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PubMed2001

Theories of reasoned action and planned behavior as models of condom use: a meta-analysis.

To examine how well the theories of reasoned action and planned behavior predict condom use, the authors synthesized 96 data sets (N = 22,594) containing associations between the models' key variables. Consistent with the theory of reasoned action's predictions, (a) condom use was related to intentions (weighted mean r. = .45), (b) intentions were based on attitudes (r. = .58) and subjective norms (r. = .39), and (c) attitudes were associated with behavioral beliefs (r. = .56) and norms were associated with normative beliefs (r. = .46). Consistent with the theory of planned behavior's predictions, perceived behavioral control was related to condom use intentions (r. = .45) and condom use (r. = .25), but in contrast to the theory, it did not contribute significantly to condom use. The strength of these associations, however, was influenced by the consideration of past behavior. Implications of these results for HIV prevention efforts are discussed.

Attitude↗
PubMed2006

Impact of a social influence intervention on condom use and sexually transmitted infections among establishment-based female sex workers in the Philippines: a multilevel analysis.

The authors assessed the relative impact of structural and social influence interventions on reducing sexually transmitted infections (STIs) and HIV risk behavior among female sex workers in the Philippines (N = 897). Four conditions included manager influence, peer influence, combined manager-peer influence, and control. Intervention effects were assessed at the establishment level in multilevel models because of statistical dependencies among women employed within the same establishments. Control group membership predicted greater perceived risk, less condom use, less HIV/AIDS knowledge, and more negative condom attitudes. Combination participants reported more positive condom attitudes, more establishment policies favoring condom use, and fewer STIs. Manager-only participants reported fewer STIs, lower condom attitudes, less knowledge, and higher perceived risk than peer-only participants. Because interventions were implemented at the city level, baseline and follow-up city differences were analyzed to rule out intervention effects due to preexisting differences.

Acquired Immunodeficiency Syndrome↗
PubMed2005

HPV type concordance in sexual couples determines the effect of condoms on regression of flat penile lesions.

We earlier demonstrated, in a randomised clinical trial, that the regression time of flat penile lesions in male sexual partners of women with cervical intraepithelial neoplasia (CIN) was shorter in men who used condoms compared to those who did not. To further evaluate this finding, we examined whether the effect of condom use on the regression of flat penile lesions depends on the presence of human papillomavirus (HPV) type concordance in sexual couples, as determined in cervical and penile scrapes by GP5+/6+ PCR testing. A Cox model with time-dependent covariates showed a beneficial effect of condoms on regression of flat penile lesions in concordant couples (hazard ratio 2.63, 95% CI 1.07-6.48) but not in those who were nonconcordant. When both partners harboured different HPV types, no effect of condoms was found (hazard ratio 0.90, 95% CI 0.27-2.96). Delayed regression of flat penile lesions was associated with either stable lesions or with new penile lesions developing at sites surrounding pre-existing lesions suggesting reinfection of the penile epithelium. We conclude that condom use blocks sexual HPV transmission by preventing reinfection and development of new penile lesions in men who are susceptible to the same type as present in the female partner.

Adult↗
PubMed1989

A critical review of the physics and statistics of condoms and their role in individual versus societal survival of the AIDS epidemic.

Condom failure rates for HIV are substantially greater than for pregnancy, even for highly motivated people who may reach the limit set by allowed manufacturing imperfections. This makes condoms ineffective for lifelong protection from HIV-infected sexual partners; therefore, in general, condoms provide inadequate risk reduction for the individual. Nevertheless, they are sufficiently effective that if everyone used condoms, the AIDS epidemic would stop. Quantitative public health goals to reduce the "reproductive rate" of HIV from an estimated 4-12 people infected per infected person to below 1 are needed. Government and scientific testing of condoms could be improved statistically and by utilizing relevant physics.

Acquired Immunodeficiency Syndrome↗
PubMed2002

The association of campus resources for gay, lesbian, and bisexual students with college students' condom use.

The author and colleagues examined campus resources for gay, lesbian, and bisexual (GLB) students at 119 US colleges to determine how the presence of such resources affected sexually active students' condom use. A random sample of unmarried, sexually active college students surveyed in 1999 completed questionnaires. Condom use was compared across schools with different levels of GLB resources. Condom use rates, analyzed by sex and sex-partner groups, ranged from 32% to 52%. With additional college variables controlled for, GLB resources were positively associated with the proportion of sexually active students who used condoms (p < .001). This association existed primarily for students with only opposite-sex partners. The author's findings suggest that campus resources for GLB students may be associated with college students' condom use.

Adult↗
PubMed2002

Sexual behaviour patterns and condom use in Tanzania: results from the 1996 Demographic and Health Survey.

