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PubMed1999

Psychosocial correlates of heterosexual condom use: a meta-analysis.

Despite increasing incidence of HIV/AIDS, there has been no systematic review of correlates of condom use among heterosexual samples. To rectify this, the present study used meta-analysis to quantify the relationship between psychosocial variables and self-reported condom use. Six hundred sixty correlations distributed across 44 variables were derived from 121 empirical studies. Variables were organized in terms of the labeling, commitment, and enactment stages of the AIDS Risk Reduction Model (Catania, Kegeles, & Coates, 1990). Findings showed that demographic, personality, and labeling stage variables had small average correlations with condom use. Commitment and enactment stage variables fared better, with attitudes toward condoms, behavioral intentions, and communication about condoms being the most important predictors. Overall, findings support a social psychological model of condom use highlighting the importance of behavior-specific cognitions, social interaction, and preparatory behaviors rather than knowledge and beliefs about the threat of infection.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Attitudes to using condoms in a group of Darwin women.

This study was a qualitative descriptive interpretive investigation into a group of women's attitudes to the use of condoms in Darwin, Northern Territory, Australia. Twenty women were interviewed using a semi-structured interview schedule. The participants' perception of who should be responsible for providing and ensuring use of condoms varied, as did their attitudes to condom use. Negative attitudes centred around the need to be prepared for sex, the nuisance value and the need to be careful of slip-ups, while positive attitudes centred around the lack of mess. Most women in a committed relationship did not use condoms other than for contraception because they trusted their partners to be faithful. Raising the issue outside of birth control suggested unfaithfulness. These women were on the whole more confident of their ability to negotiate condom use than had been found in previous studies. It was concluded that the safe sex message is not getting through to many women, that health promotion should continue to stress the message about safe sex and that advertising should stress the positive aspects of condom use.

Adolescent↗
PubMed2004

Condom use self-efficacy among U.S. and foreign-born Latinos in Texas.

The objective of this study was to assess the influence of condom use self-efficacy on the reported condom use of Latinos. We conducted a rapid needs assessment study among U.S. and foreign-born Latinos living in Houston, TX, to identify behavioral and psychosocial factors that influence their risk for HIV. Bilingual Latino interviewers conducted confidential face-to-face interviews with individuals living in apartment complexes or residential areas primarily populated by Latinos. A total of 152 participants completed the survey. Regression results indicate that education and gender influenced condom use self-efficacy, which in turn influenced condom use in the last sexual encounter and with the primary sexual partner. However, gender and relationship risk were stronger predictors of condom use. Study results indicate that there are differences in condom use self-efficacy and sexual risk behaviors between Latino men and women that need further exploration.

Acculturation↗
PubMed2006

Female condom awareness, use and concerns among Nigerian female undergraduates.

A cross-sectional study of female condom awareness, usage and concerns among the female undergraduates of the University of Ibadan was conducted in September 2004. The results of 850 out of the 879 female students interviewed were used for analysis (96.6%). Over 80% had knowledge of the female condom as a form of modern contraception and the majority of them learnt about it through the mass media (39.9%) and health workers (34.4%). However, only 11.3% had ever used the female condom, with most (40%) using it to prevent both unwanted pregnancy and sexually transmitted infections including HIV (STI/HIV). The sexual partners' approval was appreciable, accounting for about 42.7% among those that had experience of the female condom usage. Major concerns mentioned such as difficulty of inserting it into the vagina and lack of sexual satisfaction, were not different from those in earlier studies. The result of this study looks promising judging from a high awareness level of the female condom, even though its usage is low. The female condom may be an alternative strategy to combat unsafe sexual practises and its sequelae in a country like Nigeria that is male dominated.

Adolescent↗
PubMed2001

Condom awareness and intended use: gender and religious contrasts among school pupils in rural Masaka, Uganda.

