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PubMed1999

Implementation of condom social marketing in Louisiana, 1993 to 1996.

OBJECTIVES: This article describes the implementation and impact of the first statewide condom social marketing intervention in the United States. METHODS: A statewide social marketing program made condoms freely available in 93 public health clinics, 39 community mental health centers, 29 substance abuse treatment sites, and more than 1000 businesses in neighborhoods with high rates of sexually transmitted diseases (STDs) and HIV. Surveys about condom use were conducted annually. RESULTS: Between 1994 and 1996, more than 33 million condoms were distributed without significant opposition. Over time, self-reported condom use at the last sexual encounter increased among African American women (from 28% in 1994 to 36% in 1996), particularly African American women with 2 or more sex partners (from 30% to 48%). Condom use at the last sexual encounter increased among African American men (from 40% in 1994 to an average of 54% in 1996). The number of reported sex partners did not increase. CONCLUSIONS: Condom social marketing can be successfully implemented in the United States. The widespread availability of free condoms is associated with increased condom use, particularly among persons at high risk for STDs and HIV.

Adolescent↗
PubMedDate not supplied

Condom discomfort and associated problems with their use among university students.

In addition to consistent use, condoms must be used correctly. The purpose of this study was to identify prevalence and types of condom-associated discomfort among university students, the outcomes of this discomfort, and the role of discomfort in condom breakage. We conducted a cross-sectional study of 206 students attending a private university in the southern United States. We assessed 3 potential outcomes: breakage, not using condoms throughout sex, and low condom-use motivation. Nearly one third reported discomfort, including tightly fitting condoms, vaginal irritation, and loss of sensation. Discomfort was associated with breakage (p = .0001), incomplete use (p = .0001), and less motivation to use condoms (p = .018). Gender moderated the latter 2 findings. Adjusted findings indicate that students reporting discomfort were 3.6 times more likely to also report breakage (p = .0009). Continued investigation of this topic is warranted. Prevention education may benefit university students by promoting several key practices, such as adding lubricant to condoms before they dry out and acquiring condoms that fit properly.

Adolescent↗
PubMed2005

The relationship between condom use and herpes simplex virus acquisition.

BACKGROUND: Few studies have evaluated the relationship between condom use and herpes simplex virus type 2 (HSV-2) and HSV type 1 (HSV-1) acquisition. OBJECTIVE: To assess the relationship between condom use and acquisition of HSV-2 and HSV-1 among men and women. DESIGN: Analysis of data collected as part of a clinical trial of an ineffective candidate vaccine for HSV-2. SETTING: Sexually transmitted disease clinics. PARTICIPANTS: Men and women at risk for HSV-2 acquisition, defined as having 4 or more sexual partners or having a sexually transmitted disease in the past year. MEASUREMENT: Acquisition of HSV-2 and HSV-1 as measured by viral culture or change to positive HSV serostatus. RESULTS: Of 1843 participants, 118 (6.4%) became infected with HSV-2. In multivariate analyses, participants reporting more frequent use of condoms were at lower risk for acquiring HSV-2 than participants who used condoms less frequently (hazard ratio, 0.74 [95% CI, 0.59 to 0.95]); categories of increasing condom use were 0% to 25%, 25% to 75%, and greater than 75% of sexual acts. Nineteen (2.9%) of 659 participants at risk for infection with HSV-1 became infected. No statistically significant association between condom use and infection with HSV-1 was found (hazard ratio, 0.79 [CI, 0.48 to 1.31]). LIMITATIONS: Use of condoms was measured by self-report, and persons who used condoms may have differed from those who did not. CONCLUSIONS: Consistent use of condoms is associated with lower rates of infection with HSV-2 and should be routinely recommended.

Adult↗
PubMed2000

Knowledge and attitudes toward condom use--do they predict behavior among Filipino Americans?

