Systematic review and meta-analysis assessing the knowledge and use of the female condom among Nigerians

BackgroundThe female condom (FC) is a critical component in a comprehensive and sustainable approach to prevent HIV, other sexually transmitted infections and unintended pregnancies.ObjectivesThis review provides comprehensive information about Nigerian''s knowledge and use of FC.MethodsWe screened search output, evaluated study eligibility, and extracted data in duplicate. Data from similar studies were combined in a meta-analysis.ResultsThere was a significantly (p < 0.0001) high-level of awareness amongst the respondents. However, the use of the FC was very low at 5.5% among female respondents. There was a significant (p < 0.0001) difference between FC awareness and use. The main reasons for FC use were prevention of unintended pregnancy (55%) and STIs/HIV (31%). We observed a significant difference between reasons of non-use of the FC [F (5, 13) = 5.195, P = 0.0077]. Furthermore, there were significant differences between the sources of information on FC [F (3, 8) = 32.89, P < 0.0001].ConclusionDespite the high levels of awareness, especially among the female respondents, the use of the FC has remained extremely low even among the young, educated undergraduate students. There is aneed for robust and consistent advocacy to make the FC available and affordable.     

A mathematical treatment of AIDS and condom use

In this paper we examine the impact of condom use on the sexualtransmission of human immunodeficiency virus (HIV) and acquiredimmune deficiency syndrome (AIDS) amongst a homogeneously mixingmale homosexual population. We first derive a multigroup SIR-typemodel of HIV/AIDS transmission where the homosexual populationis split into subgroups according to frequency of condom use.Both susceptible and infected individuals can transfer betweenthe different groups. We then discuss in detail an importantspecial case of this model which includes two risk groups andperform an equilibrium and stability analysis for this specialcase. Our analysis shows that this model can exhibit unusualbehaviour. As normal, if the basic reproduction number, R₀,is greater than unity then there is a unique disease-free equilibriumwhich is locally unstable and a unique endemic equilibrium.However, when R₀ is less than unity two endemic equilibriumsolutions can also co-exist simultaneously with the disease-freesolution which is locally stable. Numerical simulations usingrealistic parameter values confirm this and we find that incertain circumstances the disease-free solution and one of theendemic solutions are both locally asymptotically stable, whilethe other endemic solution is unstable. This unusual behaviourhas important implications for control of the disease as reducingR₀ to less than unity no longer guarantees eradication of thedisease. For a restricted special case of this two-group modelwe show that there is only the disease-free equilibrium forR₀ 1 which is globally stable. For R₀ > 1 the disease-freeequilibrium is unstable and there is a unique endemic equilibriumwhich is locally stable. We then attempt to fit the model toHIV and AIDS incidence data from San Francisco, USA. The paperconcludes with a brief discussion.     

Development and psychometric evaluation of a condom use self-efficacy measure in Spanish and English

Background: Condom self-efficacy is an important construct for HIV/STI prevention and intervention. A psychometrically sound measure of the self-efficacy for using condoms that has been designed for Hispanic women to respond in Spanish or English is needed.

Objectives: The goal of this study was to develop and evaluate a brief self-report measure of condom use self-efficacy.

Methods: We developed a 15-item measure of condom use self-efficacy based on expert knowledge of measurement and HIV/STI prevention with Hispanic women using a translation-back translation approach. Participants were 320 Hispanic women from the Southeastern US.

Results: Internal consistency of the full measure was 92. A short form of the instrument with a subset of five items also had acceptable internal consistency, alpha = .80, and was significantly correlated with the full scale, r_s = .93, p < .001. A single latent factor explained 9–48% of the variation in these items. Evidence of construct validity of the short form was provided by correlations of the scale with two self-report measures of condom use: r_s = .34** with condom use, r_s = .37** with condom use during vaginal sex.

Conclusions: Either the full measure or the five-item measure could be used in studies where condom use is an important behavioral outcome, such as evaluating prevention interventions, with Hispanic women. Future studies should examine the performance of this measure with other groups, including Hispanic men and members of other ethnic and language groups.     

