Correct Condom Use Research Articles

Intention to use condom among students in Agena preparatory school, Guraghe Zone, Ethiopia: with the application of health believe model

BackgroundHIV/AIDS is affecting the majority of the population, particularly the productive age group between 15–49 years resulting in social and economic crisis. The rate of HIV infection would undoubtedly be lowered if safe sexual practices such as correct and consistent use of condoms had been followed. The aim of this study was therefore to assess intention to use condom among students in Agena preparatory school, Guraghe zone, Ethiopia. Agena is an urban area in south Ethiopia.MethodsInstitution based cross-sectional study was conducted. A two stage sampling was applied by stratifying students in to (grade 11 and 12) with each grade having four section (A, B, C, D). Then systematic random sampling was used to select students in each section. Analyses of frequencies and summary measures like mean and Standard Deviation of selected variables were done. Bivariate and multivariate analysis was done to measure the association between different variables.ResultsOut of 450 respondents 122(27.1%) had history of sexual intercourse. Of whom the majority 86(70.5%) had two or more sexual partners. And 45(37%) never used condom, 12(9.8%) used condom sometimes and 65(53.2%) used condom every time during sex. About 300(67.7%) of the respondents have no intention to use condom in the next sexual encounter. On multivariate analysis those students who have high perceived susceptibility (AOR = 1.94 (1.16-3.2)) and high self-efficacy (AOR = 27 (14.4-54.2)) were more likely to have intention to use condom than others.ConclusionsIntention to use condom in the next sexual intercourse is very low. Information Education and Communication (IEC) on reducing number of sexual partners along with condom use promotion targeting in-school adolescents should be the primary strategy of HIV/AIDS prevention process.

Proficiency in Condom Use Among Migrant Workers

Consistent and correct use of condoms is important to prevent the transmission of HIV and other sexually transmitted diseases. We evaluated condom use skills on an 11-point scale in which participants were observed placing a condom on a penile model. Participants were 375 sexually active African American and Hispanic migrant workers. For analysis, subjects were divided into skilled and unskilled groups by a median split of the condom use skills score. Sexual risk behaviors were analyzed between condom use skilled and unskilled groups and level of condom use skills between African Americans and Hispanics. African Americans showed better skills in using condoms, and participants in the condom-use skilled group used condoms more frequently. Finally, a logistic regression was conducted to find predictors of condom use skills. Significant predictors were ethnicity, language, and assistance-related social support (obtaining advice from people who could provide tangible assistance).

The study of KBP of road construction workers of highway AIDS prevention project before and after intervention

ObjectiveTo get scientific basis for further health education through the research of the road construction workers' KBP before and after the interventions of highway AIDS prevention project. MethodsMulti-stage random sampling method was employeed to select workers of 8 sites from 14 sites along highway to investigate their AIDS knowledge, belief and performance (KBP) before and after highway AIDS prevention project. ResultsOver 90% of the investigated workers had ever heard about AIDS, and the non-skilled workers of lower educational level improved more after intervention. The correct answer rate of the three transmitting ways of AIDS of drivers which is the focused group of highway before and after intervention had the obvious statistical significance (P<0.05), and the other group's correct answer rates also had improved after intervention. Most people's understanding of preventing AIDS through correct use of condoms when having sex had a statistically significant difference(P<0.05) after prevention. The rates of using condoms of foremen and skilled workers when having sex with commercial sex worker/casual partner increased after intervention. ConclusionsThe health education of HIV among the road construction workers is effective and further health education of HIV prevention should be carried out among the road construction workers to improve their knowledge and awareness of avoiding the high-risk behaviors.

Condom use behaviours and correlates of use in the Botswana Defence Force

Preventing HIV infection is a priority for militaries. HIV prevention research is needed to monitor existing programme, identify areas for modification, and develop new interventions. Correct and consistent condom use is highly effective against HIV. However, use among soldiers is lower than ideal. This study describes condom use behaviours and examines correlates of use in the Botswana Defence Force (BDF). Analyses were based on 211 male BDF personnel, aged 18-30, who completed a cross-sectional survey that collected baseline data for an intervention study. Results showed that 51% of participants reported always using condoms, 35% used condoms most times, and 14% used condoms occasionally/never. Condom use varied by partner type and was typically higher with casual partners in comparison to regular partners. After adjustment for age and marital status, factors associated with lower condom use included excessive alcohol use, perception that using condoms reduce sexual pleasure, and having a trusted partner. However, higher levels of HIV knowledge and reports of being circumcised were protective against lower condom use. HIV interventions aimed at increasing condom use in the BDF should address condom perceptions, alcohol abuse, and issues of trust. Innovative ways to increase condom use in this population should also be explored.

