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PubMed1995

Student opinions of condom distribution at a Denver, Colorado, high school.

Over the past two decades, the reported number of women and men who have had intercourse by age 18 has increased by approximately 20%. Concomitant increases occurred in the incidence of teen-age pregnancies and sexually transmitted diseases (STDs), including HIV. Increasing condom availability within schools has been proposed as one means of preventing the serious potential consequences of unprotected sexual intercourse. Although published surveys report 68% to 75% of adults have supported distributing condoms in schools, little is known about what students think about making condoms available at school. In this survey, high school students in Denver initiated and helped conduct a school-wide survey to assess student opinions about condom distribution in their school. Of 931 high school students responding to the survey, 85% replied that condoms should be distributed in their school, and 76% believed making condoms more accessible would not change the frequency of sexual activity among teens.

Adolescent↗
PubMedDate not supplied

[A possibility for verifying condom use in sex offenses].

In order to elucidate the circumstances of sexual crimes, the forensic laboratory is increasingly forced to consider whether the offender has used a condom. The detection presented here depends on Lycopodium spores used in several condom coatings. They can easily be detected e.g. in vaginal swabs. A screening of 40 various condoms available in Germany revealed that 32 (= 80%) were coated with Lycopodium spores. The microscopical investigation of the spores is explained and some sources of error in interpretation are discussed.

Condoms↗
PubMed2006

Unprotected sex among HIV-positive injection drug-using women and their serodiscordant male partners: role of personal and partnership influences.

We investigated the characteristics of human immunodeficiency virus (HIV)-positive injection drug-using women who reported unprotected vaginal and/or anal sex with HIV-negative or unknown serostatus (serodiscordant) male partners. Of 426 female study participants, 370 were sexually active. Of these women, 39% (144/370) and 40% (148/370) reported vaginal and/or anal sex with serodiscordant main and casual partners, respectively. Sixty percent of women inconsistently used condoms with their serodiscordant main partners, whereas 53% did so with casual partners. In multivariate analysis, during sex with main partners, inconsistent condom users were less likely to feel confident about achieving safe sex (self-efficacy), personal responsibility for limiting HIV transmission, and that their partner supported safe sex. Inconsistent condom use was also more likely among women who held negative beliefs about condoms and in couplings without mutual disclosure of HIV status. Regarding sex with casual partners, inconsistent condom users were more likely to experience psychologic distress, engage in sex trading, but they were less likely to feel confident about achieving safe sex. These findings suggest that there are widespread opportunities for the sexual transmission of HIV from drug-using women to HIV-uninfected men, and that reasons vary by type of partnership. Multifaceted interventions that address personal, dyadic, and addiction problems are needed for HIV-positive injection drug-using women.

Adult↗
PubMed2005

Gender differences in sexual behaviours in response to genitourinary symptoms.

OBJECTIVE: To understand gender differences in sexual behaviours in response to genitourinary symptoms. METHODS: 473 (239 female and 234 male) subjects were enrolled at an STD clinic regardless of symptoms or infection status. Subjects completed a 30 day calendar recall interview of genitourinary symptoms, coital activity, sexual partners, and condom use. RESULTS: Of the total of 473 participants, 261 (55%) reported symptoms (61% women and 39% men). STI prevalence was 73% and 75% for symptomatic women and men, respectively. For black women the probability of coitus was decreased in the presence of vaginal discharge (OR 0.64, 95% CI 0.47 to 0.89). No change in coital activity was seen in non-black women in the presence of vaginal discharge. Having vaginal discharge did increase the likelihood of condom use by their partners (OR 2.48, 95% CI 1.05 to 5.88), if coitus occurred. Urethral discharge was not associated with coitus or condom use in men. However, in men, dysuria was associated with increased likelihood of condom use (OR 4.25, 95% CI 1.57 to 11.56) if coitus occurred. CONCLUSION: Black women altered both coital activity and condom use behaviours in response to vaginal discharge. In contrast, non-black women did not modify coital activity. Men increased condom use when having dysuria but did not alter coital activity. Changes in sexual behaviours may alter the risk of STI transmission independent of interactions with the healthcare system. STI education and prevention programmes need to better understand these gender and racial differences in developing effective strategies to reduce STI transmission.

Adolescent↗
PubMed2004

[Sexually transmitted diseases and gender: a cross-sectional study with adolescents in Rio de Janeiro].

