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PubMedDate not supplied

Knowledge, attitude, and practice about AIDS and condom utilization among health workers in Rwanda.

Health workers in rural Rwanda were surveyed cross-sectionally on knowledge, attitude, and practice (KAP) about AIDS, HIV, and condom utilization. Participants were 350 health workers from six randomly chosen communities (three rural, three semirural). In general, knowledge about HIV/AIDS was moderate to good, with an average of 63% of the questions answered correctly; men (and younger respondents) had a better knowledge than did women (p =.01; older participants, p =.015). However, in the specific area of HIV/AIDS symptoms, knowledge was inadequate. In general, the attitude of health workers toward condoms was not sufficiently positive. Regular use of condoms was reported by 17%; the only variable significantly associated with condom use was having more than one partner during the past year. Men and those who scored high on knowledge had a more positive attitude toward infected individuals than did women (p =.003) and those with less knowledge (p =.001). In conclusion, there is an urgent need to institute educational programs to reduce the stigma about condoms among health workers in Rwanda.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Sex workers' perspectives on condom use for oral sex with clients: a qualitative study.

The authors conducted in-depth interviews with 46 female brothel-based sex workers to explore their perceived barriers and approaches in getting clients to use condoms for oral sex. Reasons given by sex workers for not using condoms for oral sex as compared to vaginal sex included self-perception of low vulnerability to AIDS and sexually transmitted infections, misconceptions on transmission of the HIV virus, lack of negotiation skills, lack of support from brothel keepers and peers, and unpleasant taste and smell of condoms. Some sex workers could get all their clients to use condoms for oral sex by using negotiation skills, including the positive approach, the fear approach, the emotional appeal approach, and the assertive approach. Findings from this study would help design more appropriate messages and improve negotiation skills of sex workers to increase consistent condom use for oral sex.

Acquired Immunodeficiency Syndrome↗
PubMed2007

Informing school sex education using the stages of change construct: sexual behaviour and attitudes towards sexual activity and condom use of children aged 13-16 in England.

A survey of 3820 school children in England aged 13-16 years examined sexual activity using the Transtheoretical Model (TTM) Stages of Change. A quarter (26%) of teens were sexually experienced, 44.8 per cent did not use contraception and 48.9 per cent did not use condoms, every time. Past history of condom and contraceptive use, and partner willingness to use condoms were the best predictors of being in Action or Maintenance stage for condom use. Of virgins, 19.82 per cent were in Contemplation or Preparation stages for intercourse, and 85.4 per cent would use condoms every time. Sex education should be tailored to Stage, and signposting to sexual health and contraception services.

Adolescent↗
PubMed2006

Correlates of condom use in a sample of MSM in Ecuador.

BACKGROUND: In Ecuador, the prevalence of HIV in the general population is approximately 0.3%. However, up to 17% prevalence has been reported among specific groups of homosexual and bisexual men. The objective of this study is to explore correlates of condom use among men who have sex with men (MSM) across eight cities in Ecuador. METHODS: A cross-sectional survey design was used. A questionnaire including variables on sexual behaviour, demographics, and socio-economic characteristics was distributed to a sample of MSM in eight Ecuadorian cities. RESULTS: Information was obtained for 2,594 MSM across the eight cities. The largest subcategory of self-identification was active bisexuals (35%), followed by those who described themselves as "hombrados" (masculine gays, 22%). The mean age was 25 years, and the majority were unmarried (78%), with a median of 10 years of schooling (IQR 7 - 12). Regarding condom use, 55% of those interviewed had unprotected penetrative sex with each of their last three partners, and almost 25% had never used a condom. The most important correlates of condom use were single status, high life-skills rating, and high socio-economic status (RP 5.45, 95% CI 4.26 - 6.37; RP 1.84, 95% CI 1.79 - 1.86, and RP 1.20, 95% CI 1.01 - 1.31, respectively). CONCLUSION: Our data illustrate the urgent need for targeted HIV-prevention programs for MSM populations in Ecuador. MSM have the highest HIV prevalence in the country, and condom use is extremely low. It is imperative that prevention strategies be re-evaluated and re-prioritized to more effectively respond to the Ecuadorian epidemic.

Adult↗
PubMed2003

Predictors of consistent condom use: a hierarchical analysis of adults from Kenya, Tanzania and Trinidad.