Face-to-face interviews were conducted with 211 Filipino-American adolescents and young adults residing in Los Angeles County to assess AIDS related knowledge, attitudes and behaviors. Among both sexually active and never sexually active respondents, HIV knowledge and self-efficacy with respect to condom use were generally high, and the majority held peer norms that were supportive of condom use. More than half of sexually active respondents reported condom use at last intercourse. Knowledge of HIV transmission, demographic variables, barriers to condom use, peer norms, and being comfortable asking a steady partner to routinely use condoms were not related to condom use at last intercourse. Higher self-efficacy (odds ratio 2.4, P<.06) and carrying condoms (odds ratio 1.9, P<.08) were the only two variables that approached statistical significance in their relationship to condom use at last intercourse. Findings suggest that variables that are related to AIDS risk behavior among non-Asian populations may not explain condom use among Filipinos. Therefore, future studies should identify determinants of AIDS risk behavior among Filipinos and other Asian American populations as a first step towards developing culturally relevant AIDS prevention programs for these groups.

Adolescent↗
PubMed2002

AIDS-related knowledge, condom usage among medical postgraduates.

OBJECTIVE: To investigate the knowledge about safety/unsafety of sexual acts relating to HIV transmission, levels of embarrassment related to condom and condom usage among medical postgraduates. METHODS: From August to December, 1998, a self-administered anonymous questionnaire was given to 271 new medical postgraduates from two medical colleges of Beijing and Hebei Province. RESULTS: There was a hazy understanding of the protective function of condom from AIDS among medical postgraduates. Only 14.4% medical postgraduates persisted in using condom, and 27.94% had never or almost never used it. The levels of embarrassment about condom were high. The median score was 3.55 +/- 0.98. Whether to use condom was related with the attitudes to condom, but not to AIDS. CONCLUSION: There was some misunderstanding about condom and inconsistent condom usage in medical postgraduates. So it is essential to strengthen the sexual health education among them.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Motivations for condom use and nonuse.

This exploratory study investigates the motivations for condom use and nonuse among a sample of drug users and nonusers. Participants who reported condom use in the previous 30 days rated various reasons for using a condom the last time they had had sex (79 participants). Those who reported not using a condom rated reasons for not using a condom the last time they had had sex (147 participants). Factor analyses of these responses were used to summarize reasons for condom use and nonuse. It was found that a peer norms motivation and a relationship motivation (caring) supported both condom use and nonuse. A moral norms motivation supported condom use, but a motivation that denied moral norms supported nonuse. A self interest motivation of personal pleasure supported nonuse. No strictly self-interest motivation was identified for condom use: self-protection was associated with protection of the partner.

Adult↗
PubMed1992

Teenagers seeking condoms at family planning services. Part I. A user's perspective.

The promotion of condom use is an essential part of any AIDS prevention programme. By distributing condoms and promoting their use, clinics that provide family planning services can play an important role in preventing the spread of AIDS. This study assesses the accessibility of condoms to teenagers at selected family planning services in Durban. Twelve randomly selected clinics in Durban were visited by each of 4 teenage fieldworkers. During these visits, the fieldworkers' experiences were recorded in detailed notes which were subsequently analysed for content. The fieldworkers experienced difficulty in locating a few of the clinics and some were embarrassed by security staff. The two female fieldworkers, in particular, were intimidated by their reception at the clinics and found resistance to their requests for condoms. On two occasions, supplies of condoms had run out. When condoms were available, they were distributed in a setting that lacked privacy. Information on how to use condoms, if offered at all, was supplied by way of pamphlets and information on AIDS was rarely offered. Overall, the experiences of the fieldworkers indicated that it was difficult for teenagers to obtain condoms from clinics providing family planning services in Durban. It is recommended that there be signs indicating the location of the clinics, and that privacy be ensured and adequate stocks of condoms maintained. Most importantly, clinic staff need to use every opportunity to discuss AIDS prevention with teenagers attending the clinic.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Pattern of condom use among commercial sex workers in Ibadan, Nigeria.