Determinants of female condom use among female tertiary students in the Hohoe Municipality of Ghana using the Health Belief Model

Background: Besides abstinence, the condom has proven to be the only effective method of preventing sexually transmitted infections (STIs), including HIV/AIDS. This study investigated the determinants of female condom (FC) use among female tertiary students in the Hohoe Municipality, Ghana using the Health Belief Model (HBM). Methods: A cross-sectional design was adopted. Data were collected using a structured questionnaire in January 2019 and analysed using STATA version 14.0. Logistic regression was used to measure the strength of associations between the dependent and independent variables. A p-value <0.05 was considered statistically significant. Results: The overall utilisation of the FC was 35.0%. Among the constructs of the HBM, it was perceived self-efficacy for FC use that was significantly associated with FC use: respondents who had the confidence to convince their partners to use the FC were 2 times more likely to use it than respondents who did not [AOR =2.15(CI: 1.26, 3.71); p= 0.005]. Conclusion: Female students in the current study exhibited poor utilization of the FC. Health promotion interventions should, therefore, focus on increasing their self-efficacy for FC use.     

Condom use and risk factors of inconsistent or low use of the condoms during heterosexual anal intercourse in sub-Saharan Africa: a scoping review

BackgroundAnal intercourse (AI) has been reported to be the riskiest among other sexual intercourses in spreading human immunodeficiency virus (HIV) and the risk could be minimized by the use of condoms. Whilst AI is believed to be practised mainly by men who have sex with men, AI has also been reported to occur in heterosexual relationships. However, data on condom use during heterosexual AI are inadequate in sub-Saharan Africa.MethodA scoping review of English language published articles on condom use during heterosexual anal sex, whose studies were conducted in Sub-Saharan Africa from January 2010 to May 2020 was conducted. Articles were searched systematically on PubMed and Google Scholar electronic databases. Heterosexual AI was defined as penile penetrative anal sex between a man and a woman regardless of the sexual orientation of the 2 parties involved in the act of heterosexual AI.FindingsA total of 21 studies were eligible for analysis. Most of the studies (17 out of 21) reported females to be involved in heterosexual AI whilst 9 out of 21 studies reported males to be involved in heterosexual AI. The lifetime prevalence estimate of condom use during heterosexual AI ranged from 29%–97.5%. Other prevalence estimates of condom use during heterosexual anal intercourse were reported over various recall periods which were: 12 months'' recall period with prevalence estimates ranging from 2.9%–59%; prevalence estimates for the past 3 months which ranged from 50%–94.4%; 1 month''s recall period with prevalence estimates ranging from 5%–96% and prevalence estimates for the last intercourse experienced ranging from 1%–55%. Condom use during heterosexual AI was generally low and/or inconsistent among female sex workers (FSWs), men who have sex with men and women (MSMW) and some women in the general population. There were no risk factors identified in the study for the inconsistent or low use of condoms during heterosexual AI.ConclusionEvidence from this study suggests condom use during heterosexual AI could be fairly low especially among groups such as FSWs, MSMW and some women in the general population. Risk factors for using condoms inconsistently or using condoms less during heterosexual AI are not clear. Heterosexual anal intercourse and condom use during the AI practice is generally an under-studied subject in Sub-Saharan Africa. Future studies need to explore on heterosexual AI and condom use practices during AI comprehensively so that there can be concrete evidence on the subject which will inform targeted interventions aimed at reducing HIV among heterosexual populations in SSA.     

Perceptions of couple HIV counseling and testing in Botswana: A stakeholder analysis

Objective

To explore stakeholder's perceptions of Couples HIV Counseling and Testing (CHCT) as opposed to individual testing and potential couples’ preferences for CHCT promotion and service provision.

Methods

Study was conducted as formative research for a phase III clinical trial of Herpes (HSV-2) suppression to prevent HIV transmission among HIV discordant couples. We used non-probability purposive sampling and snowballing techniques to identify study participants. Data were collected using key informant interviews and focus group discussions. Systematic textual data analysis was used. Two independent coders coded and compared their codes for agreement. Data was categorized by emerging themes.

Results

The general themes from both key informant interviews and focus group discussions were a preference for CHCT as opposed to individual counseling in HIV prevention and the need for a client-centered approach to promotion and provision of couple HIV testing services.

