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PubMedDate not supplied

Effects of latanoprost on blood-retinal barrier permeability in rabbits.

PURPOSE: To investigate the effect of latanoprost (LP) on the inward and outward permeability (Pin and Pout) of the blood-retinal barrier (BRB). METHODS: Four New Zealand white rabbits received topical LP (0.005%) once daily for 3 weeks in one eye and phosphate-buffered saline (PBS) in the fellow eye (topical group). Five New Zealand white rabbits were injected intravitreously with LP (0.1 ml, 0.005%) in one eye and PBS (0.1 ml) in the fellow eye (injection group). In the injection group, vitreous fluorophotometry (VFP) to estimate the Pin and differential vitreous fluorophotometry (DVF) to estimate the Pout were performed 60 min after LP was injected. After the baseline measurements, VFP and DVF were performed 60 and 180 min after intravenous injection of sodium fluorescein, respectively. Fluorescein (F) and fluorescein monoglucuronide (FG) concentrations were obtained by DVF, and the F/FG ratio was calculated as an index of the Pout. RESULTS: In the topical group, there were no significant differences in the Pin or F/FG ratio between the LP- and the PBS-treated eyes. In the injection group, the Pin in the LP-treated eyes was significantly higher than in PBS-treated eyes (p < 0.05). There was no significant difference in the F/FG ratio between the two groups. CONCLUSION: Although we cannot exclude the effect of differences in species, the physiologic effect of LP, which increased the Pin, was seen in experimental studies. Because antiglaucoma drugs are generally used over an extended period, further clinical studies of the effect of LP on the BRB should be performed in patients who have BRB breakdown, such as in uveitis, and in patients who are pseudophakic and aphakic.

Administration, Topical↗
PubMed2000

Promotion of condom use in a high-risk setting in Nicaragua: a randomised controlled trial.

BACKGROUND: In Latin America, motels rent rooms for commercial and non-commercial sex. We investigated the impact of providing health-education material and condoms on condom use in Managua, Nicaragua. METHODS: In a randomised controlled trial, in 19 motels, we gave condoms on request, made them available in rooms, or gave condoms directly to couples, with and without the presence of health-education material in the rooms. In a factorial design we assessed condom use directly by searching the rooms after couples had left. FINDINGS: 11 motels were used mainly by sex workers and their clients and eight mainly for non-commercial sex. 6463 couples attended the motels in 24 days. On 3106 (48.0%) occasions, at least one used condom was retrieved. Condom use was more frequent for commercial sex than for non-commercial sex (60.5 vs 20.2%). The presence of health-education material lowered the frequency of condom use for commercial sex (odds ratio 0.89 [95% CI 0.84-0.94]) and had no effect on use for non-commercial sex (1.03 [0.97-1.08]). Condom use increased for commercial (1.31 [1.09-1.75]) and non-commercial sex (1.81 (1.14-2.81) if condoms were available in rooms. Directly handing condoms to couples was similarly effective for commercial sex but less effective for non-commercial sex (1.32 [1.03-1.61] vs 1.52 [1.01-2.38]). INTERPRETATION: In Latin America, motels are key locations for promoting the use of condoms. Making condoms available in rooms is the most effective strategy to increase condom use, whereas use of health-education material was ineffective. These findings have important implications for HIV-prevention policies.

Condoms↗
PubMed1992

Patterns and predictors of high-risk sexual behavior in female partners of HIV-infected men with hemophilia.

OBJECTIVE: To characterize and quantify high-risk heterosexual activity in HIV-discordant couples. DESIGN: Analysis of cross-sectional and longitudinal questionnaire data from 217 HIV-negative female sexual partners of HIV-infected hemophilic men. METHODS: Comparison of prevalence rates of anal sex, oral sex, vaginal intercourse with or without condoms, and use of other contraceptives between 1985 and 1991. Logistic regression analysis of demographic, sexual and clinical variables to predict unprotected vaginal sex. Actuarial estimates of semi-annual relapse rates to unsafe sex. RESULTS: The proportion of women at low risk increased from 7 to 69% between 1985 and 1991, mainly because more women were using condoms during all acts of vaginal intercourse. Other contraceptive practices did not change during this time. The proportion engaging in oral or anal sex decreased (from 26 to 13% and 13 to 4%, respectively). Unprotected vaginal sex was more common among women who enrolled earlier, had less education, engaged in oral or anal sex, and among those whose partners had not had AIDS. Unprotected vaginal sex before enrollment was the strongest predictor of this high-risk activity during follow-up. Two-year rates of relapse to high-risk behavior were significantly higher among women who enrolled at high risk compared with those who enrolled at low risk (39 versus 8%, P = 0.005). CONCLUSIONS: Although high-risk sexual behavior became much less prevalent in this population between 1985 and 1991, many continued to have unprotected vaginal sex occasionally. Counseling efforts should target couples who have been the most sexually active or have less education, and should emphasize not only initial risk reduction but also maintenance of low-risk behavior.

