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PubMed2004

A, B and C in Uganda: the roles of abstinence, monogamy and condom use in HIV decline.

Uganda is often cited as a role model in the fight against HIV/AIDS because of its success in reducing both prevalence and incidence of HIV infection since the late 1980s. Although an increase in sexual abstinence has been highlighted as a primary cause of the declines, large increases have also been recorded in monogamy and condom use. The extent to which each of these factors actually influenced the overall decline in Uganda's HIV rates has become a highly charged political issue in the United States, leading to restrictions on how US development funding for combatting HIV is allocated. The Alan Guttmacher Institute investigated changes that occurred in abstinence, monogamy and condom use in Uganda in the 1990s, using nationally representative data from Uganda's Demographic and Health Surveys of 1988 (women only), 1995 and 2000 (women and men), and national-level findings from two surveys by the Global Programme on AIDS in 1989 and 1995 (women and men). Reduction of infection risk by lowering numbers or types of partners among people with more than one relationship was not covered. Here we reprint the chapter on "Implications" from the AGI report, a commentary on the lessons that can and cannot be taken from the data, published in a 2003 Guttmacher Report on Public Policy.

Condoms↗
PubMedDate not supplied

Sexual behavior and condom practices among Los Angeles women.

BACKGROUND: The sociodemographic correlates of the number of recent sexual partners and condom use are investigated in a population-based sample of 1,178 unmarried women living in Los Angeles County. RESULTS: Asian Americans, foreign born, and older women are less likely to be sexually active and that more educated and previously married women are more likely. Among the sexually active (n = 909), Hispanic women and older women are less likely to have multiple partners, and younger and previously married women more are more likely. African-American women and younger women are more likely to use condoms; older and previously married women are less likely. CONCLUSIONS: Results from this study indicate that women-centered primary and secondary prevention efforts may benefit from targeting women not previously considered, such as women of post-reproductive age and divorced women.

Adult↗
PubMed1998

Reinforcement value of unsafe sex as a predictor of condom use and continued HIV/AIDS risk behavior among gay and bisexual men.

The pleasure or reinforcement value of high-risk sex may be an important influence on success in risk reduction efforts. Seronegative gay and bisexual men (N = 297) completed measures assessing their unprotected and safer sex practices, as well as measures of cognitive and skill factors and a measure assessing the subjective reinforcement value of unprotected anal intercourse. Regression analyses showed that the reinforcement value of unprotected anal intercourse accounted for variance in predicting levels of condom use above that that could be accounted for by factors such as knowledge, behavior change intentions, perceived vulnerability, condom attitudes, and sexual communication skills. Only reinforcement value of unprotected sex and substance use significantly predicted how frequently participants engaged in high-risk sex. Increased attention to the valence of sexual reinforcers will improve HIV risk reduction models and enhance AIDS prevention efforts.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Transtheoretical model and condom use in HIV-positive youths.

The purpose of the study is to test constructs of the Transtheoretical Model for predicting unprotected intercourse in HIV-positive youths (ages 16-25 years). Questionnaires and interviews about sexual behavior, stage of change, self-efficacy, substance use, emotional distress, and social support were obtained from 60 HIV-positive youths. Path analysis, with standard errors determined by methods appropriate to small samples, suggested that self-efficacy completely mediated the relationship between stage of change and unprotected intercourse acts. Social support specific to reducing risk was associated with increased self-efficacy. Emotional distress and low general social support were not associated with decreased condom use. The path between substance use and decreased condom use approached significance. Results highlight the potential of prevention interventions that simultaneously boost self-efficacy and social support specific to practicing safer sex as well as those that reduce substance use.

Adolescent↗
PubMed2001

Gay men's casual sex encounters: discussing HIV and using condoms.

Some gay men disclose their HIV serostatus to enable them to decide to discard condoms in at least some casual encounters. In this paper we consider under what circumstances this occurs. We draw on data from the Sydney Men and Sexual Health cohort study, including both structured and semi-structured interviews. We find that casual sexual encounters among gay men are complex events, involving a broad range of types of partner and circumstance. A significant minority of men disclose their HIV serostatus; 36.3% of those who discussed their serostatus with casual partners engaged in unprotected anal intercourse (UAI) with those partners, while only 9.9% of those who did not discuss their serostatus engaged in UAI with those partners. We also find that disclosure of HIV serostatus, discussion and use of condoms during casual encounters are affected by the particular circumstances of those encounters, including the degree of familiarity between casual partners.