Sexually transmitted diseases (STDs) are frequent in adolescence and contribute to the increase in the number of AIDS cases. Early sexual initiation, multiple sex partners, and lack of condom use are considered risk factors and are influenced by a male-dominated gender system. We interviewed 356 adolescent patients at the Adolescent Health Research Center in Rio de Janeiro State University to identify possible STD risk factors in adolescence. Young men reported more partners and early sexual initiation. Females used condoms less frequently and were more subject to sexual abuse. The results confirm a model sustained by traditional gender values that demarcate the male and female spheres, with male supremacy. We conclude that to achieve more effective STD control, it is necessary to expand the discussion on culturally constructed patterns of masculinity and femininity.

Adolescent↗
PubMed1994

Impact of Thailand's HIV-control programme as indicated by the decline of sexually transmitted diseases.

The Thai government began an HIV-control programme in 1989. The programme had the following parts: the government bought and distributed sufficient condoms to protect much of the commercial sex in the country; sanctions were brought against commercial sex establishments where condoms were not used consistently; and a media campaign bluntly advised men to use condoms with prostitutes. Between 1989 and 1993 the use of condoms in commercial sex in Thailand increased from 14 to 94%, according to surveys of prostitutes, and the number of cases of the five major sexually transmitted diseases declined by 79% in men. We estimate that sex acts with prostitutes where there was a risk of HIV transmission declined from about 2.6% in June, 1989, to about 1.6% in June, 1993. If condom use in commercial sex stays high, future cohorts of young men and women may experience lower HIV incidence rates than those of the recent past. However, although condom use is high, there are many more infected prostitutes than before and many infected men who will pass HIV to their wives.

Condoms↗
PubMed1998

Objective markers of condom failure.

BACKGROUND: Studies of condom efficacy rely on self-reported behavior. Objective markers of exposure to semen may provide a more valid assessment of condom failure and failure to use condoms. GOALS OF THIS STUDY: To compare three semen biomarkers: acid phosphatase (AP) activity, prostate specific antigen (PSA), and the human seminal plasma antigen (MHS-5). STUDY DESIGN: Twenty women were intravaginally inoculated with six measured, increasingly larger amounts of their partners' semen. Vaginal fluid was collected by the participant using swabs and tested. RESULTS: Background levels of PSA were low (0.00-1.25 ng/ml), background levels of AP were variable (0-350 U/l), and all preinoculation samples were negative for MHS-5. All postinoculation samples were positive for PSA, 64 of 117 (55%) for AP, and 14 of 120 (12%) for MHS-5. CONCLUSION: The PSA immunoassay was the best semen biomarker under these sampling and testing conditions.

Acid Phosphatase↗
PubMed2006

Changing behaviors and patterns among Cambodian sex workers: 1997-2003.

OBJECTIVE: Identify patterns and behaviors among direct and indirect female sex workers (DFSWs and IDFSWs, respectively) across Cambodia's 5 major cities from 1997 to 2003. METHODS: Interviews with DFSWs and IDFSWs followed random selection from clusters in 5 cities. Individual characteristics and condom use with clients and other partners were assessed in univariate and multivariate analyses. RESULTS: From 1997 to 2003, consistent condom use with clients increased from 53% to 96% among DFSWs and from 30% to 84% among IDFSWs. DFSWs reported staying in their profession longer, had fewer clients per day, stayed longer in each brothel, were in increasingly larger brothels, and were tested more for HIV. For IDFSWs, there were significant changes: more reported practicing commercial sex and testing for HIV. In adjusted models, reported condom use with clients was significantly higher among DFSWs in later survey years (odds ratio [OR], 2.17) and who were never married (OR, 1.69), were in larger brothels (OR, 1.02), and charged more for sex (OR, 1.27), but lower for DFSWs with sweethearts (OR, 0.68) and who reported abnormal vaginal discharge (OR, 0.52). For IDFSWs, in the adjusted models, reported condom use with clients was higher in later years (OR, 1.77) and for those reporting abnormal vaginal discharge (OR, 1.34) and HIV testing (OR, 1.46), and lower for those with sweethearts (OR, 0.49). CONCLUSIONS: From 1997 to 2003, Cambodian direct and indirect sex workers increased their use of condoms each year with commercial as well as noncommercial partners, contributing to the evidence that HIV prevention programs can produce significant changes in risk behaviors.

Adult↗
PubMed1997

Promoting condom-only brothels through solidarity and support for brothel managers.

Brothel workers in Thailand are at high risk of HIV infection but they alone do not have adequate bargaining power to insist on condom use with all clients. Brothel managers, on the other hand, are a source of influence over both clients and their workers and can promote universal condom use in their establishments. To test whether brothel managers in Khon Kaen City would adopt and successfully implement a condom-only policy in their establishments, all 24 brothel managers in Khon Kaen City attended a meeting on the dangers of HIV and benefits of an all-condom policy. Ideas on how to implement the policy were discussed. Follow-up visits were made once a month to brothels to resupply condoms, provide reinforcement and to collect data. All brothel managers approved of the condom-only in principle and are now implementing the policy. Results of the evaluation of condom use and degree of solidarity in these 24 brothels are available for the AIDS prevention programme. However, a condom-only policy in brothels can only succeed if managers and brothel workers show solidarity in rejecting all non-condom using clients. Laws to promote condom use may not be needed if brothels are given the opportunity to implement a condom-only policy using their own resourcefulness and determination.