Conclusion

CHCT is important in HIV prevention and should be integrated in existing HIV testing programs. The study also demonstrates the challenges of HIV status disclosure and discordance among sexual partners who test as individuals.

Practice Implications

Current low HIV status disclosure rates imply that reducing HIV incidence rates will require integrating CHCT into current testing programs. Increasing CHCT uptake however, requires improving access, training providers and addressing social, cultural, political and logistical barriers.     

Tackling sexually transmitted infection burden in Ugandan communities living in the United Kingdom: a qualitative analysis of the socio-cultural interpretation of disease and condom use

BackgroundDespite being in a different country and social environment, Ugandans living in the UK still reportedly have the lowest rates of condom usage and one of the highest incidences of STIs in UK. In Uganda, STIs and HIV prevalence has been reported to be on the increase. Understanding peoples'' beliefs and the attitudes that influence their behavior is a key factor to effectively designing control programs.MethodsA qualitative study that interviewed 37 purposively selected Ugandans living in the UK was conducted. Lay theories and interpretations were derived using thematic analysis.ResultsCondoms generally carried a lot of stigma and were perceived for use primarily in extramarital affairs and pregnancy control. HIV/AIDS was most feared due to its perceived socio-psychological or physical effects unlike other STIs described as “non-threatening” due to wide availability of “quality” treatment in UK. Notions of trust, the purpose of relationships, symptom recognition and partner selection greatly influenced decisions to undertake consistent condom use.ConclusionsThe socio-cultural understanding of STIs, sex, trust and relationships are symbolic in influencing consistent condom use among Ugandans. This indicates a need to acknowledge community beliefs and values about sexual health and design messages about STIs and condoms that would help eliminate these serious condom-related misconceptions.     

Knowledge,attitudes & barriers to condom use among female sex workers and truck drivers in Uganda: a mixed-methods study

Background

There is limited documentation on knowledge, attitudes and barriers to condom use among female sex workers (FSWs) and truck drivers (truckers).

Objective

To explore knowledge, attitudes and barriers to condom use among FSWs and truckers operating along major transport corridors in Uganda

Methods

Structured questionnaires were administered to explore FSWs'' and truckers'' knowledge of and attitudes towards condom use among 259 FSWs and 261 truckers. Qualitative data were collected on barriers to condom use using focus group discussions. Quantitative data were analyzed using SPSS while qualitative data were audio-recorded, transcribed and thematically analyzed.

Results

Condom knowledge was high with 97% of FSWs and 95% of truckers agreeing with the statement, “using condoms properly and consistently reduces risk of HIV infection”. Attitudes towards condom use were generally favorable with 91% of FSWs and 82% of truckers agreeing with the statement, “condom use is the best method of HIV prevention”. Qualitative findings show that poverty, refusal to use condoms by male partners, alcohol use before sex and beliefs that condoms ‘kill the mood for sex’ remain key barriers to consistent condom use.

Conclusions

Consistent condom use among FSWs and truckers is still hampered by economic and relationship factors.     

Characteristics of African-Americans with multiple risk factors associated with HIV/AIDS

Multiple risk factors in young African-Americans have tremendous implications for the spread of AIDS. Two hundred forty-two heterosexual college students were classified as having low, moderate, or high risk for HIV infection based upon their self-reported sexual practices. Results indicated that subjects differed in AIDS knowledge and attitudes toward condoms with respect to both Gender and Risk level, with men and High Risk individuals being less knowledgeable and having more negative attitudes than their female and Low Risk counterparts respectively. Interaction effects revealed that High Risk men were less knowledgeable than both Low Risk men and High Risk women. High Risk men as well as High and Low Risk women reported more anger surrounding condom usage than Low Risk men. Low perceptions of vulnerability for AIDS were reflected in the entire sample. The implications of this study for primary prevention and future research are discussed.     