The two regions hardest hit by the HIV/AIDS epidemic are sub-Saharan Africa and the Caribbean. It is estimated that more than 28 million persons within these regions are currently living with HIV/AIDS. Therefore, it is imperative that more effective models of protective behaviour change be developed and implemented. Data from 4293 adults from Kenya, Tanzania and Trinidad who agreed to participate in the Voluntary Counseling and Testing Efficacy Study were examined employing hierarchical regression modelling. Only 19% reported consistent condom use with most recent sex partner. Factors associated with consistent condom use were relation to most recent sex partner, gender, study site, perceived difficulty in requesting condom use and actually making requests for condom use. Interventions that are grounded in theory and consider the relationship between the various independent variables along with the dependent variable may be more effective in promoting HIV protective behaviour change, such as consistent condom use, than current prevention efforts.

Adult↗
PubMed2006

Sex work practices and condom use in female sex workers in Sydney.

The aim of this study was to determine sex work practices and predictors of condom use among female sex workers (SWs) in Sydney. SWs from two centres completed a self-administered questionnaire covering demographic and sexual characteristics and sex work practices. One hundred and forty-eight international (born in Asia) and 141 local SWs (born in Australia, New Zealand or the UK) were recruited. Local SWs saw more clients per shift than international SWs (P = 0.002), but international SWs worked more shifts per week than local SWs (P = 0.001). International SWs used condoms less consistently at work than local SWs (P = 0.001). About 37% of international SWs never used condoms with non-paying partners, compared with 14% of local SWs (P = 0.01). Speaking Thai (odds ratio [OR] 8.9, 95% confidence interval [CI]; 3.19-24.87) or Chinese (OR 17.4; 95% CI 4.98-60.89) (both P < 0.001) and previous sex work in Thailand (OR 10.0 95% CI 2.31-43.52; P = 0.02) were associated with inconsistent condom use. Strategies to improve condom use need to be evaluated.

Adolescent↗
PubMed1999

Facilitators and barriers to use of the female condom: qualitative interviews with women of diverse ethnicity.

Women in the United States, particularly African-Americans and Hispanics, are at increased risk for HIV. The female condom now offers women a potentially important option for HIV prevention, yet few efforts have been made to increase its use. To elucidate strategies to promote the use of the female condom, we conducted in-depth interviews with 62 women recruited from the four major racial/ethnic groups of the U.S. (African-American, Asian-American, Hispanic, and white). Subject recruitment took place at a family planning clinic in San Francisco during 1996-97. We identified four major types of facilitators and barriers to use of the female condom: mechanical, psychosexual, interpersonal, and situational. Specifically, the mechanical facilitators and barriers included positive and negative aspects of the device, and difficulty with insertion. The psychosexual factors were female empowerment, more options for contraception and disease prevention, discomfort with vaginal insertion, and condom use norms. The interpersonal factors included: enhanced communication, relationship status, partner preferences, and partner objections. Finally, the situations that made women disinclined to use the device were: no access to the female condom when having sex and using other forms of contraceptives. The implications of these findings for HIV prevention and future research are discussed.

Adolescent↗
PubMed2005

Determinants of condom use among a random sample of single heterosexual adults.

OBJECTIVES: The aim of this study was to identify the determinants of single heterosexuals' use of condoms during each sexual intercourse. DESIGN: Cohort of individuals followed over a period of 2 years. METHODS: Respondents were 574 single heterosexual individuals who answered questions during a telephone interview. RESULTS: Attitude, perceived behavioural control, self-efficacy and moral norm explained 65% of the variance in intentions to use condoms ( p, .0001). The determinants of condom use at 1 year follow-up (27% explained variance) were perceived behavioural control, past behaviour, and the interaction between intention and intention stability. At 2 years follow-up, the significant determinants were past behaviour and intention by intention stability. In the present study, intentions to use condoms which remained stable across time were strong predictors of condom use (at 1 year: beta = .42, p < .0001; at 2 years: beta = .39, p, < .003), while unstable intentions were not (at 1 year: beta = .02, ns; at 2 years: beta = .19, ns). CONCLUSION: Intention stability is a major determinant of the accuracy of intention for the prediction of subsequent behaviour.

Adolescent↗
PubMed2006

Promoting female condom use to heterosexual couples: findings from a randomized clinical trial.

CONTEXT: The female condom remains the only female-initiated method for preventing pregnancy and STDs, including HIV. Innovative methods for promoting its use, and for involving male partners in its use, are needed. METHODS: A sample of 217 women and their main male sexual partners were randomly assigned to one of three study conditions: a six-session relationship-based STD prevention intervention provided to the couple together, the same intervention provided to the woman only or a single-session education control provided to the woman only. Assessments were conducted at baseline and three months postintervention. Contrast coding was used to examine whether the effects of the two active interventions differed from those of the control intervention, and whether the effects of the two active interventions differed from each other. Regression analyses were used to estimate treatment effects. RESULTS: During follow-up, participants in either active intervention were more likely to use a female condom with their study partner and with all partners, and used female condoms at a higher rate with all partners, than individuals assigned to the control intervention; at the end of three months, they were more likely to intend to use the condom in the next 90 days. No significant differences in outcomes were found between the active intervention groups. CONCLUSIONS: Focusing on both a woman and her main male sexual partner is efficacious in increasing female condom use and intention to use among heterosexual couples at risk for HIV and other STDs.

