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PubMedDate not supplied

Patterns of partnership and condom use in two communities of female sex workers in Tanzania.

Two rapid ethnographic studies have found that commercial sex workers (CSWs) and other high-risk women in Tanzania have different categories of partners, ranging from single-time contacts to long and enduring relationships. Since the advent of HIV/AIDS prevention programs in Tanzania in the late 1980s, CSWs and their clients have been aware of the multiple benefits of condom use for the prevention of pregnancy and STDs including HIV. These women often use condoms for the single-time contact. However, since the HIV/AIDS epidemic, casual partners have decreased in number. These days, most of their sexual contacts occur within long-term partnerships, and within these relationships, condom use is rare. Although the message that condoms should be used during high-risk behavior has been largely accepted, the definition of a high-risk relationship needs to be extended from casual partnerships to include multiple long-term partnerships. In addition, men and women's empowerment through education, business, and equal rights needs to be addressed at all levels of society.

Adolescent↗

PubMed2003

Condom use behaviors in HIV-infected African American crack cocaine users.

The purpose of this study was to investigate sexual risk behaviors and factors associated with consistent condom use of HIV+ African Americans receiving HAART who smoke crack. Participants were African Americans in Houston, Texas and over 18, being treated for HIV, and reported currently using crack. Measures included demographic variables, sexual behaviors, drug use, and nine psychosocial scales and seven escape scales. One hundred thirty seven participated in the study. Condom use was low across all partner types. Regression analyses revealed two demographic variables, and two psychosocial and one escape scale were significantly associated with intention to use condoms. One of the more alarming findings of this study concerns the large number of individuals who know they are HIV positive yet continue to have unprotected sex. The inconsistent condom use by these HIV+ individuals threatens the progress that has been made to stem the epidemic.

Adult↗

PubMed2003

Patterns of HIV risk behavior and condom use among youth in Yaoundé and Douala, Cameroon.

This study describes the levels of sexual risk behavior and condom use among Cameroonian urban youth in order to evaluate the need for reproductive health programs targeting youth and to inform the design of such programs. We use data from a survey conducted in July-August 2000 among a representative sample of 1,956 unmarried youth aged 15-24 years. The data show that in urban Cameroon, first intercourse often occurs at an early age. Despite the HIV epidemic, a substantial fraction of youth, particularly males, continue to have high rates of partner change. A substantial fraction of youth consistently use condoms with casual partners. However, consistent condom use in regular relationships remains low, even though many youth have multiple regular partners. These findings illustrate the need for youth-targeted reproductive health programs in urban Cameroon. To ensure that youth are reached before they adopt risky behaviors, there is a need for programs that target very young teenagers and emphasize consistent condom use.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Condom use as a dependent variable: a brief commentary about classification of inconsistent users.

Transformation of nonnormally distributed measures of condom use frequency can be problematic for researchers. Distributions are typically dichotomized. We used data collected from 483 university undergraduates in an anonymous, cross-sectional survey to illustrate the value of a screening analysis before dichotomization. Inconsistent condom users were compared to consistent users with respect to 14 measures. Subsequently, inconsistent users were compared to those who never used condoms with regard to the same 14 measures. Findings suggest that a screening analysis is a potentially important aspect of analyzing distributions that assess frequency of condom use.

Adolescent↗

PubMed2004

Perceptions and attitudes regarding sex and condom use among Chinese college students: a qualitative study.

Perceptions regarding sex and condom use among Chinese college students were examined within a framework provided by protection motivation theory. Data from semistructured individual interviews indicate that Chinese students generally perceive a low level of vulnerability to HIV and sexually transmitted disease (STD) infection and a minimum exposure from family to drugs and risky sexual behaviors. While only a small proportion of students reported being sexually experienced, the majority of them expressed tolerance toward premarital sex and a high level of perceived intrinsic rewards from sexual experience. Students view condoms to be efficacious in preventing pregnancy or HIV/STD, but they also perceive a high level of response cost for use of condoms. The findings suggest that efforts to adapt HIV/STD prevention programs targeting Chinese adolescents and young adults need to consider cultural aspects of perceptions regarding sex and condoms among Chinese students and to address the conflict between traditional Chinese cultural values and modern influences.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Inhibition conflict and alcohol expectancy as moderators of alcohol's relationship to condom use.

