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PubMed1993

How many people actually use condoms? An investigation of motel clients in Managua.

Motels in Nicaragua are popular venues for both commercial and non-commercial sexual encounters and thus provide a potential location for the spread of sexually transmitted agents, including the human immunodeficiency virus. Condoms are known to be effective barriers against these infections, but are infrequently used by Nicaraguans. We interviewed all motel owners in one district of Managua and in five randomly selected motels ascertained, by retrieval and inspection, actual rates of condom use by clients. Six out of 26 establishments initially supplied condoms: when provided on entry to the motel condoms were used in 37% of observed encounters. Condom use can be assessed objectively in certain circumstances and this method can provide a reliable outcome measure for condom promotion programmes.

Condoms↗
PubMed1994

Contextual and interactional factors influencing condom use in heterosexual prostitution contacts.

The protection behavior of prostitutes and prostitutes' clients has been studied from a contextual and an interactional point of view. Different protection styles (subject's cognitive and behavioral position regarding condom use) have been identified in both prostitutes (N = 119) and clients (N = 91). Risk-taking prostitutes were found to have the least favorable working conditions, to have the highest financial need, to have the lowest levels of well-being and job satisfaction and to have been victimized more often than consistent condom users and selective risk-taking prostitutes. Consistent condom users among the clients were found to be better educated, to have a less strong external Health Locus of Control, to evaluate condoms and visiting prostitutes more positively, and prostitutes less negatively, and to have more fear of AIDS than non-consistent condom using clients. Various protection styles were found to be thoroughly intertwined with different interaction scenarios. Four different interaction scenarios (a standard, a romantic, a friendship and a fighting scenario) with a different chance of condom use are set forth. It is shown that the scenario approach gives good insight into the process by which unsafe sex in commercial contacts comes about. For both actors, the context and the meaning of prostitution influence the way they play the game. The interaction and its outcome in their turn reinforce their attitudes towards prostitution. Implications for AIDS prevention are discussed.

Adult↗
PubMed1996

Types of adolescent sexual relationships and associated perceptions about condom use.

PURPOSE: The purpose of this study was to describe the various types of adolescent sexual relationships and to examine the association between the type of sexual relationship and adolescents' perceptions about the consistency with which other adolescents use condoms. METHODS: Adolescents attending a university-based adolescent medicine clinic completed a self-administered questionnaire. Subjects were asked to rate the importance of six qualities (caring about each other, length of time of relationship, ability to talk about anything, ability to talk about sex and condoms, doing things together, and attraction to partner's looks) for each of four different types of sexual relationships (steady, casual, friends, and "one-night stands"). Subjects were also asked to estimate the frequency with which adolescents use condoms with each type of sexual partner. RESULTS: Questionnaires were completed by 75 sexually experienced adolescents. The mean age of the sample was 16.6 years, and 41.3% were male. All qualities, except attraction to partner's looks, were rated more important for steady partners compared with the other partner types, and more important for sexual relationships with casual partners and friends than for "one-night stands" (p < .001). Sexually experienced subjects believed that condoms are used less frequently with steady partners and more frequently with "one-night stands" (p < .001). CONCLUSIONS: Interventions designed to increase the consistency with which adolescents use condoms should take into account the different types of sexual relationships, each with distinct expectancies about the consistency of condom use.

Adolescent↗
PubMed2005

Brief report: the effects of condom insistence on the perceptions of adolescents in first time and repeated occasions of sexual intercourse.

The research reported here replicated Hocking et al. (Journal of Adolescence 22 (1999) 355) and further examined the effects of insisting on condom usage, by expanding the experimental conditions under which condom use occurs to include repeated sexual encounters in ongoing relationships. In Study 1, Hocking et al. (Journal of Adolescence 22 (1999) 355) results were replicated. In Study 2, using identical procedures, participants imagined engaging in sexual intercourse in which their partner of 3 months either insisted on the continued use of a condom or requested that no condom be used. Results for Study 2 were such that participants in the condom insistence conditions reported greater feelings of positivity about themselves, their partners, and the sexual experience, than participants whose partners did not insist on condom use during sex.