Adult↗
PubMed2004

Perceived STD risk, relationship, and health values in adolescents' delaying sexual intercourse with new partners.

OBJECTIVES: To examine the amount of time adolescents waited to have intercourse with past partners (main and casual), and intentions to delay with future partners. To determine psychosocial factors which predict delay intentions among adolescent males and females with future partners (main and casual). METHODS: Adolescent STD clinic attendees were approached before clinical appointments to participate in an interview. Data from 205 participants who had previous experience with both main and casual partners were used in the current study. RESULTS: Adolescents waited less time to have intercourse with most recent casual than with most recent main partners (chi2 = 31.97, p<0.0001). The amount of time waited with past partners was shorter than intended time to wait in future relationships (medians of 1 month v 2 months (main) (t = 3.47, p<0.0010; medians of 2 weeks v 1 month (casual) (t = 6.14, p<0.0001)). Factors influencing intentions to delay intercourse with future main partners differed by sex; males were negatively influenced by importance of sex in relationships, while females were positively influenced by importance of intimacy in relationships, perceived risk of STDs, and health values. CONCLUSIONS: Implications for designing interventions for adolescent males and females are discussed.

Adolescent↗
PubMed1997

Condom use with main partners by sterilized and non-sterilized women.

This study examined condom use with main partners by surgically sterilized and non-sterilized women at risk for HIV infection. Data were obtained from 379 African American women residing in low-income urban communities. Sterilized women were one-fifth as likely as non-sterilized women to use condoms. Multivariate logistic regression indicated that for both groups of women, higher perceived benefits of condom use for disease prevention were associated with condom use. In addition, younger age, self-efficacy for condom use, peer support for condom use, and whether condoms were ever used for pregnancy prevention were associated with condom use among non-sterilized women. Results of this study indicate the role of fertility status in condom use and the value of developing targeted prevention programs that reach women at high risk for HIV infection. Risk reduction programs need to emphasize the role of condoms in disease prevention and address attitudes towards condom use.

Adolescent↗
PubMed2003

Multilevel analysis of women's empowerment and HIV prevention: quantitative survey Results from a preliminary study in Botswana.

This preliminary study explored relationships between women's empowerment and HIV prevention on the national and individual level with a focus on Botswana. Among sub-Saharan Africa countries, HIV prevalence was positively correlated with indirect indicators of women's empowerment relating to their education (female enrollment in secondary education and ratio of female to male secondary school enrollment), but not to their economic status (female share of paid employment in industry and services) or political status (women's share of seats in national parliament), while controlling for gross national income, percentage of births attended, and percentage of roads paved. Condom use at last sexual encounter was positively and significantly correlated with both indicators of women's educational empowerment, but was not significantly related to the other two indices. Empowerment at the individual level was explored through a preliminary quantitative survey of 71 sexually active women in Gaborone, Botswana, that was conducted in February 2001. Regression analyses showed that women's negotiating power and economic independence were the factors most strongly related to condom use, and did not show that education was a crucial factor. Economic independence was the factor most strongly related to negotiating power. These results suggest that in Botswana, HIV prevention efforts may need to improve women's negotiating skills and access to income-generating activities.

Adult↗
PubMed1996

HIV and the social world of female commercial sex workers.

This research, based on repeated interviews with 12 female commercial sex workers (SWs) in Perth, Australia, attempts to explain why SWs in that city are not a source of transmitting HIV to clients during sexual intercourse. Perth SWs report that they routinely use condoms during work-sex. But it was also found that they are at risk of being infected with HIV through sexual intercourse with boyfriends and husbands because use of condoms during sexual intercourse with these men is reportedly rare. This pattern of selective condom use is part of the larger social world within which SWs use, with varying degrees of success, six strategies to demarcate work-sex from nonwork-sex. Within this social world SWs also construct six rationales to help them cope with the threat of HIV infection during nonwork-sex. Further research into this social world may help to lessen the threat of HIV infection to these women.

Adult↗
PubMed2000

HIV risk reduction behavioral interventions with heterosexual adolescents.

