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PubMed2001

"It's some kind of women's empowerment": the ambiguity of the female condom as a marker of female empowerment.

The female condom is the latest in a series of sexual and reproductive technologies to be imported into the third world, following the contraceptive pill, the Depo-Provera injection, the latex male condom, and others. It is an example of "traveling technology", which accrues different meanings and connotations in the different settings into which it is introduced in its journey through the circuits of international technological diffusion, from the headquarters of international NGOs and bilateral aid programs, through the bureaucracies of national ministries of health to the communities in urban and rural settings where the condoms are distributed. The female condom almost always carries connotations of women's empowerment, and the possibility of greater sexual autonomy for women. This association is a result of the female condom being the first new "post-Cairo" technology, the diffusion of which was spurred by the consensus reached at the 1994 International Conference on Population and Development in Cairo, at which the need to promote women's empowerment was moved to the center of international family planning and population movements. However, I demonstrate that "empowerment" is an ambiguous term, interpreted in different ways in different contexts. I illustrate this through interviews conducted in 1998 and 1999 with stakeholders in the female condom in Cape Town, Nairobi, and in rural western Kenya. These stakeholders range from directors of US-based development programs to heads of national AIDS-prevention efforts to community-based distributors and primary health care nurses at the village level. I argue that three different notions of empowerment are being articulated with respect to the female condom--two which correspond to Maxine Molyneux's typology of strategic and practical gender interests, and a third in which women's empowerment is conceived of as something which diminished the power of men. I argue further that the disjunctures between these three different notions of what "empowerment" means will pose a challenge for people at all levels which are seeking to make the female condom more widely accessible to women at risk of HIV/AIDS.

Single-Use Internal Condom↗
PubMed2003

Measurement of condom use as a risk factor for HIV infection.

Correct and consistent condom use can prevent susceptible people from acquiring HIV infection. However, in many countries repeated cross-sectional studies reveal a trend of increasing prevalence of HIV infection alongside an increase in reported condom use. Changes in sexual behaviour that reduce the number of new HIV infections will not become apparent through changes in HIV prevalence until some time after the behaviour change takes place. Limitations in the data used to assess condom use may also explain the concurrent increases in condom use and HIV prevalence. One common indicator of condom use, the UNGASS indicator (condom use at last higher risk sex of those aged 15-24), has been chosen to illustrate how changes in the proportion of people who report using condoms do not always explain changes in the size of the group who had high risk behaviour. Indicators based on the proportion of the whole population who have sex without using a condom would be better measures of the size of the group at highest risk of HIV infection.

Adolescent↗
PubMed2001

Correct condom application among African-American adolescent females: the relationship to perceived self-efficacy and the association to confirmed STDs.

PURPOSE: To assess condom application ability and the relationship between perceived ability and demonstrated ability. Also, to examine the association between high-demonstrated condom application ability and recent sexual risk behaviors and laboratory-diagnosed sexually transmitted diseases (STDs) among African-American adolescent females. METHODS: A purposeful sample of sexually active African-American females (n = 522) completed a structured interview and provided vaginal swab specimens for STD testing. Subsequent to the interview, adolescents demonstrated their condom application skills using a penile model. A 9-item scale assessed adolescents' perceived self-efficacy to apply condoms. Sexual risk behaviors assessed by interview were noncondom use at last intercourse and the last five intercourse occasions for steady and casual sex partners as well as any unprotected vaginal sex in the past 30 days and the past 6 months. RESULTS: Approximately 28% of the sample tested positive for at least one STD and nearly 26% self-reported a history of STDs. Controlled analyses indicated that adolescents' self-efficacy for correct use was not related to demonstrated skill. Adolescents' demonstrated ability was not related to any of the sexual risk behaviors. Likewise, recent experience applying condoms to a partner's penis and demonstrated ability were not related to laboratory-diagnosed STDs or self-reported STD history. CONCLUSIONS: Adolescents may unknowingly be at risk for human immunodeficiency virus and STD infection owing to incorrect condom application. Further, high-demonstrated ability to apply condoms was not related to safer sex or STDs. Reducing sexual risk behaviors may require more than enhancing adolescent females' condom application skills and may require addressing other relational skills.

