Condoms get better: tests of 30 models show far fewer failures than in past years.
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Condoms↗
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[Sexually transmitted diseases in adolescence: study of risk factors].
Sexually transmitted diseases are frequent in adolescence and facilitates HIV contamination. The early age limit of the first sexual intercourse, the diversity of partners, the habit of not using condoms and illicit drug abuse are pointed out as risk factors for sexual transmitted disease. We interviewed 356 adolescents who sought medical attendance at the Adolescent Health Study Center of The State University of Rio de Janeiro between August/2001 and July/2002 regarding their sexuality and to identify risk behaviors. Periodical analysis and chi-square tests were performed on the collected data. We observed statistically significant correlations between Sexual transmitted diseases and the variables of: slow learning, alcohol, tobacco and drug abuse, sexual abuse and the habit of not using condoms during sexual intercourse. The results indicate multiple Sexually transmitted disease risk behaviors in adolescence, and the failure to use condoms is the factor which is most possibly influenced by programs run by health workers.
Adolescent↗
Breakage and slippage of condoms among users in north Gondar Province, Ethiopia.
OBJECTIVE: To determine the frequency of condom breakage and slippage among male condom users and to analyse some factors affecting condom breakage. DESIGN: Prospective study undertaken from March to June 1996. SETTING: Gondar, Teda and Aykel health centres in north Gondar province. PARTICIPANTS: One hundred and seventy literate male condom users who volunteered to participate in the study were enrolled, but data were collected and analysed for 143 persons. MAIN OUTCOME MEASURES: Condom breakage was measured as the number of condom broken while opening the package, putting on, during intercourse or withdrawal; and condom slippage was measured as the number of condoms slipped off the penis during intercourse or withdrawal. RESULTS: Of 143 participants, 26.6% broke condoms. Total condom breakage rate was 4.6% and slippage rate was 0.1%; half of the condom breakage occurred at the tip. Condom breakage was more observed in less educated (p < 0.05). Breakage rate and experience of condom use were negatively correlated (r = -0.214, P < 0.05). CONCLUSION: User's knowledge and experience reduce the breakage of condom.
Adolescent↗
Condom use with primary partners among injecting drug users in Bangkok, Thailand and New York City, United States.
OBJECTIVE: To determine factors associated with likelihood or failure to use condoms with primary sexual partners among injecting drug users (IDU) in two cities. DESIGN AND METHODS: Interviews were conducted with 601 IDU in Bangkok in 1989 and with 957 IDU in New York City in 1990-1991. Subjects were recruited from drug-use treatment programs and a research storefront. Informed consent was obtained and a World Health Organization standardized questionnaire about AIDS risk behaviors administered by a trained interviewer. RESULTS: A substantial minority (37%) of IDU in Bangkok and a majority (55%) of IDU in New York City reported penetrative intercourse (vaginal, anal or oral) with a primary partner in the 6 months before the interview. Of those reporting penetrative intercourse with a primary partner, only 12% in Bangkok and 20% in New York reported that they always used condoms. Parallel bivariate and multiple logistic regression analyses were conducted to distinguish between subjects who reported always using condoms and subjects who reported unsafe sexual activity with primary partners. The same two factor--knowing that one is HIV-seropositive and talking about AIDS with sexual partners--were most strongly associated with always using condoms with primary partners in both cities. CONCLUSIONS: Programs to prevent sexual transmission of HIV among IDU should provide voluntary and confidential/anonymous HIV counseling and testing, and should facilitate discussions of AIDS and sexual transmission of HIV between IDU and their sexual partners. That the same two factors were associated with always using condoms with primary partners among IDU in these two cities suggests that these factors may also be important in other groups at high risk for HIV.
Adult↗
Condom use in incarcerated adolescent males: knowledge and practice.
