Condom Purchase Research Articles

Use of preexposure prophylaxis and condom purchasing decisions.

Preexposure prophylaxis (PrEP) prevents human immunodeficiency virus (HIV) but not other sexually transmitted infections (STIs). Men who have sex with men (MSM) who take PrEP tend to report reduced condom use, but little is known about the underlying mechanisms. For this study, MSM who take PrEP (i.e., PrEP experienced; n = 88) and MSM who do not (i.e., PrEP naïve; n = 113) completed an online study, including the condom purchase task (CoPT). The CoPT assesses decisions to purchase condoms across escalating prices (range: free-$55) for sex with different types of hypothetical partners: those least likely to have an STD (least STD) and those that participants most want to have sex with (most want sex with). When condoms were free, PrEP-experienced MSM had a lower rate of condom purchasing than did PrEP-naïve MSM. For both partner types, PrEP-experienced MSM reached a price break point (i.e., would not buy condoms) at a lower price than did PrEP-naïve pariticipants. For the most-want-sex-with partner at the price at which participants elected not to buy condoms, only 23% of PrEP-experienced MSM chose to abstain from sex when not purchasing condoms versus 53% among PrEP-naïve MSM. Similar patterns were observed for the least-STD partner. The results support the potential utility of the CoPT in identifying behavioral mechanisms related to condom use and PrEP.

Exploring Self-efficacy for Condom Use in Spanish People: A Trend Analyses by Gender from 2004 to 2020

Self-efficacy seems to be one of the most important resources for the different stages underlying condom use and STI prevention. For this reason, this study evaluates trends in self-efficacy by gender, from 2004 to 2008, 2013 and 2020 in Spain. Throughout these years, 6,698 people ranging from 17 to 40 years old, participated filling the Brief scale of condom use self-efficacy. According to our findings, despite the slight improvement in the recent years, self-efficacy still maintains a risky profile for safe sex, especially among the youngest people. Moreover, most of the traditional gender differences continue over the years with women reporting lower scores for condom purchase and men for putting them. However, these differences are not relevant in other dimensions such as using condoms despite drug consumption where women reveal worse results over the years. Therefore, our findings reaffirm the need of intensifying gendered preventive efforts aimed at Spanish people and, particularly, among the youngest.

How Social Marketing Contributed to Expanding Size of Overall Condom Markets in Ethiopia, Brazil, and Indonesia

Background and Situation Analysis For more than 50 years, social marketing has been used to address a variety of health issues in the Global South, including the promotion and distribution of condoms for family planning and HIV prevention. Condom social marketers aim not just to increase sales of their own brands; they seek to increase demand for all condoms—whether it be through the commercial, non-profit or public sectors. The number of male condoms distributed through social marketing increased from 591 million in 27 countries in 1991 to more than 1.5 billion in 66 countries in 2020. Concurrent with this growth in the number of countries, the size of the condom markets also grew in most, if not all, of those countries. Target Audience(s) The primary audiences of condom social marketing programs are low income and high-risk populations in the developing countries of Africa, Asia, Eastern Europe, Latin America, and the Caribbean. They often focus on young people and high risk groups—such as sex workers and their partners, injecting drug users, soldiers, and migrant workers—who do not always have reliable access to affordable condoms. As condom social marketing programs mature, they often use market segmentation to add higher priced condoms aimed at middle-income and even higher-income consumers, and the profits are used to “cross-subsidize” the lower-priced brands. Behavioral Objective To increase purchase and use of condoms, particularly with low-income people and certain high risk individuals (such as young people, commercial sex workers, injecting drug users and men who have sex with men), by selling them through a wide variety of sales outlets at highly subsidized prices. Strategy The authors examined mature condom social marketing programs in Ethiopia, Brazil and Indonesia where the growth in condom social marketing was accompanied by similar growth of the total condom market. They looked at the evolution and sales of these three programs, and the larger condom universes in those countries. The authors were interested to know if social marketing programs help expand the larger condom markets, and not just grow sales of their own products. Results Based on the evidence, the authors believe that these three programs contributed significantly to creating larger markets even though there were surely other forces at work (such as changes in government policy or fears of being infected with HIV). This article adds to the limited literature on the effect of successful condom social marketing programs on their broader markets. Recommendations for Social Marketing Practice The authors make five recommendations for social marketers interested in replicating the success of these programs: 1) keeping one product in each product category highly affordable, 2) applying market segmentation through cross-subsidization, 3) showing flexibility in distribution, 4) pushing the limits on behavior change communication, and 5) building the product category ( Neugaard, 2008 ).

