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Effects of an institutional AIDS prevention intervention: moderation by gender.

AIDS risk reduction programs are being conducted in many institutional settings, but rigorous evaluations of their effectiveness are lacking. This is particularly unfortunate in that these programs are expensive, and tend to be of lower intensity than those that have been shown to be effective. Further, risk reduction is generally regarded as entailing greater difficulty for women, who do not use condoms themselves but must negotiate their use with male partners. We used a quasi-experimental design to evaluate an institutional AIDS prevention program on a New Jersey college campus. Sexual behavior was assessed via linked, anonymous mailed surveys at the beginning and end of an academic year among 1st-year students on the campus and others on a nearby control campus. Responses from the spring survey indicated that intervention campus students had been exposed significantly more than control students to intervention components. While MANCOVA analyses indicated no main effect of treatment group on outcome variable, we obtained a significant group by gender interaction, indicating a significant effect on number of risky encounters for men but not for women. In fact, relative to women on the control campus, women on the intervention campus displayed reduced self-efficacy to perform safe sex at the end of the year. These results may indicate that although men can be effectively reached by low-intensity risk reduction programs, women may not be. In fact, interventions without adequate intensity to provide substantial and individualized negotiation skill training may cause women to experience failure in these efforts.

Adolescent↗

Female condom launched in UK.

The lone-awaited female condom, Femidom, is to be launched at the end of September by manufacturers Chartex. It is being welcomed by the FPA [Family Planning Association] and other family planning experts as a valuable addition to the existing range of contraceptive methods and as an alternative to the male condom in offering effective protection against sexually transmitted diseases including HIV. A lubricated, loose-fitting polyurethane sheath, Femidom is inserted into the vagina at any time before sex. An inner ring holds the condom in place beyond the pubic bone and an outer ring lies flat against the vulva. In addition to extending choice, it is under direct control of the woman. As FPA Director Doreen Massey puts it: "We have to face the fact that some women who want safer sex can't get their partners to use condoms. for the 1st time with Femidom, you can insist that if he won't use a condom, you'll use yours." In trails of self-selected couples, up to 2/3 of women and their partners found the product acceptable. a study at the Institute of Population Studies in Exeter showed that while some couples had initial misgivings about the condom's size and appearance, especially its visibility when in position, these often declined with repeated use. Researcher Dr. Nicholas Ford pointed out that if the female condom makes a woman feel unattractive, her partner's comments may well influence these feelings. Users' experience of insertion and the condom's comfort also improved with repeated use. While there are no large studies showing ranges of effectiveness, it is likely to be as effective as the male condom (about 85%-98%). In a study of 106 women at the margaret Pyke Center in London, there were 7 unplanned pregnancies: 4 were due to inconsistent use of the method and 3 were method failures. Breakages were rare. 1/3 of participants dropped out in the 1st month. Users should continue with their existing contraceptive method until they are sure that they are using Femidom efficiently, recommended the authors. In October the FPA is launching a new free consumer leaflet on male and female condoms. 1/2 million leaflets will be distributed to UK pharmacies in October and November via the Pharmacy Healthcare Scheme as part of a safer sex campaign. a launch event will include the results of a survey asking pharmacists and consumers what they think of condoms.

Behavior↗

[Contraception and pregnancy in adolescence]

OBJECTIVE: To review and discuss different contraceptive methods currently used by adolescents, and also discuss adolescent pregnancy, including the associated risks and the importance of prenatal care. METHODS: Review of literature and clinical experience with different contraceptive methods and with adolescent pregnancy. RESULTS: The oral contraceptive pill is the most common method used by teenagers due to its low failure rate and other non-contraceptive effects. Emergency contraception is a good option in cases of rape, unplanned sexual intercourse, condom rupture, nonuse of oral contraceptives during short intervals. In this case, the pill should be taken within 72 hours after the intercourse (preferably before 24 hours for best effect). Most problems related to adolescent pregnancy have a social or economic origin; however, some medical complications such as preterm labor and anemia are frequently reported. CONCLUSIONS: The use of male and female condoms combined with other contraceptive methods should be encouraged to prevent sexually transmitted diseases. If pregnancy is confirmed, prenatal care must be implemented as soon as possible in order to minimize the risks of complication and to allow for an effective multidisciplinary approach.

Journal Article↗

Increasing condom use by undermining perceived invulnerability to HIV.

