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Multiple sexual partners and condom use among long-distance truck drivers in Thailand.

Sexual behaviors of long-distance truck drivers in Thailand were investigated to define patterns and determinants critical to the transmission of HIV. This article reports on commercial, spousal, and other sexual partners and on condom use among 327 drivers interviewed in 1992. Forty-eight percent reported a commercial sex worker (CSW) as their first partner and 87% had contact with a CSW at some time. Median lifetime number of all partners was 29. In the 6 months prior to interview, 35% had two or more partners. Among the currently married, 23% had CSW contact within the past 6 months; 13% had contact with a nonmarital, noncommercial partner; and about 8% reported marital as well as both CSW and noncommercial relationships in the same time period. Over half the unmarried reported sexual relations in the 6 months; 25% reported contacts with both CSW and noncommercial partners. About 40% of subjects visiting CSWs used condoms inconsistently or not at all. Drivers were knowledgeable about AIDS and prevention measures, with some important misconceptions, but self-assessment of risk of HIV showed a negligible sense of their personal vulnerability.

Adolescent↗

The efficacy of the health belief model for predicting condom usage and risky sexual practices in university students.

This investigation examined the ability of the health belief model (HBM) to predict condom usage and risky sexual practices in 122 white heterosexual college students (ages 17 to 33 years). The HBM did not significantly explain condom usage in the 58 men and 64 women surveyed; rather it partially explained the variance in sexual risk behaviors. Results were not consistent for men and women. The HBM components significantly explained 18% of the variance in multiple sexual partnerships in men and 22% of the variance in this behavior in women. The HBM constructs also explained 9% of the variance in the likelihood of women being intoxicated or high during sex and 18% of the variance in the number of sexual risk behaviors endorsed by women. These findings suggest that the HBM has differential and limited utility for predicting sexual practices in university students. Future research is needed to examine more comprehensive models of behavior change.

Acquired Immunodeficiency Syndrome↗

Factors related to condom use among four groups of female sex workers in Bali, Indonesia.

This article tests a behavioral model of condom use for four groups of female commercial sex workers. Data were drawn from a study of 614 female sex workers conducted in Bali, Indonesia. AIDS knowledge, risk behaviors, and factors related to condom use varied substantially among the four groups of women and reflect the social context of their work. Interventions for each group need to reflect these differences. Important factors to consider include the level of AIDS and STD knowledge in their environment, the characteristics of the clients served, and the degree of supervision that they receive.

Acquired Immunodeficiency Syndrome↗

The pathological effects of glove and condom dusting powders.

Dusting powders are used on latex gloves and condoms. They help to release these products from their moulds during manufacture and facilitate processing and donning. Dusting powders are also used on contraceptive diaphragms, sanitary napkins and in toiletries. There are numerous dusting powders in current use around the world. At present a consensus exists about the best dusting powder to use on surgical gloves, based on data about the safety of these agents in humans, as well as their manufacturing qualities. No such consensus exists for the use of dusting powders in other situations. However, there is uncertainty about whether dusting powders used in situations other than on surgical gloves are responsible for harmful effects. This study uses intraperitoneal injections in rats to examine the pathological effects of dusting powders that are in current use on surgical gloves and condoms. We suggest that dusting powders may be a source of morbidity when used in situations other than on surgical gloves and confirm the findings of previous investigators that the dusting powders we tested differ in their ability to produce pathological effects.

Aluminum Silicates↗

Condom use among South African adolescents: developing and testing theoretical models of intentions and behavior.

We developed and tested models of intentions and behavior among adolescents from Cape Town, South Africa. Data from 261 participants who completed an initial measure of attitudes, beliefs, and prior behavior were used to develop a model of intentions to use condoms based on the Theory of Planned Behavior (TPB) and additional constructs found to be important in previous research with adolescents. Of the initial sample, 227 (87%) completed a behavioral follow-up 4 months later, and approximately one-third of those (n=72; 44 boys and 30 girls) reported having had sex in the prior 4 months. Data from this smaller sample were used to develop a model of condom use behavior based on intentions (as per the TPB) and the additional sub-population relevant constructs. Analyses generally supported the validity of the TPB in this context for predicting intentions and behavior. HIV knowledge and positive outlook (self-esteem and future optimism) were significantly related to TPB predictors of intentions. Intentions, acceptance of sexuality, and gender were significant predictors of behavior. Implications for the status of the TPB and the design of interventions for South African adolescents are discussed.

Adolescent↗

Contextual determinants of condom use among female sex exchangers in East Harlem, NYC: an event analysis.

