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PubMed2005

Modeling censored-in-the-middle condom use data.

Many HIV prevention programs seek to reduce the risk of infection through increases in condom use. Condom use is often expressed as a proportion: the number of sexual contacts in which a condom is used divided by the total number of sexual contacts. The distribution of this proportion has several undesirable characteristics-the principal one is bimodality. Bimodality results from excessive numbers of 0% and 100% responses, creating distributions that are censored-in-the-middle. The purpose of this paper is to show how censored condom use data can be usefully modeled using Tobit regression. Tobit regression first transforms observed variable scores into latent variable scores, scores on an unobserved, hypothetical condom use variable, and then the latent variable scores are modeled using one or more explanatory variables. Data from the National Institute on Drug Abuse Cooperative Agreement for HIV/AIDS Community-Based Outreach/Intervention Research program for frequency of condom use and number of drug injecting sex partners were used to illustrate the method. We found that for every additional drug injecting sex partner, the probability of using condoms decreased by approximately 1%.

Condoms↗
PubMed2006

Condoms + pleasure = safer sex? A missing addend in the safer sex message.

Since the emergence of HIV, sexual risk-reduction intervention and prevention programmes have promoted the 'condoms equal safer sex' message with a particular focus on the preventative aspects of condoms (i.e. disease or pregnancy prevention). Yet despite the pervasiveness of this message, research has found that most people fail to use condoms consistently. Using the thought-listing technique, we asked men who have sex with men (MSM) and heterosexuals to list thoughts that immediately came to mind when thinking about condoms. Results show that MSM have more sexual/sensory associations to condoms than heterosexuals, suggesting that interventions highlighting the sexual/sensory aspects of condoms might be an important component to increase condom use among MSM while a combined approach (i.e. messages that integrate preventative, interpersonal, and sexual/sensory components) might be more appealing to heterosexuals.

Adolescent↗
PubMed2006

Explaining the increase in condom use among South African young females.

Since 1998 South Africa has experienced stability in HIV prevalence among its 15 to 19 year olds, and to a lesser extent among its 20 to 24 year olds. While a few studies point to behavioural change, mainly an increase in condom use, none has established the reasons. This article explores the influence of various information sources about AIDS upon the use of condoms among rural and urban South African young females, using the South Africa Demographic Health Survey of 1998 (1998 SADHS), while controlling for various socioeconomic and cultural parameters. The results show that condom use among urban residents was positively correlated with mass media exposure, television as a source of information about AIDS, and the number of mass media sources from which the respondent received information about AIDS. Condom use among rural residents was associated with the number of sources of information about AIDS, exposure to mass media, and the language and education of the respondent. Among urban residents condom use was almost twice as high as among rural residents. The results from the article indicate that three elements influenced the increase in condom use among females: the threat of AIDS, mass media, and receptiveness to condom use. The receptiveness was culturally dependent.

Adolescent↗
PubMed2005

Obstacles to condom use among secondary school students in Maputo city, Mozambique.

This study explores how urban youth in Mozambique perceive their sexual behaviour and identifies the factors that hinder them from having safer sex in the context of HIV/AIDS, with special emphasis on the condom use. Data was collected form high school students in Maputo, Mozambique. Using a combination of focus group discussions, interviews and informal conversations, it was possible to identify that one major obstacle to the use of condoms was young people's belief that they did not have to use condoms in steady relationships built on love and trust. Trust and love provide a sense of immunity to infection. Such a perception is reinforced, it is argued, by previous HIV/AIDS campaigns in Mozambique that have advocated the use of condoms only with 'occasional sexual partners'. Students' understandings of pleasure, lack of accurate information, lack of sex education at home and at school, and gender inequalities further contribute to making condom use a difficult issue. There should be a change in focus in condom campaigns. Efforts should also be made to encourage young people to 'emotionally invest' in their health by using condoms.

Adolescent↗
PubMed2006

The intent and practice of condom use among HIV-positive men who have sex with men in Japan.

To evaluate the intent and practice of condom use among Japanese HIV-positive men who have sex with men (MSM), a survey using anonymous questionnaires was carried out and 117 respondents were investigated. For anal sex and oral sex, respectively, 58.1% and 15.2% intended to use condoms and 47.2% and 12.4% used condoms all of the time. The intent of condom use decisively affected the practice of condom use and was closely related to the perceived risk level of HIV/sexually transmitted (STI) transmission. In anal sex, willingness to protect sexual partners from HIV infection was strongly related not only to the intent but also to the practice. Enhancement of willingness to protect oneself from STI was suggested to enhance willingness to protect his/her sexual partners from HIV infection with secondary enhancement of the intent or the practice of condom use. Specific support of MSM with HIV for improving the intent and practice of condom use is urgently needed.

