Using Anatomical Dolls in HIV/AIDS Prevention Programs

BackgroundThis study investigated the extent and predictors of condom use and condom refusal in the Free State province in South Africa.MethodsThrough a household survey conducted in the Free Sate province of South Africa, 5,837 adults were interviewed. Univariate and multivariate survey logistic regressions and classification trees (CT) were used for analysing two response variables ‘ever used condom’ and ‘ever refused condom’.ResultsEighty-three per cent of the respondents had ever used condoms, of which 38% always used them; 61% used them during the last sexual intercourse and 9% had ever refused to use them. The univariate logistic regression models and CT analysis indicated that a strong predictor of condom use was its perceived need. In the CT analysis, this variable was followed in importance by ‘knowledge of correct use of condom’, condom availability, young age, being single and higher education. ‘Perceived need’ for condoms did not remain significant in the multivariate analysis after controlling for other variables. The strongest predictor of condom refusal, as shown by the CT, was shame associated with condoms followed by the presence of sexual risk behaviour, knowing one’s HIV status, older age and lacking knowledge of condoms (i.e., ability to prevent sexually transmitted diseases and pregnancy, availability, correct and consistent use and existence of female condoms). In the multivariate logistic regression, age was not significant for condom refusal while affordability and perceived need were additional significant variables.ConclusionsThe use of complementary modelling techniques such as CT in addition to logistic regressions adds to a better understanding of condom use and refusal. Further improvement in correct and consistent use of condoms will require targeted interventions. In addition to existing social marketing campaigns, tailored approaches should focus on establishing the perceived need for condom-use and improving skills for correct use. They should also incorporate interventions to reduce the shame associated with condoms and individual counselling of those likely to refuse condoms.

Purpose This study sought to determine whether including two types of questions in surveys administered via face-toface interview can contribute to more accurate measures of correct and consistent condom use among populations at risk for HIV. The study compared initial rates of selfreported condom use to rates found when respondents were asked to provide confirmation of correct and consistent use via follow-up questions. Methods Paired t-test analyses were conducted on data from 11 surveys of female sex workers and men who have sex with men, from five Central American countries and the Dominican Republic. All surveys included either a testretest item for consistent condom use or else a combination of the test-retest item and a second item measuring correct condom use. Results In all 11 datasets, the proportion of respondents qualifying as consistent condom users decreased significantly after answers to either one or both follow-up questions were taken into account. In the six datasets from surveys of female sex workers, the difference between the initial and final level of self-reported condom use ranged from 4.3% to 23.2%. In the five datasets from surveys of men who have sex with men, the difference between the initial and final level of self-reported condom use ranged from 9.9% to 37.0%. Conclusion Given the amount of recall bias and social desirability bias usually associated with condom use survey items, a measure that identifies a lower proportion of condom users than initially found is taken to be more accurate. The two follow-up questions examined in this study appear to substantially reduce the proportion of people claiming consistent condom use. As most behavioral surveys rely on self-reported measures, the addition of such questions could significantly improve estimates of consistent condom use. We therefore recommend that these and other types of follow-up items be added to future condom use surveys and evaluated further as potential means of obtaining more accurate information about this important behavior. Background

We evaluated whether offering a choice of barrier methods can increase overall barrier method use without decreasing condom use in women using oral contraceptives (OCs) for contraception. We randomized 167 OC users at risk for sexually transmitted diseases (STDs) into two groups, one receiving male latex condoms only (Condom group), the other receiving both male latex condoms and nonoxynol-9 film (Choice group). All participants received similar hierarchical STD protection counseling. We assessed method use with daily diaries. The Choice group protected a significantly higher percentage of their coital acts with a barrier method (month 1 to 2: 29% vs. 22%; month 3 to 4: 33% vs. 21%; and month 5 to 6: 35% vs. 19%; adjusted P = 0.012). Condom use in the Choice group was higher as well (adjusted P = 0.036). When we used a transitional multilogistic regression approach to account for differential loss to follow-up in the two groups, results were similar. Offering a choice of barrier methods increased overall barrier method use without decreasing condom use.