Recent studies have revealed a variety of contexts involving HIV risk behaviors among women who exchange sex for money or drugs. Event analysis was used to identify the individual, relationship, and contextual factors that contribute to these high-risk sex exchange practices. Analyses were conducted on data obtained from 155 drug-using women who reported details of their most recent sex exchange event with male clients. The majority of sex exchange encounters (78%) involved consistent condom use. In multivariable analysis, protective behavior was associated primarily with situational and relationship variables, such as exchange location, substance use, sexual practices, and respondent/client discussion and control. In order to inform HIV prevention programs targeted to women sex exchangers, further research is needed on the contextual determinants of risk, especially with regard to condom-use negotiation and factors involving substance use that adversely affect women's ability to manage protective behavior in the context of sex exchange.

Adult↗

Altered surface character of stretched condom latex.

A new type of imperfection in condom latex, present during moderate stretching, was observed by low magnification scanning electron microscopy. The normally smooth surface of relaxed natural latex was transformed into an accordion-like arrangement of ripples in addition to tears. A corollary experiment with Alcian blue dye placed into both stretched and unstretched condoms leaked no dye. These surface features are consistent with latex acting as a molecular barrier. The tears may represent areas of lowered mechanical resistance and raise questions concerning quality control.

Contraceptive Devices, Male↗

Attitudes of adolescents and parents of adolescents concerning condom advertisements on television.

The major television networks have considered airing condom advertisements. A Louis-Harris poll entitled "Attitudes About Television, Sex and Contraceptive Advertising" conducted in early 1987 concluded that at least 60% of adult Americans were in favor of such advertisements. To better understand the attitudes of adolescents and parents of adolescents in a private practice setting toward contraceptive advertisement on television, the present study was performed. Between March and June 1987, 108 parents of adolescents, 100 adolescent females, and 90 adolescent males filled out a questionnaire asking their opinions of such advertisements. Eighty-three percent of the parents, 89% of adolescent females, and 92% of adolescent males approved of such advertisements. The data suggest that a majority of adults and adolescents approve of condom advertisements on television. The use of the media to take advantage of the present opportunity to educate and promote birth control and disease prevention to our adolescent population may be beneficial.

Adolescent↗

Condom use rates for specific sexual behaviors among opioid abusers entering treatment.

A structured interview was used to determine the details of high risk sexual behaviors, including number of sexual partners, frequency of condom use, and involvement in commercial sexual activity in 165 opioid abusers (mean age 34 years, 36% minority, 47% female) entering out-patient methadone substitution therapy. The median number of sexual partners in the sample was one, and 95% were sexually active in the past year. Most patients (84%) denied any commercial sexual activity and reported rates of monogamy and sexual abstinence (81%), and rates of condom use (15%), that were comparable with reports from general population surveys. However, intravenous drug abusers (IVDAs) remain at higher risk for exposure to HIV-1 because they are likelier to have sexual contact with other IVDAs and former IVDAs. Continuing efforts are needed to improve the safe sex practices of IVDAs, but it may be a significant challenge to reduce their high risk sexual behavior considerably below that of the general population. Concomitant drug abuse treatment may help in efforts to accomplish sexual behavior change.

Adult↗

Measurement of condom use in 72 studies of HIV-preventive behaviour: a critical review.

Ninety-four distinct measures of condom use were identified in a review of 72 psychosocial studies of HIV-prevention. A coding scheme was developed which characterised each measure in terms of: (1) type of measure (e.g. frequency of use, use at last intercourse), (2) response alternatives (e.g. Likert scale), (3) recall period (e.g. lifetime, last month), (4) partner specification (e.g. 'new' partner), and (5) activity specification (e.g. vaginal or anal intercourse). Results show a great deal of inconsistency in measurements of condom use across studies. Single-item frequency or consistency measures were most common. Several difficulties with measures employed to date were identified. These included indeterminate reliability and validity of measures, lack of attention to the epidemiological significance of different types of use and terminological and self-presentational problems with items assessing use. Implications of extant measurement approaches for the accumulated knowledge base on predictors of 'safer' sex and suggestions for future research in this area are outlined.

Condoms↗

Primary prevention of human papillomavirus-dependent neoplasia: no condom, no sex.

Cervix cancer is one of several neoplastic disorders that arise following transfer of human papillomavirus (HPV) during unprotected sexual intercourse, and like most other sexually transmitted diseases (STDs), is largely preventable by consistent condom use. This primary prevention strategy has received little support, however, when compared with massive secondary prevention initiatives involving cervical screening. The reasons for this anomalous situation are complex, and include: (i) the asymptomatic nature of most primary HPV infections; (ii) widespread ignorance concerning the venereal aetiology of HPV-related cancers; (iii) the common but incorrect belief that condom use does not reduce HPV transmission; (iv) the perceived irrelevance of safe sex campaigns based on reducing transmission of human immunodeficiency virus (HIV) in high-HPV but low-HIV countries such as the Philippines; (v) the promotion of oral contraception by the medical and pharmaceutical sectors as the sexual prophylaxis of choice; and (vi) the assumption that HPV vaccines will solve the problem. Here it is proposed that the high prevalence of non-HIV STDs, including distressing disorders such as genital warts and herpes simplex, can be exploited with greater efficacy as a public health deterrent to unsafe sex and HPV transmission. Targeting a "mutually assured infection" campaign at vulnerable subgroups such as teenagers and oral contraceptive users could help reverse the global expansion of HPV-related cancers.