We conducted this study to determine the factors associated with high-risk sexual behaviour and condom use among men and women who participated in the 1996 Tanzania Demographic and Health Survey (TDHS); and to assess changes in sexual behaviour between 1991/92 and 1996 TDHS. Respondents were regarded to have practised high-risk sexual behaviour if they were married or cohabiting and had other regular or non-regular sexual partners; or if they were unmarried and had non-regular partners or multiple regular partners. About 8% of women and 29% of men practised high-risk sexual behaviour. High-risk sexual behaviour was common among younger men and women, and decreased with increasing level of education in women. Respondents who were unmarried, Muslims and those who perceived themselves at increased risk of HIV/AIDS were more likely to practise high-risk sexual behaviour. About 4% of women and 15% of men reported to have used condoms during their last sexual encounter. Condom users were significantly more likely to practise high-risk sexual behaviour. Overall, no major changes in sexual behaviour and condom use were observed during the period between the two surveys. Predictors of high-risk sexual behaviour and condom use identified in this report provide valuable information that can be used to design targeted HIV/AIDS interventions in Tanzania.

Adolescent↗
PubMed2004

Protection and participation: an interactive programme introducing the female condom to migrant sex workers in Cambodia.

The female condom has received much attention for its potential to empower users in negotiating safer sex. Studies demonstrate that the process used to introduce the method can influence subsequent use rates, resulting in calls for comprehensive documentation of introduction activities. This paper details an intervention study introducing the female condom to Vietnamese sex workers in Cambodia. Part of a wider community mobilization approach to reducing HIV/AIDS transmission, the intervention emphasized informed debate, group skills building and collective support. Research methods included both quantitative and qualitative data collection to evaluate the introduction's effect on sex workers' negotiation skills and social support networks. The findings show that approximately 16% of sex workers tried the female condom. Ever-use was significantly associated with participation in intervention workshops, and with indicators of both individual and community empowerment. Sex workers who incorporated the female condom into their work were also more likely to feel a sense of community identity. Introduced through an appropriate process, the female condom can serve as an 'entry point' to building community capacity. It can support sex workers in achieving protected sex and developing cooperative relationships, even in severely restrictive settings.

Adult↗
PubMed2004

Attitudes towards male condom use in two different populations in Thrace, Greece.

OBJECTIVE: To outline Thracian women's disposition and attitude towards the male condom. METHODS: Representatives of the two major religious subgroups in Thrace (127 Christian Orthodox and 120 Muslim women) were studied. All respondents were of reproductive age (from 17 to 39 years) and were encouraged to answer a specific questionnaire. Women expressed their opinions about their mood while using it, its safety and similarity to natural contraception, and its contribution to the prevention of carcinogenesis and sexually transmitted diseases (STDs). They were also questioned about the ease of accessibility to supplies, the convenience experienced in buying it, its cost, and whether they thought it was necessary to use one in every act of intercourse as a contraceptive method. The statistical software package used was the Sigma Stat 2.0. RESULTS: The majority of the respondents in both subgroups had a positive opinion about the condom's contribution to the prevention of acquired immune deficiency syndrome (AIDS) and STDs. Christians were better informed about the condom's contribution to the prevention of carcinogenesis, while the majority of Muslims did not feel convinced about the condom's contraceptive efficacy. CONCLUSIONS: The study results reveal a significant difference in the way that Christian and Muslim women in Thrace consider the impact of condom use on sexual behavior and reproductive health care.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Noninferiority testing in crossover trials with correlated binary outcomes and small event proportions with applications to the analysis of condom failure data.

Regulatory agencies may require demonstrating a new therapy or device as noninferior to an existing method. For example, a new condom type must demonstrate noninferiority to existing latex condoms before consideration as an equivalent method of pregnancy prevention. Studies designed to assess condom effectiveness typically measure experimental and standard condom failure in a crossover trial, resulting in unbalanced correlated binary outcomes with low event proportions. We used simulations to evaluate the test size of a simple population average approach to noninferiority testing with the small event proportions, intracluster correlations, and sample sizes frequently found in condom studies. Results emphasize the importance of considering test accuracy when designing any study.

Binomial Distribution↗
PubMed2003

Delayed application of condoms is a risk factor for human immunodeficiency virus infection among homosexual and bisexual men.