Adolescent↗
PubMed1996

Heterosexual transmission of HIV in Haiti.

BACKGROUND: Despite the importance of human immunodeficiency virus (HIV) transmission through heterosexual contact, the incidence of HIV infection in heterosexual cohorts has not been well studied, particularly in the developing world. OBJECTIVE: To 1) determine the incidence of HIV infection in discordant heterosexual couples (couples in which one partner had HIV infection and the other did not) in Haiti and 2) assess risk factors for and methods of preventing HIV infection. DESIGN: Prospective study. SETTING: National Institute for Laboratory Research, Portau-Prince, Haiti. PARTICIPANTS: 475 HIV-infected patients and their noninfected regular sex partners. MEASUREMENTS: Patients and their partners were evaluated at 3- to 6-month intervals for HIV infection, sexually transmitted diseases, and sexual practices. The efficacy of counseling and provision of free condoms was also evaluated. RESULTS: Among the 177 couples who remained sexually active during the prospective study period, 20 seroconversions to HIV positivity occurred, for an incidence rate of 5.4 per 100 person-years (95% CI, 5.16 to 5.64 per 100 person-years). Thirty-eight couples (21.5%) discontinued sexual activity during the study. Only 1 seroconversion occurred among the 42 sexually active couples (23.7% of the 177 sexually active couples) who always used condoms. In contrast, the incidence in sexually active couples who infrequently used or did not use condoms was 6.8 per 100 person-years (CI, 6.49 to 7.14 per 100 person-years). Transmission of HIV was associated with genital ulcer disease, syphilis, and vaginal or penile discharge in the HIV-negative partner and with syphilis in the HIV-infected partner. CONCLUSION: Counseling and the provision of free condoms contributed to the institution of safe sex practices or abstinence in 45% of discordant heterosexual couples. However, 55% of couples reported that they continued to have unprotected sex, resulting in an incidence of HIV infection of 6.8 per 100 person-years.

Condoms↗
PubMed2005

L-type amino acid transporter 1-mediated L-leucine transport at the inner blood-retinal barrier.

PURPOSE: L-type amino acid transporters (LATs) prefer branched-chain and aromatic amino acids, including neurotransmitter precursors. The objective of this study was to clarify the expression and function of LAT at the inner blood-retinal barrier (BRB). METHODS: [3H]L-Leucine transport at the inner BRB was characterized by using in vivo integration plot analysis and a conditionally immortalized rat retinal capillary endothelial cell line (TR-iBRB2). The expression of the LAT1 was demonstrated by quantitative real-time RT-PCR, immunoblot, and immunohistochemical analyses. RESULTS: The apparent influx permeability clearance of [3H]L-leucine in the rat retina was found to be 203 microL/(min.g retina), supporting a carrier-mediated influx transport of L-leucine at the BRB. [3H]L-Leucine uptake by TR-iBRB2 cells was an Na+-independent and concentration-dependent process with a Km of 14.1 microM. This process was more potently cis inhibited by substrates of LAT1, D-leucine, D-phenylalanine, and D-methionine, than those of LAT2, L-alanine, and L-glutamine. [3H]L-Leucine efflux from TR-iBRB2 cells was trans-stimulated by substrates of LAT1. The expression of LAT1 mRNA was 100- and 15-fold greater than that of LAT2 in TR-iBRB2 and magnetically isolated rat retinal vascular endothelial cells, respectively. The expression of LAT1 protein was observed in TR-iBRB2 and primary cultured human retinal endothelial cells and immunostaining of LAT1 was observed along the rat retinal capillaries. CONCLUSIONS: LAT1 is expressed at the inner BRB and mediates blood-to-retina L-leucine transport. This transport system plays a key role in maintaining large neutral amino acids as well as neurotransmitters in the neural retina.