A cross-sectional questionnaire survey examining knowledge, attitudes and intended use of condoms was conducted among 1,821 pupils (mean age = 14.2 years, range = 9--24) from 27 primary and secondary schools in rural south western Uganda. Condom education is not provided in Ugandan schools, but both boys and girls had relatively high overall levels of knowledge, even though boys demonstrated a higher level than girls. This suggests that respondents had successfully obtained reliable information from other sources. Boys and girls had similar and fairly positive attitudes towards condoms, although considerable shyness was expressed, both about discussing condoms with a partner and buying them. Fifty-eight per cent said that they themselves would use a condom if one were available, but girls were far less likely than boys to say so. Roman Catholics (46% of the sample) were less knowledgeable and less positive about condoms than non-Catholics, and the boys in this group, but not the girls, were also much less likely to say they would use one. Possible interventions based on these findings are discussed, and a research agenda for the delivery of assertiveness training to girls is proposed.

Adolescent↗
PubMed2000

Preventing HIV infection through peer education and condom promotion among truck drivers and their sexual partners in Tanzania, 1990-1993.

HIV prevention through peer education and condom promotion among truck drivers and their sexual partners is described. Trends during an initial 18-month intensive phase, followed by a 24-month maintenance phase, were monitored with surveys. Trends for self-reported condom use were: increase among men (56 to 74%) during the first phase with a decrease (72%) during the maintenance phase. Respective figures for women were 51%, 91% and 70%. Multivariate analyses revealed that men most likely to report using condoms were unmarried, had children, were more educated, had previously reported a genital ulcer, and perceived themselves at risk for HIV infection (OR = 1.95-3.47). Women tending to use condoms were unmarried, aware of the limitations of condoms, not in denial as to the existence of HIV, harboured inaccurate information about HIV transmission and were afraid (OR = 1.35-2.52). Both sets of results suggest that the most sexually experienced men and women who did not have a permanent stable relationship and who perceived themselves at risk, were most likely to use a condom. Peer education was an effective tool for increasing knowledge and encouraging appropriate behaviour change. It was most effective as an intensive high-input intervention and sustainable with the relatively stable population of truck drivers.

Adolescent↗
PubMed2002

Relationship power, condom use and HIV risk among women in the USA.

Women's ability to negotiate safer sexual practices, particularly condom use, is a vital component of HIV/STD prevention strategies. Gender-based power imbalances may constrain women's negotiation ability, yet few empirical studies have tested the hypothesis that sexual relationship power constitutes a key factor in condom use negotiation. In this investigation, a new measure - the Sexual Relationship Power Scale (SRPS) - was applied. Data were collected from 388, mostly Latina, women at an urban community health centre in Massachusetts. Women with high levels of relationship power were five times as likely as women with low levels to report consistent condom use, after controlling for sociodemographic and psychosocial variables (p < 0.05). Population attributable risk estimates indicate that 52% of the lack of consistent condom use among women can be attributed to low sexual relationship power. The strong association between the Sexual Relationship Power Scale and consistent condom use supports the hypothesis that relationship power plays a key role in safer sex decision making. These findings underscore the importance of including the issue of relationship power in the design and implementation of programmes that promote sexual and reproductive health, as well as research investigating condom use and HIV risk.

Adolescent↗
PubMed2003

Patterns of condom use in urban males in Zimbabwe: evidence from 4600 sexual contacts.

The objective of this paper is to get detailed information on the dynamics of condom use with various partner types, including consistency of use, and to estimate the frequency of unprotected intercourse. The study is based on a prospective cohort study of 222 urban workers in urban Zimbabwe. Respondents' sexual behaviour and condom use were tracked for a period of six weeks using daily interviewer-administered questionnaires. In total, the observation period covers 9324 person-days, during which 4601 sexual contacts were reported. The results indicate that most sexual encounters with casual partners are protected, and condom use with these partners is very consistent. However, although the majority of sex acts with regular non-marital partners are protected, only four out of ten men with regular partners used condoms consistently. Because many men have both regular and casual partners, fewer than one in seven males used condoms in all their sex acts. We estimate that nearly half of all males have more than 85 unprotected sex acts per year. Although many of these acts are with spouses, who have comparatively low risk, we estimate that about one in five men have 25 or more unprotected acts with regular non-marital partners annually. WI conclude that regular partners are likely to be a major source of HIV transmission in Zimbabwe, partly because condom use is inconsistent and partly because they account for a large share of all sex acts. Given that over one in four adults in the general population are HIV-positive, and that some studies show that married persons have the highest HIV prevalence, it is important for future HIV programmes to focus on increasing levels of protection with regular partners.

