Current Condom Use Research Articles

Recent Semen Exposure Impacts the Cytokine Response and Bacterial Vaginosis in Women.

BackgroundThe presence of semen in the vagina from unprotected sex may influence the immune and microbial environment of the female genital tract. Inflammatory cytokine concentrations and BV-associated bacteria in female genital secretions may influence HIV risk, although the effect of recent sexual intercourse on incident BV and the cytokine milieu of cervicovaginal secretions has rarely been measured in previous studies. Here, we investigated the extent to which partner semen impacts the cytokine response and incident BV.MethodsAt baseline, we assessed the recency of semen exposure in menstrual cup supernatants by quantifying prostate specific antigen (PSA) levels using ELISA in 248 HIV-uninfected women at high risk for HIV infection. Luminex was used to measure 48 cytokines in menstrual cup supernatants and vaginal swabs to diagnose BV by Nugent score. Point-of-care screening for Chlamydia trachomatis and Neisseria gonorrhoeae was conducted using GeneXpert while OSOM was used for Trichomonas vaginalis detection. Multivariable models, adjusted for age, sexually transmitted infections, BV, current contraception use and condom use, were used to assess the impact of semen exposure on biomarkers of inflammation and BV.ResultsPresence of PSA, indicating recent semen exposure within 48 hours prior to sampling, was observed in menstrual cup supernatants of 17% (43/248) of women. Of these women, 70% (30/43) had self-reported condom use at their last sex act and 84% (36/43) had BV (Nugent score >7). PSA presence was significantly associated with prevalent BV (Relative Risk (RR), 2.609; 95% Confidence Interval (CI), 1.104 - 6.165; p = 0.029). Furthermore, women with detectable PSA had high median concentrations of macrophage inflammatory protein- beta (MIP-1α, p=0.047) and low median concentration of the stem cell growth factor beta (SCGF-β, p=0.038) compared to those without PSA.ConclusionA degree of discordance between self-reports of consistent condom use and PSA positivity was observed. There was also evidence of a relationship between recent semen exposure, BV prevalence and altered cytokine concentrations. These findings suggest that PSA, as a semen biomarker, should be taken into consideration when investigating biological markers in the female genital tract and self-reported condom use in studies on reproductive and sexual health.

“Condoms Are Boring”: Navigating Relationship Dynamics, Gendered Power, and Motivations for Condomless Sex Amongst Adolescents and Young People in South Africa

Condoms remain an important method for preventing HIV prevention and unintentional pregnancies, however their use in South Africa is sub-optimal. We analyzed survey data on reported condom use among 3009 sexually active adolescent girls and young women (AGYW) aged 15–24 years, and qualitative data from interviews and focus group discussions with 237 AGYW and 38 male peers. Our findings describe the current condom use landscape among adolescents and young people in South Africa, illustrating relationship dynamics, gendered power and notions of masculinity which influence condom negotiation and use in young heterosexual South Africans’ sexual encounters.

Condom use during COVID-19: Findings from an Australian sample of heterosexual young adults

Condoms are a valuable tool in combating the continued spread of sexually transmitted infections (STIs). Despite the fact that condoms are effective and easily accessible, young adults report inconsistent condom use and young adults represent a disproportionately large amount of new STI cases annually. The Behavioural Immune System theory suggests that health behaviours, such as condom use, are impacted by cognitive activation of perceived threat of disease. The advent of the COVID-19 pandemic may then have unforeseen impacts on condom use and the spread of STIs. The present study investigated changes in condom use during the pandemic, and any associations these changes may have had with perceived vulnerability to COVID-19. An Australian sample of 269 students completed a survey asking them to recall their condom use prior to COVID-19, and then their current condom use. Final analyses included a sample of 149 sexually active heterosexual participants. Results revealed a general decline in condom use. Single and coupled participants both reported less frequent condom use, but this decrease was more pronounced among single people. Gender did not moderate these effects. Surprisingly, diminished condom use was not significantly related to perceived threat of COVID-19. Findings of the present study have concerning implications for sexual health and sexual messaging during pandemics.

Prevalence and incidence of HIV among female sex workers and their clients: modelling the potential effects of intervention in Rwanda

BackgroundRwanda has identified several targeted HIV prevention strategies, such as promotion of condom use and provision of antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) for female sex workers (FSWs). Given...

