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PubMed2001

Condom use among sterilized and nonsterilized Hispanic women.

BACKGROUND: Women who use sterilization for contraception are at risk for various sexually transmitted diseases, unless they use a barrier method. Use of condoms is significantly lower among sterilized women than among hormonal-contraceptive users. Among Hispanics, women's perception of risk and the influence of male partners are strong correlates of dual-method use. Limited data are available concerning use of condoms among sterilized women, in particular among Hispanics. GOALS: Past and future use of condoms was examined and compared among 224 sterilized women and 104 hormonal-contraceptive users of Hispanic origin, and the reasons for use or nonuse of condoms were examined. STUDY DESIGN: Cross-sectional survey. RESULTS: As compared with hormonal-contraceptive users, sterilized women were significantly less likely to have used condoms in the 3 months before the study or to have plans to use them in the future (P < 0.001). Despite similarities between various HIV-related characteristics of sterilized and nonsterilized women, the former group had significantly lower perceptions of being at risk for both HIV and other sexually transmitted diseases. Sterilized women were also more likely to have used condoms for the purposes of dual protection from pregnancy. The strongest correlates of consistent condom use by both sterilized and nonsterilized Hispanic women were their perceived susceptibility to disease, male partners' positive opinion about condoms, and the women's ability to use condoms in long-term relationships. Furthermore, the practice of concealing the use of a contraceptive from a male partner was not uncommon, although this characteristic was not related to increased dual-method use. CONCLUSIONS: Sterilized women may be at a higher risk of disease than hormonal-contraceptive users. Among Hispanics, women's perception of risk and male partners' influences predict whether the women protect themselves from pregnancy and disease simultaneously.

Condoms↗
PubMed2003

Condom use for preventing HIV infection/AIDS in sub-Saharan Africa: a comparative multilevel analysis of Uganda and Tanzania.

This study explored the relationships between individual-, household-, and community-level variables and condom use to prevent HIV infection in women and men in Uganda and Tanzania using multilevel modeling. Using data from the Demographic and Health Surveys for Uganda (1995) and Tanzania (1996) as well as data collected by the MEASURE Evaluation Project at the Carolina Population Center for Tanzania (1996 and 1999), the study found higher condom use among men than women. There was also heterogeneity in condom use among different clusters for both women and men. More specifically, women and men living in clusters with higher indicators of development were more likely to use condoms to prevent HIV infection. In addition, condom use was much more prevalent in areas where health care services were nearby (0-5 km). In addition, condom use was more common among women (but not men) who lived in clusters where HIV/AIDS testing, counseling, and treatment were provided. The results further revealed that education improved condom use; however, the effect of education was considerably reduced in the models that included HIV/AIDS knowledge and cluster-level variables. The positive effect of household wealth on condom use also diminished after controlling for the effects of the knowledge and cluster-level factors. Knowledge about HIV and perceiving oneself to be at risk for contracting HIV infection improved condom use.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Condom use and risk of gonorrhea and Chlamydia: a systematic review of design and measurement factors assessed in epidemiologic studies.

BACKGROUND: Studies of condom use to reduce risk of most sexually transmitted infection provide inconsistent results. This inconsistency is often attributed to methodologic limitations yet has not been assessed systematically. OBJECTIVES: The objectives of this study were to review studies of condom use and risk of gonorrhea and chlamydia, and to evaluate the importance of 4 key design and measurement factors on condom effectiveness estimates. DESIGN: We reviewed studies published 1966-2004 to assess risk reduction for gonorrhea and/or chlamydia associated with male condom use. RESULTS: Of 45 studies identified, most found reduced risk of infection associated with condom use. All studies reviewed had methodologic limitations: only 28 (62%) distinguished consistent from inconsistent use; 2 (4%) reported on correct use or use problems; 13 (29%) distinguished incident from prevalent infection; and one (2%) included a population with documented exposure to infection. Eight of 10 studies with 2 or more of these attributes reported statistically significant protective effects for condom use versus 15 of 35 studies with zero or one attribute (80% vs. 43%, P = 0.04). CONCLUSIONS: Condom use was associated with reduced risk of gonorrhea and chlamydia in men and women in most studies, despite methodologic limitations that likely underestimate condom effectiveness. Epidemiologic studies that better address these factors are needed to provide more accurate assessment of condom effectiveness.

