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Changes in adolescent males' use of and attitudes toward condoms, 1988-1991.

Data from more than 1,000 sexually active young males interviewed in 1988 for the National Survey of Adolescent Males at ages 15-19 and reinterviewed in 1990-1991 at ages 17-22 show that as the respondents grew older, their condom use declined. Although respondents' attitudes about the effects of condoms on pregnancy risk, partner appreciation, sexual pleasure and embarrassment became more favorable toward condom use over time, their degree of worry about AIDS and their perceived likelihood of getting AIDS declined. When data on males aged 17.5-19 in each time period were contrasted, the level of condom use was found to be essentially constant. Several condom-related attitudes among this age-group had become more favorable, although their perceived risk of acquiring AIDS had diminished. Multivariate analyses revealed that decreased worry about AIDS and increased denial of the seriousness of AIDS were modestly associated with a decline in condom use. Change in condom use was also affected by change in perceived reduction in sexual pleasure and by female partner's appreciation of condom use.

Acquired Immunodeficiency Syndrome↗

Condom use among U.S. men, 1991.

A 1991 study of a nationally representative sample of men aged 20-39 finds that 27% of sexually active men had used a condom in the four weeks before interview. Black men are more likely than white men to report condom use (38% vs. 25%), and men younger than 30 are more likely to do so than are those older than 30 (36% vs. 19%). Among white men, condom use increases with years of education; among black men, however, those with 12 years of education are much less likely to report condom use than are those with more or less than 12 years (28% vs. 43-50%). Condom use is positively related to number of partners. Men who have engaged in anal intercourse, those who have had a one-night stand and those who are bisexual or homosexual are also more likely to report condom use. Among those who reported using a condom in the previous four weeks, 55% of whites and 18% of blacks had done so only for birth control and 7% of whites and 9% of blacks had done so only for protection against infection with the human immunodeficiency virus and other sexually transmitted organisms; the remainder had used a condom for both reasons.

Acquired Immunodeficiency Syndrome↗

AIDS-relevant condom use by gay and bisexual men: the role of person variables and the interpersonal situation.

This study examined the relative ability of selected person variables (interpersonal self-efficacy, self-control, attitudes about the effect of condoms on sex, normative beliefs) and interpersonal-situational variables (partner preference, partner serostatus) to explain gay and bisexual males' (N = 267) condom use during insertive and receptive intercourse. Partner preference accounted for a large amount of variance in condom use by itself and when controlling for the effects of the remaining variables. Exploratory hierarchical regression analyses suggested that the receptive partner's preference influenced condom use decisions to a greater extent than did the insertive partner's. Partner serostatus alone explained little variance in condom use. However, partners serostatus interacted with subject serostatus such that dyads with concordance serostatus (i.e., both partners HIV positive or both HIV negative) used condoms the least, and dyads with discordant serostatus used condoms the most. Results suggest that the interpersonal situation plays an important role in condom use decisions.

Acquired Immunodeficiency Syndrome↗

Predictors of African American adolescents' condom use and HIV risk behavior.

This study evaluated predictors of risky and safer behavior in a sample of low-income African American adolescents, assessed their perceptions of the risk associated with their sexual behavior, and examined differences between adolescents who used condoms consistently, inconsistently, or engaged only in unprotected intercourse. African American adolescents (N = 312) completed measures related to AIDS knowledge, frequency of condom use, attitudes toward condoms, and sexual behavior over the preceding 2 months. Multiple regression analyses for the sexually active youths (N = 114) revealed that lower self-efficacy, higher perceived risk, and male gender were associated with high-risk behavior. Positive attitudes toward condoms and younger age had the strongest association with condom use. Consistent condom users were more knowledgeable and held more positive attitudes toward condoms, and nonusers were older. Regardless of their behavior, the adolescents generally did not perceive themselves to be a risk for HIV infection. The findings suggest that precautionary practices (condom use) and high-risk behavior (unprotected sex with multiple partners) may have different correlates. In addition, the data indicate that theoretical models developed with homosexual male populations may also be generalizable to African American adolescents' sexual behavior.

Adolescent↗

Young men's experience with condom breakage.

In a nationally representative sample of men aged 17-22, 23% of those using condoms reported experiencing at least one condom break during the previous 12 months. Of all condoms used, 2.5% had broken. In multivariate analyses, increased experience with condoms reduced the likelihood of experiencing condom breakage. Recent sex education was associated with an almost 80% decrease in the risk of breakage among young men who used condoms infrequently. Young males who had ever had a sexually transmitted disease (STD), or whose sexual partner had had an STD, were almost three times as likely as other respondents to have experienced condom breakage. In addition, young men with a household income of less than $60,000 were 2-3 times as likely to have broken a condom as were those with a higher household income.

