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PubMed2005

How condom use, number of receptive anal intercourse partners and history of external genital warts predict risk for external anal warts.

Few analytic opportunities have allowed us to evaluate the role that specific sexual acts and male latex condoms play in the acquisition of external anal warts (EAW) using longitudinal data. The acquisition of EAWs occurs from epithelial contact with other HPV-infected surfaces, and hence is dependent upon sexual behaviour. Our objectives were to classify the relative importance of condom use, receptive anal intercourse (RAI) and prior history of EGWs on acquisition of EAWs. The observational Multicenter AIDS Cohort Study followed 2925 men over nine semiannual study visits for behavioural and physical examinations with laboratory testing. The main outcome measure was the occurrence of examiner-diagnosed EAWs in a homosexual population. EAWs were diagnosed among 10% of men studied across 22,157 visits reviewed for this study. Men with history of EGWs were more likely than those previously unaffected to have developed EAWs (cOR = 2.4 (2.0, 2.9)), as were men who reported multiple anoreceptive intercourse partners (e.g., compared with men who reported no RAI partners, men with 1, 2-5, > or = 6 RAI partners had crude risk ratios 1.0 (0.8, 1.3), 1.6 (1.2, 2.1), 3.9 (2.7, 5.8), respectively). These relations persisted after other demographic and sexual risk factors were controlled for in the analyses. Consistent condom usage showed no protective effect for EAWs in our crude or adjusted analyses. Patient education messages should be tailored to reflect our uncertainty about the protective nature of condoms for the development of anal warts, but to continue to assert the protective effects of a limited lifetime number of sexual partners and the heightened risk for wart recurrence once infected.

Anus Diseases↗

PubMed2001

Condoms and sexually transmitted diseases.

Many of our patients and colleagues will be surprised and disturbed by the latest revelation from the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). For more than a decade, the NIH and CDC have been promoting "safe sex," a message apparently based solely on the hope that condoms are effective in prevention of sexually transmitted diseases (STDs). This hope was discredited in mid-July when the NIH released the "Scientific Evidence on Condom Effectiveness for STD Prevention," commissioned in June 2000 by then-House member, Dr. Tom Coburn (R-OK). The report disclosed that the body of medical research shows no evidence that condoms protect against most STDs. I refer to the NIH and CDC's "hope" because their recommendations have not been based on good science, but rather on theoretical models, possibly unduly influenced by a strong bias that condoms would prove to be effective.

Condoms↗

PubMed2005

Can safer-sex promotion leaflets change cognitive antecedents of condom use? An experimental evaluation.

An experimental evaluation of a safer sex promotion leaflet was undertaken to assess its capacity to change antecedent cognitions of condom use. The leaflet was identified in a previous study as addressing research-based cognitive antecedents of condom use. A pre-post-test experimental study including three conditions was conducted: (a) presentation of the leaflet; (b) presentation of the leaflet plus incentive for systematic processing; (c) no-leaflet control. The leaflet was evaluated in terms of its capacity to change eight cognitive correlates of condom use identified in a recent meta-analysis. The sample consisted of 230 tenth-grade students. Following baseline assessments, leaflet-induced change was measured immediately following the intervention and at a follow up 4 weeks post-intervention. The target leaflet alone did not result in significant changes in the cognitive antecedents of condom use compared with the control condition. However, in combination with an incentive for systematic processing, the target leaflet had a greater impact on cognitive antecedents than the no-leaflet control condition. The findings are discussed with regard to the development and evaluation of research-based health-promotion materials.

Adolescent↗

PubMed2004

Gender differences in condom-related behaviors and attitudes among Mexican adolescents living on the U.S.-Mexico border.

Adolescents are at increasing risk for HIV infection in Mexico. Research on gender differences in risk behaviors and determinants is needed to develop effective HIV prevention interventions targeting Mexican adolescents. This study examined gender differences in the likelihood of unprotected sex and theoretical correlates among high school students in the border city of Tijuana. Three hundred seventy high-school students completed a face-to-face interview and a self-administered survey. Differences in sexual initiation, condom use, intentions to use condoms in the future, and attitudes towards condoms in this population were assessed. Although male students initiated sexual practices earlier than females, females were more likely to have unprotected sex. Females perceived themselves as more likely to avoid unprotected sex in the future and held more favorable attitudes about condoms. The results suggest that stereotypical gender roles and communication barriers place Tijuana female high school students at higher risk for HIV infection than their male peers.