Ambulatory Care Facilities↗
PubMed2007

HIV prevention among travelers: why do men not use condoms when they engage in commercial sex overseas?

OBJECTIVES: We investigated factors associated with condom use among men patronizing female sex workers abroad and locally. STUDY DESIGN: We conducted a survey on 372 local men attending the only public sexually transmitted infections clinic in Singapore between 2001 and 2003. RESULTS: Condom use was higher among clients patronizing sex workers in Singapore than those patronizing sex workers abroad (87.5% vs. 54.4%, P<0.001). Condom use in both groups was associated with initiation of condom use by the sex workers (adjusted prevalence ratios: 1.67, 95% confidence interval: 1.11-2.49; 1.87, 1.21-2.90) but was not associated with clients' knowledge of disease, self-perceived risk, confidence in condom use, and dislike of condoms. Less sex workers abroad than in Singapore (32.7% vs. 75.6%, P<0.001) initiated condom use. CONCLUSION: Lower condom use among Singaporean travelers abroad was determined by extrinsic factors, whereby sex workers abroad were less likely to initiate condom use rather than by clients' factors.

Adolescent↗
PubMed2004

Maintaining sexual health in commercial sex workers in Australia: condom effectiveness, screening, and management after acquiring sexually transmissible infections.

OBJECTIVE: To provide practical advice to health care providers and public health practitioners regarding screening and management of sexually transmitted infections (STIs) in sex workers, and to examine the effectiveness of condoms in reducing transmission of STIs. METHODS: Medline search using the key words sex workers, prostitutes, condoms and these terms in conjunction with pregnancy, sexually transmitted infections (including the names of individual STIs), infectivity, exclusion periods. Additional articles were identified from cited references. Articles were selected on the basis of information provided on efficacy of condoms in STI prevention, prevalence of STIs in sex workers and changes following condom promotion, and advice about management of STIs in infected workers. RESULTS: Condoms offer some protection (30-90%) against STIs passed in semen, urethral, vaginal or cervical secretions (such as HIV, gonorrhoea, chlamydia). They give little to no protection (0-30%) against diseases due to skin-to-skin contact such as genital herpes and genital warts. Transmissibility of STIs varies according to the sex of the exposed person and the sexual practice. Condom effectiveness against STIs also varies with gender, and experience and consistency of condom use. CONCLUSIONS: Sex workers require regular screening for STIs as condom use is not fully protective. Management of sex workers identified with infection requires understanding of the issues faced by sex workers, biological characteristics of the infective organism, treatment efficacy, and test sensitivity and specificity. Advice on frequency of STI testing, supply of medical certificates, management of condom breakage, and management of infected sex workers is proposed.

Australia↗
PubMed2003

Predictors of condom use among adolescent Thai vocational students.

PURPOSE: To describe the prevalence of premarital sexual behavior and condom use, and to identify predictors of condom use using the expanded health belief model (EHBM) among vocational students in Bangkok, Thailand. METHODS: A cross-sectional correlational design was used with a cluster-based sample of 425 students aged 18 to 22 years from eight randomly selected private vocational schools in Bangkok. Anonymous self-report questionnaires were used to collect the data. Stepwise multiple regression was conducted to identify predictors of condom use. RESULTS: Overall, 49.9% of participants were sexually active, 64.8% of men and 32% of women. Of the sexually active participants, only 6.3% reported using condoms every time when having sex in the beginning of the relationship, and 10.2% during the last few times. Twenty-four percent of sexually active participants had unplanned pregnancies, and 7% had sexually transmitted diseases (STDs). The predictive model of condom use consisted of perceived benefits from using condoms; interactions between intention to use condoms and gender: knowledge of STDs, HIV, AIDS, pregnancy and peer norms; and alcohol use and age. Adjusting for modifying factors, the predictor set explained 27% of the variance in condom use. CONCLUSIONS: Most of this sample of sexually active Thai vocational students practiced unsafe sex, and many had unplanned pregnancies and STDs. The EHBM provided a modest predictive model of condom use.

Adolescent↗
PubMed2004

Assessing the potential of condom use to prevent the spread of HIV: a microsimulation study.