Risk-based screening to identify reproductive tract infection among HIV-infected women desiring use of intrauterine contraceptives

BackgroundReproductive tract infections (RTIs) are a major cause of morbidity and mortality, yet RTI testing remains limited in resource-constrained settings. We assessed performance of an existing RTI risk assessment screening...

Insights from outside BJOG

Insights from outside BJOG

Socio-demographic, marital and psychosocial predictors of safe sex behaviour among Mozambican women at risk for HIV/AIDS

Heterosexual encounters remain the primary route for HIV transmission in Africa. Safer sex behaviour is not adopted by many women due to several social and psychological factors. This paper aims to identify socio-demographic, marital and psychosocial predictors associated with current sexual activity and condom use in Mozambican women at sexual risk for HIV/AIDS. Women (173), patients at a public hospital and at risk for HIV infection, completed measures of condom use negotiation self-efficacy, perceived barriers against safer sex, current sexual activity and condom use. Having more than 6 years of education and being younger and single were significant predictors for current sexual activity and condom use. Regarding psychosocial factors, talking about AIDS with partners, condom use negotiation self-efficacy and fewer perceived barriers to safer sex were significant predictors for current sexual activity (intention to use and buy/get condoms). Condom use negotiation self-efficacy is a significant predictor for condom use. These results should be considered in new HIV prevention intervention design in Mozambique.

Gendered Power and the Use of Contraception and Condoms among Married Women in Ghana

Demographic and Health Survey (DHS) data are used to examine what predicts current contraception and condom use among married women in Ghana. Women’s gender-based power is examined in the three dimensions of interpersonal decision-making power, household status, and socioeconomic status; these dimensions are considered as predictor or focal variables. Ghanaian women’s higher sexual decision-making power, greater education, work outside of the home, work for pay, more living children, and monogamous marriages are associated with a greater likelihood of contraceptive use. Higher contraceptive use is found among young urban women who do not want more children and who have been visited by a family planning worker. In contrast, condom use is shaped by different factors that highlight its distinctiveness as being male-controlled. Policy planning should consider the importance of women’s power and the uniqueness of condom use as a male-controlled contraceptive method as well as the positive effect of contact with a family planning worker in shaping both contraceptive and condom use.

The interplay between feelings and beliefs about condoms as predictors of their use

Objective: Negative feelings about condoms are a key barrier to their use. Using the behavioural affective associations model, we examined the joint effects of affective associations and cognitive beliefs about condoms on condom use.Design: In Study 1 (N = 97), students completed measures of their affective associations and cognitive beliefs about sex and condoms, sexual activity and condom use. In Study 2 (N = 171), a measure of behavioural intentions and condom selection task were added.Main outcome measures: Condom use measured in Study 1 as (1) current condom use, and (2) willingness to use condoms; in Study 2 as: (1) behavioural intentions, (2) number of condoms selected.Results: Affective associations with sex and condoms were behaviour-specific, were directly associated with the respective behaviour, and mediated the relations of cognitive beliefs to behaviour, ps < .05. In Study 2, affective associations were associated with behavioural intentions and the number of condoms selected, ps < .05; cognitive beliefs were indirectly associated with these outcomes through affective associations, indirect effects: ps < .05.Conclusions: Affective associations are a behaviour-specific and proximal predictor of condom use, mediating the effect of cognitive beliefs, suggesting they may be a particularly viable intervention target.

Satisfaction and Condomless Anal Sex at Sexual Debut and Sexual Risk Among Young Black Same-Sex Attracted Men.

First sex may be a sentinel event crucial to understanding sexual health trajectories of young Black same-sex attracted men (YBSSAM). We sought to understand whether satisfaction, condomless anal sex, and contextual factors during first sex were associated with sexual risk and recent condom usein YBSSAM. A total of 201 YBSSAM aged 15-24 years completed an Internet survey exploring first sex,current condom use, andsexual risk.High risk was defined as≥3 of the following: new/concurrent sex partners, STI history, and no/inconsistent condom use. Multivariate logistic regression assessed the association between predictor (satisfaction and first condomless anal sex) and outcome (sexual risk and condomless sex in the past 3months) variables. Mean age at first sex was 15.2 (SD=2.9) years, and emotional satisfaction (51.7%), physical satisfaction (63.7%), and condomless first anal sex (55.2%) were common. YBSSAM describing high levels of satisfaction were no more likely to be at high risk or engage in recent condomless sex. Condomless first sex (AOR=4.57, p=.001), younger age (AOR=3.43, p=.02), and having a partner>5years older (AOR=2.78, p=.03) at first sex were significantly associated with increased risk. Only condomless first sex (AOR=4.28, p<.001) was associated with condomless recent sex. Satisfaction at first sex may not influence later sexual risk in YBSSAM. However, context of first sex, including condom use at first sex, may play an important role insubsequent risk. Prevention strategies on condom negotiation prior to first sex may help to mitigate HIV burden in YBSSAM.