Adolescent↗
PubMedDate not supplied

A qualitative assessment of condom use decisions by female adolescents who use hormonal contraception.

Young women who use hormonal contraception are at increased risk of HIV. This study, based on the Health Belief Model, was designed to understand how adolescent women who use hormonal contraceptives make decisions about condom use. Thirty-nine young, minority women participated in open-ended interviews. The interviews were transcribed and analyzed by both authors separately. The results suggest that barriers to condom use include use of a hormonal method of contraception, perceived trust in a partner, and a perception of the condom as "irritating." Facilitators for condom use included not being with a steady partner and fear of pregnancy and infection. The young women also suggested that being able to talk to their parents about condom use, having condoms widely available, and seeing HIV-prevention messages in many venues would increase their use of condoms. They noted that seeing young, HIV-positive women demographically similar to themselves would also prompt them to use condoms. Nurses should incorporate these factors into HIV-prevention interventions for adolescents.

Adolescent↗
PubMed1994

A test of the AIDS risk reduction model: psychosocial correlates of condom use in the AMEN cohort survey.

We examined the AIDS Risk Reduction Model (J. Catania, S. Kegeles, & T. Coates) in a sample of unmarried heterosexual adults with an HIV risk factor (n = 716). Labeling one's sexual behavior as risky was associated with having a history of sexually transmitted diseases, particularly genital herpes, and fewer stereotypic health beliefs. For people with secondary sexual partners, greater condom commitment was related to increased labeling, supportive condom norms, and greater enjoyment, and high levels of condom use were related to greater condom commitment, supportive norms, greater enjoyment, and health protective sexual communication. For people with primary partners, greater condom commitment was correlated with increased supportive condom norms, greater enjoyment, and having genital herpes, and high levels of condom use were correlated with greater condom commitment, greater enjoyment, and health protective sexual communication.

Adult↗
PubMed2002

Expectancies specific to condom use mediate the alcohol and sexual risk relationship.

The present study tested the role of alcohol expectancies for condom use in mediating the alcohol and risky sex relationship. Expectancies for condom use are specific anticipations for alcohol's effect on one's ability to use a condom. College students (N = 563) reported on beliefs, intentions and actual sexual and drinking behavior. Among the sexually active, alcohol was directly related to future intention to use a condom in drinking situations for men, but not for women. In the men, alcohol expectancies for condom use mediated the relationship between drinking and condom intention. Beliefs that alcohol negatively impacts one's ability to use condoms were associated with more drinking and lower intentions to use a condom. These expectancies may help explain how alcohol affects risky sex in men. Gender differences and implications are discussed.

Adult↗
PubMed1989

Condom sales at public universities in California: implications for campus AIDS prevention.

Public health officials have called for increased use of condoms to protect Americans from sexually acquiring human immunodeficiency virus (HIV) infection. To investigate the availability of condoms for sale on college campuses, we asked student union directors and bookstore managers from all 28 public universities in California, with a combined enrollment of half a million students, to complete a detailed questionnaire in August and September 1987. Two thirds of the campuses reported having condoms for sale in either their bookstores or convenience stores; one third said condoms were available in the men's and women's restrooms in their student unions. On most campuses, sales were instituted in the past year in response to the AIDS (acquired immune deficiency syndrome) epidemic. However, very few campuses provided AIDS education at the point of sale, and condoms were not easily available outside of store hours. Respondents felt that the most important obstacles to increasing the distribution of condoms on campus included concern about presenting a negative image of the university and the low priority assigned to this issue by the university administration and others on campus. This study suggests that although condom availability has improved in the past year, the opportunity exists at most California public universities to increase the distribution of condoms and improve associated AIDS-related health education efforts.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Heterosexual relationship characteristics, condom use and safe sex practices.