Adolescent↗

PubMed2006

[Use of condoms during sexual intercourse: a population-based study].

OBJECTIVE: To describe characteristics associated with failure to use condoms during sexual intercourse by women. METHODS: We conducted a cross-sectional population-based study including 1,026 women aged 20-60 years living in the urban area of a city in Southern Brazil, in 2003. Cluster sampling was carried out by randomly selecting 40 of the city's 270 census sectors. We performed logistic regression analysis of failure to use condoms in relation to socioeconomic, demographic, obstetric, and health care usage variables. RESULTS: Among studied women, 867 (84.5%) reported being sexually active; of these, 252 (29.1%) wore condoms during sexual intercourse. Logistic regression showed that the most vulnerable groups were women who were married or in stable partnerships, and women aged more than 40 years. We found no associations with the other variables explored. CONCLUSIONS: Prevalence of condom use was low; we were able to identify a group of women that needs to be targeted by health policies and services in order to improve perception of the risk of acquiring sexually transmitted diseases.

Adult↗

PubMed2005

Factors associated with condom use in women from an urban area in southern Brazil.

This study investigated the prevalence of factors associated with condom use during last sexual intercourse in 15-49-year-old women in a probabilistic sample from the urban area of Pelotas, southern Brazil. A questionnaire administered by an interviewer, investigating socioeconomic characteristics and habits, and another (self-administered) questionnaire on sexual behavior-related variables were used. Poisson regression, following a hierarchical model, was used for data analysis. 1,543 women were included, and losses and refusals amounted to 3.5%. Prevalence of condom use in last sexual intercourse was 28.0%. Condom use was positively associated with younger age, greater schooling, non-white color, single marital status, and greater number of sex partners in the previous three months. This suggests that the group most vulnerable to STDs/AIDS due to lack of condom use is white, adult women, in stable unions, with fewer sexual partners.

Acquired Immunodeficiency Syndrome↗

PubMed2002

Decisional balance of condom use and depressed mood among incarcerated male adolescents.

The association between depressed mood and condom use was examined among incarcerated male adolescents. One hundred and eighty male adolescents who were detained in Birmingham, Alabama in the United States were interviewed during a period of incarceration. Contrary to patterns generally found in adult samples, nearly 50% of this adolescent sample that did not use condoms regularly actually recognized the advantages of condom use. This behavior pattern was deemed "inconsistent," and those engaging in this "inconsistent" behavior pattern were found to have a higher score of depressed mood compared to participants with a "consistent" behavior pattern. As a result, a relationship between depressed mood and decisional balance for condom use within adolescents was evident. These findings suggest that assessment and treatment of depressed mood within this high-risk population could potentially contribute to a reduction in high-risk sexual behaviors.

Adolescent↗

PubMed1993

Commentary: condoms and HIV/STD prevention--clarifying the message.

In the United States and throughout the world, the majority of human immunodeficiency virus (HIV) infections are sexually transmitted. an estimated 12 million other sexually transmitted diseases occur annually in the United States. Avoiding sexual intercourse altogether or restricting sex to partners known to be uninfected will prevent infection; this needs to be promoted as the most effective strategy. Studies show that correct and consistent use of latex condoms is highly effective in preventing sexually transmitted HIV infection and other sexually transmitted diseases. The effectiveness of condoms depends on individual behavior leading to correct and consistent use. Further studies are needed to maximize the use and effectiveness of condoms for those who choose to be sexually active as well as to develop and evaluate other methods, particularly those more under the control of women. In the interim, our prevention message should be clear: When used correctly and consistently, condoms are highly effective; when used otherwise, they are not.

Adolescent↗

PubMed1994

Standardized protocols for condom breakage and slippage trials: a proposal.

In the absence of well-controlled studies on the clinical effectiveness of condoms against pregnancy and sexually transmitted diseases, breakage and slippage data may provide the best indication of the protection offered by condom use. According to the recent literature, condom breakage rates range from 0% to 12%, with many US studies falling in the 2% to 5% range. Few studies have collected slippage data. In addition to discussing methodological issues associated with these studies, we propose a standardized protocol for future condom breakage and slippage trials and discuss how results may be used to estimate perfect-use and typical-use pregnancy rates.

Condoms↗

PubMed1994

Condom availability in schools: the need for improved program evaluations.

