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PubMed1996

Factors influencing the intention to use condoms in Quebec sexually-inactive male adolescents.

PURPOSE: The purpose of this study was to determine whether attitudes and other variables would be associated with intention to use condoms in sexually-inactive male adolescents. METHODS: The survey was conducted from April to June 1989 on a sample of 879 sexually-inactive boys aged 12-19 years registered in secondary schools in Laval, Quebec. RESULTS: The major findings of the study were that: (1) information on condoms provided by peers was significantly associated with the intention to use condoms; (2) information provided by schools, while not significant in the final model, was positively associated with younger adolescents' intention to use condoms; and (3) sexually-inactive male adolescents in a less committed couple relationship had a greater intention to use condoms. CONCLUSIONS: The results of this study highlight the importance of peer instructors as a source of information on condoms, as well as that of teachers and health professionals from the school environment. Other channels of communication, however, need to be developed particularly for older sexually-inactive adolescents who may be impervious to this latter source. The findings also underline the necessity to make sexually-inactive adolescents in stable couple relationships more aware of their potential vulnerability to STDs and AIDS should they commence sexual relations.

Adolescent↗
PubMedDate not supplied

Breakage and acceptability of a polyurethane condom: a randomized, controlled study.

CONTEXT: Although the first commercial polyurethane condom was approved for use several years ago, no U.S. clinical trial has compared its performance to that of the latex condom. METHODS: In a masked crossover study, 360 couples were randomized to use three polyurethane condoms and three latex condoms. After each use, couples recorded condom breaks, condom slips and other aspects of performance. At completion of the study, couples compared the sensitivity, ease of use, fit and lubrication of the two types of condoms. RESULTS: The clinical breakage rate of the polyurethane condom was 7.2%, compared with 1.1% for the latex condom (relative risk of 6.6, 95% confidence interval of 3.5-12.3). The complete slippage rate (combining incidents during intercourse and withdrawal) of the polyurethane condom was 3.6%, compared with 0.6% for the latex condom (relative risk of 6.0, 95% confidence interval of 2.6-14.2). Most male users preferred the sensitivity provided by the polyurethane condom to that of the latex condom. CONCLUSIONS: The clinical breakage rate of the polyurethane condom is significantly higher than that of the latex condom. However, nearly half of the users preferred the polyurethane condom, which provides an option for couples who have rejected conventional condoms or who cannot use latex products.

Adolescent↗
PubMed1993

Why do homosexual men relapse into unsafe sex? Predictors of resumption of unprotected anogenital intercourse with casual partners.

OBJECTIVE: To assess predictors of relapse into unprotected anogenital intercourse with casual partners among homosexual men in Amsterdam, The Netherlands. DESIGN: A prospective study ongoing since October 1984. METHODS: Self-reported data on sexual behaviour were obtained at 12 semi-annual intervals. Participants who reported unprotected anogenital intercourse with casual partners at wave 12 but not at wave 11 were considered to have relapsed into unsafe sex (n = 47). Men who did not report unprotected anogenital intercourse at wave 11 or at wave 12 were considered to have maintained behaviour change (n = 197). RESULTS: Relapse into unsafe sex with casual partners occurred more frequently among men with a less positive attitude towards condom use, lower personal efficacy with respect to using condoms with casual partners, a weaker intention to avoid anogenital intercourse with casual partners and those who were not involved in a primary relationship. Intention to avoid anogenital intercourse with casual partners was related to an individual's attitude, normative beliefs and personal efficacy with respect to avoiding anogenital intercourse. CONCLUSIONS: In order to improve motivation it is important to support homosexual men in their personal decision-making process, which may be more resolute when the outcome is in accordance with individual preferences. Therefore, health education should be community-based and sensitive to individual needs.

Adult↗
PubMed1982

Birth weight and birth defects in relation to maternal spermicide use.

