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PubMed2002

Condom distribution: a cost-utility analysis.

OBJECTIVE: To explore the cost-effectiveness of a condom distribution programme. METHODS: We conducted a cost-utility analysis of a social marketing campaign in which over 33 million condoms were made freely available throughout Louisiana. Surveys among 275,000 African Americans showed that condom use increased by 30%. Based on the estimated cost of the intervention and costs of HIV/AIDS-associated medical treatment, we estimated the quality-adjusted life years (QALYs) saved, and number of HIV infections averted by the programme. RESULTS: The programme was estimated to prevent 170 HIV infections and save 1909 QALYs. Over $33 million in medical care costs were estimated to be averted, resulting in cost savings. Sensitivity analyses showed that these results were quite stable over a range of estimates for the main parameters. Condom increases as small as 2.7% were still cost-saving. CONCLUSION: Condom distribution is a community-level HIV prevention intervention that has the potential to reach large segments of the general population, thereby averting significant numbers of HIV infections and associated medical costs. The intervention is easy to scale up to large populations or down to small populations. The financial and health benefits of condom social marketing support making it a routine component of HIV prevention services nationally.

Condoms↗
PubMed2002

Sexual activity and condom use among Eastern European adolescents--the Study of Hungarian Adolescent Risk Behaviours.

While rates of HIV and STD infection in Eastern Europe are increasing rapidly, little is known about sexual behaviour, including condom use, among Eastern European youths. The Study of Hungarian Adolescent Risk Behaviours was designed to assess the knowledge, attitudes, and behaviours of adolescents studying in secondary schools in Budapest, Hungary. Students (n =3486) in a random sample of public secondary schools completed a self-administered questionnaire, including measures of sexual activity and condom use. Thirty-eight percent of students reported ever having had vaginal intercourse. Condom use by those reporting having had sex in the past five weeks was classified as consistent/every time (40%); irregular (25.6%); and none (34.3%). Multivariate analysis revealed positive opinions about condoms, fear of AIDS, and initiation of condom use by both partners to predict more frequent condom use. Implications for targeted AIDS/STD education and prevention among adolescents are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed2006

A review of female-condom effectiveness: patterns of use and impact on protected sex acts and STI incidence.

We conducted a systematic review of 137 articles and abstracts related to various aspects of the female condom, as well as a closer analysis of five randomized controlled trials on effectiveness. These five studies indicated strongly the benefits of female-condom use in increasing protected sex acts, and two studies found promising decreases in sexually transmitted infection (STI) incidence with the introduction of the female condom. Ten studies provided detailed information on patterns of long-term use, many suggesting that the female condom reaches women less likely to use other dual protection methods. There exists limited but convincing evidence that the female condom is effective in increasing protected sex and decreasing STI incidence among women. Future research on the female condom must move away from assessing acceptability and focus on assessing effectiveness and improving impact in diverse settings.

Clinical Trials as Topic↗
PubMed1999

The acceptability of the female condom among substance-using women in Washington, DC.

This research is based on structured interviews, semi-structured interviews, and informal firsthand observation of women residents of Washington, DC who used crack and/or injected drugs during the previous 30 days. The study entailed introducing these women to the female condom, exposing them to an HIV risk reduction intervention teaching them how to use it and how to negotiate its use with their sexual partner(s). Women were tested for HIV and asked to return one week later for their results. They were asked to try the female condom within that first week. Upon returning for their tests results, ethnographers discussed with them their experiences with the female condom. They were reinterviewed for follow-up three months later to assess changes in behavior from baseline as well as their longer term experiences with and opinions of the female condom. The data presented in this paper are based on the interviews conducted one week after baseline. Of particular interest and concern to this research were: women's perceptions of the female condom prior to and subsequent to using it, women's partners' perceptions of the female condom after being introduced to it, and potential barriers to use. In all, 131 women, mostly African-American, took part in this study, which was conducted during the winter of 1997-1998.

Adult↗
PubMed2001

Gender differences in condom usage among rural crack-using men and women.