An intervention to increase condom use by undermining perceptions of invulnerability to HIV was tested in a sample of 128 college students. Participants were randomly assigned to the invulnerability undermined (IU) condition or a demand characteristic control (DCC) condition. The IU condition used tasks that highlighted past failures to protect oneself and the failure of illusory protection strategies. Participants in the DCC condition watched a video on protecting oneself from HIV. Participants in the IU condition, relative to those in the DCC group, had lower perceptions of invulnerability to HIV and higher intentions to use condoms on the immediate postintervention measures; they reported more condom use at the 3-month follow-up. Contrary to prediction, perceptions of invulnerability did not mediate the effects of the intervention on condom use intentions or condom use. The advantage of indirect methods of reducing denial of vulnerability is discussed.

Adolescent↗

Effectiveness of latex condoms as a barrier to human immunodeficiency virus-sized particles under conditions of simulated use.

Condoms were tested in an in vitro system simulating key physical conditions that can influence viral particle leakage through condoms during actual coitus. The system quantitatively addresses pressure, pH, temperature, surfactant properties, and anatomical geometry. A suspension of fluorescence-labeled, 110-nm polystyrene microspheres models free human immunodeficiency virus (HIV) in semen, and condom leakage is detected spectrofluorometrically. Leakage of HIV-sized particles through latex condoms was detectable (P less than 0.03) for as many as 29 of the 89 condoms tested. Worst-case condom barrier effectiveness (fluid transfer prevention), however, is shown to be at least 10(4) times better than not using a condom at all, suggesting that condom use substantially reduces but does not eliminate the risk of HIV transmission.

Contraceptive Devices, Male↗

Latex condom breakage and slippage in a controlled clinical trial.

Although millions of couples rely on male latex condoms to protect against unintended pregnancy and sexually transmitted infections, their use is limited in part by questions about their performance. Rates of condom breakage and slippage, two measures of performance, vary broadly across studies. This variation in part reflects study variability and limitations, including sample size, reliance on subjects' memory, user populations, and products evaluated. In an effort to define condom performance in a group of monogamous couples typical of those using condoms for contraception, we conducted a clinical trial of a single brand of lubricated condoms (Durex Ramses). A total of 4637 attempts to use the condom were evaluated. Six breaks occurred before intercourse (nonclinical breaks), and 10 condoms broke during intercourse or were only noted to have broken upon withdrawal (clinical breaks), resulting in a nonclinical breakage rate of 0.13% (95% confidence interval, 0.05-0.28%), clinical breakage rate of 0.28% (0.15-0.48%), and a total breakage rate of 0.41% (0.25-0.64%). The rate of complete slippage was 0.63% (0.42-0.90%), and total failure (clinical breaks plus complete slips) was 1.04% (0.76-1.37%). These rates are lower than those in other studies with the exception of one, a prospective investigation in a population of female prostitutes. Results indicate that condoms can, in experienced, motivated populations, provide excellent performance and suggest that their efficacy at preventing pregnancy may equal that of the most reliable forms of contraception. Because this study involved a single condom brand, these results may not be generalizable to other brands.

Adult↗

A comparative study of two types of urinary sheath.

AIM: The aim of this study was to compare the newly developed Conveen Optima urinary sheath with the established Clear Advantage urinary sheath in terms of patient satisfaction and preference. METHOD: This was a randomised, prospective, open, crossover study, in which each participant tested 10 urinary sheaths. RESULTS: Conveen Optima provided a higher feeling of security, was easier to handle and apply and was more comfortable to wear than Clear Advantage. Furthermore, Conveen Optima was easier to apply with gloves. Finally, the overall product preference for the Conveen Optima sheath was 67 per cent. CONCLUSION: The new Conveen Optima urinary sheath was found to perform better than the well-established Clear Advantage sheath. Declaration of interest This study was funded by Coloplast A/S.

Adhesives↗

Are all contraceptive failures unintended pregnancies? Evidence from the 1995 National Survey of Family Growth.

CONTEXT: The incidence of unintended pregnancy has long been used as a primary indicator of the state of reproductive health. However, the definition--and therefore the measurement--of this indicator has been elusive. METHODS: Data from the 1995 National Survey of Family Growth (NSFG) were used to compare levels of unintended pregnancy among contraceptive users based on two definitions--the standard definition based on women's reports of contraceptive failure, and the NSFG definition based on pregnancy timing (wanted then, wanted later, or not wanted then or in the future). An attitudinal scale was used to examine women's feelings about their unintended pregnancy. RESULTS: Of pregnancies classified as contraceptive failures under the standard definition, only 68% were unintended pregnancies--94% of those ending in abortion and 60% of those ending in birth. Just 59% of women with a contraceptive failure classified as an unintended pregnancy reported feeling unhappy or very unhappy about their pregnancy, while 90% of those with a failure classified as an intended pregnancy reported being happy or very happy. CONCLUSIONS: Measures of wantedness based on women's feelings about their pregnancy may correlate more closely with important pregnancy outcomes than do traditional measures of intendedness.