The possible effects of maternal spermicide use on birth characteristics of offspring were examined in two studies. First, birth weight of offspring was examined in a cohort study of 302 women who reported using spermicides and 716 women who used no contraceptive methods in the year prior to pregnancy resulting in a 1974 live birth (without a malformation) in Upstate New York. There was no evidence that spermicide use prior to the last menstrual period (LMP) had an effect on mean birth weight or on the proportion of lower weights. Mean birth weight of female births was significantly lower in post-LMP spermicide users than in pre-LMP-only spermicide users and no-contraceptive users. In multiple linear regression analyses of birth weight among births to spermicide users, including maternal smoking during pregnancy and other variables, time of discontinuation of spermicide use was an important predictor of female (but not male) birth weight. In the second (case-control) study of 715 Upstate New York births with selected birth defects and 715 control births (matched on maternal age and race), no significantly increased relative risks were associated with maternal spermicide use prior to LMP or after LMP. Based on small numbers, relative risks for post-LMP spermicide use were greater than 1.00 for hypospadias (8/2 or 4.00, not significant) and for limb reduction defects (6/3 or 2.00, not significant).

Abnormalities, Drug-Induced↗
PubMed1995

Impact on sexually transmitted disease spread of increased condom use by young females, 1987-1992.

BACKGROUND: Sexual behaviour data are crucial for understanding the spread of sexually transmitted diseases (STD). Over a period (1987-1992) in which the HIV epidemic increased public awareness of safe sexual practices, we describe predictors of condom use, changes in condom use over time, and the estimated effects of these changes on the spread of STD. METHODS: Condom use reported by females aged 18-35 years with non-cohabiting partners was analysed using data from two cross-sectional postal surveys performed 5 years apart (1987 and 1992) on two separate representative samples of 10,000 subjects aged 18-60 years living in Norway. A simple mathematical model was used to assess the effects of selection bias. A more complicated model was used to predict the effects of condom use on the prevalence of STD in a population which includes a core group of highly sexually active subjects. RESULTS: We found an increase in the prevalence of condom use in the latest intercourse from 14% to 20% with non-foreign partners and from 10% to 38% with foreign partners, from 1987 to 1992. In a logistic regression model, low frequency of intercourse, high education, one lifetime partner, and late sexual debut were predictors for condom use. Controlled for these variables, the odds ratio (OR) for condom use in 1992 versus 1987 was 1.4 (95% confidence interval [CI]: 0.9-2.0) if the partner was non-foreign, and 7.1 (95% CI: 2.5-20.5) if the partner was foreign. Not using other contraceptive methods was a strong predictor for condom use; OR = 17.4 (95% CI: 8.0-38.0). Condom use in the first intercourse with the last partner was a strong predictor for condom use in the last intercourse; OR = 19.2 (95% CI: 8.2-45.3). It appeared unlikely that the increase in condom use could be explained by response bias. The predicted reductions in STD prevalence due to the increase in condom use ranged from zero to 30% depending on consistency of use, and on the agent that is transmitted. CONCLUSIONS: Condom use among 18-35 year old women has increased over the period, particularly with foreign partners. Condoms are used primarily as contraception. The prevalences of STD with high transmission rates are not reduced by inconsistent condom use, while the prevalences of STD with low transmission rates are reduced by both consistent and inconsistent condom use. Condom use in a core group is more effective for reducing the STD prevalence than condom use in the non-core group for gonorrhoea and HIV. For chlamydial infection, condom use in the non-core group is more effective.

Adolescent↗
PubMed1994

HIV-1 infection among lower class commercial sex workers in Chiang Mai, Thailand.

OBJECTIVE: To determine risk factors for HIV-1 infection in female commercial sex workers (CSW) in northern Thailand. METHODS: A cross-sectional survey of female CSW from 11 sex establishments frequented by military conscripts that included an interview and serological testing for HIV-1. RESULTS: The HIV-1 seroprevalence in 230 CSW was 65%; the rate was lower among CSW from Chiang Mai than from rural areas. Multivariate logistic regression analysis for HIV-1 included the following significant factors: non-urban location of the sex establishment, ethnic Thai lowlander, lower price, history of genital warts and dysuria. Condom use, number of partners and duration of employment were not significantly associated with HIV-1 prevalence after adjustment for other risk factors. CONCLUSIONS: The high level of HIV-1 seroprevalence in this sample demonstrates the risk of transmission in lower cost commercial sex encounters in northern Thailand. Non-Thais (ethnic Hill tribes and Burmese) had lower HIV-1 prevalence than ethnic Thais. Type of establishment ('direct' brothel-based or 'indirect' establishments) was not predictive of HIV-1 seroprevalence. However, rural establishments were less vigilant in promoting condom use, suggesting the need for renewed efforts to enforce the Ministry of Public Health's '100% Condom Campaign' in commercial sex establishments.