Behavioral economics and safe sex: Examining condom use decisions from a reinforcer pathology framework.

Condom use substantially reduces unwanted pregnancies and sexually transmitted infections. While condom availability is a significant public health priority, effects of condom availability constraints remain relatively under-researched. The limited research on condom availability suggests two major barriers to use: (1) effort/costs and (2) delay to access. To date, we are aware of no study that explores both demand for and discounting of condom availability; the focus of this study was to account for condom decisions using a reinforcement pathology framework. This study used a condom purchase task and the Sexual Delay Discounting Task to quantify behavioral economics of condom use. Low sexual discounting was associated with higher willingness to engage unprotected sex. Demand metrics suggest participants indicating abstinence at condom breakpoint were willing to pay nearly double for condoms relative to individuals indicating unprotected sex at breakpoint. Finally, we grouped participants into reinforcement pathology risk groups based on their discounting and demand indices; these groups significantly differed in self-reported number of sexual partners, unprotected sexual partners, and Sexual Desire scores. This study demonstrates the value of behavioral economic approaches to public health concerns, and further underscores the translational benefits of quantitative metrics to shed novel light on risky health decisions.

Condom-vending machines in Italy: a qualitative exploration of gender differences to improve promotion and use

Objectives The purposes of this study were to explore gender differences in condom purchasing from condom-vending machines (CVMs) and identify ways to improve CVM promotion. Methods Semi-structured interviews with 42 men and women aged 18–50 years (mean ± standard deviation, 29.1 ± 7.9) and living in or near Florence, Italy, were conducted between May and June 2019. Techniques from expanded grounded theory-guided data analysis allowed for a constant comparative approach to contextualise data and identify emergent themes. Results Three themes emerged: (1) attitudes and barriers towards CVMs; (2) gender-specific purchasing influences and behaviours; and (3) CVM improvement and promotion. Women and men described varied concerns surrounding CVM purchasing, illuminating reasons for hesitancy. Focussing on CVM quality and improving product offerings were suggested by participants to increase use. Conclusion Findings offer practical recommendations to guide CVM messaging to increase access to and use of condoms and other personal care items. Men were cited as primary CVM users, expressing practical concerns surrounding CVMs, while, for women, CVM visibility was as much an advantage as a drawback. Reflecting consumer needs via diversified product offerings should be considered a priority for increased CVM use. Working to promote CVMs requires clear messaging that attends to gender norm limitations, details product safety and establishes CVMs as a reliable condom purchase outlet.

The condom purchase task: A hypothetical demand method for evaluating sexual health decision-making.

Behavioral economic theory has proved useful for understanding the influence of delay and probability on sexual health decision-making. Demand is another principle at the intersection of microeconomics and psychology that has helped advance research relevant to health behaviors. The purpose of the present study was to develop and test a demand measure related to sexual health decision-making and the influence of sexually transmitted infection (STI) risk. Participants (N = 438) recruited using Amazon Mechanical Turk completed a commodity purchase task assessing hypothetical condom demand. Condom demand was evaluated at varied prices for use with hypothetical sexual partners that varied in STI risk. Demand was characterized by prototypic decreases in consumption with increases in cost. Higher partner STI risk was associated with greater intentions for condom-protected sex at no cost and smaller decreases in condom demand with increases in cost. Price sensitivity was also related to individual difference factors relevant to sexual health (e.g., alcohol use severity, lower STI knowledge). This study supports the utility of a condom purchase task for indexing condom valuation and capturing individual difference and contextual risk factors relevant to STI transmission. Future studies may leverage this methodology as a means to study sexual health decision-making.