Adult↗

Sensation seeking and HIV serodiscordant couples.

Studies have shown that a modest percentage of HIV serodiscordant couples continue to practice unprotected sex. This study examined sensation seeking and unprotected sex practices among this group. Objectives of the study were to describe unprotected sex practices among HIV serodiscordant couples and assess sensation seeking and unprotected sex with other psychosocial covariates. The method used was a survey of HIV-negative individuals in serodiscordant relationships. Results of the study were that approximately 50% of individuals did not use condoms for penetrative sex within the 3 months of being surveyed. The odds ratio between sensation seeking and unprotected sex was 3.51 to 5.09, depending on the sensation seeking subscale. Negative beliefs regarding condom use were also related (odds ratio, 1.28). Variables such as extroversion, sex under the influence of drugs/alcohol, beliefs in susceptibility to HIV infection, and the ability to perform safer-sex practices were not related to unprotected sex. The conclusions were that sensation seeking may help explain the failure of risk-reduction methods in this subgroup and may suggest new approaches to address this problem.

Adult↗

Microbicide acceptability research: current approaches and future directions.

With growing recognition of the potential value of microbicides for HIV/STI prevention, the importance of the acceptability of this brand-new technology has been widely acknowledged. We review the current body of microbicide acceptability research, characterize the limitations in assessment approaches, and suggest strategies for improvement. Electronic databases and abstracts of recent meetings were searched for acceptability data regarding vaginal and rectal products that may be used for HIV prevention. Of the 61 studies reviewed, more than half assessed acceptability based primarily on the description of a hypothetical microbicide, or with the demonstration of a spermicide or lubricant. Physical characteristics of microbicidal products, their effects after insertion, and their effects on sensation during intercourse (for both partners) were the dimensions most frequently assessed (measured in 77%, 49% and 49% of studies, respectively). Attention to the social context of use was inadequate. As acceptability is likely to be a key determinant in the use-effectiveness of microbicides, in-depth understanding of the social processes that shape microbicide acceptability across diverse populations will become increasingly valuable. This includes exploring the effects that sexual partners, health care providers, and key opinion leaders have on the acceptability of microbicides among women and men, including youth and people living with HIV. Future research will benefit from studies of the acceptability of other contraceptive-barrier methods (especially the female condom), use of an agreed-upon operationalization of acceptability, use of acceptability assessments within clinical trials, expansion of measurement domains, and assessment of changes in perceptions of acceptability and use over time. Failure to understand the key factors associated with microbicide acceptability is likely to hinder the adoption and continued use of products that are effective in preventing HIV infection.

Anti-Infective Agents, Local↗

[Indwelling transurethral catheter].

Apart from injuries occurring during catheter placement, the most important of the risks associated with indwelling transurethral catheters are incrustation of the catheter and infection, possibly leading on to urosepsis. Recommended countermeasures are the application of strict criteria when establishing the indication for catheterization, reversion to alternative measures, such as condom urinals, and the careful selection of catheter material.

Bacteriuria↗

Nonoxynol-9 vaginal pessary: a preliminary Indian experience.

BACKGROUND: Barrier methods of contraception do not have systemic effects and allow the user complete control over their use. For women, the ease of use of a contraceptive is often more important than its efficacy. Hence, barrier methods could be offered as a useful alternative method of contraception. Nonoxynol-9 (a spermicide) is a locally acting, non-hormonal method free from systemic side-efforts. It is a woman-controlled, reversible method which is to be used before intercourse. There are little data available on its efficacy, side-effects and acceptability among Indian women. METHODS: The vaginal pessary nonoxynol-9 was offered as a contraceptive option to 3200 women attending the Family Planning clinics at 31 Human Reproduction Research Centres (HRRCs) of the Indian Council of Medical Research. The other contraceptives offered included an intrauterine device, oral pills, condoms, Norplant, tubal sterilization and vasectomy using the cafeteria approach. Those who accepted nonoxynol-9 were followed up to assess the rates of continuation, failure and side-effects. RESULTS: The nonoxynol-9 pessary was accepted by 541 women who were followed up for 3470 woman-months of use. The reasons given for acceptance were that it was user-controlled and/or they did not wish to use other methods because of the side-effects or contraindications of these methods. The overall continuation rates were 41.2% and 33% at 9 and 12 months of use, respectively. Most women (31.3%) discontinued its use due to personal reasons such as husband dissatisfaction, desire for further pregnancy, irregular use of pessary and difficulty in insertion. Twenty-nine women became pregnant during the study period (15 due to method failure and 14 due to user failure) giving a use-effectiveness of 8.8% at 12 months. The method failure rate was 4.3% at 12 months of use. The failure rates were lower compared with the reported failure rates of barrier contraceptives (1%-30% at 1 year of use) and the side-effects were minimal. CONCLUSION: Nonoxynol-9 had low acceptability (16.9%) and overall continuation rates--41.2% and 33% at 9 and 12 months of use. It could be offered to women looking for a short term, user-controlled contraceptive.