BACKGROUND: Information is limited on how well adolescents use condoms and where they learn how. OBJECTIVE: The objective of this study was to determine how often incarcerated males used condoms incorrectly and where, how, and from whom they learned condom use. STUDY: This study consisted of an interviewer-administered survey during intake physicals at a juvenile detention center. Results were based on self-report; condom use models were not used. RESULTS: During usual use among 141 males, errors included failure to secure the condom to the penis on withdrawal (37%), loss of erection before condom removal (18%), and failure to leave space at the tip (14%). Learning occurred at home (27%), school (23%), probation/detention facilities (14%), and community programs (3.4%). Subjects learned from educators/counselors (37%), family (27%), and friends (6.9%). Methods of learning included reading the package insert (45%), demonstrations (39%), explanations (33%), and media (19%). CONCLUSIONS: These adolescents had relatively few condom errors. Common methods of learning correct condom use included observing a demonstration, reading the package insert, and hearing an explanation. The last 2 methods are easy to implement.
Adolescent↗
Abortion as a backup method for contraceptive failure in China.
Contraceptive failure rates for modern methods including sterilization are reported to be high in China, but little is known about the consequence of contraceptive failure and characteristics of women who decide to have an abortion if a contraceptive failure occurs. Using 6225 contraceptive failures from the 1988 Chinese Two-per-Thousand Fertility Survey, this study examines the resolution of contraceptive failure and assesses the impact of some women's sociodemographic characteristics on the decision to terminate contraceptive failure in abortion. This study has three important findings: (1) The abortion rate was 50.1%, 75.3% and 80.2% for IUD, condom and pill failures, respectively; (2) The abortion rates differed by contraceptive method and women's social and demographic characteristics. In particular, a woman with just one child was most likely to have the contraceptive failure aborted; (3) Some women experienced repeated abortions because of contraceptive failure. The results suggest that abortion was a backup method if contraception failed in China and the correlates of aborting an unwanted pregnancy reflect the strong impact of the Chinese family planning programme.
Abortion, Induced↗
Sexual behaviour and condom use in the general population of Spain, 1996.
A national household survey of a representative sample of 9,984 individuals aged 15 years or over, carried out in 1996 using a combination of face-to-face interviews and self-completion questionnaires, was analyzed in order to describe the frequency of HIV sexual risk behaviours and condom use in Spain. Of a total of 8,101 persons (81%) who completed the questionnaire, 37% reported no sexual partner during the previous 12 months, 57% reported one partner and 6% reported more than one partner. Three per cent reported engaging in HIV sexual risk behaviour (i.e. more than one partner and failure to use a condom systematically), a pattern of behaviour which showed independent positive association with the male sex, an age of 20-59 years and being unmarried. Among those who had casual sexual partners during the preceding 12 months, 38% had always used condoms. In the multivariate analysis, failure to use a condom systematically with casual partners was associated with a higher age and being married. Of those who had regular partners during the previous 12 months, 26% had always used condoms, a finding associated with a lower age, higher educational level, unmarried status and non-cohabitation with the sexual partner. This survey has furnished some useful indicators for prevention purposes. Periodic repetition of this survey would enable possible changes in sexual risk behaviours to be detected.
Adolescent↗
Towards an understanding of barriers to condom use in rural Benin using the Health Belief Model: a cross sectional survey.
BACKGROUND: HIV/AIDS is the most dramatic epidemic of the century that has claimed over two decade more than 3 million deaths. Sub Saharan Africa is heavily affected and accounts for nearly 70% of all cases. Despite awareness campaigns, prevention measures and more recently promotion of anti viral regimens, the prevalence of cases and deaths is still rising and the prevalence of systematic condom use remains low, especially in rural areas. This study identifies barriers to condom use based on the Health Belief Model (HBM) in Benin, West Africa. METHODS: The study was a cross-sectional survey conducted from June to July 2002. Two hundred fifty one (251) individuals were interviewed using a structured questionnaire adapted from a standardized WHO/GAP questionnaire. A logistic regression was used to identify factors associated with condom use. RESULTS: In spite of satisfactory knowledge on HIV/AIDS transmission, participants are still at high risk of contracting the infection. Sixty three (63) percents of the interviewees reported being able to recognize infected people, and condom use during the last occasional intercourse was declared by only 36.8% of males and 47.5% of females. Based on the HBM, failure to use condom was related to its perceived lack of efficacy [OR = 9.76 (3.71-30.0)] and perceived quality [OR = 3.61 (1.31-9.91)]. CONCLUSIONS: This study identifies perceived efficacy (incomplete protective effect) and perceived utilization-related problem (any reported problem using condoms) as the main barriers to condom use. Hence, preventions strategies based on increasing perceived risk, perceived severity or adequate knowledge about HIV/AIDS may not be sufficient to induce condom use. These data will be useful in designing and improving HIV/AIDS prevention outreach programs in Sub Saharan Africa.