Adult↗
PubMed2003

Exposure to the 'SIDA dans la Cité' AIDS prevention television series in Côte' d'Ivoire, sexual risk behaviour and condom use.

This study assesses factors associated with viewing of 'SIDA dans la Cite', a weekly television soap opera on AIDS in Côte d'Ivoire, and the relationship between 'SIDA dans la Cite' viewing, sexual risk behaviour and condom use. The study uses across-sectional survey of 2150 respondents aged 15-49 in three regions. Logistic regression analysis was used to assess the effect of'SIDA dans la Cite' exposure on condom use. The results show that 65% of the sample had seen at least one 'SIDA dans la Cite' episode. Among viewers, 27% of males and 41% of females had seen ten or more episodes. Persons who had risky sexual partners were particularly likely to watch the programme. Women who had seen ten or more episodes were 1.4 times more likely than non-viewers to have used a condom in last sex. Men who had seen ten or more episodes were 2. 7 times more likely to have used a condom. We conclude that television soap operas on AIDS, such as 'SIDA dans la Cite',can be an important tool for promoting condom use. The programme was most appealing to viewers who engaged in risky behaviour, who are the core transmitters of the virus. HIV prevention programmes that provide continuous information, through multiple media channels or through series of broadcasts, are likely to have the greatest impact on condom use.

Adolescent↗
PubMed1991

Sexual behaviour and use of the condom among Ugandan students.

HIV infection is widespread in Uganda. Have its university students, the country's leaders of tomorrow, taken appropriate action? A questionnaire was completed by 661 men and 270 women in a one-in-four sample of Makerere University undergraduates (93% response rate). More than 60% of the men and 36% of the women reported at least two sexual partners in the past year. Over 18% of respondents reported at least one episode of sexually transmitted disease in the past year. Most respondents correctly identified the main routes of HIV transmission but risk was also often incorrectly associated with non-penetrative sex. Only a minority saw the condom as an effective preventive method: most saw it as unsafe or an encouragement to promiscuity. Condoms had been used by 35% of men and 24% of women but were currently always used by only 9% of men and 11% of women. The condom was approved of by only one quarter of respondents. Condom use increased with the number of sexual partners but was less likely if the respondent had seen official publicity about the condom. Whilst there were some encouraging signs of behaviour change, opportunities for the spread of HIV continued to abound in this important group. More positive promotion of the condom is urgently required.

Adult↗
PubMed1991

Condom use in a large cohort of homosexually active men in England and Wales.

As part of a prospective study of the seroprevalence of HIV, a cohort of 930 men were interviewed regarding their condom use. Of the 270 respondents that engaged in insertive anal intercourse in the month preceding interview 38.9% always used a condom, 49.6% never used one, and 11.5% sometimes used one. Of the 254 respondents that engaged in receptive anal intercourse in the same time period 42.5% always used a condom, 45.7% never used one, and 11.8% sometimes used one. Compared to other research the proportion of respondents who always use a condom for anal intercourse is relatively high, though use is by no means universal. Condom use is more widespread and consistent with casual rather than regular sexual partners, and it is significantly more common within open rather than monogamous relationships. Out of a wide range of other factors only geographical location (London against outside), marital status, perceived HIV status, number of sexual partners, and how seriously respondents take safer sex are correlated with condom use.

Adult↗
PubMed2006

HIV/AIDS knowledge and condom use among Somali and Sudanese immigrants in Denmark.