Inhibition conflict theory predicts that alcohol will decrease condom use only among individuals who are highly conflicted about using a condom, whereas expectancy theory predicts such an effect only among individuals who hold strong beliefs about alcohol's effects on sexual risk taking. In Study 1, the first of these two theories was tested using a newly developed measure of conflict. Data from 308 college students who reported on the first time they had sexual intercourse with their most recent partner (FMRP) supported the utility of this measure and showed that quantity of alcohol consumed was negatively associated with condom use only among high-conflict individuals. In Study 2, 17- to 25-year-old respondents reported on their first sexual intercourse, FMRP, and last intercourse (ns = 465, 1136, and 984, respectively). In a simultaneous test of both inhibition conflict theory and expectancy theory, amount of alcohol consumed was found to be negatively associated with condom use at first intercourse among individuals high in both conflict and expectancy, at FMRP among high-expectancy individuals, and at last intercourse among high-conflict individuals. These results lend partial support to both theories of alcohol's effects and suggest that an integration of these two perspectives will ultimately be required if researchers are to model adequately alcohol's effects on human social behavior.

Adolescent↗

PubMed2005

Condom use among high-risk adolescents: testing the influence of alcohol use on the relationship of cognitive correlates of behavior.

The goal of this study was the exploration of distal effects of alcohol use on condom use. Criminally involved adolescents completed an initial measure of attitudes, beliefs, and prior behavior. Of the 300 who completed the initial measurement, 267 (89%) completed a behavioral assessment 6 months later. Analyses validated a theoretical model of condom use intentions and indicated that intentions and attitudes measured at baseline were significant predictors of condom use behavior 6 months later. Neither alcohol use nor alcohol problems moderated relationships among model variables or the influence of intentions and attitudes on behavior. The findings do not support a distal role for alcohol use in altering the cognitive correlates of condom use intentions and behavior among high-risk adolescents.

Adolescent↗

PubMed1998

Changes in sexual behaviour focusing on condom use in STD clinic attenders in Göteborg, Sweden, from 1989 to 1994--a questionnaire survey.

During the 4 years from 1989/1990 to 1994 an increase in the use of condoms was registered. A high frequency of condom failures was reported and probably reflects inappropriate use. More efforts should be made to educate people how to use the condom. The impact of alcohol intake as a risk factor for unsafe sex seems to be significant and should also be stressed in educational safer sex programmes. STD patients are a well-motivated group for information about safer sex and condom use. Health workers in STD clinics have an important task in this context.

Adolescent↗

PubMed2000

AIDS and STD knowledge, condom use and HIV/STD infection among female sex workers in Bali, Indonesia.

The objectives of this paper were to examine changes in AIDS/STD knowledge and behaviour from 1992-1998, current levels of STD infection and psychosocial and demographic determinants of condom use and STD infection among female sex workers. Data for the study were drawn from cross-sectional surveys of female sex workers conducted in 1992, 1994 and 1997-8. For each survey, women participated in a face-to-face interview in the brothel complexes. Survey questions included information on AIDS/STD knowledge, demographics, sexual history and psychosocial factors related to condom use. After the last survey, women were offered a vaginal exam for STD diagnosis and treatment. Sera were tested for HIV infection (anonymous, Elisa/Western blot) and syphilis (TYPHA, RPR). Cervical mucous was tested for chlamydia (LcX), gonorrhea (LCx), herpes (pcr) and HPV (pcr). Knowledge of AIDS and awareness of STDs has increased tremendously in this population since 1992. Reported condom use has also increased substantially (69.9%). Perceived susceptibility toward HIV infection remains low. Ineffective preventive strategies such as medication use continue to be common. HIV infection remains very low in this population (0.2%), although the prevalence of other STDs such as gonorrhea (60.5%), chlamydia (41.3%) and HPV (37.7%) were very high. STD knowledge and self-efficacy were significantly related to condom use as were the sex workers' perceived susceptibility to STD and HIV infection. Women with a larger number of partners were more likely to be infected with gonorrhea, chlamydia and HIV. Women who had come to Bali recently were more likely to be infected with HIV and gonorrhea.

Adult↗

PubMed2001

'Don't know' and 'didn't think of it': condom use at first intercourse by Latino adolescents.