Adult↗
PubMed2003

Efficacy of the female condom as a barrier to semen during intercourse.

In 1996-1998, the authors measured prostate-specific antigen (PSA) in vaginal fluid to assess the frequency of female condom failure and to evaluate the association of self-reported failure with semen exposure. Women at low risk of sexually transmitted diseases (n = 210) were recruited in Birmingham, Alabama. They were trained to use the female condom, sample vaginal fluid before and after condom use, and complete forms to report problems during each use. Semen exposure was assessed by comparing pre- and postcoital PSA levels in vaginal fluid. A total of 175 women used 2,232 condoms. The rate of semen exposure ranged from 7% to 21% of condom uses, depending on the exposure criterion. Exposure was more likely (21-34%) and more intense (mean postcoital PSA, 24.7 ng/ml) if participants reported a mechanical problem versus other problems or no problems (exposure rate, 5-20% in both instances; mean postcoital PSA, 9.6 and 7.8 ng/ml, respectively). In logistic regression analyses for repeated measurements, user-reported problems accounted for less than 59% of the instances of semen exposure. The female condom prevented semen exposure in 79-93% of condom uses. Exposure was associated with user-reported problems but also occurred in their absence. Reported problems and semen exposure decreased with user experience.

Adult↗
PubMed2005

Application of the case-crossover design to reduce unmeasured confounding in studies of condom effectiveness.

This analysis examined how unmeasured confounding affects estimates of the effectiveness of condoms in preventing sexually transmitted infections. Data were analyzed from a prospective cohort study of 1,122 female sexually transmitted disease clinic patients in Alabama (1992-1995), wherein participants were evaluated for sexually transmitted infections at six 1-month intervals. Associations between condom use and incident gonorrhea and chlamydia infection were compared between case-crossover and cohort analyses. In a case-crossover analysis of 228 follow-up visits ending in gonorrhea/chlamydia ("case intervals") and 743 self-matched follow-up visits not ending in gonorrhea/chlamydia ("noncase intervals") (183 women), consistent condom use without breakage or slippage was associated with significantly reduced risk of infection relative to nonuse (adjusted risk odds ratio = 0.49, 95% confidence interval: 0.26, 0.92). Conversely, a cohort analysis of 245 case intervals and 3,896 noncase intervals (919 women) revealed no significant reduction in infection risk from consistent use of condoms (adjusted risk odds ratio = 0.79, 95% confidence interval: 0.53, 1.17). Dose-response relations between the number of unprotected sex acts and infection were stronger in the case-crossover analysis (p for trend = 0.009) than in the cohort analysis (p for trend = 0.18). These findings suggest that epidemiologic studies confounded by unmeasured differences between condom users and nonusers underestimate condom effectiveness against these infections. The case-crossover method provides an additional technique for reducing unmeasured confounding in studies of condom effectiveness.

Adult↗
PubMed2006

Male heterosexual crack smokers with multiple sex partners: between- and within-person predictors of condom use intention.

Little research has examined predictors of condom intention within concurrent partnerships. This study examined predictors of intention among 259 male African-American crack smokers with multiple partners. Each participant reported personal condom intention at next sex, condom use self-efficacy, responsibility and outcome expectances for himself and his perceptions for his last two sex partners. Stepwise logistic regressions showed that for both partners one and two, condom use at last sex and personal responsibility for condom use were predictors of intention to use condoms at next sex. Perceived partner responsibility was an additional positive predictor with Partner 2. Hierarchical generalized linear model analyses showed that positive intention was associated negatively with perceived partner responsibility and intimacy, while positively related to situational self-efficacy. Personal responsibility interacted with intimacy such that only men who indicated the highest levels of intimacy were more likely to intend to use condoms. Overall, the findings in this study support the need for examining additional social cognitive constructs that capture the interpersonal aspects of sexual relationships such as personal and perceived responsibility, intimacy and how beliefs may change between multiple partners and across time. Finally, the differences in the valence of perceived partner responsibility across analyses and the interaction of personal responsibility with intimacy suggest the need for studies that include measure of power within the relationship.

Adult↗
PubMed2001

Long-term effectiveness of a peer-based intervention to promote condom and contraceptive use among HIV-positive and at-risk women.