Adolescent↗
Spermicides and barrier contraception.
The contraceptive failure rate of condoms varies from 2 to 13%, depending on the study population, yet it is the contraceptive method with the greatest capacity to protect against sexually transmitted diseases (STDs) and AIDS. Breakage and slippage during intercourse are important causes of failure, and individual behavior leading to consistent and correct use is the most important factor in condom effectiveness. Female-controlled barrier methods may actually prevent more STDs than condoms, because of their more consistent use. Using the diaphragm continuously and without spermicide was well accepted and effective in preventing pregnancy in one study. The female condom appears to have a contraceptive effectiveness close to that of other vaginal methods. It is likely that it also protects against STDs and AIDS. Nonoxynol-9 appears to have a protective effect against some STDs and the data concerning the protective effect of spermicides containing nonoxynol-9 against HIV is conflicting, yet suggests some protection, especially if products are used with relatively low frequency that avoids dose-dependent vaginal irritation. New spermicides which could also protect against viral infection without affecting epithelial cells are currently being studied.
Acquired Immunodeficiency Syndrome↗
The male polyurethane condom: a review of current knowledge.
Condoms are one of the oldest form of contraceptive and the best recognized form of protection against sexually transmitted diseases. Their use, however, is limited by both behavioral factors and device-related factors, including complaints about decreased sensitivity and sexual enjoyment. To address these limitations, a male condom made of polyurethane was developed. Polyurethane is a strong impermeable material with good heat transfer characteristics that is less susceptible to deterioration during storage than latex. Because little information is available comparing polyurethane and latex condoms in terms of consumer preferences as well as breakage and slippage, we reviewed four pre-marketing studies of polyurethane condoms, one of which included comparison to latex. No significant differences in slippage and breakage rates between latex and polyurethane condoms were reported in the study that included a latex comparator, and other studies of polyurethane condoms alone resulted in rates in the same range as published for latex condoms. Subjectively, consumers expressed significantly greater preference for the polyurethane condom over latex in regard to appearance, lack of smell, likelihood of slippage, comfort, sensitivity, natural look, natural feel, and overall. While additional testing is needed, these preliminary results suggest that the male polyurethane condom reviewed performed at least as well as latex condoms and is preferred by consumers. If preference translates to greater use, the male polyurethane condom may address important barriers that have been linked with inadequate condom use in the past. These results, however, may not be generalizable to other brands of polyurethane condom currently under development.
Condoms↗
Adolescents' knowledge of human papillomavirus and cervical dysplasia.
STUDY OBJECTIVE: This study examined adolescents' knowledge of human papillomavirus (HPV) and cervical dysplasia (CD). Factors associated with knowledge and self-reported change in health-related behaviors were identified. DESIGN: Interviews were conducted at an average of 2.5 years following the diagnosis of HPV/CD. Medical charts were reviewed. SETTING: The study was conducted at a university-based adolescent dysplasia clinic. PARTICIPANTS: Fifty females, ages 15-23 participated in the study: 88% African-American, 12% Caucasian. RESULTS: On average, participants responded correctly to 86% of the questions regarding HPV/CD. However, the following key points were routinely missed: 52% did not know cigarette smoking increased the risk for cervical cancer; 42% believed that HPV/CD was always symptomatic; and 22% did not know condoms decreased the transmission of HPV. According to participants, their health care provider explained the diagnosis and treatment of HPV/CD using words they understood "some" or "most of the time." Higher academic skills significantly correlated with greater knowledge of HPV/CD. Forty-one percent of participants with a smoking history reportedly increased their smoking since the diagnosis, and only 40% used condoms "most of the time." However, 90% had maintained or increased their frequency of Pap tests. CONCLUSIONS: Adolescent girls had knowledge of most factors related to HPV/CD, but many did not understand the risks of cigarette smoking and failure to use condoms. To improve understanding and compliance, health care providers should tailor educational strategies to the functional level of adolescents.