P3.419 Effect of Intervention Exposure on Self-Reported Condom Use Among Men Who Have Sex with Men in Southern India

BackgroundThe Avahan HIV prevention intervention programme promotes condom use amongst men who have sex with men (MSM) in high HIV prevalence states in India. We assessed how self-reported condom use...

P3.418 Factors Associated with Condom Breakage Among Men Who Have Sex with Men in India

BackgroundCondom use has long been identified as one of the most effective means of preventing HIV/STI. However recent studies among female sex workers suggest high rates of condom breakage. There...

Strategizing Systematic HIV Intervention: A Case Study

For any intervention in public health, one needs to gather the evidence on the basis of which systematic plans and strategies can be built. In Rajasthan, for HIV and AIDS prevention, care and support activities apex organisation is Rajasthan State AIDS Control Society (RSACS). IIHMR, Jaipur, provided technical support to RSACS in targeted interventions, capacity building, strategic planning and public private partnership. In systematising the intervention with the sex workers living in district Sawai Madhopur, a situational analysis was carried out. The district is internationally known tourist place in Rajasthan and has remarkable mobility pattern among sex workers. It was found that in the district, the risk and vulnerabilities of sex workers has increased because of this mobility and illiteracy. It was reported that majority of sex workers in Sawai Madhopur knew that AIDS is not curable and the rest had either no idea or they thought AIDS could be cured. Amongst those who reported that they had no idea about the cure of HIV/AIDS, most of them were active sex workers. These active sex workers, hence, due to lack of awareness about STI, HIV and AIDS, were very vulnerable against HIV infection. Majority of the sex workers reported that they were not willing to use female condoms. Nearly half of the sex workers in Sawai Madhopur joined this profession as tradition of their families and caste. For HIV prevention and BCC, the better strategy is to use such IEC materials which contains pictures on various issues like condom negotiation, managing violence, sex workers collectives, correct and consistent use of condoms, STI, RTI, HIV and AIDS. Efforts should also be made to integrate the children from sex workers family into formal education process and, simultaneously, a little older children should be imparted skills in alternative trainings for joining other acceptable means of earning livelihood.

Combination prevention: new hope for stopping the epidemic.

HIV research has identified approaches that can be combined to be more effective in transmission reduction than any 1 modality alone: delayed adolescent sexual debut, mutual monogamy or sexual partner reduction, correct and consistent condom use, pre-exposure prophylaxis with oral antiretroviral drugs or vaginal microbicides, voluntary medical male circumcision, antiretroviral therapy (ART) for prevention (including prevention of mother to child HIV transmission [PMTCT]), treatment of sexually transmitted infections, use of clean needles for all injections, blood screening prior to donation, a future HIV prime/boost vaccine, and the female condom. The extent to which evidence-based modalities can be combined to prevent substantial HIV transmission is largely unknown, but combination approaches that are truly implementable in field conditions are likely to be far more effective than single interventions alone. Analogous to PMTCT, “treatment as prevention” for adult-to-adult transmission reduction includes expanded HIV testing, linkage to care, antiretroviral coverage, retention in care, adherence to therapy, and management of key co-morbidities such as depression and substance use. With successful viral suppression, persons with HIV are far less infectious to others, as we see in the fields of sexually transmitted infection control and mycobacterial disease control (tuberculosis and leprosy). Combination approaches are complex, may involve high program costs, and require substantial global commitments. We present a rationale for such investments and cite an ongoing research agenda that seeks to determine how feasible and cost-effective a combination prevention approach would be in a variety of epidemic contexts, notably that in a sub-Saharan Africa.

Condom use among HIV sero-concordant couples attending a secondary health facility in North-Central Nigeria