In this study, a microsimulation model is used to assess the potential impact of condom use on women's lifetime risk of acquiring HIV in rural southern Malawi. The model draws on survey data for information on sexual activity, marriage and divorce, and on the biomedical literature for input parameters governing the transmission and spread of HIV and other sexually transmitted diseases (STDs). We show that lifetime risk could be as high as 42 percent with no condom use and as low as 8 percent if everyone consistently uses condoms with nonmarital partners. Next, we examine the impact of more realistic, intermediate strategies of condom use, varying men's propensity to use a condom with nonmarital partners, varying the per-coitus probability of condom use, varying probabilities of slippage or breakage, and finally, examining the effect of condom use in the presence of STD symptoms. We demonstrate profound effects of consistent condom use and of condom use prompted by symptomatic STDs.

Age Factors↗
PubMed2006

Condom use with steady and casual partners in inner city African-American communities.

OBJECTIVES: This study examined rates of and factors associated with consistent condom use with steady partner and with casual partners in inner city African-American communities with high sexually transmitted infection (STI) prevalence. METHODS: Structured interviews were conducted using street intercept methods and venue based sampling with 997 African-American residents of inner city neighbourhoods in Houston and Dallas, Texas; of which data were analysed for the 736 that reported having sex in past 2 months. Condom use was measured as a proportion of use in last five sex acts with steady and casual partners. RESULTS: Reported rates of consistent condom use were high-31.4% with steady partner and 29.5% with casual partner. Multivariate logistic models differed by type of partner. Married people and those with history of STI were less likely to use condoms with the main partner, while older people were less likely and males, and those visiting a doctor more likely to use condoms with casual partners. CONCLUSIONS: The proportion of condom use with both partner types was relatively high reflecting a general trend towards increased condom use in the United States. The finding of lower reported rates with casual partners has been discussed. Factors associated with condom use differ according to type of partner. Precise measurement of actual condom use continues to be an elusive task but is required for the design of appropriate messages and evaluation of STI programmes.

Adult↗
PubMed2001

An investigation of condom use by frequency of sex.

OBJECTIVES: To examine the association between condom use and frequency of sex across sexual partner types. METHODS: Data were collected from African American drug users residing in Washington, DC. Participants were asked to provide the first name of the last three partners with whom they had had vaginal sex, to define the type of relationship, the number of times they had had vaginal sex in the last 30 days with each partner, and whether they had used a condom during their last sexual encounter with each partner. Condom use was examined by frequency of sex in the past 30 days controlling for partner type. RESULTS: Frequency of sexual encounters varied by partner type. The largest number of sexual encounters was with casual partners, followed by commercial and primary partners, respectively. Within partner types, participants had sex most frequently with primary partners. Condom use was lowest within primary partner relationships. Regardless of partner type, condom use varied consistently depending on the frequency of sex with the same partner. CONCLUSIONS: Condom use is related to the frequency of sex between partners when partner type is controlled. The association between frequency of sex and condom use is independent of partner type, suggesting that partner type may become less influential in determining condom use as the frequency of sex increases. This finding suggests that contextual factors determining condom use go beyond partner type designations and include other relationship variables.

Adult↗
PubMed2002

Reasons for not using condoms among the Hong Kong Chinese population: implications for HIV and STD prevention.

OBJECTIVE: To assess the prevalence and reasons for non-use of condoms among the Hong Kong Chinese population and obtain baseline data to monitor sexual behavioural change. METHODS: Cross sectional self administered questionnaire surveys in convenience sampled groups of Hong Kong Chinese residents were carried out. RESULTS: Of the 1508 respondents, 24% reported consistent condom use and 76% inconsistent use. Overall, 17% of respondents reported having sex with strangers. People who were at increased risk for inconsistent condom use included STD clinics attendees, those who never married, and those reporting low self efficacy for condom use or sex with strangers. Common reasons for not using condoms were trust in partner, use of other contraceptives, and reduced sensation while using condoms. CONCLUSIONS: Given the reported high prevalence of travel and sexual contact with strangers, and misconceptions about condoms among the Hong Kong Chinese population, innovative condom social marketing campaigns are needed. Periodic monitoring of condom use behaviours should be an integral part of HIV/STD surveillance activity.

Adult↗
PubMed2001

Brief report on the effect of providing single versus assorted brand name condoms to hospital patients: a descriptive study.

