest ranked theme was living for the moment with a total score of 43. The fourth highest ranked theme was feeling invincible with a total score of 42. The authors provide a number of recommendations for consideration in the development of HIV prevention programs for African American college students.

Adolescent↗
PubMed1998

Factors related to condom use among four groups of female sex workers in Bali, Indonesia.

This article tests a behavioral model of condom use for four groups of female commercial sex workers. Data were drawn from a study of 614 female sex workers conducted in Bali, Indonesia. AIDS knowledge, risk behaviors, and factors related to condom use varied substantially among the four groups of women and reflect the social context of their work. Interventions for each group need to reflect these differences. Important factors to consider include the level of AIDS and STD knowledge in their environment, the characteristics of the clients served, and the degree of supervision that they receive.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Prioritizing education about condom use among sexually active adolescent females.

Many factors have been shown to influence condom use among adolescents, including negative experiences with prior use, risk-taking behaviors, perception of condom efficacy, and self-efficacy in obtaining and using condoms. In order to help prioritize topics for clinic-based education, this study attempted to determine which factors are most significantly associated with planned condom use. A 53-item questionnaire was administered to sexually active females presenting consecutively to an adolescent clinic. Two hundred ethnically and religiously diverse patients, with a median age of 17 years, participated. Median age at first sexual encounter was 15. Median number of lifetime partners was 2, with a median of 1 partner in the last year. Past condom use was reported by 88%, with 22% always, 38% usually, and 26% occasionally using condoms. Only 47% had used condoms during their most recent sexual encounter. Negative experiences with condom use were reported by 85%. Only 54% stated they would definitely use condoms during their next sexual encounter. Intent to use condoms in the future was significantly associated with both past use and fear of HIV infection. Intent was not significantly associated with most prior negative experiences, perception of condom efficacy in preventing STDs and pregnancy, or other perceived benefits of condom use. Thus, this novel approach to prioritizing topics revealed that health education among a clinic-based population should emphasize condom use from the onset of sexual activity, as well as its efficacy in preventing HIV infection.

Adolescent↗
PubMed2003

Fuzzy-trace theory, risk communication, and product labeling in sexually transmitted diseases.

Health care professionals are a major source of risk communications, but their estimation of risks may be compromised by systematic biases. We examined fuzzy-trace theory's predictions of professionals' biases in risk estimation for sexually transmitted infections (STIs) linked to: knowledge deficits (producing underestimation of STI risk, re-infection, and gender differences), gist-based mental representation of risk categories (producing overestimation of condom effectiveness for psychologically atypical but prevalent infections), retrieval failure for risk knowledge (producing greater risk underestimation when STIs are not specified), and processing interference involving combining risk estimates (producing biases in post-test estimation of infection, regardless of knowledge). One-hundred-seventy-four subjects (experts attending a national workshop, physicians, other health care professionals, and students) estimated the risk of teenagers contracting STIs, re-infection rates for males and females, and condom effectiveness in reducing infection risk. Retrieval was manipulated by asking estimation questions in two formats, a specific format that "unpacked" the STI category (infection types) and a global format that did not provide specific cues. Requesting estimates of infection risk after relevant knowledge was directly provided, isolating processing effects, assessed processing biases. As predicted, all groups of professionals underestimated the risk of STI transmission, re-infection, and gender differences, and overestimated the effectiveness of condoms, relative to published estimates. However, when questions provided better retrieval supports (specified format), estimation bias decreased. All groups of professionals also suffered from predicted processing biases. Although knowledge deficits contribute to estimation biases, the research showed that biases are also linked to fuzzy representations, retrieval failures, and processing errors Hence, interventions that are designed to improve risk perception among professionals must incorporate more than knowledge dissemination. They should also provide support for information representation, effective retrieval, and accurate processing.

Adolescent↗
PubMed1997

Sexual relationships, condom use and risk perception among female bar workers in north-west Tanzania.

This paper discusses the background characteristics, sexual relationships, condom use and risk perception of bar workers in Magu district, north-west Tanzania. Bar workers in Magu are geographically mobile. They are not highly educated but probably have a higher level of schooling than average. They are mostly unmarried or divorced. They choose bar work because, given the resources available, it provides them with a good balance between earning their own income and being independent. Although the women are still partially dependent on the financial support provided by sexual partners and sexual relations tend to be based on exchange, bar workers cannot simply be equated with prostitutes. Some have a regular partner and the odd casual partner while others may have large numbers of casual contacts. Regular partners are almost always married and often itinerant. The distinction between regular and casual partners is important and based on the nature and extent of financial support. It is also related to condom use and therefore to risk. Women claim to be able to demand condom use from casual partners but not from regular partners. Although women claim that regular partners can be trusted, they nonetheless admit feeling at risk of AIDS and STDs from these same partners.