Adult↗
PubMed1989

Sex worker, client sex behaviour and condom use in Harare, Zimbabwe.

One-hundred sex workers and 100 clients were interviewed at a bar/disco complex in Harare, Zimbabwe in 1989. Sociodemographic characteristics of sex workers and clients were examined. Almost a third of sex workers and nearly 90% of clients had engaged in commercial sex over 5 or more years. Sex workers reported that they worked an average of 4.6 nights a week, averaged 2.2 clients a night and charged a mean of Z$8.7 per session and Z$19.8 per night. Clients reported that they averaged 7.4 visits a month to a sex worker and paid a mean of Z$6.2 per session and Z$17.2 per night. Over half the sex workers said their last client was drunk and nearly two-thirds said he was a repeat client. Sex workers and clients were asked about the sex behaviours completed in their last paid sex act. Vaginal intercourse was reported by 98% of sex workers and clients alike. Manual stimulation of the sex worker's and client's genitalia was reported by roughly 80% of sex workers and clients. Oral and anal sex were rarely reported. Fifty-four percent of sex workers and 44% of clients reported using a condom in their last paid sex act. Client reports thus suggest that sex worker reports of sex acts and condom use with the last client possess considerable validity. Ethnographic approaches were used to study the social and work environment of sex workers. Ethnographic analysis demonstrated a lack of organisation among sex workers and a need to develop cohesive groups for successful health interventions. The study also highlighted the need to include clients in health interventions, the possible role of alcohol as an impediment to health interventions and the feasibility of using bar/disco security and the bar personnel as health educators.

Adolescent↗
PubMed1991

Risk reduction among injecting drug users: changes in the sharing of injecting equipment and in condom use.

In an investigation of risk behaviour among injecting drug users in the North-West of England, information was obtained concerning the sharing of injecting equipment, respondent's sexual partners and the use of condoms. Between six and nine months after the initial contact, 169 respondents (56%) were contacted again. The emphasis in the second phase of the project was on changes, if any, in risk behaviour that had occurred in the intervening period. Significant reductions were found in sharing, mostly in the more indiscriminate use of others' injecting equipment. No reduction was observed in sharing between injecting partners and little in sharing between close friends. The number of sexual partners had decreased and the use of condoms, although it increased among those involved in temporary relationships, remained low. Impediments to further progress in risk reduction are discussed.

Adolescent↗
PubMed2002

Knowledge and perception of risk for HIV and condom use among male injecting drug users in Cebu City, Philippines.

Injecting drug users (IDU) represent a small fraction of the HIV and AIDS cases in the Philippines. To determine if these people are engaging in behaviors that put them at risk for HIV, interviews were conducted with 360 male IDUs in Cebu City, Philippines, from 1997 to 1999, as part of a national surveillance system. The interviews assessed knowledge about HIV transmission, sources of information about HIV/AIDS, perceived risks of contracting HIV, needle-sharing practices, condom use, self-reported signs and symptoms of STDs and number of sex partners. Although most of the men were able to recognize behaviors accurately that put them at risk for HIV, more than two-thirds claimed that they shared needles and almost two-thirds of those who were sexually active claimed that they never used condoms. Intervention strategies must be developed for this population if the nation is to avoid the dramatic increase in HIV infection among IDUs that has been witnessed in neighboring Southeast Asian nations such as Malaysia and Vietnam.

Adolescent↗
PubMed2004

Allergic contact dermatitis to condoms: description of a clinical case and analytical review of current literature.

We describe the case of a 42-years-old non-atopic man who developed a severe eczematous reaction in the genital area some hours after the use of a condom (Settebello-Hatù Durex) containing a retarding cream. Patch test revealed a strong allergic reaction to the retarding cream and to benzocaine and paraben mix contained in the cream itself. Condoms with retarding cream should be avoided in man sensitized to local anestethetics.

Adult↗
PubMed2004

Determination of zinc dialkyldithiocarbamates in latex condoms.

