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PubMed2001

Sociodemographic, behavioral, and clinical correlates of inconsistent condom use in HIV-serodiscordant heterosexual couples.

We examined sociodemographic, behavioral, and clinical characteristics associated with inconsistent condom use in a cross-sectional analysis of 145 sexually active HIV-serodiscordant heterosexual couples who participated in the California Partners Study II. All couples were aware of their HIV-serodiscordant status. Forty-five percent of couples reported having had unprotected vaginal or anal sex in the previous 6 months. In the multivariate couple-level analyses, factors independently associated with inconsistent (i.e., <100%) condom use in the previous 6 months included lower educational level, unemployment, African-American ethnicity, and practice of anal sex by the couple. Injection drug use was associated with inconsistent condom use among couples with younger HIV-infected partners. In addition, couples with HIV-infected partners who had higher CD4 cell counts and couples in which the HIV-infected male partner ever had sex with a man were more likely to use condoms inconsistently. Consistency of condom use did not depend on the gender of the HIV-infected partner or duration of sexual relationship. The findings suggest that many HIV-serodiscordant heterosexual couples remain at high risk of HIV transmission and may benefit not only from behavioral interventions but also from structural interventions aimed at improving their social and economic conditions.

AIDS Serodiagnosis↗
PubMed2006

Country-wide distribution of the nitrile female condom (FC2) in Brazil and South Africa: a cost-effectiveness analysis.

OBJECTIVE: To evaluate the cost-effectiveness and potential impact of expanded female condom distribution. DESIGN: Cost-effectiveness analysis assessing HIV infections averted annually and incremental cost per HIV infection averted for country-wide distribution of the nitrile female condom (FC2) among sexually active individuals, 15-49 years, with access to publicly distributed condoms in Brazil and South Africa. RESULTS: In Brazil, expansion of FC2 distribution to 10% of current male condom use would avert an estimated 604 (5-95th percentiles, 412-831) HIV infections at 20,683 US dollars (5-95th percentiles, 13,497-29,521) per infection averted. In South Africa, 9577 (5-95th percentiles, 6539-13,270) infections could be averted, at 985 US dollars (5-95th percentiles, 633-1412) per infection averted. The estimated cost of treating one HIV-infected individual is 21,970 US dollars (5-95th percentiles, 18,369-25,719) in Brazil and 1503 US dollars (5-95th percentiles, 1245-1769) in South Africa, indicating potential cost savings. The incremental cost of expanded distribution would be reduced to 8930 US dollars (5-95th percentiles, 5864-13,163) per infection averted in Brazil and 374 US dollars (5-95th percentiles, 237-553) in South Africa by acquiring FC2s through a global purchasing mechanism and increasing distribution threefold. Sensitivity analyses show model estimates to be most sensitive to the estimated prevalence of sexually transmitted infections, total sexual activity, and fraction of FC2s properly used. CONCLUSIONS: Expanded distribution of FC2 in Brazil and South Africa could avert substantial numbers of HIV infections at little or no net cost to donor or government agencies. FC2 may be a useful and cost-effective supplement to the male condom for preventing HIV.

Adolescent↗
PubMed2005

A comparative study of condom use and self-reported sexually transmitted infections between foreign Asian and local clients of sex workers in Singapore.

OBJECTIVE: We conducted a survey to compare condom use and its associated factors between foreign Asian and local clients of female sex workers in Singapore. STUDY: A survey was conducted between 2001 and 2002 on a random sample of 810 clients (677 foreign Asian workers and 133 locals) recruited from the streets and outside the brothels in Singapore. RESULTS: Foreign clients were more likely than locals to be inconsistent condom users with sex workers. Clients from China reported the highest percentage of inconsistent condom use (29.2%) and sexually transmitted infections (16.7%) compared with 8.3% (P < 0.003) and 2.3% (P < 0.005), respectively, among locals. On multivariate analysis, inconsistent condom use among foreign clients increased significantly with the number of freelance sex workers. The reverse trend was found for local clients. CONCLUSION: There is a need to design separate condom-promotion programs for foreign Asian and local clients of sex workers in Singapore.