OBJECTIVES: This study examined condom acquisition by persons in a hospital setting when single versus assorted brand name condoms were provided. METHODS: Condom receptacles were placed in exam rooms of two clinics. During Phase 1, a single brand name was provided; for Phase 2, assorted brand names were added. Number of condoms taken was recorded for each phase. RESULTS: For one clinic there was nearly a two-fold increase in number of condoms taken (Phase 1 to Phase 2); for the second clinic there was negligible difference in number of condoms taken. CONCLUSIONS: The provision of assorted brand name condoms, over a single brand name, can serve to increase condom acquisition. Locations of condoms and target population characteristics are related factors.

Adolescent↗
PubMed1989

STD patients' knowledge about AIDS and attitudes toward condom use.

Patients (N = 71) from a sexually transmitted disease (STD) clinic in an urban setting were surveyed to determine their knowledge about acquired immune deficiency syndrome (AIDS) and attitudes toward condom use. Overall knowledge scores were high with a mean score of 22 on the 28-item true-false questionnaire. No statistical significance was found between AIDS-knowledge scores and condom-use behavior. The majority of subjects or their partners had STD symptoms and multiple partners within a 6-month period. Thirty percent of the respondents reported using condoms at least 25% of the time. In response to open-ended statements about condoms, 10 beliefs were mentioned most frequently. The majority of subjects reported protection against sexually transmitted disease and preventing pregnancy as the most important reasons for condom use. "Avoids getting AIDS" only ranked as the eighth most salient belief and few subjects with multiple partners in the previous 6-month period even cited this belief. Other significant beliefs about condom use included decreased feeling, worry about breakage, decreased pleasure for partner, uncomfortable, feeling safe, inconvenient, and not romantic. The most significant referent (normative belief) influencing condom-use decision making was "mother" in younger subjects and "sexual partner" for older subjects. The sexual partner had unfavorable attitudes toward condom use. These results indicate the need to incorporate attitudes and normative beliefs to change condom-use behavior.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Perceptions and acceptability of the female condom [Femidom] amongst commercial sex workers in the Songkla province, Thailand.

In a prospective descriptive study on the perceptions and acceptability of the female condom in a group of Thai commercial sex workers (CSWs) in the Songkla province, we invited CSWs from selected brothels to participate. Those who used the female condom were interviewed after one week and 16 weeks of use. Focus group discussions were also conducted at the end of the study period to obtain additional information. The group comprised 56 CSWs. Only 34% of them had heard of the female condom prior to this study and none had ever used one. A high proportion of CSWs reported positive experiences and perceptions. There were no significant changes in perceptions and experiences during the study. Eighty per cent of participants said they were satisfied with the female condom and would use it again in the future and would recommend it to their friends. However, the female condom was used in only 29% of the total number of sexual acts reported, and 98% of CSWs said they would prefer to use a male condom for sex work. Many of the women were concerned that the physical appearance of the condom would reduce its acceptability to their clients. This was the most frequently cited reason for not using the female condom in the future. While a promising device, the female condom must also become more acceptable to men if it is to enable women to be in control of their own protection from pregnancy and STD/HIV.

Adolescent↗
PubMed2005

Main partner's resistance to condoms and HIV protection among disadvantaged, minority women.

From a study of high-risk minority women, we examined data for a subgroup of 201 women who participated in a "male condom- focused" HIV prevention intervention, and who reported having attempted to convince their main partner to use condoms in the 3 months following intervention. Factors related to consistent condom use with a main partner post-intervention were not living with the partner, fewer sexual encounters, and no recent sexual encounter in which either partner was under the influence of drugs. At 3 months following intervention, factors related to women's future intentions to use condoms consistently with a main partner were no recent sex while either partner was under the influence of drugs, and the woman's desire to use condoms consistently with the partner. Main partner's resistance to condoms was unrelated to consistent condom use or future intentions to use condoms consistently. Findings identify barriers to consistent condom use within primary relationships, a critical yet challenging focal point for HIV prevention interventions.

Adult↗
PubMed2002

Social influence, AIDS/STD knowledge, and condom use among male clients of female sex workers in Bali.