Condoms↗

Condom failure among adolescents: implications for STD prevention.

This study of 921 adolescents found condom failure (past 90 days) was experienced by at least one-third of the sample, regardless of gender. Frequency of condom failure was positively associated with STD diagnosis (AOR = 1.22, 95% CI = 1.01-1.48), with the odds of testing positive increasing 22% for each added event of failure.

Adolescent↗

Relationship quality, coital frequency, and condom use as predictors of incident genital Chlamydia trachomatis infection among adolescent women.

PURPOSE: To explore associations of relationship quality, coital frequency, unprotected coitus, and chlamydia infection over time. METHODS: Data came from 142 adolescent females with sexually transmitted infections attending three primary care adolescent clinics and one county STD clinic. Interview data were collected at 3 time points: enrollment, 1 month, and 3 months after enrollment. Predictor variables included relationship quality, coital frequency, unprotected coitus, and partner change. The outcome variable was infection with C. trachomatis at 3 months. Analyses were conducted using structural equation modeling. RESULTS: Chlamydia infection at 3 months was directly influenced by unprotected coitus during the previous 2 months (Beta = .25; p < or = .05) and partner change during the enrollment/1-month interval. Unprotected coitus was directly associated with coital frequency, both cross-sectionally and longitudinally. Increased relationship quality was associated with increased coital frequency but did not have direct effects on unprotected coitus. CONCLUSIONS: The data showed a protective effect of condom use for chlamydia infections. Prevention efforts should attend to the interpersonal factors behind decisions to use or not use condoms.

Adolescent↗

Measuring true contraceptive efficacy. A randomized approach--condom vs. spermicide vs. no method.

No investigator has attempted to measure prospectively the true efficacy of a contraceptive method, compared with a control group using no method, because contraceptive trials focus on women trying to avoid pregnancy and ethical concerns do not permit the withholding of contraception. We tested the feasibility of an approach that recruited women who desired pregnancy but were willing to postpone conception by 1 month. In this protocol, we restricted frequency and timing of intercourse to one coital act on the most fertile day of the menstrual cycle, as measured by a luteinizing hormone (LH) detection kit. Participants were randomized to use either a male latex condom, spermicidal film, or no method. In this feasibility study we recruited 58 women at three sites, with one site recruiting 25 women in 5 months. Among 54 women who completed the study, we found a 12% pregnancy rate for the group using no method (2/17; 95% confidence interval [CI], 1-36%) and an 11% pregnancy rate for the group using spermicidal film (2/18; 95% CI, 1-35%). No pregnancies occurred among the 19 women using condoms (0/19; 95% CI, 0-18%). The wide confidence intervals illustrate the small sample size of this pilot study and no conclusions can be drawn about the relative efficacy of the methods. Having demonstrated the feasibility of this study design, we now urge the initiation of a large-scale study to evaluate the efficacy of barrier methods using our randomized approach, with a control arm using no method of contraception.

Adult↗

Urethrocutaneous fistula due to a retained ring of condom.

Hidden foreign bodies have been described as a rare cause of both strangulation of the glans penis and urethrocutaneous fistula. We present the case of a 30-year-old man who developed a urethrocutaneous fistula and penile shaft necrosis after a condom broke during intercourse. Neither the patient nor several physicians could identify the retained ring of condom, which had been buried under newly epithelialized skin. He underwent removal of the foreign body under general anesthesia, followed 5 months later by a formal urethrocutaneous fistula repair.

Adult↗

Selling sex in the time of AIDS: the psycho-social context of condom use by sex workers on a Southern African mine.

This paper provides a detailed account of the social organisation of commercial sex work in a squatter camp in a South African gold mining community. On the basis of in-depth interviews with 21 women, living in conditions of poverty and violence, the paper examines factors which might serve to help or hinder a newly implemented community-based peer education and condom distribution project aimed at vulnerable single women. Attention is given to the way in which the routine organisation of sex workers' everyday working and living conditions, as well as the strategies they use to construct positive social identities despite working in the most stigmatised of professions, serve to undermine their confidence in their ability to insist on condom use in sexual encounters with reluctant clients. However, even amongst this disadvantaged group of women, the interviews suggest that the tendency to speak of women's 'powerlessness' (as is the case in many studies of African women in the context of the HIV epidemic) is unduly simplistic and fails to take account of the range of coping strategies and social support networks that women have constructed to deal with their day to day life challenges. These strategies and networks could serve as potentially strong resources for community-based sexual health promotion programmes.

Acquired Immunodeficiency Syndrome↗