AIMS: This study explores the knowledge, attitudes and practices among Somali and Sudanese immigrants in Denmark with regard to HIV/AIDS and condom use. MATERIAL AND METHODS: A 78-item questionnaire, divided into five thematic sections, was given to 192 purposively selected Sudanese and Somalis of both sexes, aged 18-49, who had lived in Denmark for one or more years. It was administered in Arabic and Somali in four locations and supplemented by 13 semi-structured interviews. RESULTS: Education, sex, and nationality, but not length of residence in Denmark, were positively associated with knowledge about HIV/AIDS. Less than half of both men and women scored more than 70% on the knowledge portion of the questionnaire, while Sudanese knew more than Somalis. Men had a more negative attitude towards condoms than women, but greater knowledge about them. One-third of the women reported never having seen or heard of a condom, and almost half had never received information about condoms. Both sexes preferred receiving such information from the TV or friends instead of family doctors or HIV-positive individuals. CONCLUSIONS: This study suggests that knowledge about HIV/AIDS is low in these two Danish immigrant groups, both of which are characterized by reported incidence rates that are higher than the national average. The groups receive little information, while condom knowledge is particularly low among poorly educated women, and men have a negative attitude to condom use. The findings indicate a need for targeted, culturally sensitive HIV/AIDS information and advice.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Condom use and partner characteristics among young adult males in urban Ghana, aged 15-24.

Addressing male sexual behavior and condom use is a high priority for adolescent health programs. Using the 1997 Ghana Psychographic Survey, the aim of this study is to explore the factors related to current, partner-specific condom use, by Ghanaian males aged 15-24 years. A multivariate regression analysis reveals an independent association between psychographic attitudes, peer network characteristics, sexual partner characteristics, and some level of condom use with a nominated sexual partner. The most important predictor for both condom use consistently as well as condom use at least sometimes was respondents' knowing someone who died as a result of AIDS. This finding suggests that future interventions should aim to personalize the risk of HIV/STIs, promote condom use with a range of partner types, and educate youth about the importance of consistent use.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Estimating and comparing correct-use failure probabilities in clinical studies of condom functionality.

In a clinical study comparing the failure probabilities of two condom types, the sample of all reported acts of intercourse in which a study condom was used by a randomized participant is typically defined to be the primary analysis sample. However, it may also be desirable to make comparisons among only those acts in which the participants correctly followed all condom use instructions before, during, and after the act of intercourse (i.e., the "correct-use" subset). The timing associated with the definition of correct use creates a dilemma in that an act cannot be classified as a "correct-use act" until after the completion of both intercourse and withdrawal; if a condom fails (e.g., breaks or slips completely off of the penis) during intercourse then the couple has no chance at correct use during withdrawal. As a result of the implicitly conditional nature of this problem, it is not a simple matter to specify a correct-use subset of the primary analysis sample. With this in mind, we develop estimators for the correct-use failure probabilities, the corresponding standard errors, and test statistics for comparing the correct-use failure probabilities between condom groups. We demonstrate the utility of the proposed methods by applying them to data from a clinical study of condom contraceptive effectiveness, and we use simulated data to investigate the finite sample properties of the proposed methods. The simulation results indicate that one of our proposed estimators is at least approximately unbiased, even in small samples. Furthermore, one-sided noninferiority tests performed using this estimator tend to have sizes that are only marginally larger than the nominal test size in moderate to large samples.

Computer Simulation↗
PubMed2000

Condom promotion in women attending inner city general practices for cervical smears: a randomized controlled trial.

BACKGROUND: Although condom promotion schemes have been widely piloted in UK general practices, there have been no rigorous evaluations of their effectiveness. OBJECTIVES: To see if a practice-based sexual health education intervention increases the number of women having smears who are given condoms and advice on avoiding STDs. To see if this low cost intervention affects subsequent condom use. METHOD: We conducted a cluster randomized trial of condom promotion in 1382 women aged <35 years attending 28 South London general practices for cervical smear tests. RESULTS: More women in intervention than control practices reported receiving advice on avoiding sexually transmitted infections (27% versus 10%) and being given condoms (28% versus 1%, P < 0.05). However, there was no difference in subsequent condom use, even in the 22% of women reporting >/=2 sexual partners in the previous year. CONCLUSIONS: To provide evidence of effectiveness, future interventions may need to be more intensive or focus on higher risk groups.

Adolescent↗
PubMed1994

Condom use negotiation among sex workers in Singapore: findings from qualitative research.