What predicts self-efficacy? Understanding the role of sociodemographic, behavioural and parental factors on condom use self-efficacy among university students in Nigeria.

BackgroundRisky sexual behaviours are not uncommon among young adults particularly those in the higher levels of education. It is known that higher self-efficacy could contribute to better sexual and reproductive health outcomes including the use of condoms. However, there is limited research on the role of socio-demographic, behavioural and parental factors as predictors of condom-use self-efficacy. As a result, this exploratory study was designed to assess the predictors of self-efficacy for condom use among university students in NigeriaMethodsA cross-sectional survey was conducted with 755 university students in Nigeria from February to April 2018. Self-efficacy for condom use was assessed by combining responses to 11-items measures of condom self-efficacy drawn from the work of Barkley and colleagues. We fitted a structural equation model to identify the pathways through which socio-demographic, behavioural and parental factors predict two constructs of condom-use self-efficacy (self-efficacy for condom purchase and use and partner communication self-efficacy) in the sample.ResultsDemographic factors such as age (β = -0.29, p<0.05) and sex (β = 0.42, p<0.05), as well as ratings on religious importance (β = -0.08, p<0.05) were directly associated with self-efficacy for condom purchase and use. These factors showed significantly mediated effects through sexual experience which also had a direct positive relationship (β = 0.73, p<0.05) with self-efficacy for condom purchase and use. The receipt of parental support, on the other hand, was directly associated with higher partner communication efficacy for condom use (β = 0.07, p<0.05). We found no evidence that the level of partner communication efficacy was directly associated with any of the behavioural, demographic or parental factors.ConclusionThe findings of this study affirm that sex, or age or having higher ratings on religious importance alone does not increases self-efficacy but also exposure to sexual activity through which these factors affect self-efficacy for condom purchase and use. These findings also highlight the need to address and strengthen condom use self-efficacy among young adults, particularly the sexually inexperienced, highly religious and young adults with limited support from their parent.

Barriers to Purchasing Condoms in a High HIV/STI-Risk Urban Area.

The Centers for Disease Control and Prevention (CDC) have identified Atlanta, Georgia as a high-risk environment for STI/HIV infection. Condoms are an inexpensive and effective method for preventing STI/HIV infection. The majority of individuals acquire their condoms through purchase, rather than through free condom distribution programs. However, individuals purchasing condoms in stores encounter numerous barriers. This study assessed the environmental and physical barriers surrounding condom purchases in stores in downtown Atlanta. The findings revealed a combination of high environmental and physical barriers, low visibility of condoms in stores and limited selection of safer sex supplies. In the most densely populated area of the city, stores which sold condoms were few (n = 25), equating to 1 store per ~ 7000 people. In 80% of stores, personnel were required in order to access the condoms. In 28% of stores, condoms were hidden underneath the counter. The majority of stores offered only one brand of male condoms with a limited selection of lubricants and no dental dams or internal condoms. Barriers and discomfort surrounding purchasing condoms can contribute to embarrassment, which has a negative impact on condom acquisition and ultimately on condom use. Efforts must be made to lower barriers in Atlanta and make condoms more readily available to high-risk populations. Community advocacy has been effective in removing barriers to condoms. Access can furthermore be improved by: installing condom vending machines in public locations, offering self-check-out in stores that do not have physical barriers and encouraging individuals to order condoms online.

Implementing Evidence-Based HIV Prevention for Female Sex Workers in Mexico: Provider Assessments of Feasibility and Acceptability.

This study examined service provider perceptions of feasibility and acceptability of implementing evidence-based practices for preventing HIV/AIDS and STIs in female sex workers (FSWs) in Mexico. Semi-structured interviews were conducted with 124 directors, supervisors and counselors from 12 reproductive health clinics located throughout Mexico participating in a large randomized controlled trial to scale-up the use of a psychoeducational intervention designed to promote FSW condom use and enhance safer sex negotiation skills. Feasibility was based on assessment of personal, organizational and social costs, benefits, and capacity. Costs included anxiety over intervention competency, purchase of condoms and other supplies, expenses of laboratory tests for HIV/STIs, and stigma associated with FSWs. Benefits included increase in personal knowledge and experience, enhanced clinic reputation and service delivery capacity, and increased public health. Capacity was expressed in terms of provider skills to deliver the intervention and additional workload. Acceptability was expressed in terms of provider enthusiasm in delivering these services and FSWs willingness to receive the services. Service provider evaluations of feasibility and acceptability of implementing evidence-based prevention interventions are grounded in local contexts that define costs and benefits of and capacity for implementation and determine features of the intervention and its implementation that are acceptable.