To assess safety and acceptability of Reality condoms for anal sex among men who have sex with men. Crossover study among HIV-seroconcordant (33 HIV-negative and 5 HIV-positive) monogamous male couples, randomized to latex male and Reality condom use with anal sex. Slippage with removal was reported more frequently with Reality than male latex condoms [odds ratio (OR), 2.7; 95% confidence interval (CI), 1.2-5.8 for receptive partners and OR, 34.1; 95% CI, 13.8-84.1 for insertive partners]. Receptive partners more frequently reported pain or discomfort (OR, 5.0; 95% CI, 2.6-9.4) and rectal bleeding (OR, 1.9; 95% CI, 0.9-4.1) with Reality condoms than male condoms. Over 20% reported willingness to use the Reality condom in the future with a partner of unknown HIV status; willingness was associated with past problems with male condoms and no problems with Reality condoms among receptive partners, and with past use of Reality condoms and HIV seropositivity among insertive partners. Men reported more frequent problems with Reality condoms than male latex condoms used for anal intercourse, particularly slippage, discomfort, and rectal bleeding. Design modifications, training, and research on the clinical significance of safety outcomes are needed for use of Reality condoms with anal sex.

The purpose of this study is to correlate knowledge of correct condom use and consistency of use among high school female learners in Limbe urban city of Cameroon. A cross-sectional research design was adopted, using a self-administered questionnaire to collect data from a representative sample of 210 female learners selected through disproportional, stratified, simple, random sampling technique from three participating high schools. Statistics were calculated using statistical package for social sciences (SPSS) version 20 software program. Of the respondents, 56.2% reported being sexually active, of whom only 27.4% reported using condoms consistently. The respondents demonstrated low knowledge of correct condom use. There were significant associations between knowledge of correct condom use, and condom use at the 0.05 level, with the majority of the female learners who demonstrated lack of knowledge of correct condom use, not using condoms during sexual intercourse. These results point to a need for better education and instruction regarding how to use a condom.

An adolescent and young adult condom self-efficacy scale.

Background: Over the years, there has been frequent concern on the use of male latex condoms because of its dual functions of preventing unintended pregnancy and sexually transmitted infections in the society. However, their use is limited in part by questions about their performance which may be influenced by many factors including its production qualities. In Nigeria, all condoms in use are imported and as such greater effort needs to be applied in quality assurance of the numerous sources. Objectives: To estimate the rate of condom leakage among the available male latex condoms in Nigerian market and compare it with results published from other countries. Methods: A water leak hang test on a random sample of available brands of male latex condom in Nigerian health shops was done. Six commonly available male latex condoms were selected and labeled A I AII B C D & E. Fifty (50mls) of water was instilled into the unused condom and sequentially hung up for gravity effect. The primary outcome measure was the leakage of water in the condom within 2 minutes. Analysis was done using Epi-info 2008 version 5.3.1. Results: A total of 495 male latex condoms were used in the trial. All the condoms are expected to expire in at least 24 months. Of this number, 25 condoms leaked water, giving the estimated condom leakage rate of 5.05% in Nnewi South-East Nigeria. Conclusion: The leakage rate for male latex condom was very high in Nnewi, Nigeria based on this estimate. This poses a reproductive/public health concern with respect to prevention of unintended pregnancy and other preventable Sexually Transmitted Infections (STIs). Condom studies are therefore a high priority in Nigeria given the HIV/AIDs, hepatitis and sexually transmitted disease high prevalence.

To guide acquired immunodeficiency syndrome (AIDS) prevention program planning, 181 tenth grade students residing in or near an AIDS epicenter completed a survey measuring past year involvement in sexual intercourse and condom use, beliefs about self-efficacy for AIDS preventive behaviors, and beliefs about susceptibility to and severity of AIDS, and outcome efficacy of AIDS preventive actions. A degree of uncertainty existed for all areas of self-efficacy surveyed: refusing sexual intercourse under a variety of circumstances, questioning sex partners about past risky behaviors, and correct and consistent condom use. Students were most uncertain of their ability to refuse sex with a desirable partner, under pressure, or after drinking alcohol or using marijuana; to purchase condoms, or use them consistently after drinking alcohol or using marijuana; and to question partners about past homosexual history. Those students with lower self-efficacy for refusing sex were twice as likely to have had sexual intercourse. Similarly, those students with lower self-efficacy for correct, consistent condom use were five times less likely to have used condoms consistently. These associations remained even after adjusting for the influence of other AIDS-related beliefs. Implications of these findings focus on exploiting the link between self-efficacy and behavior by building a prevention program that emphasizes skills-building rather than the traditional knowledge-only approach.