Adolescent↗
PubMed1994

Determinants of condom use by Australian secondary school students.

PURPOSE: To identify factors that are associated with condom use to aid in the understanding of how to change the behavior of those young people who have sex without using condoms. METHODS: The article reports data from 932 sexually active grade 10-12 students from a sample of 72 public secondary schools in seven Australian states and territories. The data were collected using a cross-sectional, self-report questionnaire. RESULTS: Boys were more likely than girls to report that a condom was used the last time they had sex. For boys and girls, communication with a partner about avoiding infection with HIV/STDs, the belief that more peers use condoms, and a higher perceived risk of becoming infected with HIV/STDs were associated with using a condom, as was lower knowledge of STDs. The use of oral contraception and the unavailability of condoms were reported by the students as prominent reasons for non-use of condoms. Number of sexual partners in the past year and type of relationship with partner on the most recent occasion were not associated with condom use. CONCLUSIONS: Adolescents are more concerned with unwanted pregnancy than with disease prevention. School students more at risk are not more likely to take the necessary precautions to protect themselves from HIV/STDs.

Adolescent↗
PubMedDate not supplied

Patterns of condom use and sexual behavior among never-married women.

BACKGROUND AND OBJECTIVES: Use of condoms is one of the main methods sexually active persons may choose to prevent infection with sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). Little is known about patterns of condom use among women in the United States. We provide a conceptualization of patterns of condom use and factors associated with these patterns. GOAL OF THIS STUDY: To examine patterns of condom use and associated characteristics among sexually active, never-married women in the United States. STUDY DESIGN: Analysis of data from the 1988 National Survey of Family Growth, which is a nationally representative sample of women in their childbearing years. RESULTS: Only a minority of sexually active, never-married women report using condoms, and even fewer report using them consistently. Women with characteristics traditionally associated with increased risk of infection with STD and HIV appear to be less likely to report using condoms and to report using them consistently. Women who report use of condoms to prevent STDs are more likely to report consistent condom use; less likely to cease using condoms; and more likely to initiate consistent condom use. CONCLUSION: Findings suggest the need for innovative programming targeted for specific sexually active populations to promote both initiation and maintenance of use of condoms.

Adolescent↗
PubMed1996

Sexual health and use of condoms among local and international sex workers in Sydney.

OBJECTIVES: To compare indicators of sexual health and predictors of condom use for commercial sex among local and international female sex workers first attending an STD clinic. SETTING: A public STD clinic in Sydney, Australia. SUBJECTS: All sex workers first attending between June 1991 and May 1993. METHODS: Cross-sectional analysis of demographic, behavioural and morbidity data from proforma medical records. RESULTS: 91 local sex workers and 123 international sex workers (predominantly from Thailand, Malaysia and China) first presented during the study period. There were significantly higher prevalences of chlamydia (0 v. 15%, p = 0.0002), gonorrhoea (0 v. 14%, p = 0.0006), syphilis (0 v. 10%, p = 0.006) and clinical genital herpes (0 v. 5%, p = 0.04) among international sex workers. The only case of HIV infection was in an international sex worker. Inconsistent condom use for commercial sex was significantly more common among international sex workers (RR = 4.5; 95% CI 3.1-6.5). On multivariate analysis, inconsistent condom use in international sex workers was associated with a recent history of prostitution outside Australia (p = 0.04), while inconsistent condom usage among local sex workers was associated with increasing age (p = 0.003). CONCLUSIONS: These data illustrate the efficacy of condoms and the success of targeted education programmes in local sex workers in Sydney. By contrast, international sex workers continued to be at high risk of STDs. The international sex industry in Sydney requires enhanced culture-specific interventions. Immigration laws as they affect sex workers should also be reviewed.

Adult↗
PubMedDate not supplied

Correlates of condom use in the young adult population in Ontario.