Regular condom use has been proven to remarkably reduce the transmission of sexually transmitted diseases (STDs) and its regular use for casual and commercial sex is important for the success of any STD/AIDS control programme. We studied the pattern of condom use among commercial sex workers in Ibadan, Nigeria in an attempt to identify the factors associated with it. Two hundred and ninety-five commercial sex workers in 21 brothels were randomly selected, using a multi-stage sampling technique, from a total of 31 identified in the 5 local government areas that make up Ibadan municipality. They were administered a pre-tested, semi-structured questionnaire by trained research assistants. Results showed that over half (53.2%) of the respondents were in the 20-29 year age group and most (71.5%) had been in the profession for less than a year. Sixty-five (22.0%) had no formal education, 29.8 % had some secondary education whilst 22.4 % had completed secondary school. Their overall knowledge of sexually transmitted diseases (STDs) was rated as poor (20.7%), moderate (64.1%) and good (15.2%). Their perceived risk of contracting HIV/AIDS was low (21.7%) although 87.8% regard it as a health problem in Nigeria. Eighty-three percent of the respondents always insisted that their clients used condoms, 13.2% did so frequently whilst 1.4% only occasionally. Of those who asked clients to use condoms, 69.5% of the women would refuse sex without condoms, 49 (16.6%) would do nothing and have sex without condoms, but 4.4% would charge extra money. No factor was found to have a significant association with the practice of asking clients to use condoms or of refusing sex without condoms. We concluded that consistent condom use was high among sex workers in brothels in Ibadan and was independent of the sex workers knowledge and perception of STDs.

Adolescent↗
PubMed1992

Black males who always use condoms: their attitudes, knowledge about AIDS, and sexual behavior.

One hundred six black males completed a questionnaire concerning attitudes and knowledge about the use of condoms and acquired immunodeficiency syndrome (AIDS). Of the 106 males in the study, 27 (26%) reported that they "always" used condoms, 31 (29%) did not use condoms and had low intentions of using them, and 48 (45%) reported high intentions to use condoms. Results indicated that knowledge about AIDS was exceptionally high for black males in all three groups. Black males with low intentions to use condoms reported significantly more negative attitudes about the use of condoms (eg, using condoms is disgusting) and reacted with more intense anger when their partners asked about previous sexual contacts, when a partner refused sex without a condom, or when they perceived condoms as interfering with foreplay and sexual pleasure. A significantly larger percentage of low intenders were treated for gonorrhea, syphilis, herpes, and genital warts than males in the other groups. Drug use did not differentiate the three groups, although marijuana was used more often by males in the low-intender group. Finally, a larger percentage of black males in the low-intender group reported experiences with anal intercourse and sex with a prostitute, but considered themselves at lower risk for AIDS than did their high-intender or steady-user counterparts.

Acquired Immunodeficiency Syndrome↗
PubMed2004

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

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

Anti-Infective Agents↗
PubMed2004

Effectiveness of condoms in preventing sexually transmitted infections.

In June 2000, the United States National Institutes of Health (NIH) organized a review of the scientific evidence on the effectiveness of condoms in preventing sexually transmitted infections (STIs). The review concluded that condoms were effective in protecting against transmission of HIV to women and men and in reducing the risk of men becoming infected with gonorrhoea. Evidence for the effectiveness of condoms in preventing other STIs was considered to be insufficient. We review the findings of prospective studies published after June 2000 that evaluated the effectiveness of condoms in preventing STIs. We searched Medline for publications in English and included other articles, reports, and abstracts of which we were aware. These prospective studies, published since June 2000, show that condom use is associated with statistically significant protection of men and women against several other types of STIs, including chlamydial infection, gonorrhoea, herpes simplex virus type 2, and syphilis. Condoms may also be associated with protecting women against trichomoniasis. While no published prospective study has found protection against genital human papillomavirus (HPV) infection, two studies reported that condom use was associated with higher rates of regression of cervical intraepithelial neoplasia and clearance of cervical HPV infection in women and with regression of HPV-associated penile lesions in men. Research findings available since the NIH review add considerably to the evidence of the effectiveness of condoms against STIs. Although condoms are not 100% effective, partial protection can substantially reduce the spread of STIs within populations.