Adolescent↗

Condom use and sexual habits of heterosexual intravenous drug users in northern Italy.

In order to assess modes of human immunodeficiency virus (HIV) transmission from heterosexual intravenous drug users (IVDUs) to their partners, condom use and sexual habits with both steady and occasional partners were investigated. A total of 349 heterosexual IVDUs (247 men and 102 women) who ignored, at the time of interview, their HIV serostatus were interviewed. Respondents were asked for information on condom use and sexual habits for the three year period prior to the interview. Nearly 40% of IVDUs reported sexual intercourse with both steady partners and occasional partners. Fifty-four percent of their steady partners and 48% of their occasional partners were individuals who did not belong to groups at risk for HIV infection. Anal intercourse with steady partners was reported by 29% of IVDUs and 24% of IVDUs with occasional partners. Condom use during vaginal intercourse was seldom reported: 83% of IVDUs never used a condom with steady partners and 75% did not use one with occasional partners. IVDUs who were 1) unmarried, 2) enrolled in the study after 1986, 3) partners of not at-risk individuals, 4) partners of a foreigner and, 5) aware of their partners HIV seropositivity showed significantly higher, albeit still low, frequencies of condom use with steady partners. Conversely, all these factors seemed to have little impact on condom use with occasional partners. Condom use and sexual habits were similarly reported by HIV-positive and HIV-negative IVDUs. The present study shows that high-risk sexual behaviours among IVDUs are very widespread and it stresses the need for intensive counselling to promote condom use among IVDUs.

Adult↗

Sex-structured HIV/AIDS model to analyse the effects of condom use with application to Zimbabwe.

We present a sex-structured model for heterosexual transmission of HIV/AIDS in a community. The model is formulated using integro-differential equations, which are shown to be equivalent to delay differential equations with a time delay due to incubation period. The sex-structured HIV/AIDS model divides the population into a two sex-structure consisting of females and males. The threshold and equilibria for the model are determined and stabilities are examined. We extend the model to focus on the effects of condom use as a single-strategy approach in HIV prevention in the absence of any treatment. Initially we model the use of male condoms and further extend the model to incorporate the use of both female and male condoms. The model includes two primary factors in condom use to control HIV that are condom efficacy and compliance. The exposure risk of infection after each intervention is obtained. Basic reproductive numbers for these models are computed and compared to assess the effectiveness of male and female condom use in a community. The models are numerically analysed to assess the effectiveness of condom use on the transmission dynamics of HIV/AIDS using demographic and epidemiological parameters for Zimbabwe. The study demonstrates the use of sex-structured HIV/AIDS models in assessing the effectiveness of female and male condom use as a preventative strategy in a heterosexually active population.

Condoms↗

Safe sex versus safe love? Relationship context and condom use among male adolescents in the favelas of Recife, Brazil.

This study examined the influence of the relationship context where adolescent sexual activity takes place on contraceptive decisions. The data were collected in a specially designed survey carried out in May 2000 on 1,438 adolescent males aged 13-19 residing in favelas (urban slum areas) of Recife, Brazil. A logistic regression analysis of condom use at last sexual intercourse and a multinomial logit analysis of contraceptive method choice were performed for 678 sexually active adolescents. Educational attainment, degree of knowledge of HIV transmission and prevention, and condom use at first sexual intercourse were found to be significantly associated with current condom use. Regarding the relationship context, the analysis revealed that adolescent males in steady relationships were less likely to use condoms, less likely to regard themselves at risk of HIV infection, and more concerned about pregnancy prevention than adolescents in casual relationships. Differentials in condom use by type of relationship, however, did not result from a higher rejection of contraception by steady partners but from their higher likelihood to rely on other contraceptive methods. Results suggest that prevention campaigns need to take into account the intimate context where adolescents assess potential health risks, and to address the divergent symbolic meanings condoms may have in different types of relationships. If an increase of condom use among stable sexual partners is pursued, public health campaigns might need to romanticize condom use as a sign of love and trust and place more emphasis on the benefits of dual protection.

Adolescent↗

Relationship between condom strength and failure during use.