OBJECTIVES AND METHODS: Data from the Ontario Health Survey were used to identify sociodemographic, lifestyle and sexual history characteristics associated with the use of condoms for protection against sexually transmitted diseases (STDs) in randomly selected adults between the ages of 16 and 44 years who had had two or more sexual partners in the 12 months before the survey (n = 2,699). RESULTS: Forty-two percent reported not having used condoms for protection against STDs. Those most likely to use condoms were 16 to 24 years of age, males, students, non-binge-drinkers, urban residents, and those at higher risk for HIV/AIDS. Of those who used condoms, 68% did not use them consistently. Individuals most likely to always use condoms were 16 to 24 years of age, males, students, non-binge-drinkers, and those with secondary school education. Age, gender, occupational activity, and non-binge-drinking were common correlates of both condom use and consistent use. CONCLUSIONS: Public health messages should be focused on people with multiple sex partners who are not using condoms for STD protection, including rural residents, those with high levels of education, and those over 34 years of age.

Adolescent↗
PubMed1993

The effectiveness of condom use in heterosexual prostitution in The Netherlands.

OBJECTIVES: To assess the extent to which condoms are used effectively in commercial heterosexual intercourse. Data on the number of condoms that had broken or slipped off, the sexual technique during which this had occurred and the perceived cause of failure were collected. The use of non-water-soluble lubricants and non-fortified condoms during anal intercourse, and the demand for a greater variety of condom sizes were also examined. SUBJECTS AND METHODS: One hundred and twenty-seven female prostitutes and 91 male clients from different parts of The Netherlands were interviewed face-to-face between July 1990 and March 1991. RESULTS: Of those who used condoms during vaginal intercourse, 49% of the prostitutes had experienced condom breakage in the previous 6 months, and 16% of the clients in the previous 12 months. The breakage rate was 0.8% for prostitutes and 1.5% for clients. Condom quality was seldom reported as the cause; breakage was generally attributed to human factors, such as rough or prolonged intercourse, incorrect handling of the condom or the use of insufficient lubricant. Prostitutes also identified penis size as a cause. Condoms slipping off before or after ejaculation was reported less frequently than breakage. Thirteen per cent of clients and 36% of prostitutes expressed a need for either smaller or larger condoms. Of the prostitutes, 9% used oil or vaseline as a lubricant. CONCLUSIONS: In view of the low rate of condom failure in heterosexual prostitution in The Netherlands, the potential spread of HIV by this means is small. The use of a greater variety of condom sizes may further reduce the failure rate. Few prostitutes remain ignorant about the adverse effects of oil-based lubricants on condoms.

Condoms↗
PubMed1997

Change in sexual behaviour and decline in HIV infection among young pregnant women in urban Uganda.

OBJECTIVE: To describe sexual behaviour that may partly explain a decline in HIV seroprevalence in pregnant women in urban settings in Uganda, East Africa. SETTINGS: Two major urban districts in Uganda. METHODS: Repeated population-based behavioural surveys in 1989 and 1995, and repeated HIV serological surveys in consecutive pregnant women attending antenatal clinics from 1989 to 1995. RESULTS: During the study period, a 2-year delay in the onset of sexual intercourse among youths aged 15-24 years and a 9% decrease in casual sex in the past year in male youths aged 15-24 years were reported. Men and women reported a 40% and 30% increase in experience of condom use, respectively. In the same study area, over the same period, there was an overall 40% decline in the rates of HIV seroprevalence among pregnant women attending antenatal clinics. It can be hypothesized that the observed declining trends in HIV correspond to a change in sexual behaviour and condom use, especially among youths. CONCLUSIONS: This is the first report of a change over a period of 6 years in male and female sexual behaviour, assessed at the population level, that may partly explain the observed decline in HIV seroprevalence in young pregnant women in urban Uganda. This result should encourage AIDS control programmes to pursue their prevention activities.

Adolescent↗
PubMedDate not supplied

Sexual behaviour, drug use and hepatitis B infection in Chandigarh students.