OBJECTIVES: This article examines the impact of contentious local debates on the design and implementation of school-based condom availability programs. METHODS: Information about condom availability in schools was reviewed by 50 leading educators and health officials at a 1992 forum held in Menlo Park, Calif. RESULTS: Few existing condom availability programs were designed to yield definitive data on sexual risk-taking behavior or other measures of program effectiveness. CONCLUSIONS: In the debate over school-based condom availability programs, as in many aspects of human immunodeficiency virus (HIV) prevention programs, scientific, moral, and political concerns overlap. Behavioral research into the potential effectiveness of such programs can help inform debates about fundamental values concerning sexual decision making and privacy, family integrity and parental autonomy, and public health.

Adolescent↗

PubMed1994

Does the promotion and distribution of condoms increase teen sexual activity? Evidence from an HIV prevention program for Latino youth.

OBJECTIVES: Opponents of condom availability programs argue that the promotion and distribution of condoms increases adolescent sexual activity. This assertion was tested empirically with data from the evaluation of a human immunodeficiency virus (HIV) prevention program for Latino adolescents. METHODS: The onset of sexual activity, changes in the frequency of sex, and changes in the proportion of respondents with multiple partners were compared for intervention and comparison groups. Multivariate regression analysis was used to assess the effect of the intervention on these outcomes after adjustment for baseline differences between the intervention and comparison groups. RESULTS: Male respondents in the intervention city were less likely than those in the comparison city to initiate first sexual activity (odds ratio [OR] = 0.08). Female respondents in the intervention city were less likely to have multiple partners (OR = 0.06). The program promoting and distributing condoms had no effect on the onset of sexual activity for females, the chances of multiple partners for males, or the frequency of sex for either males or females. CONCLUSIONS: An HIV prevention program that included the promotion and distribution of condoms did not increase sexual activity among the adolescents in this study.

Adolescent↗

PubMed1997

Increased condom use without other major changes in sexual behavior among the general population in Switzerland.

OBJECTIVES: This study is part of a continuous evaluation of the Swiss AIDS prevention strategy from 1987 through 1994. METHODS: Annual telephone surveys of samples representative of the general population aged 17 through 45 years have been conducted since 1987 to monitor behavioral change. RESULTS: No major changes in level of sexual activity (lifetime number of partners, frequency of sexual encounters in the past week) or potential exposure to risk of HIV transmission (acquisition of a new steady partner during the year or of casual partners in the last 6 months) were observed. Systematic condom use with a new steady partner increased between 1988 and 1994, from 40% to 64% among 17- to 30-year-olds and from 57% to 72% among those aged 31 to 45. Systematic condom use with casual partners increased from 8% to 56% between 1987 and 1994 among 17- to 30-year-olds and from 22% to 42% between 1989 and 1994 among those aged 31 to 45. Condom use was higher among those with multiple partners. CONCLUSIONS: A general-population approach to AIDS prevention was able to achieve large-scale improvements in condom-based protection against HIV infection without inducing other major changes in sexual behavior.

Acquired Immunodeficiency Syndrome↗

PubMed1997

The effects of an abusive primary partner on the condom use and sexual negotiation practices of African-American women.

OBJECTIVES: This study examined the consequences of having a physically abusive primary partner on the condom use and sexual negotiation practices of young African-American women. METHODS: Interviews were conducted with 165 sexually active African-American women aged 18 through 29 in San Francisco, Calif. RESULTS: Women in abusive relationships were less likely than others to use condoms and were more likely to experience verbal abuse, emotional abuse, or threats of physical abuse when they discussed condoms. They were more fearful of asking their partners to use condoms, worried more about acquiring the human immunodeficiency virus (HIV), and felt more isolated than did women not in abusive relationships. CONCLUSIONS: HIV prevention programs for women should address domestic violence prevention strategies.

Adult↗

PubMed2000

The female condom: tool for women's empowerment.

International and US experience with the female condom has shown that the device empowers diverse populations of women, helping them negotiate protection with their partners, promoting healthy behaviors, and increasing self-efficacy and sexual confidence and autonomy. This commentary reflects on some approaches that have been taken to study empowerment and makes several observations on the political and scientific initiatives needed to capitalize on this empowerment potential. Women's interest in the female condom indicates a need for more women's barrier methods to be made available. For some women, cultural proscriptions against touching the genitals may create initial hesitancy in trying these methods. But the disposition of regulatory agencies and the attitudes of health care providers has unfortunately exaggerated this reticence, thereby effectively reducing access to these methods. Also, lack of important detail in clinical studies restricts our capacity to introduce the female condom, or similar methods, under optimal conditions. Future trials should prioritize community-based designs and address a range of other critical health and social issues for women. Women's need for HIV/AIDS prevention technologies remains an urgent priority. Both political and scientific efforts are needed to realize the public health potential embodied in the female condom.