Animals↗
PubMedDate not supplied

Condom use to prevent incident STDs: the validity of self-reported condom use.

BACKGROUND: Studies of sexual behavior and of interventions designed to reduce human immunodeficiency virus risk usually depend on self-report. Validation of self-reported condom use measures has not been previously reported in an urban population at high risk for sexually transmitted diseases and human immunodeficiency virus. METHODS: A prospective cohort study was performed in subjects recruited from sexually transmitted disease clinics in Baltimore. At enrollment, a questionnaire was administered that assessed human immunodeficiency virus risk factors and sexually transmitted disease history, and used a retrospective calendar to assess sexual events and condom use over the previous 30 days. Clinical evaluation was performed for sexually transmitted diseases. At follow-up 3 months later, the same procedures were repeated. Incident sexually transmitted diseases at follow-up were defined as new culture or serologically documented diagnoses of gonorrhea, chlamydia, syphilis, or trichomoniasis. RESULTS: In the 323 male and 275 female (total = 598) subjects who completed a follow-up visit, 21% reported using condoms for every act of sexual intercourse over the previous 30 days, 21% reported occasionally using condoms, and 59% reported not using condoms. At follow-up, 21% of subjects had new incident gonorrhea, chlamydia, syphilis, or trichomoniasis. Fifteen percent of the men who were "always" condom users had incident sexually transmitted diseases compared with 15.3% of "never users;" 23.5% of women who were "always" users had incident sexually transmitted diseases compared with 26.8% of "never" users. CONCLUSIONS: In this high-risk population, self-reported condom use is not associated with lower sexually transmitted disease incidence. This finding suggests that self-reported condom use measures, even in a research setting, may be subject to substantial reporting bias.

Adult↗
PubMed1996

Sexual behaviors and risk factors for HIV infection among men who have sex with men in the Dominican Republic.

OBJECTIVE: To describe self-reported types of sexual identity of men who have sex with men (MSM) in the Dominican Republic, assess sociodemographics and behavioral characteristics, and measure the prevalence of HIV-1 and syphilis. DESIGN: Cross-sectional study of MSM recruited from a variety of community settings. METHODS: A total of 354 men agreed to participate after giving verbal informed consent. Information was obtained using a standardized questionnaire assessing demographics and AIDS-relevant information. Blood was obtained for HIV and syphilis testing. RESULTS: Five main sexual identity groups emerged: cross dressers, homosexuals, gigolos, bisexuals and heterosexuals. Receptive anal and oral intercourse were commonly reported by men self-identifying as cross dressers or homosexuals, whereas nearly all of the remaining three groups practiced only insertive intercourse. Sexual contact with women was also commonly reported; overall, consistent condom use was infrequent. HIV antibodies were detected in 11.0% and serologic evidence of syphilis was found in 7.3%. Factors independently associated with HIV infection included serologic evidence of syphilis, having visited at least one of four local brothels in 1975-1985, and having had receptive anal intercourse with four or more partners in the last 12 months. CONCLUSIONS: Syphilis, sexual practices and social context of sex (commercial sex), rather than sexual identity per se, were associated with HIV infection. The complex social networks of MSM in this setting, the tendency to practice either insertive or receptive sex, but not both, infrequent condom use, high rates of syphilis and the frequency of sex with women need to be taken into account for targeted HIV prevention programs to be successful.

Adolescent↗
PubMedDate not supplied

Increased condom use among teenage males, 1988-1995: the role of attitudes.