Adolescent↗
PubMed2005

Accounting for failures may improve precision: evidence supporting improved validity of self-reported condom use.

OBJECTIVES: To determine whether a measure of unprotected vaginal sex that is adjusted for condom failures would produce improved accuracy in predicting biologically confirmed STDs (chlamydia and gonorrhea) among female teens. METHODS: Self-reported measures were collected using audio-computer-assisted self-interviewing. DNA amplification for the presence of Chlamydia trachomatis and Neisseria gonorrhoeae was conducted. RESULTS: The unadjusted measure of unprotected vaginal sex was not significantly associated with biologically confirmed prevalence of STDs (prevalence ratio [PR] = 1.51; 95% CI = 0.71-3.21; P = 0.28). Alternatively, the adjusted measure achieved significance (PR = 3.59; 95% CI = 1.13-11.38; P = 0.014). More than one quarter (25.6%) of teens using condoms inconsistently and/or incorrectly tested positive for an STD compared to 7.1% among those reporting the consistent and correct use of condoms. CONCLUSION: Findings demonstrate that studies of condom effectiveness should use an adjusted measure of condom use to achieve precision and rigor.

Adolescent↗
PubMed2005

Do participant characteristics influence the effectiveness of behavioral interventions? Promoting condom use to women.

OBJECTIVES: This study assessed whether participant baseline characteristics modified the effects of a skill-based intervention promoting condom use. STUDY: The randomized, controlled trial enrolled 427 women from a sexually transmitted disease clinic in Birmingham, Alabama. The main outcome measures: consistent (100%) and problem-free (correct, no breakage or slippage) condom use were verified by sexual diary self-report and contraceptive product counts. RESULTS: The enhanced intervention group had a 60% higher consistent condom use rate compared to the basic group (risk ratio [RR], 1.6; 95% confidence interval [CI], 1.4-1.8). There was no statistically significant difference between groups in relationship to problem-free, consistent use (RR, 1.0; 95% CI, 0.9-1.1). A binomial regression analysis identified the following factors as significant modifiers of intervention effectiveness on consistent condom use: intention to use condoms next time, early-age sexual debut, marital status combined with place of intercourse, and substance use before sex. CONCLUSIONS: The results suggest that participant baseline characteristics can be modifiers of intervention effectiveness.

Adolescent↗
PubMed2006

Associations between condom use and rectal or urethral chlamydia infection in men.

OBJECTIVE: To investigate the association of condom use with chlamydia infection in men attending a large sexually transmitted infection (STI) clinic in Australia. STUDY: Computerized records for all attendances between July 2002 and June 2003 were included and separate analyses were performed for men reporting male-to-male sexual contact (MSM) and for men reporting heterosexual contact only (non-MSM). Associations among age, condom use, and number of partners with chlamydia infection were assessed. RESULTS: Chlamydia was diagnosed at a rate of 8.6 cases per 100 consultations (95%CI: 7.1, 10.3) among MSM and at a rate of 6.8 cases per 100 consultations (95%CI: 5.9, 7.8) among non-MSM. Condom use was associated with a lower odds of rectal chlamydia but not urethral infection in MSM. Condom use was associated with lower odds of urethral chlamydia among non-MSM. CONCLUSIONS: The findings suggest that condoms do provide some protection against rectal chlamydia infection in MSM and chlamydial urethritis in non-MSM, but other factors may play an important role in the transmission of chlamydial urethritis in MSM.

Adult↗
PubMed1992

Effects of communication with important social referents on beliefs and intentions to use condoms.

Data from a 1989 survey using the condom attitude and belief instrument with 310 clients from two sexually transmitted disease clinics identified significant social referents who influence condom-use intentions. They are sexual partner, father and friends. The present study found that communication with these referents had a positive net effect on beliefs about and intentions to use condoms. Implications applicable for intervention programmes to increase condom use are to promote talking about condoms between the sexual partners and important social referents and to develop such communication skills.

Adolescent↗
PubMed2005

Young people's use of condoms and their perceived vulnerability to sexually transmitted infections.