Demographic, Socio-Economic and Psychosocial Determinants of Current and Consistent Condom Use among Adolescents in Botswana

Background: To facilitate effective program designs aimed at assisting youth avoid unnecessary negative reproductive health outcomes, there is need to understand determinants of condom use among adolescents. Objectives: To determine demographic, socioeconomic and psychosocial factors associated with adolescent condom use in Botswana. Methods: Logistic regression models were employed to analyse a weighted sample of 221 adolescents aged 15 to 19 years from the 2012 Botswana AIDS Impact Survey who had a sexual relationship during the 12 months preceding the survey. Results: A majority of adolescents were current and consistent condom users (81% and 72% respectively). Both current and consistent condom use were positively associated with secondary or higher education, unemployed, high perception of severity of HIV to health and high self-efficacy perception. However, being female, non-Christian, having medium or comprehensive HIV/AIDS related knowledge and high perceived personal risk to HIV infection were negatively associated with both outcomes. Although being 18 to 19 years, having multiple sexual partners and high perception of condom attributes were positively associated with current condom use, they were negatively associated with consistent use. Conclusions: The study showed that in addition to demographic and socioeconomic factors, psychosocial factors are important predictors for condom use among adolescents.

Attitudes Towards PrEP and Anticipated Condom Use Among Concordant HIV-Negative and HIV-Discordant Male Couples

Since the July 2012 approval by the FDA of emtricitabine/ tenofovir disoproxil fumarate (Truvada) for use as pre-exposure prophylaxis (PrEP) against HIV, its feasibility and acceptability has been under study. HIV-discordant couples are likely targets for PrEP but little is known about how this new prevention tool impacts relationships. We examined, among gay male couples, the acceptability of individual and partner use of PrEP and intentions to use condoms with primary and outside partners in the context of PrEP use. Data are from two independent samples of couples recruited in the San Francisco bay area and New York City-a qualitative one (N=48 couples) between March and November, 2011, and a quantitative one (N=171 couples) between June, 2012 and May, 2013. Data were categorized by couple HIV status and general linear models; chi-square tests of independence were used to examine condom-use intentions with primary and outside partners, by sexual risk profile, and race. Almost half of the HIV-negative couples felt PrEP was a good HIV prevention strategy for themselves and their partner. Over half reported that they would not change their current condom use if they or their partner were taking PrEP. However, approximately 30% of HIV-negative couples reported that they would stop using condoms or use them less with primary and outside partners if they were on PrEP or if their partner was on PrEP. A large percentage of couples view PrEP positively. However, to ensure safety for both partners, future programing must consider those who intend not to use condoms while on PrEP.

Prevalence and Determinants of Adolescent Pregnancy in Urban Disadvantaged Settings Across Five Cities

PurposeThe impact of pregnancy on the health and livelihood of adolescents aged 15–19 years is substantial. This study explored sociodemographic, behavioral, and environmental-level factors associated with adolescent pregnancy across five urban disadvantaged settings. MethodsThe Well-Being of Adolescents in Vulnerable Environments study used respondent-driven sampling (RDS) to recruit males and females from Baltimore (456), Johannesburg (496), Ibadan (449), New Delhi (500), and Shanghai (438). RDS-II and poststratification age weights were used to explore the odds associated with “ever had sex” and “ever pregnant”; adjusted odds of pregnancy and 95% confidence interval were developed by site and gender. ResultsAmong the sexually experienced, pregnancy was most common in Baltimore (females, 53% and males, 25%) and Johannesburg (females, 29% and males 22%). Heterosexual experience and therefore pregnancy were rare in Ibadan, New Delhi, and Shanghai. Current schooling and condom use at the first sex decreased the odds of pregnancy among females in Baltimore and Johannesburg participants. Factors associated with higher odds of pregnancy were early sexual debut (Johannesburg participants and Baltimore females) being raised by someone other than the two parents (Johannesburg females); alcohol use and binge drinking in the past month (Baltimore participants); greater community violence and poor physical environment (Baltimore males and Johannesburg participants). ConclusionsThe reported prevalence of adolescent pregnancy varies substantially across similarly economically disadvantaged urban settings. These differences are related to large differences in sexual experience, which may be underreported, and differences in environmental contexts. Pregnancy risk needs to be understood within the specific context that adolescents reside with particular attention to neighborhood-level factors.