OBJECTIVE: The authors used data from a larger study to evaluate the long-term effects of a peer advocate intervention on condom and contraceptive use among HIV-infected women and women at high risk for HIV infection. METHODS: HIV-infected women in one study and women at high risk for HIV infection in a second study were selected from the Women and Infants Demonstration Project and assigned to a standard or an enhanced HIV prevention treatment group. The enhanced intervention included support groups and one-on-one contacts with peer advocates tailored to clients' needs. The authors interviewed women at baseline and at 6-, 12- and 18-months, and measured changes in consistency of condom and contraceptive use and in self-efficacy and perceived advantages and disadvantages of condom and contraceptive use. RESULTS: Of HIV-infected women, the enhanced group had improved consistency in condom use, increased perceived advantages of condom use, and increased level of self-efficacy compared with the standard group. Of women at risk, the enhanced intervention group at six months maintained consistent condom use with a main partner and perceived more benefit of condom use compared with the standard group. These differences diminished at 12 months. CONCLUSIONS: The enhanced intervention was generally effective in the HIV+ study. In the at-risk study, however, intervention effects were minimal and short-lived. Factors related to the theory, intervention design, and sample characteristics help explain these differences.

Adolescent↗
PubMed2002

Incidence of acute urinary tract infection in young women and use of male condoms with and without nonoxynol-9 spermicides.

BACKGROUND: Acute urinary tract infection is one of the most common infections seen in primary care. METHODS: We conducted a nested case-control study among a cohort of 519 women, ages 15-29 years, enrolled in a contraceptive acceptability study to examine whether recent use of male condoms increases urinary tract infection risk. RESULTS: One hundred sixty-five incident urinary tract infections were identified during 12-month follow-up periods in a cohort study that was conducted between 1996 and 1999. After exclusions for urinary tract infection recurrences, pregnancy, antibiotic use, diabetes, diaphragm/cervical cap use, or urinary tract abnormalities, there were 100 cases and 200 controls. Compared with women not using barrier methods (and after adjustment for age, urinary tract infection history, hormonal method use, and frequency of sex) the odds ratio (OR) for any reported use of condoms coated with spermicide (Nonoxynol-9) in the previous 30 days was 2.8 (95% [confidence interval] CI = 1.2-6.5). The OR was 11.5 (95% CI = 2.5-53) for exclusive Nonoxynol-9-coated condom use. The OR for exclusive use of non-Nonoxynol-9-coated condoms was 7.4 (95% CI = 1.6-35). CONCLUSIONS: In this study, use of male condoms was associated with increased urinary tract infection risk; the largest risk was associated with exclusive condom use and use of Nonoxynol-9-coated condoms.

Acute Disease↗
PubMed1994

Consistent condom use in relationships between seropositive injecting drug users and sex partners who do not inject drugs.

OBJECTIVES: To study how condom use in injecting drug users' (IDU) relationships differs according to whether they are HIV-infected, and to whether their sex partner is an IDU. DESIGN AND METHODS: A total of 317 street-recruited IDU were HIV-antibody tested and interviewed about 421 relationships with particular sex partners. RESULTS: Condoms were consistently (100%) used in sex between partners (during the previous 30 days) in 33% of these relationships, and their use was significantly more frequent in relationships of seropositive IDU and in relationships with non-IDU partners. In relationships between seropositive IDU and non-IDU, consistent condom use was reported to be high (68%); this remained unchanged under multivariate controls. CONCLUSIONS: Self-reported condom use by IDU in New York, with its relatively mature epidemic, appears to be concentrated where it may most reduce the spread of HIV to non-IDU heterosexuals, i.e., in relationships between infected IDU and non-IDU partners. Differential condom use by serostatus and by partners' drug injection should be incorporated into mathematical models of the HIV epidemic. Causes of the high level of condom use in this subset of relationships may include drug injector altruism and pressure by sex partners; prevention programs should develop ways to use both of these factors to motivate increased condom use.

Adult↗
PubMedDate not supplied

Who knows more about condoms? A comparison between nursing students, education students, and at-risk adolescents.