We examined the specific reasons Latino adolescents did or did not use condoms at first intercourse and their specific reasons for their perceived risk for contracting HIV. Latino adolescents (n = 618), ages 11-19, completed a face-to-face interview that included information on demographics (sex, age, family-status (lives with both natural parents versus other family structure) and country of birth) and sexual behaviour. The respondents cited 'don't know' (25.9%), 'not available' (25.9%) and 'didn't think of it' (23.5%) as the most frequent reasons for not using condoms at first intercourse. Anyone can get it (41.8%), unknown knowledge of partner's serostatus (24.7%) and unprotected sex (23.8%) were the top three reasons for perceiving oneself as being at risk for contracting HIV. Sexually active adolescents were more likely to perceive themselves at risk for contracting HIV than adolescents that had not had sex. Males were significantly more likely to report using condoms for protection at first intercourse than females. The remaining demographic factors were not significantly related to use of condoms at first intercourse nor to perceived risk for contracting HIV.

Adolescent↗

PubMed2003

Power communication and condom use: patterns of HIV-relevant sexual risk management in heterosexual relationships.

Combining relationship-based theories with quantitative methods is a relatively new approach in HIV prevention research. In this paper--focusing on relationship power, communication on HIV protection measures and condom use--clusters are identified which contribute to the understanding of HIV-relevant sexual risk management in heterosexual contacts. Data on 508 heterosexual contacts were collected in the German-speaking part of Switzerland using computer-assisted telephone interviews. Condom use is practised regularly among young and middle-aged couples but not among older couples. Cluster analyses show that in sexual contacts with equal or female power, communication appears to be decisive as to whether a condom is used. Male relationship power, however, is accompanied by relatively frequent condom use, regardless of whether the couple communicated about HIV protection measures. Implications for HIV prevention research and strategies, with an emphasis on aspects of relationship, gender and age, are suggested.

Adult↗

PubMedDate not supplied

'Snag bags': adapting condoms to community values in Native American communities.

HIV/AIDS researchers working among Native Americans have consistently noted resistance to discussions of sexuality and the distribution of condoms. This resistance is inspired by long held values about shame and public discussions of sexuality. Also, American Indians have been reluctant to welcome public discussions of HIV/AIDS and sexuality from external entities, such as governmental agencies. As a result, Native peoples have some of the lowest documented condom use rates. However, innovations in culturally integrating condoms and safe sex messages into Native cultural ideals are proving beneficial. One such innovation is the snag bag, which incorporates popular Native sexual ideology while working within local ideals of shame to distribute condoms and safe sex materials to sexually active young people and adults. Using snag bags as an example, this research proposes that an effective approach to HIV prevention among Native peoples is not cultural sensitivity but cultural integration. That is, HIV prevention strategies must move beyond the empty promise of merely culturally-sensitizing ideas about disease cause. Instead of simply 'translating' HIV/AIDS programming into Native culture, prevention strategies must be integrated by Native peoples into their own disease theories and contemporary culture.

Adult↗

PubMed2001

Effects of vaginal intercourse with and without a condom on vaginal flora and vaginal epithelium.

Effects of a single episode of intercourse on vaginal flora and epithelium were examined in subjects randomly assigned to groups that used no condom or lubricated nonspermicide condoms. Subjects were evaluated at visits before (1 month and 1-2 days) and after (8-12 h, 2-3 days, and 6-8 days) an index episode of sexual intercourse. The 22 subjects who used no condoms had significantly more Escherichia coli and a high concentration (> or =10(5) cfu/mL) of E. coli in the vagina (both, P<.001) and urine (all <10(5) cfu/mL; P=.004) at visit 3 than at visits 1 and 2. The 20 subjects who used condoms had a trend toward more vaginal E. coli (P=.06) and a significant increase in other enteric gram-negative rods (P=.001) after intercourse. Intercourse was not associated with gross, colposcopic, or histologic vaginal epithelial abnormalities.

Adult↗

PubMed2003

Partner characteristics, intensity of the intercourse, and semen exposure during use of the female condom.

The objective of this study was to assess how characteristics of the intercourse and the couple relate to semen exposure during use of the female condom. From 1996 to 1998, 210 women in Birmingham, Alabama, were trained to use the female condom and follow study procedures during a group session and individually practiced inserting the device. The outcome was semen exposure as defined by comparing pre- and postcoital prostate-specific antigen levels in vaginal fluid. Women who had high income levels had lower rates of semen exposure (odds ratio (OR) = 0.3, 95% confidence interval (CI): 0.2, 0.7), while those in a relationship of less than 2 years were at greater risk (OR = 2.4, 95% CI: 1.3, 4.1). Couples with a large disparity in vaginal fundus size and penis size were at increased risk of semen exposure (OR = 2.7, 95% CI: 1.2, 6.0). Engaging in very active intercourse also increased the risk (OR = 1.7, 95% CI: 1.1, 2.6). Thus, the protective effect of the female condom appears to be a function of user- and intercourse-specific characteristics. Future studies of male condom efficacy should focus on collecting detailed data about the users and characteristics of intercourse to predict failure accurately.