Family Planning and Preconception Health Among Men in Their Mid-30s: Developing Indicators and Describing Need.

The Centers for Disease Control and Prevention and Healthy People 2020 call for improvements in meeting men's reproductive health needs but little is known about the proportion of men in need. This study describes men aged 35 to 39 in need of family planning and preconception care, demographic correlates of these needs, and contraception use among men in need of family planning. Using data from Wave 4 (2008-2010) of the National Survey of Adolescent Males, men were classified in need of family planning and preconception care if they reported sex with a female in the last year and believed that they and their partner were fecund; the former included men who were neither intentionally pregnant nor intending future children and the latter included men intending future children. Men were classified as being in need of both if they reported multiple sex partners in the past year. About 40% of men aged 35 to 39 were in need of family planning and about 33% in need of preconception care with 12% in need of both. Current partner's age, current union type, and sexually transmitted infection health risk differentiated men in need of family planning and preconception care (all ps < .01) and participants' race/ethnicity further differentiated men in need of preconception care (p < .01). More than half of men in need of family planning reported none of the time current partner hormonal use (55%) or condom use (52%) during the past year. This study identified that many men in their mid-30s are in need of family planning or preconception care.

"Sexplorando": sexual practices and condom use among an internet-based sample of men and women in Puerto Rico.

Despite the wealth of literature addressing sexual practices and condom use among men and women, very little data are available among Hispanic/Latino populations and in the Caribbean Region. This study adds to the existing literature on sexual practices and condom use in Puerto Rico (PR) and provides comparisons based on sex given the need for more current information on the sexual characteristics and condom use rates among understudied populations. The aim of this study was to assess the rates of sexual practices and condom use among adults, aged 21-49, in PR. We report the prevalence of lifetime and recent (past 3 months) sexual practices by sex, as event-level condom use rates, and condom familiarity and accessibility in an online-based sample of adult men and women in PR. The main variables assessed include sociodemographic characteristics, solo and partnered sexual practices, and condom use frequencies, as well as familiarity and accessibility to male and female condoms. Overall, 93% of the sample reported having been sexually active (engaged in oral, vaginal, and/or anal sex) in their lifetime and 78% reported sexual practices in the past 3 months. As in other studies Hispanic/Latino populations, reported rates of anal intercourse (AI) among both men and women were relatively high. Overall, a greater proportion of men reported condom use during all sexual practices (41% vaginal intercourse (VI); 65% receptive AI; 46% insertive AI) than women (22% VI; 18% AI). These findings provide current sexual practice and condom use frequency rates that can aid in the understanding of the particular sexual health needs of Hispanic/Latino populations as well as of other groups in the Caribbean. It also serves for the development of future studies and sexual health promotion programs, including comprehensive sexual health care.

Cost-effectiveness of tenofovir gel in urban South Africa: model projections of HIV impact and threshold product prices

BackgroundThere is urgent need for effective HIV prevention methods that women can initiate. The CAPRISA 004 trial showed that a tenofovir-based vaginal microbicide had significant impact on HIV incidence among women. This study uses the trial findings to estimate the population-level impact of the gel on HIV and HSV-2 transmission, and price thresholds at which widespread product introduction would be as cost-effective as male circumcision in urban South Africa.MethodsThe estimated ‘per sex-act’ HIV and HSV-2 efficacies were imputed from CAPRISA 004. A dynamic HIV/STI transmission model, parameterised and fitted to Gauteng (HIV prevalence of 16.9% in 2008), South Africa, was used to estimate the impact of gel use over 15 years. Uptake was assumed to increase linearly to 30% over 10 years, with gel use in 72% of sex-acts. Full economic programme and averted HIV treatment costs were modelled. Cost per DALY averted is estimated and a microbicide price that equalises its cost-effectiveness to that of male circumcision is estimated.ResultsUsing plausible assumptions about product introduction, we predict that tenofovir gel use could lead to a 12.5% and 4.9% reduction in HIV and HSV-2 incidence respectively, by year 15. Microbicide introduction is predicted to be highly cost-effective (under $300 per DALY averted), though the dose price would need to be just $0.12 to be equally cost-effective as male circumcision. A single dose or highly effective (83% HIV efficacy per sex-act) regimen would allow for more realistic threshold prices ($0.25 and $0.33 per dose, respectively).ConclusionsThese findings show that an effective coitally-dependent microbicide could reduce HIV incidence by 12.5% in this setting, if current condom use is maintained. For microbicides to be in the range of the most cost-effective HIV prevention interventions, product costs will need to decrease substantially.