Background: Condom use during intercourse is perceived as unnecessary in sexual encounters involving a regular partner. The non-use of condom among HIV-positive people has been found to increase the risk of resistance to anti-retroviral therapy. The objective of this study was to determine the pattern of condom use among HIV sero-concordant couples attending a secondary health facility in North-Central Nigeria. Materials and Methods: This is a cross-sectional survey that was carried out among people living with HIV and AIDS (PLWHA) who have been enrolled into care and treatment at General Hospital Abejukolo in Kogi State, Nigeria. The data instrument used was self-/interviewer-administered questionnaire. The data obtained were analysed using EPI-INFO version 3.4.1 software package. Chi-square test was used and P < 0.05 was considered significant for the study. Results: Assessment of knowledge of the respondents on the correct use of condom showed that two-thirds (60; 65.9%) had good knowledge and 70 (79.6%) of them demonstrated positive attitude towards the use of condom during sexual intercourse. About one-third of the respondents (32; 35.2%) would oblige the spouse sexual intercourse without condom mainly because they are both positive, to fulfil marital obligations and to avoid problems in marital relationship. Less than two-thirds (59.3%) of sero-concordant spouse used condom during sexual intercourse for reasons of preventing re-infection and pregnancy. Conclusion: With one-third of respondents not using condom during sexual intercourse, there is a great challenge for spread of HIV infection and risk of drug resistance in HIV care and management. Therefore, stakeholders at various levels should intensify efforts and support research towards behavioural modification in addressing the existing lacunae in HIV control.

Intention to use condom among students in Agena preparatory school, Guraghe Zone, Ethiopia: With the application of health believe model

HIV/AIDS is affecting the majority of the population, particularly the productive age group between 15–49 years resulting in social and economic crisis. The rate of HIV infection would undoubtedly be lowered if safe sexual practices such as correct and consistent use of condoms had been followed. The aim of this study was therefore to assess intention to use condom among students in Agena preparatory school, Guraghe zone, Ethiopia. Agena is an urban area in south Ethiopia. Institution based cross-sectional study was conducted. A two stage sampling was applied by stratifying students in to (grade 11 and 12) with each grade having four section (A, B, C, D). Then systematic random sampling was used to select students in each section. Analyses of frequencies and summary measures like mean and Standard Deviation of selected variables were done. Bivariate and multivariate analysis was done to measure the association between different variables. Out of 450 respondents 122(27.1%) had history of sexual intercourse. Of whom the majority 86(70.5%) had two or more sexual partners. And 45(37%) never used condom, 12(9.8%) used condom sometimes and 65(53.2%) used condom every time during sex. About 300(67.7%) of the respondents have no intention to use condom in the next sexual encounter. On multivariate analysis those students who have high perceived susceptibility (AOR = 1.94 (1.16-3.2)) and high self-efficacy (AOR = 27 (14.4-54.2)) were more likely to have intention to use condom than others. Intention to use condom in the next sexual intercourse is very low. Information Education and Communication (IEC) on reducing number of sexual partners along with condom use promotion targeting in-school adolescents should be the primary strategy of HIV/AIDS prevention process.

Predictors of Consistent Condom Use among Secondary School Male Students in Mbonge Subdivision of Rural Cameroon

Correct and consistent condom use during sexual intercourse remains the most effective protection against sexual transmission of the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) for sexually active young adults, who are hardest hit by the HIV/AIDS pandemic. This study uses data from secondary school male students in Mbonge subdivision of rural Cameroon, to determine the most significant predictors of consistent condom use, using the main components of the Health Belief Model (HBM). A disproportional, stratified simple random sampling technique was used to obtain a representative sample of 210 male respondents. A cross-sectional correlational design was adopted, collecting data using a self-administered questionnaire. Data were analyzed using the statistical package for social sciences (SPSS) version 20 software program. Majority of the respondents, 65.8% reported having ever had sex, of whom only 30.5% reported using condoms consistently. Multinomial logistic regression analysis based on the HBM components showed that perceived susceptibility to HIV/AIDS (p=0.007; Pseudo R-square=0.223); perceived severity of HIV/AIDS (p=0.000; Pseudo R-square=0.382); perceived benefit of condom use (p=0.005; Pseudo R-square=0.144); perceived condom use self-efficacy (p=0.006; Pseudo R-square=0.223) and socio-demographic variables (p=0.012; Pseudo R-square=0.534), were the most significant predictors of consistent condom use at the level p<0.05. The findings suggest that AIDS education programs to increase condom use for males in rural Cameroon should emphasize these five components of the HBM concurrently. HIV/AIDS education messages that focus on barriers to condom use as a means of inducing and maintaining consistent condom use may be counterproductive.

Condom effectiveness against non-viral sexually transmitted infections: a prospective study using electronic daily diaries

ObjectivesTo prospectively evaluate the protective value of consistent and correct use of latex condoms against the acquisition of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis.MethodsPatients (N=929) attending clinics that treat...