Adult↗
PubMed2006

Short-term acceptability of the PATH Woman's Condom among couples at three sites.

PURPOSE: The objective of this study is to evaluate acceptability of the PATH Woman's Condom among user populations in Mexico, South Africa and Thailand. METHODS: A nonrandomized, nonblinded, nonsignificant risk study was conducted among 20 couples per site. Data were collected via structured questionnaires after the first, second and third condom uses and through in-depth interviews after all condoms were used. RESULTS: Women from all sites reported that the PATH Woman's Condom was easy and comfortable to insert, and the pouch and ring were very stable during use. Both women and men reported that the comfort and sensation of sex while using the condom was acceptable. CONCLUSIONS: The PATH Woman's Condom is easy to use, stable during use, comfortable and satisfactory during sex among users from diverse populations and cultures. The iterative user-driven product development process helped ensure that this new product addresses a wide range of user preferences.

Single-Use Internal Condom↗
PubMed2006

Short-term acceptability of the Reality polyurethane female condom and a synthetic latex prototype: a randomized crossover trial among South African women.

PURPOSE: This multisite, randomized, crossover trial comparing the acceptability of the Reality(R) female condom (FC1), with a new synthetic latex prototype (FC2) of similar design and appearance to FC1, was conducted in Durban, South Africa. METHODS: In total, 276 women were enrolled and 1910 FC1 condoms and 1881 FC2 condoms were used by 218 and 216 women, respectively. RESULTS: Overall experience of use was reported as good for over half the participants with both condom types (FC1=50.9%, FC2=55.1%). Similar acceptability issues were reported in like proportions for FC1 and FC2, with features such as the lubricant (FC1=36.7%, FC2=37.0%) and the material (FC1=36.2%, FC2=29.2%) most commonly viewed positively for both condom types. Negative aspects commonly reported for both female condoms were the lubricant (FC1=30.3%, FC2=31.5%) and the appearance (FC1=29.8%, FC2=34.0%). Preference for FC1 was 29.5% and was slightly higher for FC2 (36.6%). Some women felt that there was no real difference between the two devices (33.8%). CONCLUSION: The acceptability of FC1 and FC2 was comparable, and women who find FC1 acceptable to use should also find FC2 acceptable.

Adult↗
PubMed2006

Knowledge about condoms among low-income pregnant Latina adolescents in relation to explicit maternal discussion of contraceptives.

PURPOSE: To examine pregnant adolescents' conceptual knowledge about condom use and its relation to maternal implicit and explicit communication about contraceptives. METHODS: Forty-five pregnant Latina adolescents (aged 14 to 18 years) were interviewed regarding their knowledge about how condoms prevent pregnancy. In addition, the adolescents were videotaped having a conversation with their mothers (23 English-speaking, 22 Spanish-speaking) about dating and sexuality, which was coded for maternal explicit and implicit messages about contraception. RESULTS: A more detailed, accurate understanding of how condoms work, and the ability to explicitly describe that knowledge, was associated with adolescents reporting higher levels of confidence about using condoms, and increased comfort talking to partners about condoms. Mothers' explicit mention of contraception was related to their adolescents having detailed, accurate information about condoms. Among Spanish-speaking dyads only, maternal explicit messages were associated with adolescents using more explicit terminology in describing their knowledge. CONCLUSIONS: Study results have implications for intervention with a high-risk population of Latina mothers and adolescents. The study also highlights the importance of examining specific aspects of knowledge, namely conceptual, biological knowledge.

Adolescent↗
PubMed2006

Condom use with "casual" and "main" partners: what's in a name?