The relationship between condom strength and failure during use was examined in six volunteers using artificially deteriorated condoms. Samples of each condom set exposed to ultraviolet light for three to eleven hours were tested for strength by air burst procedures. The remaining condoms were used by volunteers protected from pregnancy by other means. Burst pressure fell to 35% and burst volume to 17% of untreated levels after six hours of ultraviolet exposure. A maximum mean breakage rate during use of 30% was obtained at this time, although individuals experienced breakage rates up to 70% at this stage of deterioration. No failures occurred during use until condoms had deteriorated by more than 25%. Conclusions were: 1) that burst test parameters can effectively and sensitively measure changes in condom strength, 2) that condoms produced to western industrial standards carry a wide margin of strength over and above the minimum required for effective use, 3) that stored condoms should not necessarily be thrown out if they are uniform in strength but fall below original acceptance standards.

Contraceptive Devices, Male↗

Dry sex in Zimbabwe and implications for condom use.

'Dry sex' refers to the preference for a dry, tight vagina during sexual intercourse. Women in Zimbabwe and elsewhere have been found to use a variety of drying agents to achieve these effects. Previous studies of 'dry sex' have concentrated on documentation of the practice and investigation of any associated increased risk of HIV. In contrast, this study examines the impact of 'dry sex' on condom use and effectiveness. Focus group interviews were held with female HIV/AIDS peer educators in Zimbabwe who had a history of commercial sex work. Participants reported that drying agents had physical and psychological consequences. That is, agents were said to dry and tighten a woman's vagina, and also to serve as 'love potions' to attract sexual partners and ensure their faithfulness. Although vaginal dryness was not found to deter the use of condoms, some women were reluctant to use condoms for fear of blocking the 'magic' of drying agents. There was agreement among participants that condoms frequently broke when used in conjunction with drying agents. Participants primarily attributed condom breakage to excessive vaginal tightness. Lubricants were not routinely used during sex or with condoms. However, participants preferred the use of lubricated condoms when they used condoms. Implications of the 'dry sex' practice for AIDS prevention programs and development of new HIV prevention technologies are discussed.

Adult↗

Why are young college women not using condoms? Their perceived risk, drug use, and developmental vulnerability may provide important clues to sexual risk.

BACKGROUND: Young multiethnic college women (YMCW) are at risk for STDs and HIV secondary to high-risk sexual behaviors that are related to developmental issues such as invincibility, low perceived risk, and substance use. METHOD: One hundred YMCW on a southern California university campus completed surveys that examined variables that impacted their sexual risk. RESULTS: The study yielded many significantly correlated variables. Women with low perceived risk, lower use of drugs and alcohol, and who had parental involvement had lower sexual behavior risk. Women that were sexually assertive, had intentions to use condoms, and did not use substances used condoms more often. Older students in advanced grades who had steady partners used substances less and had decreased sexual risk, however, they experienced partner resistance to condoms, which canceled out any reduced risk. In a multiple regression analysis, condom use intention and substance use predicted condom use, perceived risk and substance use predicted sexual behavior risk. White women had significantly higher substance use, perceived sexual risk, and sexual behavior risk than did Latinas and African Americans. CONCLUSIONS: Despite their assertiveness and intentions, many participants had multiple sexual partners, and 64% of the YMCW were inconsistent condom users. Despite knowing the elevated risks, 52% used drugs and alcohol during sex. Negative attitudes (61%) about condoms were also demonstrated as a key factor in the lack of condom use.

Adolescent↗

Associations among condom use, sexual behavior, and knowledge about HIV/AIDS. A study of 13,293 public school students.

BACKGROUND: This school-based study explored associations between Mexican young people's condom use, other sexual behaviors, and HIV/AIDS knowledge. METHODS: Students (n=13,293, 11-24 years of age) from a random sample of public schools in the central Mexican state of Morelos completed a self-administered questionnaire. We performed logistic regression analysis of condom use and sexual behavior variables and a knowledge-based index on HIV/AIDS prevention and transmission. RESULTS: Average age at sexual debut was 13.6 +/- 1.9 years among young men and 14.2 +/- 2.2 years among young women; 34.5% of sample participants reported using condoms during their first sexual intercourse. More students had intermediate HIV/AIDS knowledge levels (46%, 95% confidence interval [95% CI], 45.2-46.9) than high levels (37%, 95% CI 36.2-37.8, p <0.01). Students knew more concerning HIV transmission than about prevention of HIV infection. Among young men, high levels of HIV/AIDS knowledge increased likelihood of condom use (odds ratio [OR] 1.4, 95% CI, 1.1-1.7), while among young women high levels of knowledge decreased likelihood of using condoms (OR 0.7, 95% CI, 0.5-1.0). Young men with high levels of HIV/AIDS knowledge were more likely to have had three or more sexual partners (OR 1.7, 95% CI, 1.3-2.2), but young women with high knowledge levels were more likely to have only one lifetime sexual partner (OR 0.6, 95% CI, 0.4-0.9). CONCLUSIONS: As in previous studies in smaller samples, levels of knowledge with regard to HIV/AIDS were low in Mexican youth. HIV/AIDS education programs for Mexican students should focus on conveying knowledge on HIV prevention. Because apparently knowledge is not directly correlated with condom use among young women, prevention strategies that deal with social acceptability of condoms and social skills related with condom negotiation are also needed.