PURPOSE: To examine knowledge regarding appropriate use of condoms and lubricants among three groups: female at-risk adolescents, nursing students, and education students. METHODS: Study participants were 236 adolescents: 65 recruited through community agencies, 79 female nursing students, and 92 female education students. These participants completed anonymous questionnaires concerning lubricants, general condom knowledge, and sexual experience. RESULTS: Neither nursing students nor education students were more knowledgeable than adolescents not enrolled in college. All participants were about as likely to think unsafe lubricants were safe as they were to think that safe lubricants were unsafe. Personal experience with vaginal intercourse and condom use was associated with increased knowledge (p < 0.05). However, 27% to 66% of participants who had used condoms answered the lubricant questions incorrectly. IMPLICATIONS: Nursing students need more education about condoms and condom lubricants if they intend to teach patients effectively. Moreover, nurses should not assume that youth are knowledgeable about appropriate condom use based on their level of education or sexual experience.

Adolescent↗
PubMedDate not supplied

Condom use and use-effectiveness in high-risk populations.

In vitro evidence strongly suggests that latex condoms provide an impenetrable barrier for the passage of infectious agents, but few have studied the use-effectiveness of condoms in preventing sexually transmitted diseases. In 1971, a prospective evaluation of the condom failed to demonstrate efficacy against infections with gonorrhea because users were exposed to infectious secretions before the condom was used. An ongoing multicenter study of female prostitutes in the United States shows that none of 22 women who always use condoms with all male partners has antibody to human immunodeficiency virus (HIV), but differences in HIV antibody status by patterns of condom use are not statistically significant. An educational campaign to promote the proper and consistent use of condoms as prophylactics is needed to stop the spread of gonorrhea, infections with HIV, and other sexually transmitted diseases.

Centers for Disease Control and Prevention, U.S.↗
PubMed1997

Use and effectiveness of condoms during anal intercourse. A review.

BACKGROUND AND OBJECTIVES: Anal intercourse has been associated with a high risk of human immunodeficiency virus transmission. Survey data suggest that unprotected anal intercourse is practiced by a substantial proportion of the sexually active population, regardless of sexual orientation. GOAL: To review the literature related to the use and effectiveness of condoms during anal intercourse, with emphasis on prevention of human immunodeficiency virus transmission. STUDY DESIGN: Literature review. RESULTS: Epidemiologic studies have shown that consistent, correct condom use reduces the overall risk of sexual transmission of human immunodeficiency virus. Evidence for the effectiveness of condoms used during anal intercourse is less definitive. Survey and clinical trials data indicate that condom breakage and slippage rates vary during anal intercourse and may be considerably higher than during vaginal intercourse. Although condoms designed for anal intercourse have been studied and marketed in Europe, data on their actual performance are scarce. In addition, no information exists on the effectiveness of polyurethane or other nonlatex condoms for use during anal intercourse. CONCLUSIONS: Development of newer and more effective condoms for use during anal intercourse requires consideration of the ethical issues involved in testing and marketing devices used during an activity that carries with it the potential for a substantial risk to health.

Condoms↗
PubMed2002

Promoting condoms for oral sex: impact on pharyngeal gonorrhea among female brothel-based sex workers.

BACKGROUND: Low condom use for oral sex among female brothel-based sex workers in Singapore has led to a rise in pharyngeal gonorrhea. GOAL: The goal of the study was to evaluate a program promoting the use of condoms for oral sex. STUDY DESIGN: We used the time-series design to compare condom use and pharyngeal gonorrhea trends before and after program intervention in 1996 and the pretest-posttest matched control group design to determine the impact of brothel interventions on sex workers. RESULTS: Consistent oral condom use increased significantly from 42.2% in 1996 to 89.9% in 2000, with a corresponding decline in pharyngeal gonorrhea (in comparison with no significant changes before intervention). Among sex workers in brothels with interventions there was a 10.8% absolute increase in condom use, compared with an 11.7% decrease in condom use in the control group. The gonorrhea incidence rate was also significantly much lower in the intervention group than in the control group (adjusted risk ratio: 0.22; 95% CI: 0.06-0.78). CONCLUSION: The intervention increased oral condom use, with a decline in the incidence of pharyngeal gonorrhea.

Adult↗
PubMed2002

Adolescent condom use and perceptions of risk for sexually transmitted diseases: a prospective study.