Following an earlier study of 806 sex workers in Singapore in which they were found to succeed only half the time in getting clients to use condoms, a qualitative investigation was conducted on 40 sex workers to explore their perceived barriers and approaches in negotiating condom use with clients. Five different patterns of condom use were identified: successful, unsuccessful, misinformed, passive and uninterested. The successful negotiators used several practical approaches to secure clients' compliance. Unsuccessful negotiators experienced problems such as inability to resist clients' pressure or respond to their queries. The misinformed group believed that regular clients were safe. The passive group did not negotiate condom use due to their perceptions of lack of support from peers and brothel keepers, and the uninterested group was apathetic with fatalistic perceptions of AIDS. The in-depth interviews with successful negotiators provided relevant, specific and practical information which could be disseminated to their peers to develop their negotiation skills. This qualitative study also provided useful insights on condom use negotiation and highlighted the need for comprehensive interventions which should not only aim at developing sex workers' negotiation skills but also at gathering support from brothel keepers to facilitate behaviour change, and public education directed at clients to increase condom use.

Adult↗
PubMed2001

The female condom, a tool for empowering sexually active urban adolescent women.

Adolescent women are at high risk of sexually transmitted diseases/human immunodeficiency virus (STDs/HIV) because of physiologic susceptibility and risky sexual behavior. The latter may be related to the "personal factors" of self-efficacy, sexual knowledge, self-esteem, and ability to communicate/negotiate. In the current study, near-peers attempted to have an impact on these factors by using the female condom as a negotiating tool for safer sex in a group of 100 urban adolescent women recruited from an adolescent health center waiting room. This pilot study consisted of a questionnaire, a workshop on how to use the female condom and negotiate its use, and follow-up interviews at 1 and 4 months. Demographics of the study sample define a multiethnic (40% black, 33% Hispanic) group in late adolescence (average age 18 years) completing high school. At baseline, 18% evidenced depression, 62% had moderate-to-low self-esteem, 91% had an internal locus of control. At baseline, male condom use in the prior 6 months was 28% always, 51% inconsistently, 21% never. When baseline and follow-up scores were compared, there was a statistically significant increase in sexual knowledge and self-efficacy, together with the suggestion of improved negotiating skills. At 1 month, 50% (20/40) had tried the female condom, and 17 of these women planned to use it in the future. Total percentage of protected sex acts increased significantly during the follow-up period through increased use of both the male and female condoms. The data suggest that adolescent women will accept the female condom and can be empowered to protect themselves from STDs/HIV through its application or through the using of it as a negotiating tool.

Adolescent↗
PubMed2000

Condom acceptance is higher among travelers in Uganda.

OBJECTIVE: To examine the role played by mobile residents in the spread of HIV through rural Uganda. DESIGN: Travel history and sexual network data were collected from a random sample of 1627 residents aged 15-49 years in Rakai District, Uganda during 1994. METHODS: Travelers and non-travelers are compared with respect to socio-demographic attributes, risk exposure, knowledge, attitudes and use of condoms using descriptive statistics and multivariate logistic regression. A demographic profile of travelers' partners is developed using information from a local network survey module. RESULTS: The population is highly mobile, with over 70% reporting travel to a potentially higher risk destination in the past year. Travelers are somewhat more likely to have higher levels of sexual risk behavior, but the risk appears to be offset by significantly greater knowledge, acceptance, and use of condoms. In multivariate analysis, the sexual risk differential for travelers is explained by occupational exposure and higher socio-economic status. The differential in condom acceptance, by contrast, appears to be associated with travel itself. Condom use with non-spousal partners is three times higher among travelers than non-travelers (P< 0.001), and travel remains a significant predictor after controlling for age, education, residence, occupation and multiple partners. Travelers are more likely to use condoms with both their local and non-local partners. Partners of male travelers are likely to be younger and better educated than those of male non-travelers. CONCLUSIONS: The mobile population in this rural region appears willing to adopt risk reduction measures appropriate to their exposure. This suggests that targeting condom promotion programs to travelers and their partners is likely to be effective in reducing the spatial diffusion of HIV, and may be an efficient method for spreading behavioral change into rural areas.

Adolescent↗