Consistent condom use is an important aspect of decreasing HIV transmission risk in heterosexual crack cocaine using populations. This study explores gender differences in attitudes and motivations to use condoms within a rural, economically disadvantaged sample. Qualitative data analysis identified recurrent themes regarding condom use and assessed how themes varied among men and women. Analyses showed that men and women exhibit different rationales for condom use, while both reported inconsistencies between their knowledge about safe sex, receptivity to condom use, and applications in practice. The findings suggest that prevention programs should be tailored to increase consistent condom use among main partners of crack smokers at risk for HIV.

Adolescent↗
PubMed2003

The female condom: attitudes and experiences among HIV-positive heterosexual women and men.

The female condom is a potentially effective method for the prevention of HIV, other sexually transmitted disease, and pregnancy. This study describes attitudes toward and experiences with the female condom of 89 HIV-positive individuals (n = 56 women; n = 33 men) reporting heterosexual behavior. Qualitative interviews were conducted to inform the design and implementation of a cognitive-behavioral risk-reduction and health-promotion intervention. Most respondents (n = 78) had seen or heard of the female condom. However, relatively few (n = 14 women; n = 5 men) had used it at least once. Reactions from both women and men across user groups, regardless of favorable or unfavorable attitude or experience with the female condom, centered around a similar set of factors: aesthetics, difficulties with the male condom, male partner reaction, beliefs about efficacy, and lack of training. These findings underscore the need for additional research and comprehensive education efforts aimed at both technical use and communication skills-building in order to realize the potential of the female condom as an alternative barrier method.

Adult↗
PubMed2006

Reasons for condom use among young people in KwaZulu-Natal: prevention of HIV, pregnancy or both?

CONTEXT: High levels of HIV/AIDS and unwanted pregnancy among young people are urgent public health problems in South Africa. Studies among youth have generally focused on protection against one or the other of these risks, but not both. METHODS: Data collected in 2001 from 2,067 sexually active men and women aged 15-24 in KwaZulu-Natal were examined in bivariate and multivariate analyses to assess reasons for condom use, and levels and determinants of use. RESULTS: Overall, 59% of respondents said that they used condoms at last sexual intercourse, including 6% who used them with another method. The main reason for use (cited by 64% of users) was protection against both pregnancy and HIV infection. Two-thirds of respondents thought that becoming or making someone pregnant in the next few weeks would be a big problem; fewer than one in five viewed their risk of HIV infection as medium or high. Among both sexes, young people who would consider a pregnancy highly problematic were more likely to use condoms than their counterparts who would view a pregnancy as no problem (odds ratios, 1.4-2.3). In sharp contrast, young men and women who perceived themselves as having a medium to high risk of HIV infection were less likely to use condoms than their counterparts who perceived themselves as being at no risk (0.2-0.3). CONCLUSION: Prevention programs could increase condom use in this population by increasing awareness of the twin risks of pregnancy and HIV infection, and by promoting condoms for protection against these dual risks.

Adolescent↗
PubMed2002

A validation and reduced form of the Female Condom Attitudes Scale.

The Female Condom Attitudes Scale is an instrument comprising five correlated factors derived from 15 Likert-scale survey items that measure women's attitudes toward the female condom. This scale originated from the 30-item scale of Choi, Gregorich, Anderson, Grinstead, and Gómez (2001; manuscript under review). Exploratory factor analysis of this scale extracted eight correlated factors. Reliability coefficients and confirmatory factor analyses refined the instrument by reducing the number of factors to five and halving the number of items. The reduced form of the Female Condom Attitudes Scale demonstrated both construct and convergent validity by predicting self-reported female condom use behavior. It also correlated with self-efficacy to use male condoms, sexual comfort, and attitudes toward the male condom. The five factors remaining in the final survey instrument were Sexual Pleasure Enhancement, Inconvenience, Improved Prophylaxis, Sexual Pleasure Inhibition, and Insertion Reluctance. Implications of these findings for basic and applied intervention research are discussed.

Adolescent↗
PubMed2003

Responses of male inmates to primary partner requests for condom use: effects of message content and domestic violence history.