It was examined whether sexual relationship characteristics were associated with condom use and safe sex practices against HIV. Characteristics investigated were: (1) age difference between sexual partners, (2) previous knowledge of partner, (3) type of relationship, (4) duration, and (5) exclusiveness. Safe sex practices (risky, non-safe, safe) were defined by condom use consistency, previous knowledge of partner and monogamy. Participants (N = 458, were Greek, sexually active and between 18-25 years old) responded to a questionnaire on sexual and condom use practices in their sexual relationships of the past 12 months, condom use negotiation and variables a-e. Only age difference between partners was found to differentiate consistent from inconsistent condom use. Inconsistent condom use was more frequent among partners whose age difference was over two years. Safe sex practices (risky, non-safe, safe) varied across different relationships of 36% and remained consistently non-safe or risky across those of 40%. Risky practices occurred more frequently in relationships where the man was older than the woman. When condoms had not been used, they had not been negotiated in 80% of the cases. These findings reconfirm the importance of negotiation in condom use, call attention to the neglected role of age differences between partners in safe sex and bring forward the issue of studying actual variation of safe sex practices across relationships as an indication of people's response to health campaign messages of risk reduction.

Adolescent↗
PubMed2002

A study on female sex workers in southern China (Shenzhen): HIV-related knowledge, condom use and STD history.

The present study aims to investigate the perspective relations between HIV/AIDS and condom-related knowledge, condom use, history of sexually transmitted diseases (STDs) and predictive factors of condom use by female sex workers (FSW) who were sent to the Women Re-education Center (WRC) in Shenzhen, People's Republic of China. Seven hundred and one FSW were interviewed. Whereas respondents had attained certain accurate knowledge about the HIV transmission routes, misconceptions were still commonly reported. Level of condom related knowledge was not high. The prevalence of using condoms with clients was relatively low-15%- 22% reported not using condoms consistently. One of the major obstacles was 'Refusal by clients'. Significant predictive factors associated with consistency of condom use with clients were age, educational background, average number of client intakes per day, capacity in determining the use of condoms and past STD history. The respondents may have developed a false sense of safety by subjectively assessing whether their clients had a STD but they were unaware that HIV carriers may show no obvious symptoms at all. The data has confirmed the worries regarding the potential 'bridging effect' of HIV transmission as resulted by cross-border commercial sex-networking activities.

Adult↗
PubMed2004

Intentions to use condoms in Rwandan secondary school students.

A survey was conducted among 474 (213 female and 261 male) students (mean age 21 years) in three secondary schools in rural Rwanda in order to evaluate their attitudes towards condoms. Male students and those with sexual experience had more favourable attitudes towards condom utilisation than female students and those without prior sexual contacts. Of the 44% with reported sexual experience, reported age at first encounter was lower in boys (16.8 years) than in girls (18.3 years; p=0.03); 73 students (36%) reported regular use of condoms. Having more than one sexual partner was reported by 42 (9%), of whom 20 (48%) claimed regularly using a condom. Intention to use condoms was reported by 77% of the male and 53% of the female students (p=0.001). In addition, those with prior use of condoms and those having multiple partners were more likely to report future use intentions than others. Future campaigns in Rwanda should therefore focus on sensitising adolescents to a more positive attitude towards condoms and include modules to reduce condom misconceptions and stigma.

Adolescent↗
PubMed2004

Condom use in multi-partnered males: importance of HIV and hepatitis B status.