CONTEXT: Understanding whether and to what degree changes in young men's attitudes explain increases in condom use over time can be useful in developing more effective disease prevention strategies. METHODS: Data from the 1988 and the 1995 National Survey of Adolescent Males are used to determine changes in attitudes toward condoms, pregnancy prevention and HIV and AIDS. Two-limit tobit models are employed to investigate the association between these attitudes and condom-use behavior and to examine how this relationship may have changed over time. RESULTS: Between 1988 and 1995, young men's attitudes toward partner appreciation of condom use, condom-use embarrassment and pleasure reduction from condom use all changed in a direction suggestive of more consistent condom use. However, attitudes related to pregnancy prevention and AIDS avoidance changed in a direction suggestive of less-consistent condom use. Changes over time in the strength of the relationship between three attitude measures (masculinity, pleasure reduction and partner appreciation) and condom use also were predictive of lower levels of condom-use consistency. Only the strength of the relationship between condom-use embarrassment and consistent condom use changed in a direction corresponding to observed increases in rates of condom use among young men. CONCLUSIONS: Many of the significant changes in young males' attitudes toward condoms do not explain the increase in consistent condom use among adolescent males that occurred between 1988 and 1995. However increasing male contraceptive responsibility and emphasizing the risks and consequences of contracting HIV appear to be viable routes for policymakers to explore. Efforts particularly need to be targeted toward Hispanics.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Adolescent sexual behavior along the Trans-Africa Highway in Kenya.

OBJECTIVE: To describe the demographic characteristics and HIV-related risk behaviors of adolescents frequenting truck stops along the Trans-Africa Highway in Kenya. METHODS: A cross-sectional study of 200 adolescents (52% female) aged 15-19 years was conducted at the Malaba, Sachangwan and Mashinari truck stops in Kenya. A standardized questionnaire assessing the adolescents' demographic characteristics and sexual behavior was administered. RESULTS: Most (89%) of the adolescents interviewed were out of school. Their median monthly family income was Ksh1000 (US$25). Most felt that their families provided inadequate access to food (72%), clothing (70%) and pocket money (87%). Ninety-three per cent of girls and 87% of boys had ever had sexual intercourse and of these 54% of girls and 38% of boys had ever used a condom. Fifty-two per cent of the girls and 30% of the boys reported ever having had a sexually transmitted disease. Forty-six percent of girls reported usually having sex with truck drivers, 78% of girls reported usually exchanging sex for gifts or money and 59% of boys reported usually giving gifts or money for sex. Subjects engaging in these three risk behaviors were generally less likely to be in school, less likely to live with relatives and less likely to report getting along well with their parents. CONCLUSION: Adolescents at truck stops along the Trans-African Highway in Kenya appear to be at significant risk for HIV infection. In the absence of an immediate and wide-ranging intervention, these conditions are likely to facilitate the spread of HIV from truck drivers and sex workers to adolescents.

Acquired Immunodeficiency Syndrome↗
PubMed1981

Japan, Indonesia to investigate condom plant feasibility.

The Japanese government has begun investigations on the possibility of constructing a condom manufacturing plant in Indonesia in response to a request by the Indonesian government. Indonesia, which hopes to reduce its birthrate as of 1971 by 1/2 by 1990, asked for Japanese assistance in building a condom plant based on the expectation that demand for this contraceptive method, although quite low at present, will increase rapidly in the near future with stepped-up motivation campaigns. As a 1st step in the investigation, the Japan International Cooperation Agency (JICA) sent a study team of family planning experts headed by Family Planning Federation of Japan Chairman Dr. Hidebumi Kubo and including JOICFP International Division Director MR. Tameyoshi Katagiri to Indonesia from March 15-24. During its visit, the JICA team held discussions with representatives of BKKBN (the National Family Planning Coordinating Board) including its Chairman and Minister of Health Dr. Suwardjono and reached agreement on the scope and schedule of work toward determining the feasibility of building and operating a condom plant in Indonesia. In defining the scope of work and the schedule, the JICA team and the BKKBN representatives decided on specific issues to be investigated in the feasibility study to be carried out by JICA and scheduled to be completed by the end of October of this year. To be included in the feasibility study are: estimation of future domestic demand for condoms, examination of the domestic supply of latex capacity, chemicals and packaging materials, and collection of information on infrastructure relating to water, energy, transportation, etc. Actual data collection for the study is expected to begin in late May or early June. Dr. Kubo and Mr. Katagiri, upon returning to Japan, reported great enthusiasm for the project in Indonesia and expressed the hope that the plant construction will be feasible so that the country's family planning program can be given a boost and the cooperative relationship between Indonesia and Japan deepened.