OBJECTIVE: This study examined adolescents' attitudes about and behaviors toward condom use with "casual" vs. "main" sexual partners. METHOD: Participants were sexually active adolescents aged 15-21 years (n = 1316) recruited from primary care clinics and through outreach activities in three major cities in the United States. Assessment of condom use within the past 90 days, relevant attitudes, substance use, and demographic data were obtained via audio computer-assisted self-interview (ACASI). RESULTS: Participants were divided into two groups: the 65% who reported main partners only (MP group) and the 35% who had at least one casual partner (CP group). Adolescents in the MP group were more likely to be female, whereas males were significantly more likely to report casual partners. Race/ethnicity, age, education level, household income, and sexually transmitted infection (STI) history were unrelated to group status (i.e., sexual partner type). Greater substance use and riskier attitudes were reported by teens in the CP group. The number of unprotected sex acts in the past 90 days was substantial and equivalent between the main and casual partner groups (19.2 vs. 21.5, respectively). Regression analyses revealed that perceptions of main partner attitudes toward condom use and condom use expectations were significantly related to condom use with MPs, but that attitudes were not related to condom use with CPs. CONCLUSIONS: Adolescents with either casual or main partners may be at continued risk for contracting human immunodeficiency virus (HIV) and STIs, given high rates of unprotected sex. Interventions that do not target attitudes and practices related to casual partners as compared with main partners may miss an opportunity to change risk behaviors. This study demonstrates the importance of understanding an adolescent's perception of partner types in order to design effective interventions.

Adolescent↗
PubMed2004

Does knowledge about sexually transmitted infections increase the likelihood of consistent condom use?

BACKGROUND: We aimed to assess the association between knowledge about sexually transmitted infections (STIs) and consistent condom use among university students controlling for selected socio-demographic factors. METHOD: An anonymous questionnaire survey was carried out among 720 undergraduate students (76% women) at the University of Tirana, Albania, in October-November 2002. The questionnaire included socio-demographic data, 10 multiple-choice test questions on knowledge about STIs, sexual activity and use of condoms. Two hundred seventy-nine students reported having sexual experience and provided data on condom use as well as knowledge about STIs. Binary logistic regression was used to assess the "independent" association between knowledge about STIs and condom use. RESULTS: In multivariable models, there was an overall association of knowledge about STIs with consistent condom use (OR = 1.74, 95% CI = 1.37-2.23, P < 0.001). There was evidence for an interaction between knowledge and parental education (P = 0.04): there was a positive association among students with highly educated parents (OR = 1.48, 95% CI = 1.11-1.99, P = 0.01), and particularly so among students with low-and-middle educated parents (OR = 4.75, 95% CI = 2.03-11.08, P < 0.01). CONCLUSIONS: Knowledge about STIs is an independent predictor of consistent condom use among university students. Augmentation of knowledge per se should be a component of school-based prevention programs along with the intensification of efforts toward improving students' sexual practices.

Adolescent↗
PubMed2001

Intimate relationship characteristics associated with condom use among drug users and their sex partners: a multilevel analysis.

Few studies have examined sexual risk behaviors among drug users in the context of their primary sexual relationships. The aim of this study is to examine characteristics of sexual partners associated with inconsistent condom use among a sample of 703 cocaine and opiate users from Baltimore, MD who participated in a network oriented intervention study of human immunodeficiency syndrome (HIV) risk behaviors among drug users. The current study examines relationship characteristics between drug users and their sexual partners (n=1003). Some of the study participants had more than one sexual partner, accounting for the greater number of sexual pairs than study participants. Study participants reported using multiple drugs (56% injected, 48% sniffed heroin, and 48% smoked crack) and that 70% of their sexual partners also used heroin and/or cocaine. Forty percent reported consistent condom use in the past 3 months. In multiple logistic regression, characteristics associated with consistent condom use were, the drug user being HIV infected; not living with their sexual partners; and not being financially interdependent. Previous research has demonstrated lower rates of condom use with main compared with casual and exchange partners. Primary sexual partners provide a sense of stability and introducing condoms may not be desirable or realistic. HIV prevention programs that target drug users should focus on the benefits, such as trust and a sense of security, and risks of not using condoms in primary relationships. Programs should also focus on enhancing communication and negotiation skills through targeting individuals as well as couples.