Adolescent↗

Prevalence survey on condom use and infection of urogenital mycoplasmas in female sex workers in China.

GOAL: We evaluated the prevalence of condom use and the effects of condom use on urogenital mycoplasma infection in female sex workers in Jinjiang, China. METHODS: Two-hundred ninety-nine female sex workers from Jinjiang city, Jiangsu Province, were interviewed, and three mycoplasmas of Ureaplasma urealyticum (Uu), Mycoplasma hominis (Mh) and Mycoplasma genitalium (Mg) were detected by nested polymerase chain reaction in genital secretions of 72 female sex workers and 42 female patients seen with symptoms of genital infection (control group). RESULTS: The results showed that 87.29% of the sex workers used condom in their last sexual intercourse, and that 2.68% did not use, 38.80% sometimes used and 58.52% used condoms every time in the last month. Those who were older, married and have a stable partnership used condoms less frequently. The infection rates of Uu, Mh and Mg were 77.78%, 34.72% and 16.67%, respectively, in sex worker subjects compared to those of controls at 59.52%, 9.62% and 21.43%, respectively. The infection rates of Uu and Mg were lower among all subjects (NS) who used condoms every time. In this observational study, genital mycoplasma infection was common and occurred more frequently among sex workers, and infection occurred less often when condoms were used. These results tend to support the efficacy of condom use in reducing urogenital mycoplasma infection among Chinese women.

Adolescent↗

Emergency contraception use is correlated with increased condom use among adolescents: results from Mexico.

PURPOSE: To evaluate the association between knowledge about, or experience with, emergency contraception (EC), and condom use among school-attending adolescents in the state of Morelos, Mexico. METHODS: We analyzed data from anonymously self-administered questionnaires (n = 10,918), from a cluster-randomized controlled trial among first year students from 40 (75%) public high schools in Morelos, Mexico. The survey included specific questions about EC knowledge and experience as well as questions about perceived ability to negotiate and condition sexual relations on condom use; and condom use at first and last sexual intercourse. RESULTS: Overall, 61% (6384) of students had heard of EC, and 36% (1964) of girls and 39% (1997) of boys had correct knowledge about EC. Correct knowledge was based upon knowing that EC is pills taken up to 3 days after unprotected sex to prevent pregnancy. Of 1695 (15.6%) reporting lifetime sexual activity, 16.4 % (275) reported they had tried to obtain EC and almost of all them (263) reported having used EC. The probability of a student reporting he/she is capable of interrupting sexual intercourse to use a condom was significantly higher for those who had correct EC knowledge, and a history of EC use was strongly correlated with condom use at last sexual intercourse. CONCLUSIONS: Experience with emergency contraception has no adverse effects on condom use, but rather is associated with an increased probability of condom use and an increased perceived capacity to negotiate condom use. Despite concern that information about, and access to EC may encourage sexual risk taking, our results suggest the reverse is true. These data support the position that there is no justification to withhold EC information or access from adolescents.

Adolescent↗

The impact on condom use of the "100% Jeune" social marketing program in Cameroon.