Adolescent↗
PubMed1995

Quality of condom use as reported by female clients of a family planning clinic.

OBJECTIVES: This study analyzed the prevalence and determinants of the quality of condom use after a woman's first visit to a family planning clinic. METHODS: This report presents data from 360 female family planning clients who reported using condoms as their primary method of contraception for at least 1 sexually active month during the study's follow-up period after their first clinic visit. RESULTS: Only 1% always engaged in all five use behaviors studied: using a condom for each sexual intercourse, putting the condom on before first entry, withdrawal after intercourse while there is still an erection, holding on to the condom's rim during withdrawal, and using foam. Multiple linear regression indicated that more effective condom use was reported by women who had not had an induced abortion, were not using condoms just because they were starting oral contraceptive pill regimens, had more knowledge about birth control in general, had received a nursing intervention, and had more communication with their partner. CONCLUSIONS: Increasing attention needs to be devoted to understanding determinants of the specific actions that differentiate between more and less effective contraceptive use.

Adolescent↗
PubMed2003

Prevention of sexually transmitted diseases (STDs) in female sex workers: prospective evaluation of condom promotion and strengthened STD services.

BACKGROUND: In Perú, a previous study of government-sponsored periodic examinations of female sex workers (FSWs) found no significant impact on rates of sexually transmitted diseases (STDs). GOAL: This study assessed the impact of technically improved periodic STD services on STD prevalence and on consistent condom use (CCU). STUDY DESIGN: The study involved monthly follow-up of 917 FSWs at two STD clinics, with evaluations before and during implementation of strengthened STD services, which included periodic screening and treatment for gonorrhea, chlamydial infection, trichomoniasis, bacterial vaginosis (BV), and syphilis; counseling; and supply of condoms. Outcome analyses were adjusted for participation bias. RESULTS: During 7908 person-months of observation, the prevalences of gonorrhea, chlamydial infection, trichomoniasis, and BV declined significantly and CCU increased significantly, with similar trends in both clinics. During follow-up, gonorrhea, chlamydial infection, trichomoniasis, and BV were negatively associated with follow-up after screening. BV also was positively associated with use of an intrauterine device and negatively with douching. CCU during follow-up was associated with significantly decreased risk of gonorrhea, chlamydial infection, and trichomoniasis. CONCLUSIONS: Strengthened periodic screening for and treatment of confirmed STD, in addition to condom promotion and provision, represent feasible, effective interventions in commercial sex, and time series analyses can provide a useful approach to evaluating new interventions.

Adolescent↗
PubMed2005

Factors associated with condom use among brothel-based female sex workers in Thailand.

This study sought to determine the actual levels of condom use by female sex workers (FSW) in Thailand brothels. Specifically, it examined the influence that the country of origin of the FSW patrons exerted on usage of a condom, and it assessed the relevancy of constructs from the Health Belief Model in predicting FSW requesting condom usage by their clients. A survey was administered to a cross-sectional non-randomized convenience sample of 150 FSW in four geographic locations in Thailand, which included: Bangkok, Chang Mai, Mae Hong Son and Other (comprised mainly of brothels in small villages). Statistical interpretation of the data indicated that Thai FSW requested condom use in 63% of the cases, while the overall mean of condom use was only 51%. Condom use by patrons' country of origin was as follows: westerners 76%, foreign Asians 52% and native Thai men 27%. These results fall considerably short of the Ministry of Health's goal of 100% condom use in Thai brothels. Furthermore, public health education initiatives need to effectively target the native Thai FSW patrons since they represent the clients least likely to use a condom (27%).

Adult↗
PubMed1995

Barriers to condom use among heterosexual male and female college students.

The authors used a questionnaire to assess gender differences in barriers to condom use among 198 female and 89 male heterosexual undergraduate college students. Participants were divided into three groups--consistent users, inconsistent users, and nonusers--based on their reported condom use. Factor analyses on each gender revealed similar barrier factor structures, but the barriers explained more of the variance in condom use among women than among men. Of the 9 or 10 predictors assessed, the low perceived need barrier was the most powerful predictor of condom use for both genders. Male and female participants who were nonusers, in a current monogamous relationship, and using oral contraceptives were more likely to report a low perceived need to use condoms. Implications for future research are discussed.

Adult↗
PubMed1999

Association between condom use and HIV infection: a randomised study of self reported condom use measures.