A simple high-performance liquid chromatographic (HPLC) assay is developed for measuring zinc dialkyldithiocarbamate (DTC) levels in latex condoms. After extraction of 14 different brands of latex condoms in acetonitrile, aliquots of the extracts are subjected to a preliminary screening assay by treatment with cobalt chloride and measurement of UV absorption at 320 nm, which results in the identification of 6 DTC-containing samples. Prior to analysis by HPLC, zinc dimethyldithiocarbamate (ZDMC) or zinc diethyldithiocarbamate (ZDEC) is added to the extracts in order to block transmetalation reactions with the analytes of interest. A reversed-phase C(18) column, with gradient elution and UV detection at 260 nm, is used to measure the zinc DTCs. The limits of detection for ZDEC and zinc dibutyldithiocarbamate (ZDBC) are 5 and 10 micro g/mL. Levels of ZDBC and ZDEC range from not detectable to 3.31 and 1.79 mg/condom, respectively. Total protein and latex allergenic protein levels are determined and range from 98 to 776 and 0.01 to 14.04 micro g/unit, respectively, but are not related to the level of ZDBC or ZDEC. This methodology provides both screening and specific tools for the determination of unstable zinc DTC complexes in latex products.

Chromatography, High Pressure Liquid↗
PubMed2007

Assessment of condom use among Bolivian truck drivers through the lens of social cognitive theory.

This study demonstrates that Bolivian long distance truck drivers are a high risk population of HIV infection and transmission, supporting other global studies involving truck drivers and their high risk. The aims of this investigation were to estimate the prevalence of high risk behaviors and to identify predictors of condom use in this population. Analysis was completed on survey results from 246 male truckers (aged 18-67). About one in three of the truck drivers (30%) reported having had a sexually transmitted infection sometime in their past. More than half (56%) reported having sex with casual partners. Other risks involved unprotected anal sex. Age and two social cognitive constructs (outcome expectations and perceived social norms) predicted condom use from logistic regression analysis. The authors discuss the need for expanded HIV/sexually transmitted infection prevention programs that incorporate social cognitions.

Adolescent↗
PubMed1998

Using condom data to assess the impact of HIV/AIDS preventive interventions.

The effective evaluation of preventive activities depends on the identification of indicators and the selection of appropriate outcome measures which reflect the goals of the intervention. An increase in condom use has been seen as a positive sign of the impact of HIV/AIDS public education. This paper examines possible sources of data relating to condom use in the context of assessing public response to the AIDS epidemic, with particular reference to methodological challenges presented by each; issues relating to the validity of data, problems of interpretation and the scope for improvement. A multiple indicator approach, using several types of data in unison, is advocated. Conclusions drawn from the multiple indicator approach are likely to be firmer and sounder than those drawn from the single indicator approach, and are more likely to offer insight into the mechanisms which influence particular outcomes.

Adolescent↗
PubMed2000

Increasing condom use among adolescents with coalition-based social marketing.

OBJECTIVES: This study evaluated a multimodal social marketing intervention to reduce the sexual transmission of HIV infection among adolescents in Sacramento, California, USA. DESIGN: Five rounds of a cross-sectional random sample telephone survey were conducted from December 1996 to October 1998. The total number of respondents was 1402. RESULTS: A statistically significant, increasing trend in exposure to the intervention was detected. The number of channels through which an adolescent had been exposed to the intervention was associated with condom use at last sex with main partner [odds ratio (OR) 1.26, P < 0.01] and with psychosocial determinants of this behavior. After statistical adjustments for sex, age, and race/ethnicity to make the survey rounds comparable, the proportion of adolescents who had used a condom at last sex increased 4.3 percentage points over the 1 year intervention period. CONCLUSION: Social marketing can be combined with behavioral science to reduce the risk of HIV infection and other sexually transmitted diseases (STD) among adolescents in a large geographical area. Such a reduction can exceed expectations based on national secular trends.

Adolescent↗
PubMed2002

Increase in condom use and decline in HIV and sexually transmitted diseases among female sex workers in Abidjan, Côte d'Ivoire, 1991-1998.

OBJECTIVE: To assess clinic- and community-based trends in demographic and behavioral characteristics and clinic-based trends in HIV infection and other sexually transmitted diseases (STD) in female sex workers in Abidjan, Côte d'Ivoire. DESIGN: Multiyear cross-sectional study of first-time attenders in Clinique de Confiance, a confidential STD clinic; biannual community-based behavioral surveys. METHODS: From 1992 to 1998, female sex workers were invited to attend Clinique de Confiance, where they were counseled, interviewed, clinically examined during their first visit and tested for STD and HIV infection. Community-based surveys, conducted in 1991, 1993, 1995, and 1997, interviewed women regarding socio-demographic characteristics and HIV/STD-related knowledge, attitudes and behavior. RESULTS: Among female sex workers in Abidjan, there was a trend toward shorter duration of sex work, higher prices, and more condom use. Among sex workers attending Clinique de Confiance for the first time, significant declines were found in the prevalence of HIV infection (from 89 to 32%), gonorrhoea (from 33 to 11%), genital ulcers (from 21 to 4%), and syphilis (from 21 to 2%). In a logistic regression model that controlled for socio-demographic and behavioral changes, the year of screening remained significantly associated with HIV infection. CONCLUSION: The increase in condom use and the decline in prevalence of HIV infection and other STD may well have resulted from the prevention campaign for female sex workers, and such campaigns should therefore be continued, strengthened, and expanded.