Adolescent↗
PubMed2001

Support for condom availability and needle exchange programs among Massachusetts adults, 1997.

This study was conducted to determine whether demographic factors, variables related to HIV risk status, or personal attitudes predicted public support for condom availability programs in high schools and needle exchange programs. Data for these analyses were collected from the 1997 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS) among adults aged 18-64. Overall, 79% of Massachusetts adults aged 18-64 supported condom availability programs, and 60% supported needle exchange programs. Younger age was the strongest demographic predictor of support for condom availability, and higher socioeconomic status was the strongest predictor of support for needle exchange programs. Support for both programs was weakly associated with personal HIV risk status but strongly associated with positive attitudes toward teaching about HIV in schools and advising sexually active teens to use condoms. Our data suggest that there is broad-based public support for implementation of condom availability and needle exchange programs as tools for HIV prevention.

Adolescent↗
PubMed2001

Factors associated with condom use in Kenya: a test of the health belief model.

This study examined specific cultural beliefs and knowledge about HIV as well as tested components of the Health Belief Model in relation to condom use in Kisumu, Kenya. Interviews were conducted with 223 participants at six governmental and private clinics. Although 75% had engaged in intercourse during the preceding month, fewer than 20% had used a condom. For both men and women, perceived barriers was the only component of the Health Belief Model significantly associated with condom use, with greater perceived barriers being associated with lower frequency of condom use (p < .05). Additionally, individuals with more education and HIV/AIDS knowledge were less likely to endorse stigmatizing beliefs toward HIV/AIDS (p < .001), whereas people who believe that HIV originated in the United States were more likely to endorse these stigmatizing beliefs (p <.002). Nearly everyone (97%) reported that AIDS is the disease that scares them most, suggesting that educational efforts have successfully communicated the severity of this disease. Future intervention efforts must now focus more extensively on addressing stigmatizing beliefs and providing education to overcome barriers to condom use.

Adolescent↗
PubMed2002

Increasing condom use by undermining perceived invulnerability to HIV.

An intervention to increase condom use by undermining perceptions of invulnerability to HIV was tested in a sample of 128 college students. Participants were randomly assigned to the invulnerability undermined (IU) condition or a demand characteristic control (DCC) condition. The IU condition used tasks that highlighted past failures to protect oneself and the failure of illusory protection strategies. Participants in the DCC condition watched a video on protecting oneself from HIV. Participants in the IU condition, relative to those in the DCC group, had lower perceptions of invulnerability to HIV and higher intentions to use condoms on the immediate postintervention measures; they reported more condom use at the 3-month follow-up. Contrary to prediction, perceptions of invulnerability did not mediate the effects of the intervention on condom use intentions or condom use. The advantage of indirect methods of reducing denial of vulnerability is discussed.

Adolescent↗
PubMed2003

Risk behavior and social-cognitive determinants of condom use among ethnic minority communities in Amsterdam.

This study assessed sexual risk behavior and determinants of condom use among migrants in Amsterdam, The Netherlands. We tested the predictive utility of constructs derived from the health belief model and the theory of planned behavior. Data were collected by means of a cross-sectional study in a community sample of 537 Surinamese, Antillean, and sub-Saharan African heterosexual men and women randomly recruited from participants in an epidemiological study. Participants donated saliva for HIV testing and were interviewed using two structured questionnaires. Inconsistent condom use occurred in 82% of the primary partnerships and in 25% of the casual partnerships. Multivariate analyses, controlling for sociodemographic and behavioral factors, showed that perceived behavioral control and subjective norm regarding condom use were main social-cognitive determinants of consistent condom use. However, contrary to predictions, the relation between consistent condom use and sociodemographic and behavioral factors was not entirely mediated by these social-cognitive factors.

Adolescent↗
PubMed2004

What really works? An exploratory study of condom negotiation strategies.