Condoms↗
PubMed1992

Knowledge of HIV and condom use among heterosexual patients at a Glasgow genito-urinary medicine clinic.

Knowledge of HIV and knowledge of, attitudes to and use of the condom were assessed by a survey of a sample of 778 heterosexual patients attending the genito-urinary medicine clinic at the Glasgow Royal Infirmary. The mean age was 27.4 years for men and 24.5 years for women. Over two-thirds of the men and about half of the women reported more than one sexual partner during the previous year. More than 70% reported having intercourse at least three times each week. Knowledge about HIV transmission and the condom was generally good. Over three quarters of the respondents approved of the use of the condom. However, only 27% male and 24% female respondents reported using the condom, with 11% and 8% respectively using it always. Condom use was associated with a positive attitude to the condom, having received information from the media about the condom, educational status, a belief that condoms prevented sexually transmitted diseases, and having had sex education in school. It was unrelated to age, marital status, the number of sexual partners or the frequency of sexual intercourse. The most common reported reason for not using the condom was use of another form of contraceptive.

Adult↗
PubMed1996

Determinants of multiple sexual partners and condom use among sexually active Tanzanians.

This paper is based on the analyses of data collected in the Tanzania Demographic and Health Survey (TDHS). The TDHS national sample was obtained by using 1988 population census list of enumeration areas. Information about sexual behaviour and condom use was obtained from sexually active women (N = 4620) and men (N = 1440) reporting sexual activity during the period of four weeks preceding the survey. Univariate and multivariate (using logistic regression model) analyses were done to identify predictors of condom use and highrisk sexual behaviour. About 6% of women and 31% of men reported to have more than one sexual partner during the study period. Compared to respondents married once and in monogamous union, the tendency to have multiple partners was increased among never married women [OR 10.9, 95% CI (7.1-16.9)] and men [2.6 (1 7-3.9)], formerly married women [11.5 (7.3-17.9)], and among men in monogamous marriage reporting more than one marriage [12.4 (8.3-18.4)]. Occupation, residence, ever use of contraceptives, and AIDS knowledge were not associated with history of multiple sexual partners. Only 134 (9.3%) men and 173 (3.7%) women reported to have used condoms during the study period. After adjusting for other predictors of condom use, respondents reporting multiple sexual partners were more likely to have used condom among both women [3.4 (2.2-5.4)] and men [3.3 (2.3-6.0)]. Condom use was common in urban areas than rural areas and among unmarried respondents. These results show that high-risk sexual behaviour is common among men. Condom use was very low indicating that efforts to promote condom use has been less successful in Tanzania. More efforts are needed to promote safer sexual practices and condom use in Tanzania.

Adolescent↗
PubMed1992

Attitudinal and behavioral correlates of condom use in urban adolescent males.

To determine correlates of condom use in adolescent males, we administered a sexual behavior questionnaire to 105 urban males attending a general adolescent clinic. The mean age was 16.5 +/- 1.6 years, and all reported heterosexual activity during the prior 3 months. Condom use was significantly (p less than 0.05) associated with perceived hassle of use (Spearman's rho = -0.40), perception of girlfriend's attitude toward condoms (rho = -0.36), self-confidence in correct use (rho = 0.26), younger age (rho = 0.25), reported degree of exposure to sexually transmitted disease (STD) education (rho = 0.23), perceived condom safety (rho = 0.23), and perceived risk of STD if not wearing a condom (rho = 0.21). Using stepwise multiple regression, four variables explained a significant amount of variation in condom use: perceived hassle of use, perceived girlfriend's attitude toward condom use, age, and self-confidence in correct use (adjusted R2 = 0.28, p less than 0.001). Intention to use free condoms was significantly (p less than 0.05) associated with past use (rho = 0.63), girlfriend's attitude toward use (rho = -0.46), self-confidence in correct use (rho = 0.36), perceived hassle (rho = -0.31), and degree of exposure to STD education (rho = 0.25). Three variables in a regression model explained a significant amount of variation in intent to use free condoms: self-reported past use, girlfriend's attitude, and self-confidence in correct use (adjusted R2 = 0.51, p less than 0.001).