OBJECTIVE: Although sexually transmitted infections (STIs) are most prevalent among young people, they do not use condoms consistently to prevent infection. This study examined young people's perceptions of vulnerability to STIs and pregnancy. METHOD: A cross-sectional survey on sexual behaviour was carried out on a stratified random sample of school-going Year 12 and Year 13 young people aged 16-18 years in Christchurch, New Zealand. RESULTS: 1,136 students participated in the study, half of whom were sexually active. Fewer than half of the sexually active participants (44.6%) used condoms on every occasion of sexual intercourse. Only 23% of participants reported that they felt vulnerable to acquiring an STI, with a quarter of respondents reporting not using condoms because they did not think that either they or their partner had an infection, and a quarter reported not using condoms because they used other contraceptive measures. CONCLUSIONS: The results of this study support the premise that young people are more concerned about preventing unwanted pregnancy than STIs. Their perception of low risk of acquiring STIs is not without substance, however, as it was established that there was a low prevalence of Chlamydia trachomatis among this school-going population. The key to achieving more consistent condom use for STI prevention for young people may be through finding ways to get them to accept that they are vulnerable to STIs, despite the low prevalence among their peers, because the consequences of infection are far-reaching.

Adolescent↗
PubMed2004

The moral lens of population control: condoms and controversies in southern Malawi.

The study presents an investigation of stories about condoms in southern Malawi. Malawians' concerns about coercive population control imposed by a national government or international cabal provide a moral lens through which condoms and other health promotions are viewed, with unknown but probably negative impact on the use of condoms. The focus of the study is on the long shadow cast by population control because it is underresearched and, in fact, virtually unmentioned in most studies of health promotion, yet appears to be common if not ubiquitous. Moreover, this long shadow poses a distinct challenge to HIV-prevention and intervention efforts. The data for the study were gathered by six Malawian research assistants in Balaka district, in southern Malawi, who kept journals over a period of three years in which they recorded conversations and everyday chats that they observed. These journals demonstrate that condoms do not arrive in communities as neutral, value-free objects; rather they enter a social setting permeated with ideas about health, self-protection, and danger. The lens of population control has proved to be both durable and flexible, providing a moral context in which both commodities and actors can be understood. Disentangling condoms from the symbolic nexus in which they are fused with disease, population control, and malevolence will be an ongoing challenge in the struggle to prevent the spread of HIV/AIDS in Malawi.

Adult↗
PubMed2005

Factors influencing boys' age at first intercourse and condom use in the Shantytowns of Recife, Brazil.

Despite the general recognition that the sexual practices of adolescent boys place them at high risk of acquiring sexually transmitted infections (STIs), including HIV, and of causing unwanted pregnancies, advances in mapping their sexual behaviors have been slow. This study uses data recently collected from low-income areas of the city of Recife, Brazil, to study boys' age at first sexual intercourse and factors that hinder their use of condoms. These boys become sexually active at early ages, and despite their general awareness of HIV, they rarely use condoms, especially at ages younger than 15. Sustained family involvement in guiding boys is associated with later first intercourse and an increased use of condoms. Boys who describe themselves as shy with girls have later first intercourse, although the probability of their using condoms does not differ from that of other boys of their age. Higher socioeconomic status leads to earlier sexual activity for boys (in contrast with girls), but also to a greater likelihood of using condoms during first intercourse.

Adolescent↗
PubMed1989

Free condoms in the schools of Copenhagen, Denmark.

Attitudes of ninth grade students and their classroom teachers toward using condoms as a preventive measure against contracting AIDS were studied. Students (N = 438) and their teachers (N = 28) in the council schools of the Municipality of Copenhagen were surveyed using a structured questionnaire. Overall, results demonstrated that the message regarding "safe sex" had been well understood. However, 42% of pupils reported not using a condom during their last sexual intercourse. Many pupils indicated difficulty in using condoms. A continuing need exists for advice to the young. An information campaign, with distribution of free condoms, was well accepted by pupils and teachers. Almost all (94%) pupils indicated they will use condoms more frequently in the future. This campaign differed from other efforts that focused more on general information. The importance of other strategies designed to alter behavior to reduce the risk of contracting AIDS is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Do intentions predict condom use? Meta-analysis and examination of six moderator variables.