Many women at high risk for HIV infection face resistance and, in some cases, violence as a response to their requests for condom use. The current study investigated how domestically violent and nonviolent men reacted to various condom negotiation approaches. Ten different scenarios, in which the partner provides a justification for a condom request or the context suggests one, were presented to 84 male inmates selected at random from a county jail. As predicted, condom scenarios factored into groupings with content suggestive of high and low relationship threat. Of the justifications presented, yeast infections generated more favorable responses than standard HIV prevention messages. The riskiest condom negotiation scenario was one that suggested infidelity on the part of the woman. Level of male violence severity in the relationship predicted more coercive responses to suggestions of a woman's infidelity. The results suggest that creative strategies that do not call into question the fidelity or commitment of either partner may be more effective in getting men to use condoms and/or to not react violently.

Condoms↗
PubMed2003

Does knowing someone with AIDS affect condom use? An analysis from South Africa.

Prior research in Africa suggests that personally knowing someone with HIV/AIDS or who died of AIDS (PWA) may positively influence HIV-preventive behaviors such as condom use, by countering denial and increasing perceived risk. This article uses data from the 1998 South Africa Demographic and Health Survey (DHS) of women to examine this hypothesis in South Africa, where AIDS mortality is high. Logistic regression was applied to assess whether knowing a PWA was associated with condom use, net of the effects of possible confounders. Contrary to previous findings, analyses showed no association between condom use and having known a PWA. Condom use was strongly associated with knowledge that condoms can prevent HIV/AIDS, sex with a non-marital partner, higher education level, younger age, and urban residency. Findings suggest that communities should expand preventive efforts given the current level of AIDS mortality. Campaigns must reinforce messages that condoms are effective, and reach rural, less educated women, for whom HIV risk is high in South Africa.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Respondent perspectives on self-report measures of condom use.

There is much concern about the validity of self-reported condom use. In an effort to improve self-report measures, a study using semistructured interviews was conducted to elicit the perspectives of women who had participated in a microbicide clinical trial in which self-reports of condom use were included. Women were asked about their comprehension of the questions, how they remembered their condom use and their sensitivity to the expectations of the interviewer, and how this affected their answers. Although most women believed they were accurate in their answers about condom use, a number of women admitted to exaggerating their condom use or believed other women did, citing concerns related to interviewers' expectations of them as the primary reason. Most women did not believe that comprehension or memory was a problem and a number were able to articulate strategies for remembering their condom use.

Adolescent↗
PubMed2001

Interpretations of condom use and nonuse among young Norwegian gay men: a qualitative study.

Among the strategies adopted by gay men and the gay community for HIV prevention, the promotion of condom use has been pivotal. This article discusses young gay Norwegian men's interpretations of condom use and nonuse. Meanings mediated by (non)use of condoms are meanings in the making rather than antecedently and inalterably fixed. How young gay men interpret (non)use of condoms varies with and depends upon context or relationship. In this article, young men's readings of (non)use of condoms are discussed in the contexts of (anal) sex; surrender to pleasure; semen and intimacy; and respect, disrespect, and humiliation. How condom use functions as a sign for both trust and mistrust also is discussed.

Adult↗
PubMed2006

Accessibility of condoms to young people in Manchester, UK.

BACKGROUND AND METHODOLOGY: Issues relevant to the accessibility of male condoms for young people in the Greater Manchester area (UK) were investigated, using semi-structured, in-depth interviews and a questionnaire survey. RESULTS: Family planning clinics and condom vending machines (CVMs) were the most cited sources for condom acquisition. Young people's knowledge of where and when they could access condoms varied by age and gender. Suitable positioning of CVMs would need to take such variations into account when targeting potential customers. Levels of embarrassment about acquiring condoms also varied according to gender. The lifestyles of young people indicated the sorts of places in which CVMs might offer increased accessibility. For younger men and women this tended to involve low-cost, semi-private places such as local parks, school toilets and shopping malls/streets. Older men with higher spending power and increased confidence could access condoms through pub and club toilets and chemist shops. CONCLUSIONS: Accessible positioning of CVMs was related to the age, gender and lifestyle of the participants, and programmes to enhance accessibility should reflect this. Increased accessibility for younger groups, and especially women, needs to take into account issues of cost, confidence and embarrassment. For older groups, lifestyle choices indicated pubs and clubs as key locations for both men and women.

Adolescent↗
PubMed1993

The taking of free condoms in a drug abuse treatment clinic: the effects of location and posters.