The importance of social networks is increasingly being recognized in research on HIV risk behaviors. The objective of this article is to examine the association of AIDS and sexually transmitted disease (STD) knowledge, perceived susceptibility to HIV/STD infection, condom beliefs, demographic variables, and peer influence on the condom use of clients of Indonesian sex workers. Data for the study are drawn from the Bali STD/AIDS study conducted from 1997 to 1999 in Bali, Indonesia. During the project 2,026 men were selected for interviews in low price brothels. Statistical methods included multivariate regression models. Results of the study showed that younger men, men who have resided in Bali for at least a year, and more educated men were more likely to use condoms. Furthermore, men with stronger AIDS and STD knowledge and condom beliefs were more likely to use condoms. Men whose friends knew that they visited sex workers were less likely to use condoms. However, men who reported that their friends used condoms with sex workers and that their friends encouraged them to use condoms with sex workers were more likely to use condoms with sex workers. Implications for prevention of HIV infection are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Entertainment television as a healthy sex educator: the impact of condom-efficacy information in an episode of friends.

CONTEXT: Television is often decried as a negative influence on the sexual attitudes and behavior of America's adolescents. However, television occasionally includes messages about the risks of having sex that may have a positive effect on youth. OBJECTIVE: To assess the impact of condom-efficacy messages in an episode of Friends on teens. Design, Setting, and Participants. A national sample of 506 adolescents 12 to 17 years old who had been regular viewers of Friends the previous year were surveyed by telephone shortly after the episode aired. OUTCOME MEASURES: Viewership of the Friends episode, recall of the condom-efficacy message, beliefs about condoms, self-reported change in condom knowledge, and discussions of condom efficacy with parents. RESULTS: At least 27% of the sample saw the episode, and 65% of these viewers recalled its depiction of condom failure resulting in pregnancy. Forty percent of the viewers watched with an adult. Ten percent of viewers talked to an adult about condom efficacy as a result of the show. Compared with other viewers, youth who talked with an adult were more likely to report learning about condoms from the episode and appeared less likely to reduce their perceptions of condom efficacy after the episode. CONCLUSIONS: Entertainment television can serve as a healthy sex educator and can work in conjunction with parents to improve adolescent sexual knowledge.

Adolescent↗
PubMed2005

A rose by any other name? Objective knowledge, perceived knowledge, and adolescent male condom use.

OBJECTIVE: To investigate the role of objective and perceived knowledge about condoms in adolescent males' condom use at first intercourse. METHODS: A longitudinal analysis was conducted of data from a nationally representative sample of 404 virgin male adolescents who were aged 15 to 17 years at wave 1 and reported becoming sexually experienced at the second wave of data collection. Objective knowledge was measured as a 5-item knowledge test about condoms. Perceived knowledge was measured as a 5-item scale regarding participants' confidence about their answers on the objective knowledge test. Condom use was assessed by self-report. RESULTS: Objective and perceived knowledge were moderately correlated with each other. Male adolescents with low objective but high perceived knowledge were identified as being at particular risk for not using a condom in that they were nearly 3 times less likely to report using a condom at first intercourse (odds ratio: 0.35) than those with other levels of objective and perceived knowledge. CONCLUSIONS: Previous evidence suggests that knowledge about sex does not accurately predict sexual behavior. This lack of predictive accuracy may be because studies have focused only on objective knowledge. Our results suggest that both objective and perceived knowledge serve as antecedents to male condom use at first intercourse. However, those with higher perceived knowledge, particularly in the context of low objective knowledge, may be at greater risk for not using condoms. Addressing not only objective but also perceived knowledge may increase the effectiveness of interventions that are designed to increase rates of condom use among male adolescents.

Adolescent↗
PubMed1998

Patterns of condom use among adolescents: the impact of mother-adolescent communication.

OBJECTIVES: The association between the timing of discussions about condoms between mother and adolescent and adolescents' condom use during their first and subsequent sexual encounters was examined. METHODS: Sexually active adolescents reported whether and when they discussed condoms with their mother and answered questions about their own condom use. RESULTS: Mother-adolescent discussions about condoms that occurred prior to sexual debut were strongly associated with greater condom use during first intercourse and most recent intercourse, along with greater lifetime regular condom use. CONCLUSIONS: Discussions about condoms prior to sexual debut are important in promoting condom use among adolescents.

Adolescent↗