BACKGROUND: The authors' previous research has shown that in cross-sectional analysis, partner-specific perceptions of risk for gonorrhea and chlamydial and HIV infection correlated with partner-specific intentions to use condoms. GOAL: The goal was to determine whether partner-specific measures of perception of risk for STDs (PRSTD) predict partner-specific condom use 6 months later among high-risk and low-risk youth. STUDY DESIGN: Youths aged 14 to 19 years were recruited from an STD clinic (n = 236) and an HMO teen clinic (n = 306) and were interviewed at baseline and at 6 months about PRSTD, attitudes about condoms, self-efficacy, normative expectations, and condom use. RESULTS: PRSTD with a main sex partner was an independent predictor of condom use with a main sex partner in the STD clinic cohort (odds ratio = 2.5; 95% CI = 1.1-6.2). There was no association between PRSTD with a casual sex partner and condom use in this cohort or between PRSTD for main or casual sex partners and condom use in the HMO teen clinic cohort. CONCLUSION: Interventions that target high-risk adolescents should focus on PRSTD with a main sex partner.

Adolescent↗
PubMed2004

Condom use by women recently diagnosed with a sexually transmitted infection: effects of study methodology on the apparent influence of hormonal/surgical contraception.

OBJECTIVE/GOAL: The objective of this study was to investigate potential predictors of consistent condom use (CCU), including the influence of hormonal contraception/surgical sterilization (HC/SS). STUDY: Regression methods were used to predict CCU and other measures of CU among 214 sexually active, 18- to 45-year-old women previously diagnosed with a sexually transmitted infection. RESULTS: CCU was significantly associated with younger age, African American ethnicity, having casual partners, recent HIV testing, condom use self-efficacy, and concern about partner relationship. HC/SS was not significantly associated with the likelihood of CCU, before (HC/SS, 21.3%, non-HC/SS, 25.3%; odds ratio [OR], 0.798; P=0.4914) or after (OR, 1.209; P=0.5995) controlling for confounders (age, ethnicity, casual partners). Controlling for age and ethnicity eliminated initial significant or near-significant inverse associations between HC/SS and 3 alternative measures of interval condom use ("any use," "number of unprotected acts," "proportion condom-protected contacts") and substantially diminished the association between HC/SS and "condom use at last sex." CONCLUSIONS: Choice of condom use measure and control of confounding variables can substantially affect results when studying potential predictors of condom use such as HC/SS.

Adolescent↗
PubMed2006

Factors associated with self-efficacy for condom use and sexual negotiation among South african youth.

OBJECTIVES: To use logistic regression modeling to identify factors associated with high self-efficacy for sexual negotiation and condom use in a sample of South African youth. METHODS: The Reproductive Health and HIV Research Unit (RHRU) National Youth Survey examined a nationally representative sample of 7409 sexually active South African youth aged 15 to 24 years. We used logistic regression modeling in this sample to identify factors associated with the main outcome of high self-efficacy. RESULTS: Among female respondents (n = 3890), factors associated with high self-efficacy in the adjusted model were knowing how to avoid HIV (odds ratio [OR] = 2.30, 95% confidence interval [CI]: 1.05 to 5.00), having spoken with someone other than a parent or guardian about HIV/AIDS (OR = 1.46, 95% CI: 1.01 to 2.10), and having life goals (OR = 1.28, 95% CI: 1.10 to 1.48). Not using condoms during their first sexual encounter (OR = 0.61, 95% CI: 0.50 to 0.76), a history of unwanted sex (OR = 0.66, 95% CI: 0.51 to 0.86), and believing that condom use implies distrust in one's partner (OR = 0.57, 95% CI: 0.51 to 0.86) were factors associated with low self-efficacy among female respondents. Male respondents (n = 3519) with high self-efficacy were more likely to take HIV seriously (OR = 4.03, 95% CI: 1.55 to 10.52), to believe they are not at risk for HIV (OR = 1.38, 95% CI: 1.12 to 1.70), to report that getting condoms is easy (OR = 1.85, 95% CI: 1.23 to 2.77), and to have life goals (OR = 1.30, 95% CI: 1.10 to 1.54). Not using condoms during their first sexual experience (OR = 0.51, 95% CI: 0.39 to 0.67), a history of having unwanted sex (OR = 0.47, 95% CI: 0.34 to 0.64), believing condom use is a sign of not trusting one's partner (OR = 0.63, 95% CI: 0.46 to 0.87), and refusing to be friends with HIV-infected persons (OR = 0.52, 95% CI: 0.32 to 0.85) were factors associated with low self-efficacy among male respondents in the fully adjusted model. CONCLUSIONS: We used the social cognitive model (SCM) to identify factors associated with self-efficacy for condom use and sexual negotiation. Many of these factors are modifiable and suggest potential ways to improve self-efficacy and reduce HIV sexual risk behavior in South African youth.

Adolescent↗