The objective of the research was to determine the demographic, sexual and social risk factors associated with condom use in 7,089 multi-partnered men attending the Sydney Sexual Health Centre. A review of computerized medical records from 1991 to 1999 was carried out. Males with two or more partners in the last three months were divided into three condom use groups: consistent, sometimes and never. Men reporting sex with men (MSM) were more likely to use condoms than men having sex with only women (p=0.001). HIV positive men were more likely to use condoms consistently than those who were negative (p=0.001). In HIV negative non-hepatitis-B carriers, factors independently associated with inconsistent condom use included alcohol consumption, intravenous drug use (odds ratio (OR) 0.6 (95% confidence interval (CI) 0.47-0.77)) and being married (OR 0.2 (95% CI 0.21-0.31)). Factors associated with consistent condom use were MSM (OR 1.8 (95% CI 1.26-2.49)) and having three or more partners in the last 3 months (OR 2.4 (95% CI 2.023-2.83)). In the 508 hepatitis B carriers, consistent condom users were less likely to be married or intravenous drug users (OR 0.4 (95% CI 0.23-0.85)). In the 200 HIV antibody positive men, those with three or more partners were less likely to be consistent condom users than those with two (OR 0.3 (95% CI 0.11-0.82)). The conclusions are that a small number of HIV positive men report unsafe sex with multiple partners. Health promotion activities should be directed at this group.

Adolescent↗
PubMed2005

Factors associated with condom use among brothel-based female sex workers in Thailand.

This study sought to determine the actual levels of condom use by female sex workers (FSW) in Thailand brothels. Specifically, it examined the influence that the country of origin of the FSW patrons exerted on usage of a condom, and it assessed the relevancy of constructs from the Health Belief Model in predicting FSW requesting condom usage by their clients. A survey was administered to a cross-sectional non-randomized convenience sample of 150 FSW in four geographic locations in Thailand, which included: Bangkok, Chang Mai, Mae Hong Son and Other (comprised mainly of brothels in small villages). Statistical interpretation of the data indicated that Thai FSW requested condom use in 63% of the cases, while the overall mean of condom use was only 51%. Condom use by patrons' country of origin was as follows: westerners 76%, foreign Asians 52% and native Thai men 27%. These results fall considerably short of the Ministry of Health's goal of 100% condom use in Thai brothels. Furthermore, public health education initiatives need to effectively target the native Thai FSW patrons since they represent the clients least likely to use a condom (27%).

Adult↗
PubMed2006

Coping with condom embarrassment.

This study assesses the embarrassment associated with purchasing, carrying, storing, using and disposing of condoms. It incorporates coping theory into the investigation of embarrassment by analysing the strategies individuals use to cope with embarrassment during condom purchase. The results of a survey show that individuals are embarrassed at various stages related to condom use. Purchasing condoms elicits the most embarrassment, followed by carrying and disposing, while using and storing are the least embarrassing. To cope with their embarrassment while purchasing condoms, people use multiple cognitive and behavioural coping strategies, with embarrassed people using more strategies. Both embarrassment and the number of strategies used decrease with age and experience. It appears that embarrassment associated with condoms remains a barrier to condom acquisition and consistent condom use, particularly among young adult populations. Coping strategies help individuals to bridge the gap between embarrassment and use.

Adaptation, Psychological↗
PubMed2006

Sexual behaviour and condom use among unmarried young men in Cambodia.

The objective of this paper is to describe the sexual behaviour of 665 unmarried men aged 15-24, and explore factors associated with condom use at last intercourse. We use data from a cross-sectional survey conducted in economically marginal areas of Phnom Penh and Kratie town, Cambodia. One-third of respondents reported intercourse and half had had sex by the time they were 23. Of these, 39% had given money or gifts in exchange for sex. Transactional sex often occurred in the company of other males, and condom use was higher among those males compared with those who were alone. Of all sexually active respondents, half reported three or more partners, and 71% used a condom at last sex. Regression results showed that condom use varied by type of partner, was less likely among males outside the education system, and higher among those more positive and informed about condoms. Our findings highlight the need for HIV prevention efforts to encourage young men to use condoms with all intimate partners, promote advantages of condoms for both disease and pregnancy prevention, and address the needs of young men no longer in education. Further research, to understand the positive influence that peers have on condom use in certain circumstances, would be useful.

Adolescent↗
PubMed2006

A conceptual model of women's condom use intentions: Integrating intrapersonal and relationship factors.