Asia↗
PubMed1995

The benefits of school-based condom availability: cross-sectional analysis of a comprehensive high school-based program.

OBJECTIVES: To analyze the benefits of a school-based condom availability program relative to the risks that such a program may incur. METHODS: A confidentially-administered survey instrument was completed by 152 randomly selected high-school students (approximately 14% of the entire student population). RESULTS: The respondents had a mean age of 15.9 years (range: 14-19 years) and a proportionate gender distribution. Ninety-three percent of all respondents had "heard of" the school's program and knew from whom they could receive condoms. Twenty-six percent of the respondents had received condoms from the program with 67% using them. Of those receiving condoms but not using them, more than half did not need them, owing to absence of anticipated sexual activity. Of the nonreceivers, 53% had never had sexual intercourse and 27% received condoms from other sources. The benefit of the program by aiding a sexually-active student was found to be more than three times as great as the risk of encouraging a nonsexually active student to have sexual intercourse (RR = 3.2; 95% C.I. = 2.1, 4.9). The prevalence of sexual activity among all respondents was not significantly higher than the state's average based on gender and age (59.8% vs. 54.5%; z = 1.24, p > .05, n.s.). CONCLUSION: Given the lack of increased sexual activity and the favorable benefit-risk ratio, we conclude that school-based condom availability is successfully utilized by sexually-active adolescents and may be an effective means to reduce potentially harmful outcomes, such as unintended pregnancy and sexually-transmitted diseases.

Adolescent↗
PubMedDate not supplied

Condom breakage studied.

4 specific reasons why condoms--even those of high quality--break have been identified following a series of studies in 8 countries among 1700 people. According to the studies, breakage falls into 4 general categories: incorrect methods of putting on condoms, use of oil-based lubricants, reuse of condoms, and duration or intensity of coitus. The studies, conducted by Family Health International, a North Carolina based contraceptive research and AIDS prevention organization, was the 1st large scale effort to examine condom breakage. Used properly and consistently, condoms are considered to be highly reliable for prevention of pregnancy and sexually transmitted diseases. An estimated 40 million couples worldwide currently use condoms for pregnancy prevention. The studies found that human factors caused condoms to break at rates that ranged up to 13%, with a 4-5% average breakage rate reported at most sites. Preliminary research data indicate that the vast majority of condom users very seldom experienced condom failure. Past condom "failure," as defined by the number of accidental pregnancies among US couples who used condoms for contraception, was estimated at 12% (12 of 100 couples using condoms for 1 year will experience a pregnancy). But the 12% failure rate was attributable primarily to nonuse or inconsistent use of condoms, not breakage. "W now have some guideposts as to what types of behavior lead to breakage," said Dr. Nancy Williamson, director of Family Health International's program evaluation division, which directed the studies. "We need to inform condom users and providers about which errors users make." The studies provide an important cross-cultural data base on condom use. "The causes of condom breakage were usually associated with individual behavior, not with culturally based practices," said Dr. Williamson. the 8 countries where the studies were conducted are: Ghana, Kenya, Mali, Sri Lanka, the Dominican Republic, Jamaica and Mexico.

Behavior↗
PubMed1994

Sexual partner change and condom use among urban factory workers in northwest Tanzania.

OBJECTIVE: To describe sexual partner change and condom use at the intake of a cohort study of urban factory workers in Tanzania. METHODS: From October 1991 to March 1992, 926 male and 170 female factory workers were interviewed using a structured, pre-coded questionnaire. Questionnaire reliability was assessed by pre-testing and comparison with results of unstructured interviews and carrying out repeat questionnaires on a sub-sample. RESULTS: Almost half of both men and women had had sexual intercourse by their 17th birthday. The period of premarital sex had an interquartile range of 2 to 10 years in men and 0 to 2.5 years in women. Having had sexual intercourse in the past month with more than one partner was reported by 22% of the men and 5% of the women. Factors associated with multiple partners in men were being born in or near Mwanza Region, having low education and low income, and being married. Condoms had been used in the past month by 3% only, mainly with casual partners. Condom use in men was associated with being young, living in town, being born in Kagera Region, high education and high income, being circumcised, and having causal or steady (non- martial) partners. CONCLUSION: Information, education and communication (IEC) on sexual relationships and condom use should start at an early age, and include education at primary schools. Much sexual partner change appears to occur through steady (non-marital) partnerships, indicating the need for IEC to be expanded beyond groups such as commercial sex workers and their clients.