This study used meta-analysis to quantify the relationship between intentions and behaviour in prospective studies of condom use. The effects of six moderator variables were also examined: sexual orientation, gender, sample age, time interval, intention versus expectation and condom use with 'steady' versus 'casual' partners. Literature searches revealed 28 hypotheses based on a total sample of 2532 which could be included in the review. Overall, there was a medium to strong sample-weighted average correlation between intentions and condom use (r+ = .44), and this correlation was similar to the effect sizes obtained in previous reviews. There were too few studies of gay men to permit meaningful comparison of effect sizes between homosexual versus heterosexual samples. Gender and measurement of intention did not moderate the intention-behaviour relationship. However, shorter time intervals, older samples and condom use with 'steady' rather than 'casual' partners were each associated with stronger correlations between intentions and condom use. Factors which might explain the significant effects of moderator variables are discussed and implications of the study for future research on intention-behaviour consistency are outlined.

Adolescent↗
PubMed1992

Effect of serotesting with counselling on condom use and seroconversion among HIV discordant couples in Africa.

OBJECTIVE: To determine whether HIV testing and counselling increased condom use and decreased heterosexual transmission of HIV in discordant couples. DESIGN: Prospective study. SETTING: Kigali, the capital of Rwanda. SUBJECTS: Cohabiting couples with discordant HIV serology results. MAIN OUTCOME MEASURES: Condom use in the couple and HIV seroconversion in the negative partners. RESULTS: 60 HIV discordant couples were identified, of whom 53 were followed for an average of 2.2 years. The proportion of discordant couples using condoms increased from 4% to 57% after one year of follow up. During follow up two of the 23 HIV negative men and six of the 30 HIV negative women seroconverted (seroconversion rates of 4 and 9 per 100 person years). The rate among women was less than half that estimated for similar women in discordant couples whose partners had not been serotested. Condom use was less common among those who seroconverted (100% v 5%, p = 0.01 in men; 67% v 25%, p = 0.14 in women). CONCLUSIONS: Roughly one in seven cohabiting couples in Kigali have discordant HIV serological results. Confidential HIV serotesting with counselling caused a large increase in condom use and was associated with a lower rate of new HIV infections. HIV testing is a promising intervention for preventing the spread of HIV in African cities.

AIDS Serodiagnosis↗
PubMed2004

Changes in regular condom use among immigrant transsexuals attending a counselling and testing reference site in central Rome: a 12 year study.

OBJECTIVE: To analyse data from male to female transsexuals attending between 1992 and 2003 an outpatient clinic considered the main HIV counselling and testing site in Rome for foreign people. METHODS: Data collected between 1992 and 2003, from a routine anti-HIV testing and counselling activity, were analysed. A brief standard interview was performed at each test. A cross sectional analysis to assess the association of regular condom use with demographic and behavioural variables using multiple logistic regression was performed. A follow up analysis to define the effect of single factors on the occurrence of new anti-HIV seroconversions was also performed. The incidence of anti-HIV seroconversion was calculated in person years of observation. RESULTS: Overall, 473 transsexuals sex workers were tested. Most of them (99%) were from South America (mainly Columbia and Brazil). Anti-HIV prevalence was 32%, but a progressive decrease over time was observed (from 57% in 1993 to 12% in 2003). The proportion of patients reporting regular condom use at enrolment was 75%. A progressive increase in regular condom use was reported over time (from 43% in 1992-3 to 79% in 2002-3). 15 new HIV infections were observed during follow up (incidence 2.1 per 100 person years). Though the proportion of patients reporting regular condom use increased over time, 10 out of the 15 new infections occurred in patients reporting unprotected sex during follow up (rate 8.4 per 100 person years). CONCLUSIONS: Our data suggest that counselling may lead to an increase in safe sex practices among immigrant transsexuals. However, the incidence of new HIV infections is still high and mainly related to non-regular condom use, which still remains the primary objective of prevention.

Adult↗
PubMed1999

Risk factors for the acquisition of genital warts: are condoms protective?