STUDY OBJECTIVE: To compare the association between different measures of condom use and prevalent HIV infection. DESIGN: Randomised cross sectional study to assess association between HIV infection and different measures of self reported condom use. Female sex workers were randomised to one of five different face to face questionnaires on condom use. Three questionnaires used always to never scales to measure use but differed in the reference period for use; a fourth asked about use in the last 10 coital acts; and the fifth was a retrospective log of coital acts in the past two weeks. Use was assessed with new clients, repeat clients, and non-clients. SETTING: Yaoundé and Douala, Cameroon. PARTICIPANTS: 2266 female sex workers. MAIN RESULTS: The association between condom use and prevalent HIV infection varied for different measures of condom use. None of the five level measures showed a dose response protective effect of condom use. Measures aimed at reducing recall bias (measures based on the past 10 coital acts or a coital log) showed little or no association with prevalent infection. Measures based on the past month or six months had a stronger association with prevalent infection. Regardless of the type of measure or reference period, the strongest association between use and infection was for use with partners who were not clients. CONCLUSION: These findings underscore challenges described by others of measuring condom use and interpreting the association between use and prevalent infection.

Adolescent↗
PubMed2002

A study on female sex workers in southern China (Shenzhen): HIV-related knowledge, condom use and STD history.

The present study aims to investigate the perspective relations between HIV/AIDS and condom-related knowledge, condom use, history of sexually transmitted diseases (STDs) and predictive factors of condom use by female sex workers (FSW) who were sent to the Women Re-education Center (WRC) in Shenzhen, People's Republic of China. Seven hundred and one FSW were interviewed. Whereas respondents had attained certain accurate knowledge about the HIV transmission routes, misconceptions were still commonly reported. Level of condom related knowledge was not high. The prevalence of using condoms with clients was relatively low-15%- 22% reported not using condoms consistently. One of the major obstacles was 'Refusal by clients'. Significant predictive factors associated with consistency of condom use with clients were age, educational background, average number of client intakes per day, capacity in determining the use of condoms and past STD history. The respondents may have developed a false sense of safety by subjectively assessing whether their clients had a STD but they were unaware that HIV carriers may show no obvious symptoms at all. The data has confirmed the worries regarding the potential 'bridging effect' of HIV transmission as resulted by cross-border commercial sex-networking activities.

Adult↗
PubMed2005

Incorrect condom use and frequent breakage among female sex workers and their clients.

Our objective was to assess if female sex workers (FSWs) and their potential male clients in Cotonou, Benin, know how to use male condoms correctly. From April to June 2000, 314 FSWs and 208 men were interviewed, and asked to demonstrate on a wooden penis how they usually use male condoms. In all, 27.6% of both women and men tore the condom envelope on the notch; 89.3% of the women versus 75.4% of the men easily found the correct side; 17.3% of the women versus 28.3% of the men held the top of the condom to avoid air entering; 91.4% of the women versus 75.6% of the men correctly unrolled the condom. Taking all the four criteria together, only approximately 11% of participants performed a correct condom use demonstration. FSWs frequently reported condom breakage, which was significantly associated with incorrect condom demonstration (P = 0.04). Correct condom use is suboptimal in these heavy consumers of male condoms in Benin. Condom breakage is frequent and is associated with incorrect use.

Africa South of the Sahara↗
PubMed1992

Comparison of female to male and male to female transmission of HIV in 563 stable couples. European Study Group on Heterosexual Transmission of HIV.

OBJECTIVE: To identify risk factors for heterosexual transmission of HIV and to compare the efficiency of male to female and female to male transmission. DESIGN: Cohort study of heterosexual couples. Regular partners of HIV infected subjects were tested and both members of the couples interviewed every six months. HIV prevalence in partners was analysed according to the characteristics of the couples. SETTING: Nine European countries. SUBJECTS: 563 couples comprising 156 female index patients with their 159 male partners and 400 male index patients with their 404 female partners. Partners reporting risk factors other than sexual contacts with the index patient were excluded. MAIN OUTCOME MEASURES: HIV infection in partners and high risk sexual behaviour. RESULTS: Overall, 19 (12%) male partners and 82 (20%) female partners were infected with HIV, suggesting that male to female transmission is 1.9 (95% confidence interval 1.1 to 3.3) times more effective than female to male transmission. An advanced stage of HIV infection in the index patient (odds ratio 17.6; 4.9 to 62.7) and sexual contacts during menses (3.4; 1.0 to 11.1) increased the risk of female to male transmission and stage of infection (2.7; 1.5 to 4.9), anal sex (5.1; 2.9 to 8.9), and age of the female partner (3.9; 1.2 to 13.0 for age > 45 years) increased the risk of male to female transmission. None of the 24 partners who had used condoms systematically since the first sexual contact was infected. CONCLUSIONS: Several factors which potentiate the risk of transmission through unprotected vaginal intercourse have been identified. Knowledge of these factors could be helpful for counselling patients infected with HIV and their sexual partners.

Adolescent↗
PubMedDate not supplied

Condoms.

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Behavior↗