BACKGROUND: The relationship of hepatitis B virus infection with drug use and sexual activity in Indian college students has not been studied earlier. METHODS: We studied this relationship in Chandigarh, using a prospective, cross-sectional questionnaire-based survey and blood tests for hepatitis B markers. The responders were assured of the confidentiality of their responses and blood test results. RESULTS: Of the 1311 students who participated, 192 (15%) were sexually active. Eight-four per cent of them were heterosexual, 7.3% homosexual and 8.7% bisexual. Thirty-seven per cent of heterosexuals and 36% of homosexuals had more than one partner. Condoms were used by 24% heterosexuals, 11% bisexuals and 7% homosexuals. Of the sera tested, 2.9% were hepatitis B surface antigen positive and 10.4% were positive for the antibody to hepatitis B surface antigen. Fifteen per cent consumed alcohol, but only 1.6% were addicted to other drugs. Two students were intravenous drug users. Eleven per cent had donated blood at least once and a third of these had suffered from jaundice in the past. CONCLUSION: The pattern of sexual behaviour, low condom use and the small but definite prevalence of hepatitis B virus infection in this population of students suggests that the human immunodeficiency virus infection may spread rapidly when it enters this community.

Adolescent↗
PubMed2000

Altered expression of retinal occludin and glial fibrillary acidic protein in experimental diabetes. The Penn State Retina Research Group.

PURPOSE: To investigate how diabetes alters vascular endothelial cell tight junction protein and glial cell morphology at the blood-retinal barrier (BRB). METHODS: The distribution of the glial marker, glial fibrillary acidic protein (GFAP), and the endothelial cell tight junction protein occludin were explored by immunofluorescence histochemistry in flatmounted retinas of streptozotocin (STZ)-diabetic and age-matched control rats, and in BB/Wor diabetes-prone and age-matched diabetes-resistant rats. RESULTS: GFAP immunoreactivity was limited to astrocytes in control retinas. Two months of STZ-diabetes reduced GFAP immunoreactivity in astrocytes and increased GFAP immunoreactivity in small groups of Müller cells. After 4 months of STZ-induced diabetes, all Müller cells had intense GFAP immunoreactivity, whereas there was virtually none in the astrocytes. BB/Wor diabetic rats had similar changes in GFAP immunoreactivity. Occludin immunoreactivity in normal rats was greatest in the capillary bed of the outer plexiform layer and arterioles of the inner retina but much less intense in the postcapillary venules. Diabetes reduced occludin immunoreactivity in the capillaries and induced redistribution from continuous cell border to interrupted, punctate immunoreactivity in the arterioles. Forty-eight hours of insulin treatment reversed the pattern of GFAP and occludin immunoreactivity in the STZ-diabetic rats. CONCLUSIONS: Diabetes alters GFAP expression in retinal glial cells, accompanied by reduction and redistribution of occludin in endothelial cells. These changes are consistent with the concept that altered glial-endothelial cell interactions at the BRB contribute to diabetic retinopathy.

Animals↗
PubMed1993

HIV-1 infection in young men in northern Thailand.

OBJECTIVES: To determine risk factors for HIV-1 infection in young men in northern Thailand. METHODS: At enrollment into a prospective study, data were collected from a self-administered questionnaire and serologic testing on a cohort of 1115 young men selected by lottery for conscription. RESULTS: The overall HIV-1 infection rate was 6.9%; however, the rate was 15.3% among the 387 (34.7%) men who had been living in the upper north subregion of Thailand compared with 2.5% for the remaining 728 men (P < 0.001). A history of sex with female prostitutes was reported by 74.7% of men and increased frequency of this type of sex was highly associated with HIV-1 infection and a history of sexually transmitted disease (STD) symptoms (chi 2 for trend, P < 0.001). In stratified and multivariate analyses, however, history of STD symptoms, reported by 42.5% of the cohort, was most strongly associated with HIV-1 infection. Only 42.8% of men who reported sex with prostitutes had used condoms more than half the time. CONCLUSIONS: Young men in the general population in northern Thailand are at high risk for HIV-1 infection via sex with female prostitutes; STD are highly associated with HIV-1 infection. Increasing condom use and controlling STD should be immediate goals of HIV control programs.

Acquired Immunodeficiency Syndrome↗
PubMed1994

HIV-1 seroconversion rates among female commercial sex workers, Chiang Mai, Thailand: a multi cross-sectional study.