OBJECTIVES: To characterise risk factors for the acquisition of genital warts and specifically to determine whether condoms confer protection from infection. METHODS: A retrospective case-control study comparing demographic, behavioural, and sexual factors in men and women with and without newly diagnosed genital warts, who attended Sydney Sexual Health Centre (SSHC), an inner city public sexual health centre, in 1996. Data were extracted from the SSHC database. Crude odds ratios (OR) were calculated to compare cases and controls and significant factors were then controlled for using multivariate logistic regression to obtain adjusted odds ratios (ORs). RESULTS: 977 patients with warts and 977 controls matched by sex and date of attendance were included. In both sexes, univariate analysis revealed that younger age, more lifetime sexual partners, failure to use condoms, greater cigarette smoking and alcohol consumption were associated with warts, and there was a negative association with previous infection with Chlamydia trachomatis, Neisseria gonorrhoeae, hepatitis B, and genital herpes. In males, on multivariate analysis, factors which remained significant were younger age, more lifetime sexual partners; failure to use condoms, greater cigarette smoking, and previous chlamydia. In women, factors which remained significant were younger age, more lifetime sexual partners, condom use, marital status, and previous infections with Chlamydia trachomatis and herpes. CONCLUSIONS: Independent risk factors for genital warts include younger age, greater number of lifetime sexual partners, and smoking. Consistent condom use significantly reduces the risk of acquiring genital warts.

Adolescent↗
PubMed2003

Acceptability and technical problems of the female condom amongst commercial sex workers in a rural district of Malawi.

A study was conducted among commercial sex workers (CSWs) in rural southern Malawi, in order to (a) assess the acceptability of the female condom and (b) identify common technical problems and discomforts associated with its use. There were 88 CSWs who were entered into the study with a total of 272 female condom utilizations. Eighty-six (98%) were satisfied with the female condom, 80% preferred it to the male condom and 92% were ready to use the device routinely. Of all the utilizations, the most common technical problem was reuse of the device with consecutive clients, 6% after having washed it, and 2% without any washing or rinsing. The most common discomfort that were reported included too much lubrication (32%), device being too large (16%), and noise during sex (11%). This study would be useful in preparing the introduction of the female condom within known commercial sex establishments in Malawi.

Adult↗
PubMed2005

Condom use predictors for low-income African American women.

The purpose was to investigate whether an HIV-prevention curriculum and a health maintenance curriculum produced different rates of change in reported consistent condom use and to explore what mediating variables predicted reported consistent condom use over time. A longitudinal crossover research design with extended posttest observations was used with a sample of 279 African American women. After pretesting, women received the designated curriculum and were posttested at completion, 3, 6, and 9 months. After the 9-month posttest, the curriculum was switched, and the above procedure was repeated. Using SAS macro GLIMMIX, the data revealed that the HIV curriculum yielded higher consistent condom use than did the health maintenance curriculum and that the mediating variables that predicted consistent condom use over time were self-efficacy for low-risk HIV behavior, HIV-related community behavior, and social norms. Enhancing consistent condom use over time may require the promotion and reinforcement of these mediating variables.

Adult↗
PubMed2004

Cover up or cool it? Sexual intercourse during therapy for bacterial sexually transmitted infections--a discussion of evidence for efficacy of condom use preventing transmission during an acute bacterial STI.

Effective treatment of sexually transmitted infections (STIs) such as gonorrhoea and chlamydia needs sexual behaviour modification, in addition to antibiotics, to protect the index patient and their sexual partner from re-infection during treatment. This may mean advice to avoid sex, or to use condoms for intercourse, until all current sexual partners have completed treatment. This article discusses the effectiveness of condoms as re-infection protection during therapy of gonorrhoea and chlamydial infection. Indirect evidence from studies on primary prevention indicates that, although physically, condoms are impermeable to STI pathogens, the risk of failure depends on the experience of the user and the frequency of use. Health care workers may over-estimate the protective value of condoms in this situation. Patients should be made aware of the risk of infection present, even in experienced condom users, if they choose to continue protected sexual intercourse during therapy for acute bacterial STIs.

Coitus↗