Increasing condom use without reducing HIV risk: results of a controlled community trial in Uganda

BACKGROUND: Although consistent condom use is effective in reducing individual risk for HIV infection, the public health impact of condom promotion in a generalized epidemic is less clear. We assess the change in condom uptake and number of sex partners after a condom promotion trial in Kampala, Uganda. METHODS: Two similar poor urban communities near Kampala were randomized. One received a condom promotion program that taught condom technical use skills in workshops for men aged 18 to 30 years (n = 297) and encouraged condom use. Men in the control community (n = 201) received a brief informational presentation about AIDS. Participants received coupons redeemable for free condoms from distributors in both communities and completed questionnaires at baseline and 6 months later. RESULTS: Six-month follow-up was completed for 213 men (71.7%) in the intervention group and for 165 (82.1%) men in the control group. Men in the intervention group redeemed significantly more condom coupons than men in the control group (on average, 110 vs. 13 each; P = 0.002). Men in the intervention group increased their number of sex partners by 0.31 compared with a decrease of 0.17 partners in the control group (P = 0.004). Other measures did not support a net reduction in sexual risk in the intervention community compared with the control community and, in fact, showed trends in the opposite direction. CONCLUSIONS: In this study, gains in condom use seem to have been offset by increases in the number of sex partners. Prevention interventions in generalized epidemics need to promote all aspects of sexual risk reduction to slow HIV transmission.     

The dilemma of safe sex and having children: challenges facing HIV sero-discordant couples in Uganda

Background

Sixty percent of new HIV infections in Uganda occur in stable relationships between HIV discordant couples. Given the importance of fertility in Uganda, we hypothesized that unsafe sexual practices may be used to found a family/replace a dead child. Thus, we explored sexual practices to understand to what extent these are influenced by the desire to have children and the implications for HIV transmission among discordant couples.

Methods

A cross-sectional survey of 114 HIV discordant couples in Kampala, and in-depth interviews with 15 purposively selected couples. Quantitative data were analysed using STATA. Multivariate logistic regression analysis done to identify factors associated with consistent condom use. Thematic content analysis of qualitative data was done using NVIVO 2.

Results

Participants wanting children and those with multiple sexual partners were less likely to use condoms (Adj OR 0.51, and 0.36 respectively). Three of the five types of sexual practices used by couples do not allow pregnancy to occur. Main reasons for wanting a child included: ensuring lineage continuity and posterity, securing relationships and pressure from relatives to reproduce. Challenges included: risk of HIV transmission to partner and child, lack of negotiating power for safer sex, failure of health systems to offer safe methods of reproduction

Conclusions

HIV sero-discordant couples with strong desire for childbearing have a dilemma of risking HIV infection or infecting their spouse. Some risk transmission of HIV infection to reproduce. We need to address gender issues, risky behaviour and reproductive health services for HIV sero-discordant couples.     

广州市越秀区居民安全套使用情况及影响因素分析

目的了解广州市越秀区居民安全套使用情况及影响因素。方法通过问卷的方法,对越秀区6个社区居民进行艾滋病知识、态度以及安全套使用情况的调查,采用χ2检验、Logistic回归进行统计学分析。结果居民每次或经常使用安全套的比例为60.3%。多因素结果提示,女性和已婚者每次或经常使用安全套的比例低于男性和未婚者,其OR为0.53和0.32。艾滋病知识得分高和支持“合法、安全的性行为可预防控制艾滋病”者每次或经常使用安全套比例高于得分低和不支持者,其OR为1.81和2.08。结论艾滋病知识知晓情况和防治态度对居民安全套使用的影响比较大,应继续加强艾滋病知识的宣传教育,提高居民对艾滋病的认识。     

Impact of trisomy on fertility and meiosis in male mice

BACKGROUND: Chromosomal abnormalities frequently are associated with impairment or arrest of spermatogenesis in mammals but are compatible with fertility in female carriers of the same anomaly. In the case of trisomy, mice have extra genomic DNA as well as the chromosomal abnormality, usually present as an extra, unpaired chromosome. Thus, impairment of spermatogenesis in trisomic males could be due to the presence of extra genomic material (i.e. triplicated genes) or due to the chromosomal abnormality and presence of an unpaired chromosome in meiosis. METHODS: In this study, fertility and chromosomal pairing configurations during meiotic prophase were analysed in male mice trisomic for different segments of the genome. Four have an extra segmental or tertiary trisomic chromosome--Ts(17(16))65Dn, Ts(10(16))232Dn, Ts(12(17))4Rk and Ts(4(17))2Lws--and one has the triplicated segment attached to another chromosome--Ts(16C-tel)1Cje. Ts(17(16))65Dn and Ts(16C-tel)1Cje have similar gene content triplication and differ primarily in whether the extra DNA is in an extra chromosome or not. RESULTS: The presence of an intact extra chromosome, rather than trisomy per se, is associated with male sterility. Additionally, sterility is correlated with a high frequency of association of the unpaired chromosome with the XY body, which contains the largely unpaired X and Y chromosomes. CONCLUSIONS: Intact extra chromosomes disrupt spermatogenesis, and unpaired chromosomes establish a unique chromatin territory within meiotic nuclei.     