Sex, Drugs, and Baby Booms: Can Behavior Overcome Biology?

We study the behavioral changes due to marijuana consumption on fertility and its key mechanisms, as opposed to physiological changes. We can employ several large proprietary data sets, including the 1997 National Longitudinal Survey of Youth, Nielsen Retail Scanner database, as well as the Vital Statistics Natality files and apply a differences-in-differences approach by exploiting the timing of the introduction of medical marijuana laws among states. We first replicate the earlier literature by showing that marijuana use increases after the passage of medical marijuana laws. Our novel results reveal that birth rates increased after the passage of a law corresponding to increased frequency of sexual intercourse, decreased purchase of condoms and suggestive evidence on decreased condom use during sex. More sex and less contraceptive use may be attributed to behavioral responses such as increased attention to the immediate hedonic effects of sexual contact, delayed discounting and ignoring costs associated with risky sex. These findings are consistent with a large observational literature linking marijuana use with increased sexual activity and multiple partners. Our findings are robust to a broad set of tests.

Situational Influences on Condom Purchasing

Despite the well-documented role of condoms in safe sex, people frequently fail to use them. Embarrassment and other negative emotions that occur while acquiring condoms may make it less likely that people will consistently purchase condoms, subsequently decreasing condom use. It is important to examine how situational factors affect emotions related to condom purchasing behaviors. Two experiments examined the influence of different condom purchasing situations on emotions felt and willingness to purchase condoms. Participants imagined one of three condom purchasing scenarios: anonymously at a self-checkout counter, non-anonymously at a regular checkout counter, or asking for condoms from a locked display. Results revealed that participants’ self-reported willingness to purchase condoms increased as levels of anonymity increased. Similarly, participants reported more positive emotions as anonymity increased. A negative correlation between negative emotion and willingness to purchase condoms also emerged. Overall, results suggest a need for businesses to help provide anonymity to customers, perhaps through incorporating self-checkouts into their stores to potentially decrease negative emotion felt and increase condom sales and potentially consistent condom use.

The perceived risk and the high involvement product purchase: Location-based advertisements using fearful and sensual appeals as risk reduction strategy in condom purchases

The goal of this research was to investigate the perceived risk of purchasing condoms and the risk-reducing effects of location-based advertisements. For the research, a quantitative approach was used. A questionnaire was distributed to 238 participants, using the Internet and physical distribution. This study found that 66% of the sample perceived social risk during the purchase of condoms. Of this percentage, 39% stated that embarrassment has stopped them from purchasing the product. Location-based advertisements were perceived negative, however also perceived informative by almost half of the sample. This study implies that advertisements have a positive effect on the perceived risk since the majority of the sample stated that their perceived purchase embarrassment was reduced after seeing the sensual (65%) and fearful (59%) advertisement.

Online purchases of an expanded range of condom sizes in comparison to current dimensional requirements allowable by US national standards

Across studies, 35-50% of men describe condoms as fitting poorly. Rates of condom use may be inhibited in part due to the inaccessibility of appropriately sized condoms. As regulated medical devices, condom sizes conform to national standards such as those developed by the American Society for Testing and Materials (ASTM) or international standards such as those developed by the International Organisation for Standardisation (ISO). We describe the initial online sales experience of an expanded range of condom sizes and assess uptake in relation to the current required standard dimensions of condoms. Data regarding the initial 1000 sales of an expanded range of condom sizes in the United Kingdom were collected from late 2011 through to early 2012. Ninety-five condom sizes, comprising 14 lengths (83-238mm) and 12 widths (41-69mm), were available. For the first 1000 condom six-pack units that were sold, a total of 83 of the 95 unique sizes were purchased, including all 14 lengths and 12 widths, and both the smallest and largest condoms. Initial condom purchases were made by 572 individuals from 26 countries. Only 13.4% of consumer sales were in the ASTM's allowable range of sizes. These initial sales data suggest consumer interest in an expanded choice of condom sizes that fall outside the range currently allowable by national and international standards organisations.