The objective of this analysis was to identify risk factors for recent human immunodeficiency virus (HIV) infection among homosexual and bisexual men in Ontario, Canada, during 1998-2001. Participants were recruited through the provincial HIV diagnostic laboratory and through physicians and community organizations. HIV test results were used to identify recent seroconverters (cases). A subsample of 183 men (62 cases and 121 controls) enrolled in the Polaris HIV Seroconversion Study as of June 2001 was analyzed. This analysis focused on sexual behaviors with partners who were HIV-positive or whose HIV status was unknown. In multiple logistic regression, independent risk factors were identified. Rates of unprotected receptive oral, insertive anal, and receptive anal sex and delayed application of condoms during receptive anal sex (RAS) were significantly higher among cases (97%, 41%, 53%, and 32%, respectively) than among controls (73%, 19%, 14%, and 2%). Independent risk factors for HIV infection were RAS without condoms (odds ratio = 4.4, p = 0.0004) and delayed application of condoms during RAS (odds ratio = 5.8, p = 0.01). There was an association with condom failure (breakage or slippage) during RAS that approached significance (odds ratio = 2.9, p = 0.09). Delayed application of condoms for RAS may result in contact with preejaculatory fluid. This behavior, which to date has received little attention, may pose as much risk for HIV infection as fully unprotected RAS.

Adult↗
PubMed2004

Condom effectiveness for reducing transmission of gonorrhea and chlamydia: the importance of assessing partner infection status.

This analysis examined the importance of differential exposure to infected partners in epidemiologic studies of latex condom effectiveness for prevention of sexually transmitted infections. Cross-sectional, enrollment visit data were analyzed from Project RESPECT, a trial of counseling interventions conducted at five publicly funded US sexually transmitted disease clinics between 1993 and 1997. The association between consistent condom use in the previous 3 months and prevalent gonorrhea and chlamydia (Gc/Ct) was compared between participants known to have infected partners and participants whose partner infection status was unknown. Among 429 participants with known Gc/Ct exposure, consistent condom use was associated with a significant reduction in prevalent gonorrhea and chlamydia (30% vs. 43%; adjusted prevalence odds ratio = 0.42, 95% confidence interval: 0.18, 0.99). Among 4,314 participants with unknown Gc/Ct exposure, consistent condom use was associated with a lower reduction in prevalent gonorrhea and chlamydia (24% vs. 25%; adjusted prevalence odds ratio = 0.82, 95% confidence interval: 0.66, 1.01). The number of unprotected sex acts was significantly associated with infection when exposure was known (p for trend < 0.01) but not when exposure was unknown (p for trend = 0.73). Restricting analyses to participants with known exposure to infected partners provides a feasible and efficient mechanism for reducing confounding from differential exposure to infected partners in condom effectiveness studies.

Adult↗
PubMed2005

One size fits all? Promoting condom use for sexually transmitted infection prevention among heterosexual young adults.

The aims of this exploratory qualitative study were to increase our understanding of heterosexual young adults' knowledge and beliefs about sexually transmitted infections (STIs) other than HIV, to explore their beliefs about the factors that influence condom use for STI prevention, and to explore their ideas about how best to promote condom use for STI prevention. Data came from a qualitative study that used 11 group discussions with 53 heterosexual men and women aged 18-25. Respondents thought that STI infection and unplanned pregnancy were equally likely, but were less concerned about STIs than unplanned pregnancy. Respondents gave several reasons for their low levels of concern about STIs. They also suggested several means to promote condom use for STI prevention. They supported multi-faceted condom promotion campaigns, using multiple styles of communication and a variety of media. The range of suggestions given by participants suggests that rather than employing a 'one size fits all' strategy, a variety of different approaches are needed to promote condom use for STI prevention.

Adolescent↗
PubMed2003

Intention to use condoms among three low-income, urban African American subgroups: cocaine users, noncocaine drug users, and non-drug users.

Cocaine use, marijuana use, alcohol use, and polysubstance use (e.g., alcohol and cocaine, alcohol and marijuana) are associated with high-risk sexual behavior and higher rates of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). The purpose of this study was to examine readiness for using condoms among three groups (cocaine users, noncocaine drug users, and non-drug users) of African Americans living in low-income urban settings. African Americans in this sample differed in sex risk behaviors according to their drug use status. Noncocaine drug users reported higher levels of sex risk behaviors than non-drug users, and cocaine users reported the highest levels of risk. Cocaine users also reported lower levels of condom use with their main and nonmain sexual partners than both other groups. Results of multivariate analyses indicate that, compared to the other two groups, cocaine users are at earlier stages of readiness for condom use with main partners. Cocaine users have accurate perceptions of their HIV risk, but are more likely to factor into their decisions for using condoms cost and the trouble that it takes to get condoms. Different approaches to sexually transmitted disease and human immunodeficiency virus prevention will be necessary to meet the needs of these three different subgroups.

Adolescent↗
PubMed2003

Sexual relationships, condom use, and concerns about pregnancy, HIV/AIDS, and other sexually transmitted diseases.