Adolescent↗
PubMed2006

The 100% condom use programme in Asia.

One of the main reasons for the rapid spread of HIV in Asian countries is the massive transmission among sex workers and clients. Therefore, effective interventions to prevent HIV transmission through sex work are necessary. Many efforts have been made to promote condom use in sex work. The most significant approach is the 100% Condom Use Programme. Since its conception in 1989, this programme has been implemented in Thailand, Cambodia, Philippines, Viet Nam, China, Myanmar, Mongolia and Laos PDR, with variations in programme components between countries. The main principle is to promote the practice of "No condom - No sex" in all types of sex work, through collaboration between local authorities, sex business owners and sex workers. Variations include formation of sex workers' self-help groups, peer education and issuance of membership cards by local authorities. Sex workers are empowered when they are able to refuse sex without a condom. In Thailand, the programme has increased the use of condoms in sex work from 14% in early 1989 to over 90% since 1992. The 100% Condom Use Programmes in Thailand and Cambodia, which are being implemented on a nationwide basis, are the main reason for the decline in the HIV epidemic. Scaling-up of activities is taking place in all other six countries.

Asia↗
PubMed2006

Unsafe condoms and other unsafe sex accessories.

Condoms remain the sole effective method of prevention of HIV. However, in some places--including Cambodia and China--condoms have been modified to add so-called pearls, hard rubber studs or even bristles that are painful and dangerous to the receptive partner, causing injury to the vagina and anus. Such injuries contribute to the transmission of disease, so these condoms are not useful for prevention of STIs or HIV. In addition to unsafe condoms, accessories such as the "tiger's moustache" penis ring have bristles and are as dangerous in the same way as unsafe condoms. Public health officials have outlawed the sale of unsafe condoms in Thailand, a step that should be taken in all places where both they and other unsafe accessories are available.

Asia↗
PubMed2000

The female condom and STDs: design of a community intervention trial.

OBJECTIVES: The main purpose of this study is to compare sexually transmitted disease (STD) prevalence in cohorts of women with and without access to female condoms. METHODS: Six matched pairs of communities were identified from Kenya tea, coffee and flower plantations. One community within each pair was randomly selected to receive the female condom intervention. Approximately 160 eligible women were enrolled at each site. Female condom communities underwent an education program on use of female and male condoms and STDs, comprising group meetings, puppetry and other folk media, and training of clinic service providers and community outreach workers. Control communities received similar information on use of male condoms (freely available at all sites). At baseline, participants were tested for cervical gonorrhea and chlamydia and vaginal trichomoniasis, to be repeated at 6 and 12 months. The study has 80% power to detect a 10% prevalence difference, assuming an aggregate STD prevalence of 20% with 25% loss to follow-up and intracluster correlation of 0.03. RESULTS: Among 1929 women at baseline, the mean age was 33.1 years; 78% had never used a male condom. The prevalences of gonorrhea, chlamydia and trichomoniasis were 2.6%, 3. 2% and 20.4%, respectively (23.9% overall). The intracluster correlation based on these data was near zero. CONCLUSIONS: Comparable pairs of study sites have been selected. STD prevalence is sufficiently high, and the variation between sites is acceptably low. The study is feasible as designed.

Adolescent↗
PubMed1998

User acceptability of a female condom (Reality) in Shanghai.

Thirty married couples evaluated the Reality female condom on questionnaires about its acceptability for 300 acts of coitus (10 per couple). An analysis of the summary questionnaires showed: 90% of couples considered the female condom an acceptable method and 87% felt it was a good contraceptive device; the majority of couples (87%) found it easy to use; and 80% of females and 73% of males reported that, in comparison with the male condom, the effect on sexual pleasure was either improved or no different. A little more than half of the couples (55%) preferred it to male condoms. To look at the learning curve effect, an additional analysis was completed by pooling the first 5 applications of each user and comparing the results with the pooled results of the second 5 uses. All the findings suggest that a certain proportion of couples of childbearing age will choose the Reality female condom for contraception if it enters into the Chinese market. As a new contraceptive barrier device, the female condom may require a certain amount of education and awareness before it will be fully recognized as an important option to help prevent pregnancy as well as sexually transmitted infections.