Drug abuse treatment programs can help reduce high-risk sexual behavior in drug users by promoting condom use. This study examined the influence of distribution location and poster prompts on the taking of free condoms in a drug abuse treatment clinic. Over 6 months, condoms were available alternately, with and without poster prompts, in the clinic's private restroom or public waiting area. Overall, 381% more condoms were taken from the restroom. The presence of poster prompts did not affect condom taking. These results suggest that distribution location is a critical factor in promoting condom taking in public clinic.

Advertising↗
PubMed1993

Commentary: the new female condom--item 1 on a women's AIDS prevention agenda.

A US Food and Drug Administration (FDA) advisory panel has recommended that the female condom Reality be approved for contraception and acquired immunodeficiency syndrome (AIDS) prevention. Final FDA approval will mark the first official recognition of a woman-controlled method for protection against sexually transmitted disease. A female condom allows women to use just one method to respond to the twin anxieties of AIDS and unwanted pregnancy. In those couples in which the man refuses to wear a male condom, the availability of a female condom makes protection possible for the first time. Although the female condom has some advantages over the male condom--greater comfort for some women and men and nonreliance on male arousal--general population experience with the device is needed to achieve regular widespread use and hence effectiveness at population levels. The FDA still lags behind in responding to women's needs for information on AIDS and sexually transmitted disease.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Video-based sexually transmitted disease patient education: its impact on condom acquisition.

OBJECTIVES: This study assessed the impact of video-based educational interventions on condom acquisition among men and women seeking services at a large sexually transmitted disease clinic in the South Bronx, New York. METHODS: During 1992, 3348 African American and Hispanic patients were enrolled in a clinical trial of video-based interventions designed to promote safer sex behaviors, including increased condom use. Patients were assigned to one of three groups: control, video, or video plus interactive group discussion. Subjects were given a coupon to redeem for free condoms at a pharmacy several blocks from the clinic. Rates of condom acquisition were assessed by level of intervention. RESULTS: In comparison with a control group, subjects who viewed videos were significantly more likely to redeem coupons for condoms (21.2% redemption rate vs 27.6%). However, participation in interactive sessions after video viewing augmented the positive effects of video viewing alone (27.6% redemption rate vs 36.9%). Gender and ethnicity were significantly associated with outcomes. CONCLUSIONS: The condom acquisition are almost doubled with the use of culturally appropriate, video-based interventions. Designed to present minimal disruption to clinical services, these interventions can be implemented in clinics servicing at-risk men and women.

Adult↗
PubMed2002

Effect of an STD/HIV behavioral intervention on women's use of the female condom.

OBJECTIVES: This study assessed the effectiveness of a sexually transmitted disease (STD)/HIV behavior change intervention in increasing women's use of the female condom. METHODS: A total of 604 women at high risk for STDs and HIV in New York City, Baltimore, Md, and Seattle, Wash, enrolled in a randomized controlled trial of a small-group, skills-training intervention that included information and skills training in the use of the female condom. RESULTS: In a logistic regression, the strongest predictors of use were exposure to the intervention (odds ratio [OR] = 5.5; 95% confidence interval [CI] = 2.8, 10.7), intention to use the female condom in the future (OR = 4.5; 95% CI = 2.4, 8.5), having asked a partner to use a condom in the past 30 days (OR = 2.3; 95% CI = 1.3, 3.9), and confidence in asking a partner to use a condom (OR = 1.9; 95% CI = 1.1, 3.5). CONCLUSIONS: Clinicians counseling women in the use of the female condom need to provide information, demonstrate its correct use with their clients, and provide an opportunity for their clients to practice skills themselves.

Adolescent↗
PubMed2004

The prediction of condom use intention among South African university students.

A questionnaire was administered to 294 sexually active, unmarried undergraduate students to investigate the role of social norms in the prediction of the intention to use condoms. Components of social cognitive theory and the theory of reasoned action and planned behaviour were integrated with those of the Health Belief Model to predict future intention to use condoms with a new partner. Logistic regression analyses of selected risky sexual behaviours on the intention to use condoms showed that, among males, attitudes towards using condoms and the Health Belief Model component of perceived barriers predicted the intention to use condoms. The Health Belief Model component of perceived benefits could not be interpreted. Attitudes, subjective norms and perceived self-efficacy were associated with female students' intention to use condoms. Implications for strategies of HIV/AIDS prevention are discussed.

Adolescent↗