Adult↗

PubMed2001

Gender differences in the processes of change for condom use: patterns across stages of change in crack cocaine users.

Interventions to increase condom use in crack users have had mixed results. For interventions to achieve greater success, the mechanisms of behavior change in this population need to be understood. One mechanism, the processes of change, was examined across stages of change for condom use. Results from the analysis of variance for males and females revealed that stage of change was associated with different levels of three experiential processes: consciousness raising, social liberation and self-reevaluation. However, these analyses found that male and females seem to have different patterns of behavioral process use. Specifically, females in the preparation stage were different from those in precontemplation, whereas this difference was not pronounced in males. In general, people had high levels of experimental processes in every stage of change. The patterns of behavior process use mimicked patterns found for other behaviors with a linear increase across the stages of change. This may indicate that for maintaining condom use, more emotional and behavioral activities are required throughout the process of acquisition and maintenance than are necessary for other health-related activities. Implications of this research are that interventions for increasing condom use in drug users may target behavioral steps differently for males and females.

Adult↗

PubMed2001

Female condom reuse in Lusaka, Zambia: evidence from 12 cases.

Female condom reuse could address one of the principal barriers to use, namely, cost; however, the safety of reuse has not been established. Recent reports have provided information related to reuse safety under carefully specified research study conditions. Still, little is known about reuse outside a research study context, and there are outstanding questions related to feasibility of reuse among general populations. This study reports on naturally occurring reuse from a small, purposive sample of self-identified women who, prior to the study, had reused the female condom of their own volition without reuse instruction. Three types of reuse were identified. Most women attempted to clean devices between removal and reinsertion. A number of agents, including water (only), bath soap, laundry detergent, Dettol, and beer were used for cleaning. A number of agents were used for relubrication, including Reality((R)) lubricant, various kinds of cooking oil, and Vaseline((TM)). Perception of the strength and integrity of female condoms making them suitable for reuse were influenced by both provider advice and product packaging. Most participants reported no problems with reuse. Some women, faced with barriers to single use of a female condom or use of an acceptable alternative, will resort to reuse and rely on their own "common sense" notions to implement reuse. Providers and purveyors have opportunities to shape responses to reuse for the better, and the research community is obligated to provide a solid scientific base regarding reuse safety.

Adult↗

PubMed1989

1988 public awareness survey on AIDS and condoms in Uganda.

This report presents the results of a survey conducted between February and April 1988 to ascertain Ugandans' perception of AIDS as a problem, their knowledge of the disease and how it is spread, the resultant change in their sexual behaviour and their knowledge of, and attitudes towards, condoms. Two hundred and four people (98 women, 106 men) were interviewed from three locations; Kampala (an area with a high incidence of AIDS), Kabale, a town in central Kigezi, and villages in North Kigezi (both relatively low incidence areas). The main points to emerge are: (1) all the respondents were aware of the disease; (2) only 3.6% of respondents mentioned AIDS of their own accord as a problem for Uganda; (3) those in Kampala were most knowledgeable and men in all three areas were generally more informed than women; (4) change in behaviour was more pronounced in those who had known an AIDS victim personally; (5) 100% of men and 79% of women had heard of condoms but only eight men (9.4%) and one woman (1.0%) used condoms regularly for the prevention of AIDS, and (6) there was, nonetheless, a degree of willingness to use condoms once informed that they could reduce the risk of AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Association of negotiation strategies with consistent use of male condoms by women receiving an HIV prevention intervention in Zimbabwe.

One of the fundamental aspects of HIV counselling for women is condom negotiation strategy development. The present research sought to identify condom request strategies used by Zimbabwean women and to determine which were most effective in persuading male partners to use condoms. Of six types of strategies used by women after a prevention intervention, one was significantly associated with consistent condom use 2 months later. Implications for the development of counselling and testing protocols are discussed.

Condoms↗