Verbal-direct strategies are assumed to be the most effective strategies in negotiating condom use. Both cultural and gender differences in communication styles suggest that individuals may negotiate condoms in ways that are not exclusively verbal and direct. This study examined the use of other forms of condom negotiations by developing an exploratory scale that distinguished strategies on how verbal and direct they were (i.e., verbal-direct, verbal-indirect, nonverbal-direct, nonverbal-indirect). The study compared the use of negotiation strategies among Asian and White American students at a northern California university. Results indicated that although direct strategies (verbal and nonverbal) were more frequently used, condom users also employed indirect strategies (verbal and nonverbal) to negotiate condom use. Moreover, Asians used verbal-indirect strategies more than Whites. Women used nonverbal-indirect strategies more than men. HIV preventions seeking to be culturally sensitive to Asians and women may benefit from incorporating these strategies into their interventions.

Adolescent↗
PubMed2000

Alcohol use, condom use and partner type among heterosexual adolescents and young adults.

OBJECTIVE: The present study examined the links between alcohol use and condom use, and the nature of the sexual relationship in which these behaviors occurred, and tested the notion that partner type suppresses the negative, direct effects of alcohol use on condom use. METHOD: Data were collected as part of face-to-face interviews conducted with 1,417 (54% female) randomly selected young adults (aged 18-25 years) who had had sex in the past 6 months. RESULTS: Using within-subjects analytic procedures, results showed that both drinking and condom use were more common with casual than with serious sexual partners, as expected. Moreover, consistent with the suppression hypothesis, the relationship between alcohol use and condom use became significant and negative only after controlling for partner type. CONCLUSIONS: These findings suggest that the interrelationships among partner type, alcohol use and condom use are complex and that the processes linking each pair of variables are best understood as part of a larger system of interconnected variables.

Adolescent↗
PubMed2001

Condom use by adolescents.

The use of condoms as part of the prevention of unintended pregnancies and sexually transmitted diseases (STDs) in adolescents is evaluated in this policy statement. Sexual activity and pregnancies decreased slightly among adolescents in the 1990s, reversing trends that were present in the 1970s and 1980s, while condom use among adolescents increased significantly. These trends likely reflect initial success of primary and secondary prevention messages aimed at adolescents. Rates of acquisition of STDs and human immunodeficiency virus (HIV) among adolescents remain unacceptably high, highlighting the need for continued prevention efforts and reflecting the fact that improved condom use can decrease, but never eliminate, the risk of acquisition of STDs and HIV as well as unintended pregnancies. While many condom education and availability programs have been shown to have modest effects on condom use, there is no evidence that these programs contribute to increased sexual activity among adolescents. These trends highlight the progress that has been made and the large amount that still needs to be accomplished.

Adolescent↗
PubMed1996

HIV risk behaviors and obstacles to condom use among Puerto Rican men in New York City who have sex with men.

OBJECTIVES: This paper describes the sexual risk behaviors of Puerto Rican men who have sex with men and their perceived obstacles to condom use. METHODS: Interviews were conducted with 182 Puerto Rican men living in New York, NY. RESULTS: Condoms were used inconsistently or not at all by half of the men who had anal sex with other men, by two thirds of the men who had vaginal sex, and by three fifths of those who had anal sex with women. Most of the men had had unprotected oral sex and more than one sexual partner in the previous year. Three of 10 were positive for the human immunodeficiency virus (HIV). Dislike of condoms was the most frequently cited obstacle, followed by perception of low risk, trust in and emotional connection with partner, unavailability and inconvenience of condom use, lack of control, and indifference. CONCLUSIONS: Barrier methods other than condoms, such as a microbicidal, gel, need to be developed.

Condoms↗
PubMed1998

The protective effect of condoms and nonoxynol-9 against HIV infection.

OBJECTIVES: Whether or not spermicides can reduce the risk of human immunodeficiency virus (HIV) transmission remains an important question for the control of heterosexual HIV transmission. The authors provide estimates from a reanalysis of one of the few observational studies on the efficacy of condoms and spermicides, used separately and together, per vaginal contact. METHODS: In this reanalysis, three different models were used to assess the efficacy of spermicides and condoms: linear (Pearl index), exponential (maximum likelihood), and monotonic (marginal likelihood). RESULTS: Reported use of barrier methods among 27,432 contacts was as follows: condoms plus nonoxynol-9, 39%; condoms alone, 25%; nonoxynol-9 alone, 24%; and unprotected, 11%. Under all three models, the results indicate a strong protective effect for spermicidal suppositories. The Pearl index indicated that spermicide alone is apparently efficacious, but the efficacy per contact cannot be quantified with this approach. Maximum likelihood estimates for the efficacy of nonoxynol-9 alone and condoms (with or without nonoxynol-9) were 100% (95% confidence interval [CI95] = 43%, 100%) and 92% (95% CI95 = 79%, 100%), respectively. CONCLUSIONS: The data from this observational study suggest that spermicides may be efficacious in reducing the risk of HIV transmission.

Administration, Intravaginal↗