Adolescent↗
When free condoms and spermicide are not enough: barriers and solutions to participant recruitment to community-based trials.
While randomised controlled trials remain the accepted 'gold standard' in medical research, participant recruitment is often problematic, particularly with primary care trials or those requiring healthy volunteers. Such difficulties can jeopardise the trial, leading to early abandonment, reduced statistical power or timetable and budget overruns. Substantial changes in recruitment plans may reduce the generalisability of the research. In order to overcome some of the more common recruitment difficulties, it is important that researchers share their recruitment strategy successes and failures. We report our experience of recruiting healthy volunteers to a condom trial, based within primary care and community populations. This was an RCT of the effect that using an additional spermicidal lubricant has on condom failure. We originally aimed to recruit entirely from Family Planning Clinics, but eventually required a wide variety of strategies. Targeted mailings, newspaper coverage and electronic 'posters' were among the most successful we used to bolster clinic recruitment. Concerned at our slow recruitment rates, we conducted a questionnaire survey investigating the reasons for participation and non-participation in the research completed by 101 trial participants, 112 decliners and 90 controls (total 303). The most important reasons given for taking part included 'considering the research to be important' (85%), 'wanting to help the researchers' (70%), 'having time to help' (62%) and 'getting free condoms and lubricant' (56%). The most popular reasons for declining were 'not wanting to use condoms' (38%), 'partner's unwillingness to take part' (29%), 'not wanting to alter usual contraceptive practice' (27%), 'not having time' (21%). Contrary to expectations, embarrassment and fears about confidentiality were relatively unimportant factors in this decision. In conclusion, the key to attaining recruitment targets was the core research team taking an active part, working closely with clinic staff and maintaining tight control of the process. Altruism remains a powerful motivation for participants, supported by incentives and procedural details to minimise personal inconvenience. Even for intimate research topics, these general factors outweigh specific issues.
Adult↗
Strategies to prevent HIV transmission among heterosexual African-American men.
BACKGROUND: As part of qualitative research for developing a culturally sensitive and developmentally appropriate videotape-based HIV prevention intervention for heterosexual African- American men, six focus groups were conducted with thirty African-American men to determine their perceptions of AIDS as a threat to the African-American community, characteristics of past situations that have placed African Americans at risk for HIV infection, their personal high risk behaviors, and suggestions on how HIV intervention videotapes could be produced to achieve maximum levels of interest among African-American men in HIV training programs. METHODS: The groups took place at a low-income housing project in Houston, Texas, a major epicenter for HIV/AIDS. Each group was audiotaped, transcribed, and analyzed using theme and domain analysis. RESULTS: The results revealed that low-income African-American men perceive HIV/AIDS as a threat to their community and they have placed themselves at risk of HIV infection based on unsafe sex practices, substance abuse, and lack of knowledge. They also cite lack of income to purchase condoms as a barrier to safe sex practice. They believe that HIV training programs should address these risk factors and that videotapes developed for prevention should offer a sensationalized look at the effects of HIV/AIDS on affected persons. They further believe that programs should be held in African-American communities and should include condoms to facilitate reduction of risk behaviors. CONCLUSIONS: The results indicate that the respondents taking part in this study believe that HIV and AIDS are continued threats to the African-American community because of sexual risk taking behavior, that is, failure to use condoms. Further, African-American men are having sex without condoms when having sex with women often when they are under the influence of alcohol or other mind-altering substances and they are having sex with men while incarcerated and become infected and once released resume unprotected sexual relations with women. According to the men, substance abuse is an important part of the problem of HIV in the African-American community. This is in keeping with research that shows that drug use, especially crack cocaine, is linked to sexual risk taking among African Americans and to increased likelihood of becoming infected with other sexually transmitted diseases (STDs) including HIV. Thus, interventions for men should address condom use, condom availability, skills for using condoms, eroticizing condoms and substance abuse prevention. Men in the present study also strongly recommended that HIV/AIDS videotaped messages should include footage of the sensational effects of the disease.
Adult↗
Recreational drugs and sexual behavior in the Chicago MACS/CCS cohort of homosexually active men. Chicago Multicenter AIDS Cohort Study (MACS)/Coping and Change Study.