Thai heterosexual males between 20 and 39 years old are at increased risk for HIV infection. Consistent condom use is effective against HIV transmission, but little is known about determinants of consistent condom use for these males. The purpose of this study is to explore determinants of consistent condom use for this population. The determinants of interest are age, educational level, marital status, income, and concepts from the theory of planned behavior: attitude toward condom use, subjective norm about consistent condom use, perceived behavioral control (PBC) of consistent condom use, and intention to use condoms consistently. We used a cross-sectional descriptive research design with a convenience sample of 400 heterosexual Thai males between 20 and 39 years. Our sample had a mean age of 28.71 years (SD = 6.33). During the last three months, 39.5% reported using condoms consistently, 23% reported using condoms inconsistently, and 37.5% reported never using condoms. The results from the regression analyses revealed that marital status, income, subjective norm about consistent condom use, PBC of consistent condom use, and intention to use condoms consistently were determinants of consistent condom use. Also the effect of subjective norm about consistent condom use and PBC of consistent condom use on consistent condom use was mediated by intention to use condoms consistently. These results suggest that interventions to increase consistent condom use should focus on enhancing intention to use condoms consistently by promoting subjective norm about consistent condom use and PBC of consistent condom use.

The origin of the word condom is the subject of some debate, but the use of a linen sheath as a preventive measure for venereal disease was noted in the writings of Fallopius in 1564. In recent years condom sales have increased, and in a sample of San Francisco male homosexuals consistent condom use was reported to have increased from 26% to 79% between 1984 and 1987. Condom sales in drugstores increased by over 20% from 1986 to 1987, with women being responsible for an estimated 40-50% of US purchases. Studies suggest a failure rate of 2-15/100 couples using condoms. Failure rates for 1st-year users average about 12%, but consistent and correct condom use theoretically results in approximately a 2% failure rate. Mean breakage rates ranging from 0% to 13% have been reported. Both epidemiological and laboratory studies have demonstrated that latex condoms are effective mechanical barriers to important viral transmissions including HIV, herpes simplex virus (HSV), hepatitis B virus (HBV), and cytomegalovirus (CMV), as well as bacteria such as Chlamydia trachomatis and Neisseria gonorrhea. Condoms are safe to use, particularly in view of the fact that AIDS is now 1 of the 5 leading causes of death for women ages 15-44. An important contraindication, however, is the presence of latex allergy, potentially leading to contact urticaria or manifestations of anaphylaxis. The female condom shows promise for placing personal protection increasingly under the control of women. Condom promotion in the US with education at both public and individual levels could emulate developed and developing countries that have promoted condom use with marketing and mass-media techniques, as well conspicuous and aggressive distribution methods. Nursing is involved in program efforts aimed at enhancing condom use and nurses can be effective in encouraging clients to use condoms to protect themselves.

BackgroundFor young adults seeking new experiences, international travel provides opportunities for casual sexual encounters. The aim of this study was to identify the predictive factors associated with travel-associated sex and consistent condom use in a non-random sample of single and partnered young travelers.MethodsSexually-active Canadians, aged 18–25 years, who traveled abroad in 2016, were purposively recruited to participate in an online survey. Two binomial logistic regressions were performed to examine the demographic, sexual health and lifestyle factors associated with (1) having sex abroad (N = 646), or (2) consistent external condom use abroad (n = 271 sexually-active travelers).ResultsPacking condoms for international travel was associated with more than twice the odds of both having sex abroad (AOR: 2.58, 95% CI: 1.47–4.51 p < 0.001) and using condoms consistently during intercourse (AOR: 2.62, 95% CI: 1.62–5.32, p = 0.008). Sex under the influence of alcohol at-home, history of sexually transmitted infections, travel-related plans to have sex and drug consumption were also associated with sex abroad. Consistent external condom use abroad was associated with prior condom use at-home and penetrative sexual practices abroad. Unlike previous studies, gender, sexual orientation and relationship status were not significantly associated with either travel-associated sex nor condom use.ConclusionTravelers’ characteristics and domestic sexual behaviors will inform travel health interventions, but our findings support universal promotion of barrier protection during travel regardless of relationship status, sexual orientation or gender identity. Given the increasingly open and fluid nature of sexual expressions and relationships, pre-travel sexual health interventions should be sex-positive, broadly inclusive and promote strategies for safe sexual behaviors while travelling.

Knowledge on sexuality, contraception, abortion and sexually transmitted diseases, is a fundamental prerequisite for determination of proper attitudes and increase of risk awareness level. Aim of this survey is to examine some characteristics of students sexual behavior and differences in knowledge, sexual behavior and risk perception for sexual diseases acquisition. Cross-sectional study was carried out among the student population of the Medical College of Vocational Studies in Belgrade. Examined sample population consisted of 246 students. There was used a questionnaire taken over from the Project called 'State of Health and HealthCare Needs of Population in Serbia, and Its Use of HealthCare Protection Service' from the year 2000, designed by the WHO. It was filled out anonymously. For the data statistical processing, there were used methods of descriptive and explorative analysis as well as the cross-table methods with the application of Pearson χ2 test. Analysis was done in the SPSS 13.0 software package. Results are presented in tables. Our research findings indicate that the students are well-informed on sexual transmission of HIV infection, while some smaller ration of them is familiar with the vertical transmission of HIV infection. Consistent use of condoms was found in a half of male participants and 2/5 of female ones, while 1/5 of examinees of both sexes each never use condoms. Inconsistent condom use is the main behavioral pattern in the student population. If a safe sex is considered to be a sexual intercourse with a condom during each sexual relation, with one partner and without sexual relations with unknown persons, we come to a conclusion that such a sex is being done only by 1/3 of the examinees, as well as that 2/3 of them have a risk behavior according to their statements that they never (17,8%), or occasionally (43,5%) use a condom.