Gender differences in beliefs about condom use among young, heterosexual Australian adults

Objective: To investigate gender differences in beliefs about condom use among young, sexually active, heterosexual Australian adults. Design: Cross-sectional survey of 1,113 adults aged 18–26 years. Setting: Higher education institutions across New South Wales and Victoria, Australia. Method: Participants were recruited during higher-education orientation activities and asked to complete an anonymous survey. The survey captured beliefs about condom use and demographic data. Results: Although males were more likely than females to agree that their partners endorsed the consistent use of condoms, they were less likely to agree that their friends would support consistent condom usage. Males were also more likely to believe that condoms reduce sexual pleasure and give the impression that they are sexually promiscuous. Conclusion: Normalizing the purchase of condoms, repositioning condoms as erotic stimuli, and creating a supportive peer environment using peer-to-peer communication tools may bring about more positive perceptions regarding consistent condom use. Gender-specific safe sex campaigns should also be developed to address the different pattern of condom beliefs held by males and females.

Safer Sex as the Bolder Choice: Testosterone Is Positively Correlated with Safer Sex Behaviorally Relevant Attitudes in Young Men

Higher testosterone (T) is tied to risk-taking, especially in financial domains but also in health domains relevant to acquiring sexually transmitted infections (STIs). However, safer sex constructs could themselves carry the possibility of "social risk" due to sexual stigma or embarrassment, or could involve boldness or confidence because they could represent status displays of frequent sexual activity. To determine how T and behaviorally relevant attitudes about sexual risk-taking are linked, to better understand biopsychosocial aspects of sexual health related to STIs. In 78 first-year male college students, we examined correlations between salivary T and behaviorally relevant safer sex attitudes assessed via questionnaires. T, via saliva; safer sex attitudes, via a composite and the University of California, Los Angeles Multidimensional Condom Attitudes Scale (MCAS). Higher T was significantly correlated with higher scores on the following: safer sex likelihood composite, r(73)=0.33, P=0.003; the MCAS safer sex resilience, r(32)=0.36, P=0.037; and the MCAS condom purchase comfort, r(32)=0.37, P=0.031. Associations between T and safer sex likelihood and resilience were still robust after controlling for potential confounds, though the association between T and purchase comfort diminished to a trend. Higher T was positively linked with safer sex attitudes, especially those most closely tied to STI risk avoidance. Thus, future research and interventions for STI prevention should address the possibility that safer sex may be paradoxically perceived as a "bold" or "risky" choice even as it decreases STI risk.

Factors associated with unprotected anal intercourse and age among men who have sex with men who are gay bar customers in Osaka, Japan

HIV infections among men who have sex with men (MSM) are increasing in Japan. An anonymous self-administered questionnaire among clients of a gay bar in Osaka was used to analyse the relationship between age and unprotected anal sex (UAI). The highest rate of UAI was reported among those aged ≥45 (73.3%), followed by the ≤24 (60.7%), 25-34 (56.3%) and 35-44 (54.0%) age groups (P=0.01). In multivariate analysis, UAI was related to sex with six or more sexual partners among those aged ≤24 (adjusted odds ratio (AOR), 4.88; confidence interval (CI), 1.21-19.74), bisexual identity (AOR, 2.47; CI, 1.06-5.76) and drug use (AOR, 0.49; CI, 0.26-0.93 for no drug use) in the 25-34 age group, and no lifetime HIV testing in the 35-44 age group (AOR, 2.57; CI, 1.40-4.74). Condom purchasing and condom carrying were protective of UAI in 25-34, 35-44 and ≥45 age groups. Programs promoting condom use are needed for younger and older MSM.