We developed and tested a multifaceted model of condom use intentions with cross-sectional data from 435 heterosexual women at risk for HIV/STIs. In addition to traditional intrapersonal variables drawn from established models of HIV prevention (e.g. attitudes, norms, self-efficacy), the present study examined the role of relationship factors and dynamics (i.e. relationship commitment, duration, condom use and pregnancy prevention decision-making) in shaping condom use intentions. In some cases, relationship variables were directly associated with condom use intentions. In other cases their effects on condom use intentions were mediated by intrapersonal constructs. The final model accounted for 66% of the variance in condom use intentions and confirmed the importance of integrating intrapersonal variables and relationship characteristics and dynamics in understanding women's intentions to use condoms. These results offer important insights for the design of interventions directed at promoting condom use among young women at risk for HIV/STIs and underscore the need to design prevention programs that address relationship characteristics and dynamics.

Adolescent↗
PubMed2004

The condom in relation to prevention of sexually transmitted infections and as a contraceptive method in Sweden.

OBJECTIVE: To analyze in detail the latest Swedish population survey regarding condom use in order to gain a deeper knowledge of the characteristics of women and men using or not using condoms at a time when the number of sexually transmitted infections (STIs) had started to increase. METHODS: From a population-based survey of sexual life in Sweden among men and women aged between 18 and 74 years (n = 2810), we investigated the use of condoms in relation to social demographic, lifestyle, sexual and behavioral characteristics. RESULTS: In the age group 18-49 years, every third person had experience of a legal abortion and every fourth had had an STI. Overall, use of condoms was 12% in the whole population and 15% in the age group 18-49 years. Using a condom as a method of contraception, as opposed to other methods, was found to be less frequent in six subgroups: when coitus was less frequent, age above 25 years, among those who had had many partners and those with earlier experience of abortion or STI, as well as having a risky behavior. Using a condom as a preventive against contracting an STI occurred less often in women and men older than 25 years and among those having coitus more frequently. CONCLUSION: Even with good information and easy accessibility to condoms, there are still obstacles to their use. To achieve the aim of safer sexual practice, it is a challenge for the couple as well as for counselors to reason about the advantages and disadvantages of not using a condom. Discussions about attitudes, behavior and gender differences must be continued and emphasized in coming generations, both on the individual and on a societal level, in order to achieve safer sexual practice.

Adolescent↗
PubMed2001

Predicting condom use with casual and steady sex partners among drug users.

In many Western societies, drug users are accountable for heterosexual transmission of HIV. Although various studies have shown that safe sex is not a common practice among drug users, we still have little understanding of the factors that determine their use of condoms in their sexual relationships with steady or casual partners. The objective of this study is to gain more insight into the determinants of drug users' condom use with steady and casual sex partners. In a study conducted among 103 Dutch drug users, the participants indicated their intentions, vulnerability, attitude, personal norms, subjective norms, descriptive norms, self-efficacy and response efficacy regarding condom use with steady and casual partners. The results showed that some drug users had borrowed used syringes and that most drug users practise unsafe sex, especially with steady partners. Most drug users were hardly motivated to start using condoms. The study further showed that antecedents of condom use differ with regard to steady sex partners and casual sex partners. Self-efficacy and subjective norms were predictors of intentions to use condoms with steady partners; intention to use condoms with casual partners was only predicted by self-efficacy. These differences should be taken into account when designing AIDS prevention interventions to encourage use of condoms.

Adult↗
PubMed1992

Subjective norms about condoms are better predictors of use and intention to use than attitudes.

In a study of the applicability of the Theory of Reasoned Action to condom use, 173 homosexually active men were administered a questionnaire assessing attitudes toward and intentions to use condoms, behavioral beliefs about condoms, and subjective norms and normative behavior regarding condom use. Results indicated that attitudes toward condoms were poor predictors of intention to use condoms, but that subjective norms were good predictors of intention. Previous condom use was a good predictor of intention to use. These data suggest that interventions which emphasize peer-based education are likely to be more useful than those which attempt to alter behavioral beliefs about, and attitudes toward, condoms.

Adolescent↗