As we move further into the 21st century, there are increasing numbers of teenagers and young adults infected with sexually transmitted diseases and acquired immunodeficiency syndrome. Aside from sexual abstinence, condom use is the best way to protect oneself from sexually transmitted diseases, including human immunodeficiency virus/acquired immunodeficiency syndrome. Participants in this study were predominantly female, predominantly Caucasian psychology students who experienced sexual intercourse with an opposite sex partner in the past year. Slightly fewer than half of these participants reported condom use at their last episode of vaginal intercourse and type of partner did not affect their condom use, nor did concern about human immunodeficiency virus/acquired immunodeficiency syndrome and sexually transmitted diseases. Findings such as these challenge advanced practice nurses to generate innovative strategies to promote condom use in all types of relationships. We propose that teaching about the link between cervical cancer and lack of condom use could be one of these new strategies.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use.

BACKGROUND: Sexual acquisition of HIV is influenced by choice of partner, sex act, and condom use. However, current risk-reduction strategies focus mainly on condom use. GOAL: To estimate the contribution of choice of partner, sex act, and condom use on the per-act relative and absolute risks for HIV infection. STUDY DESIGN: Per-act relative risk for HIV infection was calculated with use of estimates of HIV prevalence, risk of condom failure, HIV test accuracy, and per-act risk of HIV transmission for different sex acts. Absolute risks were calculated on the basis of these relative risk estimates. RESULTS: Choosing a partner who tested negative instead of an untested partner reduced the relative risk of HIV infection 47-fold; using condoms, 20-fold; and choosing insertive fellatio rather than insertive anal sex, 13-fold. Choosing one risk-reduction behavior substantially reduces absolute risk of HIV infection for heterosexuals but not for men who have sex with men. CONCLUSION: Clarifying the magnitude of risk associated with different choices may help people make effective and sustainable changes in behavior.

Condoms↗
PubMed2002

Do condoms prevent genital HPV infection, external genital warts, or cervical neoplasia? A meta-analysis.

BACKGROUND: Although condoms most likely prevent HIV infection, evidence of their effectiveness against other sexually transmitted diseases is mixed. GOAL: The goal of the study was to determine whether condom use prevents genital human papillomavirus (HPV) infection and HPV-related conditions. STUDY DESIGN: We conducted a literature review and meta-analysis of the effect of condom use on the prevention of genital warts, subclinical HPV infection, cervical intraepithelial neoplasia (CIN), and invasive cervical cancer (ICC). RESULTS: Among 27 estimates from 20 studies, there was no consistent evidence that condom use reduces the risk of becoming HPV DNA-positive. However, risk for genital warts, CIN of grade II or III (CIN II or III), and ICC was somewhat reduced. CONCLUSIONS: Available data are too inconsistent to provide precise estimates. However, they suggest that while condoms may not prevent HPV infection, they may protect against genital warts, CIN II or III, and ICC.

Condoms↗
PubMed1997

Ineffectiveness of latex condoms in preventing contamination of the transvaginal ultrasound transducer head.

The efficacy of condoms in preventing contamination of the transvaginal ultrasound transducer head and possible transmission of blood-borne pathogens is unknown. Our objective was to determine the rate of contamination of the transvaginal ultrasound probe after use in the emergency department. After indicated transvaginal ultrasound scans, the latex condom was removed and the transducer head was inspected for contamination. The presence of vaginal bleeding and the duration of the ultrasound scan were noted. Ten milliliters of hydrogen peroxide (H2O2) was placed in the condom. Bubbling, which occurs in the presence of blood or cervicovaginal secretions, was considered a positive test. Exposure of a clean condom or coupling gel to H2O2 did not cause bubbling. Two-tailed Fisher's Exact and Student's t tests were used for statistical analysis. Of 173 cases, 8 (5%) had a positive H2O2 test for contamination. In only 3 of these 8 cases was gross contamination seen. Latex condoms are ineffective in preventing contamination of the transvaginal ultrasound transducer head. Visual inspection of the transducer head often fails to identify the presence of blood or body fluids. This suggests that additional measures should be taken to prevent transmission of blood-borne pathogens.

Condoms↗
PubMed1996

Occasional condom use and HIV risk reduction.

Model-based estimates indicate that even occasional condom use can substantially reduce the probability of human immunodeficiency virus transmission. For many realistic parameter values, an essentially linear relationship exists between the proportion of sexual contacts in which a condom is used and the resultant reduction in the risk of infection. Thus, in many cases, the use of condoms for half of all sexual contacts reduces the probability of transmission by about half the maximum possible reduction obtained through consistent use. These results suggest that occasional condom use should be reconceptualized within a harm-reduction paradigm in which increased use is stressed for those individuals who are either unable or unwilling to use condoms consistently.

Condoms↗