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The authors tested a polyurethane women's condom for permeability to the human immunodeficiency virus (HIV) and cytomegalovirus (CMV) using an artificial intercourse model. They did not detect viral leakage in three trials for each virus. Use of this device, which can be controlled by the woman, may reduce HIV and CMV infection.
One of the factors contributing to the fact that contraceptive behaviour in The Netherlands is more effective then in most other countries seems to be that Dutch women are very well informed about all aspects of contraception as a result of formal and informal education at school, in the families and by the media. In a population based survey more than 4500 women were followed during 5 consecutive years by means of a yearly questionnaire about contraceptive behaviour, choices and trends. With regards to information sources it is concluded that the general practitioner, who plays a central role as provider of contraceptive services, is viewed as the most important and reliable source of information. On the other hand Dutch women in general view their contraceptive choices as their own, they do not feel that they are very much influenced by the opinions of their physicians, who in general do not have a normative, patronizing and/or moralizing attitude regarding sexuality and contraception.
PURPOSE: To explore data on high-risk male and female adolescents' attitudes towards female condoms, compared with male condoms. METHODS: Exploratory survey research was utilized with a convenience sample of 65 high-risk adolescents at an emergency homeless shelter. A peer-led intervention was conducted and pre-test and post-test interviews explored barriers to female condom use. The intervention consisted of 15- to 30-minute small group sessions, discussing female condoms' construction; purpose of the rings; efficacy preventing pregnancy and sexually transmitted infection (STIs); and how to lubricate, insert, and use. Content and Chi-square analyses were utilized. RESULTS: Sixty-three percent used male condoms as their primary contraceptive method; almost half (48%) said they always used male condoms, but 44% reported having sex without a male condom at least once in the 2 weeks prior to pre-test. Ninety-five percent had heard of the female condom, half 'good' and 24% 'bad' things, but only 15% had ever used one. At post-test all respondents gave reasons they might use female condoms in the future, and 77% gave reasons why they might not. Most (73%) adolescents said they would still prefer the male to the female condom. The major potential barriers to adolescents' female condom use were not having female condoms available and/or females feeling uncomfortable inserting them. CONCLUSIONS: Female condoms should be offered to adolescents as an additional choice rather than as replacements for male condoms. Further research is needed to assure access, availability, and comfort with female condoms and male participation in their use.
Greater access to alternative female-initiated barrier methods, such as the female condom, is needed among women exchanging street sex. This study describes knowledge of and experience with the female condom among 101 women exchanging sex for money and drugs on the streets of New York City, and examines the acceptability of female condom use as an alternative barrier method for HIV/STD prevention among this population. Female condom use among this sample of sex workers was found to be related to having a regular sexual partner, living with someone who is a drug or alcohol abuser, not being homeless, using alcohol or intravenous heroin, having heard of the device, and having discussed the device with other women or with a regular sexual partner. Despite decreased acceptability post-use, most sex workers indicated an intention for future female condom use.
The female condom is effective in preventing sexually transmitted diseases and when used properly reduces risk of HIV infection among women. This field experiment evaluated the effect of a video presentation on reported use of and satisfaction with the female condom. Participants were 100 women tested for HIV infection in a community agency. Ages ranged from 17 to 62 years, and one fifth of the sample were African American or Hispanic. The 23 women who viewed an instructional video were significantly more likely than 13 of the control group of 50 to try the condom and report to the researcher. Video viewing was unrelated to liking the product and future intent to use. Almost three quarters of those who used the condoms reported they liked and would use them.
This study is a cluster-randomised, community intervention trial to measure the impact of female condom introduction on STD prevalence among Kenyan agricultural workers. The intracluster correlation coefficient of baseline STD prevalences at the 12 sites was 0.0011.
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Although refraining from intercourse with infected partners remains the most effective strategy for preventing human immunodeficiency virus (HIV) infection and other sexually transmitted diseases (STDs), the Public Health Service also has recommended condom use as part of its strategy. Since CDC summarized the effectiveness of condom use in preventing HIV infection and other STDs in 1988 (1), additional information has become available, and the Food and Drug Administration has approved a polyurethane "female condom." This report updates laboratory and epidemiologic information regarding the effectiveness of condoms in preventing HIV infection and other STDs and the role of spermicides used adjunctively with condoms.