Since initial reports emerged of an association between recreational drug use and high-risk sexual behaviors in gay men, there has been interest in studying this relationship for its relevance to behavioral interventions. Reported here are the longitudinal patterns of alcohol and recreational drug use in the Chicago Multicenter AIDS Cohort Study (MACS)/Coping and Change Study (CCS) of gay men. A pattern of decreasing drug use over 6 years was observed that paralleled a decline in high-risk sexual behavior (i.e., unprotected anal intercourse). In contrast, alcohol consumption tended to be more stable over time, and to show no relationship to sexual behavior change. Men who combined volatile nitrite (popper) use with other recreational drugs were at highest risk both behaviorally and in terms of human immunodeficiency virus-1 (HIV) seroconversion throughout the study. Popper use also was associated independently with lapse from safer sexual behaviors (failure to use a condom during receptive anal sex). Use of other recreational substances showed no relationship to sexual behavior change patterns, and stopping popper use was unrelated to improvement in safer sexual behavior. When popper use and lapse from safer sex were reanalyzed, controlling for primary relationship status, popper use was associated with failure to use condoms during receptive anal sex among nonmonogamous men only. These findings suggest an association between popper use and high-risk sexual behavior among members of the Chicago MACS/CCS cohort that has relevance to HIV prevention intervention efforts.
Acquired Immunodeficiency Syndrome↗
Condoms: a wider range needed.
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Condoms↗
Failure rates of contraceptive methods.
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Coitus Interruptus↗
Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in Turkey among men With urethritis.
BACKGROUND: Chlamydia trachomatis and Neisseria gonorrhoeae are known to cause urethritis. However, only a small number of studies in Eastern European countries have investigated the causes of urethritis. GOALS: To determine the prevalence of C trachomatis and N gonorrhoeae among men with symptomatic urethritis in Istanbul, Turkey, and to determine whether contact with a commercial sex worker increased the likelihood of chlamydial infections. STUDY DESIGN: Men with a diagnosis of urethritis at the Istanbul Faculty of Medicine were screened for C trachomatis and N gonorrhoeae by Abbott's ligase chain reaction (LCR) using either urethral swabs or first-void urine. N gonorrhoeae cultures were done on a subset of these patients. RESULTS: The study enrolled 813 men. All of the men denied condom use during their previous sexual exposures. The overall prevalence of C trachomatis, as determined by LCR, was 15.7%. Only 192 patients were screened for both organisms. N gonorrhoeae prevalence was 9.4%. There was no difference in the chlamydia prevalence between men who had contact with commercial sex workers (CSWs) and men who had no such contact (15.3% versus 17.2%). However, clients of foreign CSWs were more likely to have chlamydia than clients of registered Turkish CSWs. CONCLUSIONS: C trachomatis and N gonorrhoeae are commonly found in Turkish men with urethritis. The findings did not show more chlamydial infection among men who had contact with CSWs than among men who had no such contact. The failure to use condoms among these men must be addressed.
Adult↗
Emergency contraception: change in knowledge of women attending for termination of pregnancy from 1984 to 1996.
OBJECTIVE: To compare the knowledge of emergency contraception in women attending hospital for termination of pregnancy in 1984 and 1996. DESIGN: A questionnaire survey. SETTING: Ninewells Hospital, Dundee. SUBJECTS: Cohorts of 100 consecutive women undergoing termination of pregnancy in 1984 and 1996. RESULTS: Over this 12 year period, there has been a significant improvement in the knowledge of emergency contraception. Seventy three per cent had a good knowledge of the postcoital pill in 1996 compared to 12 per cent in 1984 (p=</=0.0001). There has been a significant rise in the use of condoms (60 per cent vs 32 per cent; p=</=0.001) and the number of conceptions due to condom accidents (38 per cent vs eight per cent; p=</=0.0001). Although most women in the 1996 cohort recognised a reason for contraceptive failure and had adequate knowledge of emergency contraception, only 17 per cent considered the possibility of pregnancy. CONCLUSION: Poor knowledge of postcoital contraception is no longer a major factor leading to the failure of women to obtain emergency contraception. Improved uptake in the use of emergency contraception is likely to result from a greater awareness of the possibility of condom failure and easier availability of the postcoital pill.
Abortion, Induced↗