Attitude of Health Personnel↗

PubMed2003

Female-condom use in a gender-specific family planning clinic trial.

OBJECTIVES: We evaluated female-condom use among women participating in an HIV/STD intervention designed to reduce unprotected sex and expand prevention strategies. METHODS: Women (n = 360) were recruited from a family-planning clinic and were randomized into an 8- or 4-session intervention group or a control group. We conducted follow-up interviews at 1, 6, and 12 months. RESULTS: At 1 month, the odds ratios of first-time female-condom use were 9.49 (95% confidence interval [CI] = 4.01, 22.20) in the 8-session group and 4.39 (95% CI = 1.84, 10.49) in the 4-session group relative to controls. Repeated use (n = 21) was predicted by perceived ability to use, by self and partner satisfaction, by dislike of male condoms, and by previous diaphragm use. CONCLUSIONS: Gender sensitive cognitive-behavioral interventions can influence women to try the female condom. To increase long-term use, interventions may need to include self-insertion practice and involvement of male partners.

Single-Use Internal Condom↗

PubMed2006

"Condoms are reliable but I am not": A qualitative analysis of AIDS-related beliefs and attitudes of young heterosexual adults in Budapest, Hungary, and St. Petersburg, Russia.

HIV and STD prevention is an essential component of public health initiatives in countries throughout Central and Eastern Europe. Liberalization in sexual values, declining age at first sex, higher levels of sexual activity, and inconsistent condom use have been well-documented among young people in the region following the political, economic, and cultural transitions after the end of the state socialism era. Less well-understood are the reasons for high-risk sexual behavior and psychosocial factors that must be addressed in the development of effective HIV/STD prevention programs. This study recruited members of 12 high-risk social networks of young adult men and women (n= 66 participants) in two cities, St. Petersburg, Russia, and Budapest, Hungary. In-depth focus groups were conducted with all members of each network, and qualitatively analyzed to examine factors surrounding high-risk sexual behavior. Main themes that emerged were that STDs are less known and less feared than AIDS, HIV risk factors were relatively well known among young adults in both countries but vulnerability is perceived differently, pregnancy prevention is a more immediate concern than protection from HIV or STDs, condom use declines quickly following first sex with a new partner, reintroducing condom use in a relationship is very difficult, and young adults report many barriers to condom use including those related to alcohol or other substance use. HIV/STD prevention programs are needed that extend beyond risk education alone and that also address critical psychological, social, and relationship factors related to sexual risk behavior.

Adolescent↗

PubMed2005

Factors affecting individuals dissuading sexual partners from using condoms: a comment on McDermott and Noland.

Undergraduate students at an urban, public university were asked if they had ever attempted to dissuade a sexual partner from using condoms. Over 17% of the men and nearly 15% of the women admitted to having done so, and twice as many said that a sexual partner had attempted to dissuade them. Responses to a questionnaire indicated that individuals who had attempted to dissuade use of condoms did not show a greater tendency to engage in nonsexual risk-taking behaviors. Despite their claims that attempts to dissuade partners from using condoms occurred in committed relationships, condom dissuaders did show evidence of engaging in other high-risk sexual behaviors, e.g., greater number of sexual partners, greater number of sexually transmitted diseases.

Adult↗

PubMedDate not supplied

The context of condom nonuse among older adolescents and young adults.

This exploratory-descriptive study examined the context of condom nonuse among older adolescents and young adults. The convenience sample consisted of 23 freshman university students (18 to 20 years of age) in a rural state. Participants were asked to describe situations when condoms were not used. The responses were content-analyzed using an inductive process. Descriptions (n = 86) were identified and analyzed for common themes. The seven themes were assessment of risks, location and timing of sexual experience, extraneous events, communication about condoms, feelings of the moment, contraceptive responsibility, and relationships between sexual partners. The findings suggest strategies to promote condom use when working with older adolescents and young adults.

Adolescent↗