PURPOSE: To measure the reach of the "100% Jeune" social marketing campaign and to assess its impact on condom use and on the predictors of condom use. The campaign aims to improve condom use through intensive youth-oriented mass media and interpersonal communications and widespread distribution of subsidized condoms. METHODS: We analyzed data from the 2000 and 2002 waves of a reproductive health survey of youth aged 15-24 years, with sample sizes of 2097 and 3536, respectively. RESULTS: Exposure to campaign activities was high. During the course of the intervention, there were significant changes in perceived condom attributes and access, self-efficacy, and perceived social support. Consistent with these changes, the percentage of youth who used a condom in last sex with their regular partner increased from 32% to 45% for females (p < .05) and from 44% to 61% for males (p < .01). Additional analyses suggest that exposure to the "100% Jeune" campaign has contributed to these trends. CONCLUSIONS: The multi-faceted mass media and interpersonal communication campaign was effective for reaching youth. During the first 18 months of the campaign, significant changes occurred in perceived social support and condom use self-efficacy. Significant increases in levels of condom use also were achieved. However, the program was more effective among males than females. This indicates a need for more and possibly different campaign activities to focus specifically on risk perception and self-efficacy among females. The results also show that repeated program exposure is needed to achieve behavior change. Hence, future programs can enhance their effectiveness by using a mix of mass media and interpersonal communications to repeatedly expose youth to key campaign messages.

Adolescent↗

Applicability and reproducibility of condom catheter method for measuring isovolumetric bladder pressure.

OBJECTIVES: To report on the applicability, reproducibility, and adverse events of the noninvasive condom catheter method in the first 730 subjects of a longitudinal survey of changes in urinary bladder contractility secondary to benign prostatic hyperplasia, in which 1300 men will be evaluated three times in 5 years using this method. METHODS: Subjects were recruited by general practitioners, general publicity, and e-mail. Only those meeting the study criteria were entered in the study. If the free flow rate exceeded 5.4 mL/s, at least two consecutive condom pressure measurements were attempted using the condom catheter method. The condom pressure measured reflected the isovolumetric bladder pressure, a measure of urinary bladder contractility. The reproducibility of the method was quantified by a difference plot of the two maximal condom pressures measured in each subject. RESULTS: In 618 (94%) of 659 eligible participants, one condom pressure measurement was completed; two measurements were done in 555 (84%). The maximal condom pressure ranged from 28 to 228 cm H2O (overall mean 101, SD 34). A difference between the two pressures of less than +/-21 cm H2O was found in 80%. The mean difference was -1 cm H2O (SD 18), significantly different from 0. Some adverse events such as terminal self-limiting hematuria were encountered. CONCLUSIONS: The condom catheter method is very suitable for large-scale use. It has a success rate of 94% and a reproducibility comparable to that of invasive pressure flow studies.

Condoms↗

Prevention of transmission of human immunodeficiency virus in Africa: effectiveness of condom promotion and health education among prostitutes.

Condom use was assessed after a programme of education about the acquired immunodeficiency syndrome and a condom distribution programme in a well-characterised prostitute population in Nairobi. Women received their education at group meetings (barazas) and at individual counselling sessions during which they were given the results of serological tests for the human immunodeficiency virus (group 1) or at barazas only (group 2), or through very little of either (group 3). During the counselling sessions free condoms were distributed. Before either of the programmes started, 10%, 9%, and 7% of groups 1, 2, and 3 women, respectively, reported occasional use of condoms. By November 1986, 80%, 70%, and 58% of groups 1, 2, and 3 women, respectively, reported at least some condom use. The mean frequency of condom use was 38.7 (SD 31.8)%, 34.6 (34.5)%, and 25.6 (29.5)% of sexual encounters in groups 1, 2, and 3 women. 20 of 28 women who were non-condom-users seroconverted compared with 23 of 50 women who reported some use of condoms.

Acquired Immunodeficiency Syndrome↗

[The consistent use of condoms among intravenous drug users and their regular partners].

OBJECTIVE: To describe consistent condom use between drug injectors and their regular sexual partners and to identify factors associated to its use which may be amenable to intervention. METHODS: Information was collected by personal interviews of drug injectors in 13 sampling points of the city of Granada, Spain. A bivariate analysis of factors identified in the literature was carried out and a multivariate logistic regression was fitted to the data to test the hypothesized associations. RESULTS: The proportion of drug injectors who report consistent condom use with their regular partners was 26. 4%. Talking about condoms with other injectors and with their regular sexual partners, professional sources of information and counselling when receiving results of HIV testing are independently associated with the use of condoms. In terms of social indicators, those with the highest and lowest levels of social integration use condoms less than those who belong to the middle social group. Sociodemographic characteristics and history of drug injection are not associated with consistent condom use with the regular partner. CONCLUSION: The use of condoms between drug injectors and their regular sexual partners is associated with communication with other drug injectors, the sexual partner and hearth professionals, on this topic. Promoting consistent condom use with regular partners among intravenous drug users is best accomplished through peer groups and during HIV counseling.

Adult↗