OBJECTIVES: To determine HIV seroconversion rates among female commercial sex workers (CSW) in Chiang Mai, Thailand. DESIGN: A three-round multi cross-sectional study was used at approximately 3-month intervals. METHODS: In December 1989, 38 brothels (60%) in Chiang Mai were randomly selected. All 518 female CSW in the brothels were interviewed about their sociodemographics, sexual practices, condom use, history of sexually transmitted diseases (STD) and other risk factors. Blood was tested for Venereal Disease Research Laboratory (VDRL)-reactivity and HIV-1 antibody. The same brothels, which were all still operating, were revisited in March and July 1990 and 431 and 320 CSW, respectively, were interviewed and blood-tested. Pelvic examination, cervical, urethral and rectal cultures for gonococcus were added to the study in March 1990, although rectal culture was dropped from the study in July 1990. RESULTS: There were 5.2% [95% confidence interval (CI), 4.1-10.6] and 3.6% (95% CI, 1.5-5.4) per woman-month HIV seroconversion rates for the December-March and March-July periods, respectively. Of the CSW, 71.6-77.0% reported histories of at lest one STD. Condom-use rates among these CSW were reported to be 85.8-91.8%. High rates of positive cervical (11.2-12.3%) and urethral (8.8-11.4%) cultures for gonococcus were also found in the CSW. CONCLUSIONS: The fact that high HIV seroconversion rates and high STD prevalence rates occur despite high rates of reported condom use suggests that more aggressive education programs are needed in Thailand.

Contraceptive Devices, Male↗
PubMed1994

Sexual behavior of American adolescents: results from a U.S. national survey.

PURPOSE: This paper reports on data from a 1990 U.S. national survey of the sexual behavior of male and female adolescents aged 12-17. METHODS: A household survey using a multi-stage area probability sample of the United States was undertaken in 1990. Adolescents were interviewed about sexual history, contraceptive use, and motivations, attitudes, and expectations with regard to sexual behavior and risk. RESULTS: The majority of 17-year-olds and about half of 16-year-olds, both male and female, had initiated sexual activity, with males initiating at younger ages than females. Sexual activity was episodic; only half of sexually experienced adolescents reported having sex in the month prior to the interview. Many sexually active respondents expressed less desire to have sex than confidence that they would have sex. Over half of respondents reported using a condom at most recent intercourse, with boys being more likely than girls to report condom use. Condom use at last intercourse was unrelated to perceptions of risk and concern about AIDS. CONCLUSIONS: Given the importance of some of the undesirable consequences of sexual activity in adolescents, such as AIDS and unwanted pregnancy, accurate and up-to-date information on sexual behavior of this age group is crucially important. The results of this study underscore the need for in-depth, population-based research on adolescent sexual behavior.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Factors associated with nonuse of condoms in heterosexual men and women attending an HIV testing clinic in Israel.

OBJECTIVES: To examine gender differences in HIV-related knowledge, perceived vulnerability, beliefs in self-control, type of sexual partnership, and their associations with nonuse of condoms. METHODS: Heterosexual men and women who voluntarily attended an HIV testing clinic in Israel were asked to complete a self-report questionnaire. Scales of HIV knowledge and control and a single item for vulnerability were used. Type of sexual relationship (monogamous vs. nonmonogramous) and condom use in vaginal sex (never vs. ever) referred to the previous 6 months. Response rate was 84%; 154 men and 109 women participated. RESULTS: Beliefs in self-control did not form a reliable scale and single items were used. No statistically significant gender differences were found in knowledge, vulnerability, or beliefs in self-control. Levels of correct HIV-related knowledge were high, but so were some misconceptions. The vast majority (87%) perceived themselves as vulnerable to HIV infection. The beliefs in self-control were moderate in some items, and low in others. In logistic regression models, different factors were significantly associated with nonuse of condoms in the two genders: the belief that their lifestyle protected them against HIV infection (OR = 2.72, CI = 1.06-7.03) among men, and being monogamous (OR = 3.72, CI = 1.28-10.8) among women. CONCLUSION: Heterosexual men and women attending an HIV testing clinic need counseling to further lower misconceptions about HIV transmission and additional gender-specific counseling to address HIV-related beliefs.

Adult↗