Preexposure Prophylaxis for HIV Infection

ON JULY 16, 2012, THE US FOOD AND DRUG Administration (FDA) approved a daily oral antiretroviral drug to reduce the risk of sexual acquisition of human immunodeficiency virus (HIV) infection by uninfected adults. Emtricitabine/ tenofovir disoproxil fumarate (marketed by Gilead as Truvada) contains 2 nucleoside analogue HIV-1 reverse transcriptase inhibitors. Initially approved in 2004 to treat HIV infection in combination with other antiretroviral medications in people 12 years of age and older, emtricitabine/ tenofovir costs about $13 900 a year in the United States for a year of treatment. Preexposure prophylaxis, the treatment of an uninfected person before having sexual contact with an HIV-infected partner, is a widely anticipated advance that should help some people who are not infected with HIV but at high risk of infection to remain uninfected. Preexposure prophylaxis differs from another recent and complementary approach, known as treatment for prevention, which is the treatment of an HIVinfected person with antiretroviral agents to reduce the viral load and infectiousness, and thus the risk of transmission to an uninfected partner. Worldwide, about 2.5 million new HIV infections occur each year, primarily in heterosexual adults. Many people with HIV infection who are in ongoing relationshipshavepartnerswhoarenot infected, andasubstantialnumber of the new infections occur within such serodiscordant couples. In the United States, there are an estimated 50 000 new HIV infections each year, about three-fifths of which occur in men who have sexual contact with men. Preexposure prophylaxis with emtricitabine/tenofovir, however, is not a panacea for HIV infection. Taken every day, the drug reduces, but does not eliminate, the risk of acquiring HIV. It is not an effective morning before pill or morning after pill, to be taken as needed by uninfected persons. It is not a replacement for condoms and other safe sex practices, although some people may mistakenly assume this or wish that it was. Common adverse reactions in people who take the drug to prevent HIV infection include headache, abdominal pain, and weight loss. Safety concerns include impairment of kidney and liver function and decreases in bone mineral density. The long-term safety of the drug in healthy people is unknown because the available studies have only lasted for several years. Cost is also an issue, particularly for people without insurance to pay for the medication and in countries with limited resources. Preexposure prophylaxis for HIV requires that uninfected persons ingest a potent antiretroviral agent on a strict schedule, perhaps for an indefinite period of time, while following a comprehensive prevention strategy, including regular testing for HIV and other sexually transmitted diseases, consistent and correct condom use, and knowing one’s HIV status and that of partner or partners. In real life, fulfilling these requirements is a lot easier said than done. Frank discussions are needed between physicians and patients before prescribing the drug and between sexual partners. However, only an estimated 40% of people with HIV infection worldwide, and an estimated 80% of those in the United States, know their HIV status. Many people who know their status have neither disclosed their HIV status to their partners nor learned their partner’s status. Although FDA approval of emtricitabine/tenofovir for preexposure prophylaxis was expected, the considerations were complex and challenges exist. The critical questions include whether the drug will be prescribed appropriately to uninfected persons, and whether it will be used safely and properly. The updated prescribing information states that the drug “must only be prescribed to individuals confirmed to be HIVnegative immediately prior to initiating and periodically (at least every three months) during use.” Not only is emtricitabine/tenofovir less effective when doses are missed, but drugresistant HIV viruses may develop when people become infected while taking the medication for prophylaxis. Drug resistance has implications for the subsequent treatment of the infected person, as well as others who may acquire the strain. The FDA did not require that people show proof of testing negative for HIV before receiving their prescriptions as critics of the decision, such as the AIDS Healthcare Foundation, suggested. Although such a requirement might have enhanced the correct use of the medication, it might also have decreased access for those who might benefit. The FDA action was based on the results of 2 large randomized, double-blind, placebo-controlled trials and the rec-

Effect of condom-use measures in predicting sexually transmitted diseases: variation by individual and contextual factors of sexual risk

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.

What College Students Do Not Know: Where Are the Gaps in Sexual Health Knowledge?

Objective: This study aimed to understand the gaps in college students’ knowledge regarding sexual health information. Participants: A sample of 242 participants enrolled in an introductory college course participated in this study in the Fall 2009 semester. Methods: Students participated in 1 of 2 brief interventions and wrote a response paper about their experience. The papers were analyzed using conventional content analysis for information that was new to participants by looking for key words that suggested learning took place. Results: The findings indicated that the majority of participants learned new information. Most learning occurred regarding sexually transmitted infections (ie, types, symptoms, prevalence, treatment, testing) and correct condom use. There were also demographic differences regarding reported new information. Conclusions: Findings can be used to develop future sex education programs for college students by providing college educators with an understanding of where students lack knowledge of sexual health.