Adult↗
PubMedDate not supplied

Predictors of sexual intercourse and condom use intentions among Spanish-dominant Latino youth: a test of the planned behavior theory.

BACKGROUND: Spanish-dominant Latino youth represent a growing yet underserved segment of the U.S. population, especially in terms of protection from sexually transmitted HIV infection. There is evidence to suggest that this subgroup engages in both risk and protective behaviors that may be different from the behaviors of English-dominant Latino youth. OBJECTIVE: To examine theoretical predictors (attitude, subjective norm, behavioral beliefs, normative beliefs, control beliefs) of sexual intercourse and condom use with a sample of Spanish-dominant Latino youth. METHODS: Participants in this study were part of a larger randomized controlled intervention designed to reduce the risk of sexually transmitted HIV among Latino youth. This article is based on preintervention data from 141 Spanish-speaking Latino adolescents (77 girls and 64 boys) who completed a Spanish version of the questionnaire. RESULTS: Multiple regression analyses showed significant effects of attitudes, perceived partner approval, self-pride, and parental pride on intentions to engage in sexual intercourse. Attitudes, intentions to engage in sex in the next 3 months, self-pride, parental pride, goals, and partner approval predicted sexual intercourse in the preceding 3 months. Attitudes, subjective norms, self-efficacy, partner and parental approval, and impulse control beliefs were significant predictors of intentions to use condoms. CONCLUSIONS: This study represents initial efforts to address the needs of Spanish-dominant Latino youth. The identification of salient beliefs that may predict sexual risk and protective behavior are relevant to the design of culturally and linguistically effective interventions.

Adolescent↗
PubMedDate not supplied

Condom use prevents genital ulcers in women working as prostitutes. Influence of human immunodeficiency virus infection.

Control of genital ulcer disease (GUD) is a proposed intervention to slow the dissemination of human immunodeficiency virus (HIV) infection. Programs for the control of sexually transmitted diseases (STD) should focus on groups of high-frequency transmitters, such as prostitutes and their clientele. This study illustrates the interaction between the prevalence of chancroid, use of barrier prophylaxis against STDs, and HIV infection in a population of female prostitutes in Nairobi. Four hundred and twenty three women were evaluated. Despite the increased use of condoms, the prevalence of genital ulcers remained constant between 1986-87 and 1987-88. Genital ulcer disease was simultaneously associated with HIV infection (adjusted odds ratio: 3.7, P less than .01) whereas it was independently and inversely associated with more consistent condom use (P less than .01). The authors conclude that genital ulcer disease can be controlled in these populations but concurrent HIV infection increases the difficulty of this intervention.

Chancroid↗
PubMed2006

The impact of microbicides and changes in condom usage on HIV prevalence in men and women.

The impact on HIV prevalence in men and women of the introduction of vaginal microbicides, and subsequent changes in condom usage, depends critically on the efficacy of microbicides in both blocking transmission to women and reducing the infectiousness of infected women. Neglecting to consider how differences in microbicide efficacy by direction of transmission can affect HIV prevalence over time will result in underestimation of the effect of condom replacement.

Anti-HIV Agents↗
PubMed2004

Consistency of self-reported sexual behavior and condom use among current sex partners.

OBJECTIVE: The objective of this study was to determine concordance in sex partner reports of frequency of vaginal and oral intercourse and condom use. STUDY DESIGN: Self-reported behaviors among 112 women treated for urinary tract infection (UTI), sore throats, or receiving birth control at a student health service were compared with that of their current sex partner. RESULTS: Correlation was excellent for frequencies of vaginal intercourse (r = 0.88), cunnilingus (r = 0.72), fellatio (r = 0.76), and condom use (r = 0.86), but women with UTI compared with women without UTI reported greater frequency of sexual activity than their sex partner. This effect overwhelmed the modest increases in correlation associated with duration of relationship and marital status. CONCLUSIONS: Women with genitourinary symptoms may over-recall frequency of sexual behavior compared to women without these symptoms. Knowing the extent of this recall bias will assist in the interpretation of data and appropriate correction of parameters when included in prediction models.

Adolescent↗