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BACKGROUND: A concern with hierarchy messages, which promote male condoms and female-controlled barrier methods along a prevention continuum, is that they may discourage condom use. GOAL: To measure male-condom and female-condom use among women who received hierarchy counseling and compare this with women counseled about condoms only. STUDY DESIGN: Three observational cohorts that correspond to prevention message received were assembled, and consisted of female sexually transmitted disease clinic patients who were counseled about male condoms, female condoms, or a hierarchy message. The hierarchy message promoted male and female condoms, the diaphragm and cervical cap, spermicides, and withdrawal, in descending order of effectiveness against sexually transmitted diseases. After counseling, women were interviewed and returned for follow-up visits at 2 weeks, 4 months, and 6 months. The outcome was the mean proportion of male condom- or female condom-protected coital acts at each follow-up visit in the hierarchy cohort. The outcome was dichotomized as high (> or = 70% of coital acts protected) or low (< 70%), and generalized estimating equations were used to compare observed follow-up condom use with baseline within the hierarchy cohort and observed follow-up condom use between cohorts. It was assumed that condom use in persons not present at 6 months was equal to baseline levels, and condom use estimates were calculated for each full cohort that was initially enrolled.
BACKGROUND: Few studies have measured female condom use for more than a 6-month period or among persons at high risk of STD. OBJECTIVE: To measure long-term use of the female condom among couples at high risk of HIV infection and to evaluate the effect of female condom use on unprotected coital acts. STUDY DESIGN: Ninety-nine Zambian couples with symptomatic sexually transmitted diseases (STD) received female condoms, male condoms, and spermicides and were counseled to use either condom plus spermicide for each coital act. Couples were followed up at 3-, 6-, and 12-month visits. Barrier contraceptive use was measured prospectively by coital log. RESULTS: Among the 99 couples enrolled, 51, 38, and 30 couples were successfully followed up for 3, 6, and 12 months, respectively. Female condoms were reportedly used in 24%, 27%, and 23% of coital acts and by 86%, 79%, and 67% of the returning couples during each time interval. Higher-level female condom users used male condoms less often but had fewer unprotected coital acts (5% vs. 14%; p < 0.05) than lower-level female condom users. CONCLUSION: A majority of couples at high risk of HIV infection used the female condom in conjunction with other barrier methods over a 1-year period. The addition of female condoms accompanied by appropriate counseling to the barrier method mix may reduce unprotected sex among couples at high-risk of HIV infection.
This study investigated the risk behaviors and HIV infection rate in a sample of 210 migrant and seasonal farm workers (MSFW) working in the border city of El Paso, Texas and nearby communities. Surveys and structured interviews collected data on sexual behavior, drug use, condom use, and other potential risk behaviors associated with HIV infection. In addition, all subjects were tested for HIV exposure by using commercial kits. The MSFW participants were all Hispanic and comprised 156 males and 54 females. Only a small minority of the subjects reported engaging in same-sex (1.4%) or bisexual relations (2.8%). Most reported vaginal intercourse (94.7%), while 9% of males and 7.4% of females also reported anal intercourse. Forty-eight percent of the sample reported having sexual activity under the influence of alcohol (44%) and/or other drugs (14%). In this study, only 3.8% admitted to intravenous drug use. Furthermore, most reported that they never used any barrier method during vaginal (71.7%), anal (72.0%), or oral intercourse (87.5%). Only one subject, a male with multiple sex and needle-sharing partners was HIV positive. Although a low level (.47%) of HIV infection was detected in the MSFW population tested, this rate is much higher than that reported for the rest of the county (.0099%) and indicates that this population is at a higher risk of HIV infection.
A survey of cap use and efficacy of women who initially purchased a cervical cap at the University of California at Berkeley Student Health Service is described. It reports the follow-up of 65 U.C. women students who purchased either Vimule or Cavity-rim cervical caps from May, 1978 through June, 1981 and raises questions about cervical cap use and efficacy. Participants were divided into two groups: regular and irregular users. Of the 33 regular users, 16 experienced unplanned pregnancy during the study. Survival probabilities were 80% at 6 months, 73% at one year and 52% after 2 years. Life table analysis of the 33 regular users indicated a 20% probability of pregnancy in the first 6 months of use, 27% by 1 year and 48% by the end of 2 years.
The results of a research on Chlamydia T. (direct survey of both the antigen in the uterine cervix and plasmatic antibodies) in a group of subjects suffering for cervico-vaginitis are provided. The incidence of the Chlamydia infection (proved by either the presence of this bacterium or antibody positivity) is not different from the values reported in literature. Conversely, the presence of neither specific cytological or colposcopic patterns nor of priviledged comites at vaginal level could be demonstrated. Our data, however, confirm a greater incidence of this infection in women reporting early sexual life and a high number of partners. As for the relationship between Chlamydia and contraceptives a slightly higher incidence of positivity in the cervix of patients using oestro-progestinics was registered, whereas no significant difference was noted in the use of other contraceptives IUD included.