Adult↗
PubMed2001

Comparison of men's and women's attempts to dissuade sexual partners from the couple using condoms.

Undergraduate students were asked about their use of condoms and their attempts to dissuade sexual partners from the couple using condoms during sexual intercourse. Nearly 14% of women and nearly 17% of men who had engaged in sexual intercourse admitted to having actively tried to dissuade a partner from the couple using condoms. Thirty percent of the men and 41% of the women said that a sexual partner had tried to dissuade them. Attempts to dissuade partners from the couple using condoms were most common among students who reported having 10 or more lifetime sexual partners. For both men and women, the most frequently employed categories of verbal strategies were (1) sex feels better without a condom, (2) will not get pregnant, and (3) will not get a sexually transmitted disease. These three categories accounted for about three-fourths of the lines used. Avoidance of condoms because of a perceived decrease in physical pleasure poses a particular problem for sex and health educators.

Adult↗
PubMed1999

Distribution along a stages-of-behavioral-change continuum for condom and contraceptive use among women accessed in different settings. Prevention of HIV in Women and Infants Demonstration Projects.

The numbers of women of childbearing age in the US with HIV and AIDS from heterosexual transmission continues to rise. Behavioral interventions remain the best means of preventing transmission of HIV. Program planners often implement interventions to promote behavioral change in a wide range of settings such as family planning or sexually transmitted disease clinics, drug treatment facilities, or medical facilities that serve high risk and HIV positive women. Women recruited in different types of settings, however, may differ with respect to their experience with, attitudes toward, and willingness to use condoms and contraception. Such differences should be considered when tailoring interventions to the populations being served. We examined the readiness to use condoms and contraception among 3784 women in four cities recruited in three different types of settings: community, facilities not targeted to HIV positive women and medical facilities for HIV positive populations. Readiness to use condoms or contraception was measured using The Transtheoretical Model of Change. Women reported being in different stages along the continuum of condom and contraceptive use in the three settings. A greater proportion of women in the HIV-facility, 45%, had used condoms consistently for the previous 6 months compared to women in the other two settings (12% and 11%). Similarly, variation across settings was seen for contemplation of consistent contraceptive use to prevent unintended pregnancies. The variability in the distribution of condom and contraceptive use across settings underscores the importance of assessing the readiness for the behavior change and designing interventions that meet the specific needs of the populations being served.

Adolescent↗
PubMed1997

Condom use in unmarried Latino men: a test of cultural constructs.

The effects of cultural factors on condom use were assessed in a random digit-dialing household survey of 1,600 unmarried Latino adults in 10 states with large Latino populations. Measures of traditional gender-role beliefs, sexual coercion, sexual comfort, and self-efficacy in using condoms were developed specifically for this population. A multisample structural equation model analysis included 594 men who reported one or more heterosexual partners in the 12 months before interview. As predicted, men with more traditional gender-role beliefs reported more sexual coercion and less sexual comfort. Men reporting more sexual coercion and less sexual comfort had lower condom self-efficacy. Men with more condom self-efficacy and stronger condom social norms reported more condom use.

Acculturation↗
PubMed1999

Domestically violent and nonviolent male inmates' responses to their partners' requests for condom use: testing a social-information processing model.

This study used a model derived from social-information processing theory to investigate how men with a history of domestic violence would react to a condom request. The study used path analysis to examine men's attributional and evaluative responses as potential predictors of coercion and condom use compliance. Men responded to a hypothetical situation in which their main partner requested that they use a condom. Among 100 county jail inmates, men who used severe forms of domestic violence differed from moderately violent and nonviolent men in their tendency to react negatively to condom requests. Condom-specific attributions were significant predictors of condom use and coercive actions but were not consistently different across abuse groups. Attributions that increased the likelihood of negative responding were infidelity, selfishness, competition for dominance, or suspicion of the man's fidelity.

Adult↗