Body appreciation, sexual relationship status, and protective sexual behaviors in women

The relationship between body appreciation and sexual risk reduction behavior in women is under-explored. This cross-sectional study examined the relationships between body appreciation, male condom use, and sexually transmitted infection (STI) testing among a community-based sample of women (n=285). Logistic regression results revealed that after controlling for age, BMI, and sexual orientation, having more than one sexual partner moderated body appreciation and current male condom use (OR=4.21, p<.01, CI=1.510–11.726). Body appreciation was not a significant predictor of STI testing in the previous 12 months. This suggests that women with higher body appreciation may be more likely to engage in some protective sexual health behaviors. Interventions that seek to improve body appreciation instead of body size change such as weight loss or gain may encourage certain protective sexual behaviors in women.

P4.036 Condom Use Among Female Sex Workers (FSWs) Increased Through Drop In Center (DIC) Based Service Delivery Approach in Bangladesh

BackgroundThe HIV prevalence in Bangladesh remains low (< 1%) among FSWs. Since June 2008, with the funding supports from the Global Fund, Save the Children gradually scaled up essential services...

Age-Group Differences in Human Papillomavirus Types and Cofactors for Cervical Intraepithelial Neoplasia 3 among Women Referred to Colposcopy

Recommendations for high-risk human papillomavirus (HR-HPV) testing as an adjunct to cytology for cervical cancer screening differ by age group, because HR-HPV tests lack adequate specificity in women aged <30. Here, we assess age-group differences in HPV types and other risk factors for cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) versus CIN0-2 in women from four colposcopy clinics. Women ages 18 to 69 (n = 1,658) were enrolled and completed structured interviews to elicit data on behavioral risk factors prior to their examinations. HPV genotyping was done on exfoliated cervical cell samples. We estimated relative risks (RR) for HPV types and cofactors for CIN3+, overall and stratified by age group. After 2 years of follow-up, we identified 178 CIN3+, 1,305 CIN0-2, and 175 indeterminate outcomes. Nonvaccine HR-HPV types were only associated with CIN3+ among women ≥ 30 (RR = 2.3, 95% CI: 1.5-3.4; <30: RR = 0.9). Among all HR-HPV-positive women, adjusting for age, significant cofactors for CIN3+ included current smoking (RR = 1.5), former smoking (RR = 1.8), regular Pap screening (RR = 0.7), current regular condom use (RR = 0.5), and parity ≥ 5 (RR = 1.6, P(trend) for increasing parity = 0.07). However, the parity association differed by age group (≥ 30: RR = 1.8, P(trend) = 0.008; <30: RR = 0.9; P(trend) =.55). Subgroup variation by age in the risk of CIN3+ points to the importance of the timing of exposures in relation to CIN3+ detection. Future screening strategies need to consider natural history and secular trends in cofactor prevalence in the pursuit of appropriately sensitive and specific screening tools applied to appropriate age groups.

MOTIVATIONS FOR ENTRY INTO SEX WORK AND HIV RISK AMONG MOBILE FEMALE SEX WORKERS IN INDIA

This paper assesses the reasons for entry into sex work and its association with HIV risk behaviours among mobile female sex workers (FSWs) in India. Data were collected from a cross-sectional survey conducted in 22 districts across four high HIV prevalence states in India during 2007-2008. Analyses were limited to 5498 eligible mobile FSWs. The reasons given by FSWs for entering sex work and associations with socio-demographic characteristics were assessed. Reported reasons for entering sex work include poor or deprived economic conditions; negative social circumstances in life; own choice; force by an external person; and family tradition. The results from multivariate analyses indicate that those FSWs who entered sex work due to poor economic conditions or negative social circumstances in life or force demonstrated elevated levels of current inconsistent condom use as well as in the past in comparison with those FSWs who reported entering sex work by choice or family tradition. This finding indicates the need for a careful assessment of the pre-entry contexts among HIV prevention interventions since these factors may continue to hinder the effectiveness of efforts to reduce the spread of HIV/AIDS in India and elsewhere.