BACKGROUND: The cervical cap and the diaphragm are vaginal barrier contraceptive methods that prevent pregnancy by covering the cervix. The two devices also act as a reservoir for spermicide. The cervical cap is smaller and can remain in place longer than the diaphragm. Two types of cervical caps, the Prentif cap and the FemCap, have been compared to the diaphragm in randomized controlled trials. OBJECTIVES: The review seeks to evaluate the contraceptive efficacy, safety, discontinuation, and acceptability of the cervical cap with that of the diaphragm. SEARCH STRATEGY: We searched MEDLINE, Popline, Cochrane Controlled Trials Register, EMBASE, and LILACS for randomized controlled trials of cervical caps, and we reviewed the references of the included publications. Also, we wrote to the manufacturers and known investigators to request information about any other published or unpublished trials not found in our search. SELECTION CRITERIA: All randomized controlled trials in any language comparing a cervical cap with a diaphragm were eligible for inclusion. DATA COLLECTION AND ANALYSIS: All titles and abstracts located in the literature searches were assessed, and articles identified for inclusion were independently abstracted by two reviewers. Data were entered and analyzed with RevMan 4.1, and a second reviewer verified the data entered. Outcome measures include contraceptive efficacy, safety, discontinuation, and acceptability. Outcomes were calculated as Peto odds ratios with 95 percent confidence intervals using women as the denominators. Life-table and Kaplan-Meier cumulative rate ratios for selected measures were also presented in "Additional Tables." MAIN RESULTS: The Prentif cap was comparable to the diaphragm in preventing pregnancy, but the FemCap was not as effective in preventing pregnancy as its comparison diaphragm. The curves for the life-table cumulative pregnancy rates through 24 months for the Prentif cap and the diaphragm were not statistically significantly different (p-value of 0.39). However, the six-month Kaplan-Meier cumulative pregnancy rates for the FemCap and the diaphragm did not meet the a priori definition of clinical equivalence. The Prentif cap had a higher proportion of Class I to Class III cervical cytologic conversions at the three-month visit than the diaphragm; the odds ratio was 2.3 (95% CI, 1.0-5.1). The FemCap trial did not find differences in Papanicolaou smear results between the cap and diaphragm groups. Prentif cap users had a lower odds ratio of vaginal ulcerations or lacerations (0.3; 95% CI, 0.1-0.7) than diaphragm users. FemCap users had a higher odds ratio of blood in the device on removal (2.3; 95% CI, 1.3-4.1), but a lower odds ratio of urinary tract infections (0.6; 95% CI, 0.4-1.0) than those in the diaphragm group. In the FemCap trial, similar proportions of women reported liking their assigned device "somewhat" or "a lot" at the two-week interview. However, FemCap users were less likely than the diaphragm users to state that they were "probably" or "definitely" likely to use the device alone after completing the trial (odds ratio of 0.5; 95% CI, 0.3-0.7) or that they would recommend it to a friend (odds ratio of 0.5; 95% CI, 0.3-0.8). REVIEWER'S CONCLUSIONS: The Prentif cap was as effective as its comparison diaphragm in preventing pregnancy, but the FemCap was not. Both cervical caps appear to be medically safe.
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Recent evidence on the importance of sexual history and sexually transmissible agents in cervical cancer has been reported. Case-control studies have frequently demonstrated increased risk of cervical cancer for women using oral contraceptives, while laboratory results have shown that vaginal spermicides inactivate various sexually transmissible agents. To determine the role of contraceptive use in cervical cancer, 153 cases of Maryland women with invasive cervical cancer and age, race, and residence-matched controls were interviewed in 1985, focusing on sexual history, health care utilization patterns, screening history, contraceptive use, and smoking. Overall, lifetime use of contraceptives was protective of cervical cancer (odds ratio (OR) = 0.38, 95% confidence interval (CI) = 0.2-0.7). Use of oral contraceptives (OR = 0.48), diaphragm (OR = 0.29), and vaginal spermicides (OR = 0.28) were more frequent in controls than cases. After adjustment for behavioral factors (age at first intercourse, smoking, gaps in Papanicolaou smear testing, and obstetrician-gynecologist visits), use of vaginal spermicides remained significant (OR = 0.30), although use of oral contraceptives and barrier methods of contraception failed to remain significant. The effectiveness of vaginal spermicides in preventing cervical cancer may be due to their antiviral action.