Adolescent↗
PubMed1998

Influence of HIV positive status on sexual behavior among males.

OBJECTIVE: To compare HIV seronegative (HIV-) and HIV seropositive (HIV+) males in terms of sexual behavior with female and male partners of different types. METHOD: Cross-sectional study. From August 1994 to February 1995, a sample of 236 respondents (150 HIV- and 86 HIV+) recruited from public health centers in the State of S. Paulo (Brazil), answered a questionnaire, including questions on demographic aspects, HIV and AIDS related knowledge, sexual orientation, use of alcohol and other drugs, sexual behavior with regular and casual female and male partners, and perceived risk of HIV infection. Sexual behavior with regular and casual female and male partners within the previous three months, was investigated. RESULTS: A lower proportion of HIV+ engaged in sexual contact with regular female partners (p < .01) and in vaginal intercourse with this type of partner (p < .01). A lower proportion of HIV+ engaged in overall sexual activity (p < .001) and reported lower frequency of penetrative sexual practices (p < .05). A high level of condom use with female and male partners was identified with no significant differences being found between the two serostatus groups. Some risky sexual behavior was identified, however, especially with regular partners, suggesting that some men were continuing to practice unsafe sex. CONCLUSIONS: The high level of condom use identified suggests that safer sex advice has been taken up. Condom use was not universal, however, and some men continue to place themselves at risk, especially with regular partners. Prevention programs should strive not only to encourage HIV- to practice safer sex, but also to encourage HIV+ to do so in order to prevent further transmission of the virus.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Optical testing of condoms.

Condoms provide one of the most important means of preventing pregnancy and the spread of human immunodeficiency virus (HIV) and other sexually transmitted diseases. Pinhole defects may lead to the passage of sperm or viruses through the condom wall. Embedded particles, which may become dislodged in handling or use, may represent latent pinhole defects. Thin regions in the condom wall may lead to breakage in use. Testing for such defects in regulatory laboratories, or in the factories as part of production screening or quality assurance efforts, is a major tool for ensuring condom reliability. A new optical method for testing condoms is presented, sensitive to pinholes, thin regions, and embedded particles. The method could supplement or replace the existing, less powerful, electrical test techniques in either regulatory testing laboratories or in the factory. The optical techniques presented provide quantitative data on the condoms tested, rather than just accept/reject decisions. They thus support detailed monitoring of production or lot characteristics that is generally not possible with existing electrical techniques. The ability of the optical techniques to separately test for and identify not only pinholes, but also thin regions and embedded particles, which are not separately tested for with the electrical technologies, is an especially important new capability. Further, the new optical techniques allow the locations of defects found to be precisely marked, making possible a microscopic examination of defects useful in studying their structure and possible causes. The optical technique is also totally nondestructive, in that it does not alter the defects whose structures are of interest. Initial results are reported on the testing of latex condoms purchased in retail stores. Condoms identified optically as being potentially defective were subjected to industry standard leak and burst testing. Results of the various tests are summarized. The data suggest that use of the new optical test techniques could have prevented an unexpectedly large number of condoms with significant pinhole and thin region defects from reaching the public. Optical test systems could be used to support either regulatory, quality assurance, or clinical field testing of latex or nonlatex condoms. Due to their high rate capability and level of automation, they could also be applied to 100% screening testing in the factory. The new test techniques could also be used to detect defects in a wide range of other thin sheets and membranes.

Condoms↗
PubMedDate not supplied

Condom use and HIV risk behaviors among U.S. adults: data from a national survey.