Adolescent↗

[Reliability of the vaginal diaphragm as a contraceptive method].

With a failure rate of between 2 and 4 in recent statistics, the vaginal diaphragm can be considered a relatively reliable method of contraception. The physician can therefore recommend this method as an alternative if, e.g., ovulation inhibitors are contraindicated and the patient rejects an intrauterine pessary. In such cases diaphragms are as acceptable as condoms, the more so because the two methods are completely harmless. (Table 9 summarizes the advantages and disadvantages of diaphragms.) Whether, in the final analysis, the condom or the diaphragm is accepted, will largely depend on whether the man or the woman assumes the responsibility for family planning. The physician can use his influence when explaining the contraceptive principle of the diaphragm and showing the patient how to use it to keep the failure rate to a minimum. The present authors consider that even today, good, objective counseling on reliable family planning is one of the physician's most important tasks in the sphere of preventive medicine.

Adolescent↗

Contraception in women with IDDM. An epidemiological study.

OBJECTIVE: To study whether suitable contraceptive methods to women with diabetes mellitus in fact are applied. RESEARCH DESIGN AND METHODS: A questionnaire survey on the use of contraceptives in all 18-to-49-yr-old women (n = 261) with IDDM in Funen County, Denmark, and an age-comparable control group, (n = 287) was performed. Data were collected from 1987 to 1990. Response was achieved from 94% diabetic women and 88% control subjects. RESULTS: The overall use of contraception in diabetic women (77.1%) was almost identical to that of control subjects (73.6%). Compared with control subjects, significantly fewer diabetic women were using the OCP (P < 0.005) and partner sterilization (P < 0.05), whereas more diabetic women were sterilized (P < 0.0005). Among diabetic contraceptive users, the IUD, female sterilization, condoms, and the OCP each accounted for roughly 20%. Diabetic women using the OCP were predominantly young, and most had never been pregnant; approximately 20% of them used high-dose formulations. Sterilization was frequently used by older diabetic women, and most of these women had 2 or more children; 27% of the diabetic women using an IUD were nulligravidae. Further, 18% used a method with an unsuitable high failure rate. CONCLUSIONS: Our study demonstrates that diabetic women are not sufficiently advised concerning use of contraception.

Adult↗

[A prospective study of the provision of emergency contraception in French family planning centers].

OBJECTIVES: To describe emergency contraception provision, including the efficacy of the method, in family planning centers in suburban Paris two years after the method became available without a prescription. PATIENTS AND METHODS: A prospective study involving two questionnaires was conducted between September 2001 and July 2002 in 27 family planning centers in the Val-de-Marne region. The first questionnaire was completed at the time emergency contraception was dispensed and the second one upon a follow-up visit. Efficacy was calculated for both perfect use (only one act of unprotected intercourse in the current menstrual cycle, emergency contraception treatment initiated within 72 hours) and typical use (including multiple acts of unprotected intercourse in the cycle and/or treatment initiated after 72 hours). RESULTS: A total of 519 requests for emergency contraception was recorded, resulting in the provision of 518 treatments. The women requesting emergency contraception were young (96% under the age of 25) and cited unprotected intercourse and problems with condom use as the main reasons for the request. Information regarding the outcome of emergency contraception treatment was available in 77% of the cases, and a failure rate of 1.9% was observed with perfect use and 2.7% with typical use. DISCUSSION AND CONCLUSIONS: This prospective study of emergency contraception prescription in family planning centers confirms data on the efficacy and safety of the method observed in similar environments. The failure rate associated with typical use is higher than that observed with perfect use.

Adult↗

A comprehensive and efficient process for counseling patients desiring sterilization.

To optimize the time spent counseling a sterilization patient, this article presents a 10-step process that includes all steps necessary to ensure a comprehensive counseling session: (1) Discuss current contraception use and all available methods; (2) assess the client's interest in/readiness for sterilization; (3) emphasize that the procedure is meant to be permanent, but there is a possibility of failure; (4) explain the surgical procedure using visuals, and include a discussion of benefits and risks; (5) explain privately to the client the need to use condoms if engaging in risky sexual activity; (6) have the client read and sign an informed consent form; (7) schedule an appointment for the procedure and provide the patient with a copy of all necessary paperwork; (8) discuss cost and payment method; (9) provide written preoperative and postoperative instructions; and (10) schedule a postoperation visit, or a postoperation semen analysis.

Adult↗