Adolescent↗
PubMedDate not supplied

Are condom instructions readable? Results of a readability study.

The use of condoms has assumed a central position in the current strategy to prevent sexual transmission of the human immunodeficiency virus. The effectiveness of condoms in disease prophylaxis is dependent, to a degree, on their correct use. Condom manufacturers routinely include information on condom use either printed on the actual package or in an enclosed package insert. With the use of three readability formulas, the reading grade level was determined for 14 different sets of instructions included with 25 brands of condoms manufactured by 7 domestic and 1 overseas manufacturer. The readability formulas, when applied to instructions for condom use, estimated that, conservatively, 8 of the 14 instructions required at least reading at the level of a high school graduate and none required less than a 10th grade level. Clearly written instructions and simple concepts could assist current and future condom users in the correct use of condoms and improve the effectiveness of condoms in the prevention of AIDS and other sexually transmitted diseases.

Achievement↗
PubMed1996

Latex rubber condoms: predicting and extending shelf life.

Condoms from five manufacturers were subjected to controlled exposures of heat, humidity, and air and to different natural environments in five countries. Under aerobic conditions (condoms in permeable packages or unpackaged), stress properties declined. The relationship between rate of decline as a function of temperature was quadratic. Under oxygen-restricted conditions (foil-wrapped packages) at average storage temperatures of 30 degrees C and lower, strain properties declined with little or no significant change in stress properties. The effect is to cause condoms to become stiffer; high-breakage rates in use have been correlated with product stiffening. A new rationale for accelerated-aging tests to predict condom shelf stability is suggested, including a test to control the trend of condoms to stiffen. Silicone lubricant, impermeable packaging, and inclusion of antioxidants in the condom formulation can prevent or minimize aerobic breakdown of latex condoms. Specifying low-modulus condoms can prevent excessive stiffening.

Air↗
PubMed1994

Determinants of condom use by Australian secondary school students.

PURPOSE: To identify factors that are associated with condom use to aid in the understanding of how to change the behavior of those young people who have sex without using condoms. METHODS: The article reports data from 932 sexually active grade 10-12 students from a sample of 72 public secondary schools in seven Australian states and territories. The data were collected using a cross-sectional, self-report questionnaire. RESULTS: Boys were more likely than girls to report that a condom was used the last time they had sex. For boys and girls, communication with a partner about avoiding infection with HIV/STDs, the belief that more peers use condoms, and a higher perceived risk of becoming infected with HIV/STDs were associated with using a condom, as was lower knowledge of STDs. The use of oral contraception and the unavailability of condoms were reported by the students as prominent reasons for non-use of condoms. Number of sexual partners in the past year and type of relationship with partner on the most recent occasion were not associated with condom use. CONCLUSIONS: Adolescents are more concerned with unwanted pregnancy than with disease prevention. School students more at risk are not more likely to take the necessary precautions to protect themselves from HIV/STDs.

Adolescent↗
PubMedDate not supplied

Understanding barriers to condom usage among HIV-infected African American women.

Drawing on focus group discussions with adolescent and adult HIV-infected women between the ages of 16 and 45, this study explores the barriers to condom use among women infected with HIV. Although most of the participants were comfortable discussing condoms and sexuality, there was little, if any, negotiation of condom use with their male partners. Most of the participants used condoms inconsistently or not at all. Reasons for nonuse included a lack of trust in the reliability of condoms to protect them, a lack of desire for pregnancy prevention, and the male partner's refusal to use condoms. Women in discordant relationships explained their uninfected partner's refusal to use condoms as denial of the risk of contracting HIV or as a way of expressing their love for the infected partner. Women also had great difficulty in disclosing their HIV status to both family and partners. Prevention efforts to increase condom use among HIV-infected women should target both men and women and focus on negotiation and communication skills.

Adolescent↗