Preferences for condom placement in stores among young Dutch men and women: relationships with embarrassment and motives for having sex

Condom purchasing is an important preparation for condom use. The present study examined if products surrounding condoms in the store play a role in preferences for where to buy condoms among young people. Sixty-nine men and 111 women (<30 years) completed an online questionnaire on their preferences for condom placement, associated embarrassment with these placements, and motives for having sex. Fifty percent of men and 70% of women indicated the counter as least preferred placement. Two-fifths of men and women preferred the sensual context, including among sex toys and lubricants; however, the remainder of participants, particularly women, preferred other less sexual contexts. Both the counter and sensual placement were strongly associated with embarrassment, and this, in turn, was predictive of placement preference. Finally, the motive for having sex to experience intimacy was negatively related to counter preference, and the motive for having sex to experience pleasure was negatively related to the neutral placement and the female personal care placement preferences. The findings suggest that using multiple and alternative placements for condoms in stores may encourage condom purchasing behaviour among young people.

Risk Factors Associated With HIV Prevalence Among Female Sex Workers in 10 Brazilian Cities

HIV prevalence is 15 times higher among female sex workers (FSWs) than in the overall Brazilian female population. In this article, we investigated factors associated to HIV infection among FSW, recruited by Respondent-driven sampling (RDS), in 10 Brazilian cities in 2008-2009. The total sampling was 2523 FSWs. The variables considered in the study included sociodemographic characteristics and those related to profession, knowledge, and source of information on sexually transmitted infection/AIDS, access to condoms, sexual behavior, health care and sexually transmitted infection signs, discrimination and violence, and the use of alcohol and drugs. Sampling weights were proportional to the inverse of network size and for the generation of global results for the 10 cities, data were calibrated by the population size. Multivariate logistic regression models were used, taking into account the dependency structure of observations. The longest period of prostitution (odds ratio [OR], 1.040; 95% confidence interval [CI], 1.013-1.067), the lowest price charged for sex (OR, 0.713; 95% CI, 0.522-0.970), the association with other sexually transmitted infections such as syphilis (OR, 2.186; 95% CI, 1.064-4.488), and the fact of would waive the use of condom on client's request (OR, 3.735; 95% CI, 1.449-9.661) were the most important associated risk factors to HIV infection among FSWs. Purchase of condoms (OR, 0.503; 95% CI, 0.304-0.833) was a relevant preventive factor. The use of RDS proved to be appropriate for the recruitment of FSWs as long as the statistical analysis takes into account the dependency structure of observations. The HIV infection predictors here depicted can support public health policies focused on this population group in Brazil.

コンドーム購入および使用に関する行動の変容ステージと羞恥感情との関連

This research focused on (a) embarrassment at the time of condom purchase or use, and (b) stages of change (Prochaska & DiClemente, 1983) as psychological factors related to the use of condoms. A written questionnaire was completed by 376 university students. For condom purchases, ANOVAs revealed that scores for "intent of behavior" increased as participants moved from the "precontemplation" stage to the "action" stage. The scores for embarrassment, and many factors of embarrassment, were lower in the "action" stage than in the other stages. However, the patterns of condom use scores were unclear. These results indicate that with regard to condom purchases, persons who are in the "preparation" or earlier stages (i.e., persons who are not purchasing condoms) are particularly susceptible to embarrassment.

The Demand for, and Impact of, Learning HIV Status.

This paper evaluates an experiment in which individuals in rural Malawi were randomly assigned monetary incentives to learn their HIV results after being tested. Distance to the HIV results centers was also randomly assigned. Without any incentive, 34 percent of the participants learned their HIV results. However, even the smallest incentive doubled that share. Using the randomly assigned incentives and distance from results centers as instruments for the knowledge of HIV status, sexually active HIV-positive individuals who learned their results are three times more likely to purchase condoms two months later than sexually active HIV-positive individuals who did not learn their results; however, HIV-positive individuals who learned their results purchase only two additional condoms than those who did not. There is no significant effect of learning HIV-negative status on the purchase of condoms.