Predictors of condom use in the prevention of HIV/AIDS in South Africa

The HIV epidemic is well established in South Africa. Approximately 2.4 million people are already infected, and more than 700 new infections occur every day. To date the application of economics to the problem of HIV/AIDS in South Africa has tended to focus on the economic impact of the consequences of the condition, costing and cost effectiveness analysis of clinical and community-based strategies for care. There has been no attempt to model individual sexual behaviour and hence understand the factors which influence individual behavior. The objectives of this study are threefold. First, to identify the factors that are important in individuals' decisions to use condoms during sexual intercourse in order to prevent HIV/AIDS infection. Second, to estimate the effects of respondents' personal characteristics and service specific attributes on individuals' decisions to use condoms. Lastly, to explore the policy implications of the analysis. A logistic regression model is used to analyse empirically the determinants of the choice to use condoms using micro-level data from the 1994 South African National Household Survey of Health Inequalities. The respondents' race, gender, marital status, smoking status, beer drinking status, income, price at the facility normally visited, travel time to the source of condoms, self-assessed health status and knowledge that condoms offer contraception benefits were found to be highly significant predictors of demand for condoms. There is a need for developmental programmes aimed at raising incomes and access to modern health care services for the South Africans who were discriminated against during the apartheid era.     

Facilitory effects of male urine on feminine behavior in the male rat: Androgen-dependency

Feminine behavior in the male rat can be enhanced by exposing ORCH animals primed with estradiol benzoate and progesterone to the odor of urine collected from intact male adult congeners [20]. The present study provides evidence that this pheromonal effect is androgen dependent. A higher proportion of ORCH feminized rats displayed lordosis behavior following exposure to the odor of urine for either intact male rats or from ORCH rats supplemented with testosterone propionate than did ORCH feminized rats exposed to the odor of urine originating from non injected ORCH males.     

Lymphedematous fibroepithelial polyps of the glans penis and prepuce: a clinicopathologic study of 7 cases demonstrating a strong association with chronic condom catheter use

This report describes an underrecognized entity of the penis that is associated with chronic condom catheter use and phimosis. Our study group consisted of 7 patients who presented with polypoid or cauliflower-like masses that involved the glans penis or prepuce and that ranged in size from 2 to 7.5 cm in greatest dimension (median size, 2.5 cm). The majority of lesions affected the ventral surface of the glans, near the urethral meatus. The patients ranged in age from 25 to 58 years (median age, 40 years) at the time of initial surgical resection. The preoperative duration of the lesions ranged from 6 months to 10 years. Five patients had a history of long-term condom catheter use (duration: 5 to 21 years), and 1 patient had paraphimosis. The background history for 1 patient is unknown. Histologically, all specimens had a polypoid configuration and a keratinizing squamous epithelial surface. The underlying stroma was notably edematous, and there was vascular dilation of preexisting vessels, and in many instances, a focal mild small vessel proliferation. The stroma had mildly to moderately increased cellularity with mononucleated and multinucleated mesenchymal cells. A mild inflammatory infiltrate was often present. Two cases were examined with immunohistochemistry, and the stromal cells had limited immunoreactivity for muscle-specific actin, alpha-smooth muscle actin, and desmin and had no reactivity for S100 protein or CD34. Surgical intervention was local in all instances. Follow-up information was available for 5 of the 7 patients (71%), with a mean follow-up interval of 11 years 4 months. Two patients developed a local recurrence of the process at intervals of less than 1 years and 3 years 7 months. Both recurrent lesions were also managed by local excision.