Drawbacks of the male latex condom include the need for women to depend upon men to wear them during intercourse reduced sexual spontaneity reduced sensitivity and the fear of condom slippage or breakage. The female condom is an alternative method of contraception which women may use to protect themselves against pregnancy and sexually transmitted diseases. Effectively covering the vaginal entrance urethra and penis base women insert it of their own volition before commencing intercourse. Resistant to oils the polyurethane condom is also stronger than latex yet nonetheless soft and thin. Preclinical studies have shown the female condom to be impermeable to human HIV and cytomegalovirus. Clinical comparisons of barrier integrity in female and male condoms are summarized in this paper. 4 studies were conducted and together employed the post-coital standard ASTM water leak test spillage risk assessment questionnaires and direct post-coital exams for sperm presence in the vagina as well as performance evaluation questionnaires regarding lubricant choice in the female condom. REALITY the female condom under consideration produced a leakage rate of 0.6% versus the male latex condom rate of 3.5%. Vaginal exposure to seminal fluid was 2.7% for REALITY compared to 8.1% while overall combined risk of barrier failure for REALITY was 3% compared to condoms at 11.6%. No statistical difference was observed for performance between the 2 lubricants under study. Finally post-coital vaginal exam found no sperm present in 74 episodes of intercourse with REALITY. The studies find REALITY to be less prone to leakage and risking of female exposure to seminal fluid than the male latex condom.

There is controversy about the protective effect of condoms in preventing sexually transmitted diseases (STDs). This paper summarizes recent studies that assess the association between condom use and the prevalence of various STDs. Because condom use is considered a marker for sexual partnerships with greater risk of STD transmission, limited evidence of protection has been found among those reporting condom use compared to non-users. Previously, methodological issues have impacted the performance of valid studies on condom effectiveness including inability to determine consistency and correctness of use or the infection status of partners. These assessments are critical to interpreting data from condom studies since they tend to confound effectiveness and underestimate the protective effect of condom use. Recent studies have assessed these issues and found that consistent condom use is associated with lower rates of gonorrhea, chlamydia, syphilis, trichomonas (women) and genital herpes than inconsistent use. Pelvic inflammatory disease may be decreased and HPV-associated lesions may regress faster. While consistent use has been found to reduce STD, incorrect use undermines this benefit, especially for heterosexual men. Thus, while non-use is a significant factor affecting condom use failure, consistent and correct use of condoms is an important strategy in reducing STD risk. Keywords: condoms, sexually transmitted diseases, and prevention

Inconsistent findings in the global literature regarding the effectiveness of condom use against sexually transmitted diseases (STDs) may result from variations in the measurement of condom use. In this study, we assess the sensitivity and specificity of six condom-use measures in predicting STD infection, and assess the difference in sensitivity and specificity by type of sexual partner (clients versus stable partners), type of STD, ethnicity (Han versus non-Han), years of formal schooling (≤6 versus >6 years) and level of risk of STD exposure (high versus low). Cross-sectional data were obtained from 454 female sex workers (FSWs) in Guangxi, China. Measurements of condom use were created along types of use (any use, consistent use, correct use, or the combination of consistent and correct use) and periods of recall (life time, last month or recent three sexual episodes). Measures of consistent use had higher sensitivity and lower specificity than measures of any use in predicting STDs among FSWs, regardless of the recall period and type of sexual partner. Incorporating correct use improved the measures of consistent use. Measures of consistent use and the combination of consistent and correct use demonstrated high sensitivity in predicting particular STDs. They showed higher sensitivity in predicting STDs among FSWs who reported higher risk for STD exposure than among FSWs who reported lower risk of exposure to STDs. In conclusion, the findings suggest the superiority of consistent use and correct use of condoms in predicting STD infection. The findings also underscore the importance of considering the context of sexual risk such as type of sexual partner and risk of exposure to STD infection when we measure condom use. Future studies of condom effectiveness should collect and quantify these contextual and individual factors among the target population.