Condom Use: Slippage, Breakage, and Steps for Proper Use Among Adolescents in Alternative School Settings

School-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI), and pregnancy prevention programs often focus on consistent and correct condom use. Research on adolescents' experience using condoms, including condom slippage/breakage, is limited. This exploratory study examines proper condom use and the occurrence of condom slippage/breakage among alternative school youth. Data are from an HIV/STI prevention trial for youth in continuation school settings (N = 776). Analyses included separate hierarchical logistic regression analyses to explore the relationship between potential correlates and each outcome variable. Students' use of steps for proper condom use varied-73.8% put on the condom before sexual contact, 71.1% squeezed air from the tip, and 92.0% unrolled the condom fully. Notably, 28.5% reported condom slippage/breakage. Results from the regression analyses showed that 4 sets of variables (demographic, substance use, sexual risk behaviors, and condom psychosocial factors) were associated with putting on a condom before sexual contact; none of the variable sets were associated with the other 2 condom steps measured. For slippage/breakage, the demographic and sexual risk behaviors were significant correlates; steps for proper condom use approached statistical significance (p = .058). This study extends the limited research on how adolescents use condoms, and highlights important targets for prevention interventions.

Predictors of condom use and refusal among the population of Free State province in South Africa.

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.

Conhecimento deficiente acerca do HIV/AIDS em estudantes adolescentes: identificação de diagnóstico de enfermagem da NANDA

This study was performed with the objective to identify the nursing diagnosis – Knowledge deficit regarding HIV/AIDS – in adolescents. This cross-sectional study was performed at a public school located in Fortaleza - Ceará. The sample consisted of 182 male students, aged between 12 and 18 years, regularly enrolled at the referred school. The data collection was performed using an instrument containing statements regarding HIV, which the students marked as true or false. The defining characteristics of the referred diagnosis were grouped according to the student’s performance regarding the instrument. Knowledge Deficit was present in more than 90% of the subjects, and the most frequent defining characteristic was Inadequate Performance on a Test, according to NANDA Taxonomy I. In light of these results, considering the referred students, nursing interventions should include educational strategies aimed at prevention, such as the correct use of condoms and the ways of becoming infected with HIV. Descriptors: Nursing Diagnosis; Knowledge; Acquired Immune Deficiency Syndrome.

HIV-Related High-Risk Behaviors among Chinese Migrant Construction Laborers in Nantong, Jiangsu

BackgroundHIV transmission in rural areas of China is being fueled in part by migrant workers who acquire HIV outside of their hometowns. Recent surveillance statistics indicate that HIV prevalence among returning migrants has increased significantly.MethodsWe conducted a community-based cross-sectional study to assess HIV-related knowledge, attitudes and behaviors among migrant returnees in Nantong, Jiangsu Province, one of the largest exporters of migrant laborers.ResultsA total of 1625 subjects were enrolled with a response rate of 89%. All participants were male and of the majority Han ethnicity. The mean age was 39.0 years (SD = 6.7; range: 18 to 63), and most had a stable partner (N = 1533, 94.3%). Most correctly identified the major modes of HIV transmission (68.9%–82.0%), but fewer were able to identify ways that HIV cannot be transmitted. Nearly one-third of participants held positive attitudes toward having multiple sex partners, and nearly half believed that sex work should be legalized. Multiple logistic regression analysis indicated that risky sexual behavior (defined as sex with a casual or commercial sex partner) was associated with no stable partner; working abroad; correct condom use; age <22 at first sex; higher coital frequency; and having a positive attitude towards multiple sex partners.ConclusionsWe found high levels of reported sex with a casual or commercial sex partner and low levels of consistent condom use. HIV prevention interventions among migrant workers need to focus on younger migrants, migrants without stable partners, and migrants who travel abroad for work.

Are written instructions enough? Efficacy of male condom packaging leaflets among college students

Objective: To evaluate whether or not written condom use instructions successfully inform correct condom use skills. Design: Between-subjects, two-group design. Setting: Public university located in rural Midwestern region of the United States. Method: Participants were randomly assigned to either a control condition (read physical exercise instructions) or a treatment condition (read condom use instructions). Participants answered self-report questions related to condom use and performed a condom demonstration task. Participants: Participants were 106 male and 87 female college students, primarily in their freshmen (52%) or sophomore (22%) year. Results: On average, participants who read the condom instructions did not perform significantly better on the demonstration task. When the specific condom application and removal steps were considered, however, those who read the condom instructions had four times greater odds of successfully pinching the reservoir tip during condom application. Conclusions: These data suggest that the benefits of written instructions are limited and do not fully inform correct condom use.