This article provides a comprehensive review of research on the effects of behavioral interventions on heterosexual adolescents' HIV sexual-risk behavior. It details adolescents' risk of sexually transmitted HIV infection and describes challenges associated with adolescent intervention research, including obtaining school and parent approval and the validity of self-reported measures. It describes central characteristics of 36 controlled intervention studies assessing the HIV sexual-risk behavior of over 30,000 male and female adolescents 11-21 years of age. It summarizes the participants' race/ethnicity and age, the theoretical framework, and the intervention setting, duration and outcome. This review reveals that the most commonly assessed behavioral outcomes were condom use and abstinence, and the largest effects sized were on condom use and condom acquisition. Effect sizes for abstinence and number of sexual partners were the smallest. Perceived self-efficacy and behavioral interventions were the most commonly assessed theoretical mediators. Key questions this research engaged in included whether behavioral skills can be increased, whether intervention-induced behavior change can be sustained, whether matching the race/ethnicity and gender of facilitators and participants enhances the effectiveness of culturally sensitive interventions, whether classroom teachers can effectively facilitate interventions, whether the behavior of high-risk populations can be changed, and which kinds of interventions are most effective. This review concludes that carefully designed theory-based interventions that take into account the characteristics of the particular population or culture can cause positive changes in adolescents' HIV sexual-risk behavior, but boundary conditions for their effectiveness still need to be identified. Several suggestions for additional research are proffered.

Adolescent↗
PubMed1992

Predictors of condom use in sexually active adolescents.

Unprotected sexual intercourse places a substantial number of adolescents at risk for sexually transmitted disease (STD) and human immunodeficiency virus (HIV) infection. While the most effective means of preventing STD/HIV infection among sexually active adolescents is consistent condom use, little is known about the factors that influence their consistent use among adolescents. This study of adolescents (n = 1049, mean age = 16.2 years) found that of the 266 teens who recently became sexually active, only 29% reported using condoms consistently. Consistent condom use was more frequent in males, those with little history of risk behavior and those with stronger intentions to use condoms in the future. Fear and anxiety of HIV, attitudes about risks other than HIV, and other safe behavior intentions were not significantly related to consistent condom use. Although intentions and recent behavior were significantly related, a different group of factors was found to predict intention to use condoms (e.g., perception of condom use by friends, general impulsive attitudes). Identifying and understanding the factors that influence adolescent sexual behavior and intentions is important for developing maximally effective HIV education/prevention programs.

Adolescent↗
PubMed1996

Behavioral interventions for reduction of sexually transmitted disease/HIV transmission among female commercial sex workers and clients in Bali, Indonesia.

OBJECTIVE: To describe and evaluate a behavioral intervention targeted to low-price female commercial sex workers (CSW) in large brothel complexes, their pimps, and their male clients. DESIGN AND METHODS: Fieldwork was conducted during 1994 in Bali, Indonesia. Intervention activities included an education program for CSW, pimp training, condom sales and distribution, and client media. Theoretical perspectives guiding the intervention were the Health Belief Model and social cognitive theory. Baseline and evaluation surveys were conducted to evaluate the intervention. RESULTS: Both AIDS and sexually transmitted disease (STD) knowledge increased significantly over the intervention period. Condom use for vaginal sex with paid partners the day before the interview increased substantially in the two intervention areas: 18-75% and 29-62%. Condom use also increased in the control area, although the difference between baseline and evaluation measures was smaller. Multivariate analyses indicated that programmatic factors such as attendance at education sessions and reading the project brochure were related to condom use. CONCLUSIONS: Increasing community knowledge and awareness among low-price CSW, pimps, and clients regarding AIDS and STD using trained outreach workers is feasible and effective. In summary, this study has documented the effectiveness of a behavioral intervention for CSW and their clients.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Prevalence of anal sex among heterosexuals in California and its relationship to other AIDS risk behaviors.

This paper describes the prevalence of anal sex among heterosexual adults in California and investigates the relationship of anal sex to other risk behaviors associated with AIDS and STDs. The study consisted of telephone interviews with a household probability sample of 3,545 California adults undersampling those age 44 and older. Seven percent of the sexually active respondents, 8% of males, and 6% of females reported having anal sex at least once a month during the year prior to the survey. Of these, most engage in this activity one to five times per month, and about 60% report never using condoms. Younger respondents and those who were not married were more likely to report anal intercourse. Respondents who had anal sex were more likely to report standard AIDS risks and lifestyle risks associated with STDs, and to engage in recreational use of drugs and alcohol. Both anal sex and condom use during anal intercourse were poorly predicted by these demographic and risk variables. It is concluded that a non-trivial proportion of California heterosexual adults engages in anal sex regularly, most without condoms, and those who have anal sex are more likely to have other risk behaviors associated with AIDS and STDs. These results suggest that anal sex must be addressed specifically in clinical and educational programs designed to reduce the spread of AIDS.

Adolescent↗