CONTEXT: How much condom use among U.S. adults varies by type of partner or by risk behavior is unclear. Knowledge of such differentials would aid in evaluating the progress being made toward goals for levels of condom use as part of the Healthy People 2000 initiative. METHODS: Data were analyzed from the 1996 National Household Survey of Drug Abuse, an annual household-based probability sample of the noninstitutionalized population aged 12 and older that measures the use of illicit drugs, alcohol and tobacco. The personal behaviors module included 25 questions covering sexual activity in the past year, frequency of condom use in the past year, circumstances of the last sexual encounter and HIV testing. RESULTS: Sixty-two percent of adults reported using a condom at last intercourse outside of an ongoing relationship, while only 19% reported using condoms when the most recent intercourse occurred within a steady relationship. Within ongoing relationships, condom use was highest among respondents who were younger, black, of lower income and from large metropolitan areas. Forty percent of unmarried adults used a condom at last sex, compared with the health objective of 50% for the year 2000. Forty percent of injecting drug users used condoms at last intercourse, compared with the 60% condom use objective for high-risk individuals. Significantly, persons at increased risk for HIV because of their sexual behavior or drug use were not more likely to use condoms than were persons not at increased risk; only 22% used condoms during last intercourse within an ongoing relationship. CONCLUSIONS: Substantial progress has been made toward national goals for increasing condom use. The rates of condom use by individuals at high risk of HIV need to be increased, however, particularly condom use with a steady partner.

Adult↗
PubMed1996

Reported condom use is not associated with incidence of sexually transmitted diseases in Malawi.

OBJECTIVES: To establish frequency of reported condom use and validate reliability of self-reporting among urban women in Malawi. DESIGN: Cross-sectional survey in antenatal women in 1989 and 1993. Prospective study in cohort first surveyed in 1989. METHODS: A total of 6561 women in 1989 and 2460 women in 1993 answered questions about condom use and sexual activity, had a physical examination and were screened for HIV. A subset of women from the 1989 screening were administered a questionnaire and tested for syphilis, Neisseria gonorrhoeae and Trichomonas vaginalis infections every 6 months. RESULTS: Although between the two cross-sectional studies intermittent condom use increased from 6 to 15% (P < 0.001) with no difference according to HIV infection, consistent use was reported by less than 1%. In the prospective study, women reported a higher condom use at any visit than either group assessed cross-sectionally. Consistent condom use peaked at 62% in the first 6 months, but declined to as low as 8% in the second year of follow-up. Condom use at each visit, either intermittent or consistent, was higher in HIV-seropositive than HIV-seronegative women. Overall, the incidence of gonorrhea, trichomoniasis and syphilis did not decline in women reporting consistent condom use. CONCLUSIONS: In prospectively followed women reports of consistent condom use was substantially higher than in cross-sectional surveys, but rapidly decreased over time, irrespective of HIV status. The presence of new sexually transmitted diseases suggests that this population of urban women overreports condom use or underreports sexual activity, or both. Intensive and sustained education is needed to achieve consistent condom use. Biologic markers of sexual activity are useful in interpreting reported condom use.

Adult↗
PubMed1992

Situational factors and thought processes associated with unprotected intercourse in young gay men.

OBJECTIVES: To investigate (1) the types of justifications, if any, that young gay men give themselves at the time they make the decision to have unprotected anal intercourse and (2) the types of occasion on which they are most at risk of having unprotected intercourse. DESIGN AND METHODS: In structured interviews, gay men aged 15-21 years were asked to recall two sexual encounters from the preceding 6 months: one in which they had had unprotected anal intercourse ('unsafe' encounter) and one in which they had resisted a strong temptation to have unprotected intercourse ('safe' encounter). We studied both types of encounter to enable identification of situational variables distinguishing between them. RESULTS: The first two factors that emerged from a Factor Analysis of the self-justification data ('unsafe' encounter, n = 219) involved, respectively, high-risk behaviour in response to a negative mood state and inferring from perceptible characteristics that the partner was unlikely to be infected. The most commonly reported self-justification was of this latter type. In respondents recalling both encounters (n = 115), sexual desires, mood, communication, and use of 'dirty talk' distinguished between the encounters. In contrast, type of partner, consumption of alcohol or drugs, desire for excitement, and use of pornography did not. CONCLUSIONS: Results are discussed in relation to those obtained in our earlier study of older gay men. Young gay men appear to be more single-minded about what they want to do sexually, and more likely to infer from perceptible characteristics that their partner is unlikely to be infected. In young gay men, a negative mood state is associated with unsafe sex, an opposite finding to that obtained with older gay men. The results also suggest the possible importance of failure to communicate about desires concerning safe sex and the use of 'dirty talk'; these may help to facilitate the occurrence of unsafe sex.

Adolescent↗