Changes in the sexual health behaviours of New Zealand secondary school students, 2001–2012: findings from a national survey series

Objective : To describe trends in self‐reported sexual and reproductive health behaviours among New Zealand secondary school students. Methods : Nationally representative health and wellbeing surveys conducted in 2001 (n=9,699), 2007 (n=9,107) and 2012 (n=8,500) were analysed. Logistic regressions were used to explore variations in sexual health outcomes between 2001 and 2012. Results : ‘Ever had sex’ (?6.9%, p<0.001); ‘currently sexually active’ (? 2.3%, p<0.001); ‘always use condoms’ (?3.3%, p=0.006); ‘condoms at last sex’ (?7.0, p=0.002); ‘contraception at last sex’ (?5.8%, p<0.001) and sexually transmitted infections (?0.3%, p=0.001) have reduced over time. ‘Always use contraception’ did not change significantly (?1.4%, p=0.514) over time. Māori (OR 0.7), Pacific (OR 0.5) and socioeconomically deprived students (OR 0.7) less frequently used condoms. Māori (OR 0.6), Pacific (OR 0.4), Asian (OR 0.5), younger (OR 0.6), and socioeconomically deprived (OR 0.6) students less frequently used contraception. Conclusions : Students in 2012 were more likely to delay sexual activity, but were less likely to use condoms and contraception consistently, compared to students in 2001. Declining contraceptive use over an 11‐year period suggests that current strategies are inadequate, particularly for Māori, Pacific and socioeconomically deprived students. Appropriate and accessible sexual and reproductive health services are urgently required.     

High-risk adolescents and female condoms: knowledge, attitudes, and use patterns

Purpose: To explore data on high-risk male and female adolescents’ attitudes towards female condoms, compared with male condoms.

Methods: Exploratory survey research was utilized with a convenience sample of 65 high-risk adolescents at an emergency homeless shelter. A peer-led intervention was conducted and pre-test and post-test interviews explored barriers to female condom use. The intervention consisted of 15- to 30-minute small group sessions, discussing female condoms’ construction; purpose of the rings; efficacy preventing pregnancy and sexually transmitted infection (STIs); and how to lubricate, insert, and use. Content and Chi-square analyses were utilized.

Results: Sixty-three percent used male condoms as their primary contraceptive method; almost half (48%) said they always used male condoms, but 44% reported having sex without a male condom at least once in the 2 weeks prior to pre-test. Ninety-five percent had heard of the female condom, half ‘good’ and 24% ‘bad’ things, but only 15% had ever used one. At post-test all respondents gave reasons they might use female condoms in the future, and 77% gave reasons why they might not. Most (73%) adolescents said they would still prefer the male to the female condom. The major potential barriers to adolescents’ female condom use were not having female condoms available and/or females feeling uncomfortable inserting them.

Conclusions: Female condoms should be offered to adolescents as an additional choice rather than as replacements for male condoms. Further research is needed to assure access, availability, and comfort with female condoms and male participation in their use.     

Men's attitudes towards a potential vaginal microbicide in Zimbabwe, Mexico and the USA

Vaginal microbicides are being developed in an attempt to expand women's and men's options for protecting themselves against HIV and other sexually transmitted infections. Taking account of men's attitudes during product development and introduction could increase the likelihood that products are acceptable and used. To capture the perspectives of urban and rural men from a range of cultural settings, we conducted focus group discussions with taxi drivers and farmers in Zimbabwe, Mexico and the USA. These explored HIV/STD risk perception and prevention strategies, desirable characteristics of vaginal products and of a microbicide, and attitudes towards use of a potential product. Men were generally supportive of the idea of a microbicide; urban somewhat more than rural men. Most thought microbicides would be preferable to condoms though many raised concerns about potential side effects. The men wanted these products to be as inexpensive and readily available as condoms, and differed as to whether a woman should have permission from her partner to use it. For them to be widely used, the men thought these products must not only be safe and effective, but should also have no negative effect on sexual pleasure. When a product becomes available, introductory messages must explain the limits on its effectiveness and encourage use with condoms. Further research is needed on definitions of pleasurable sex and the ramifications of this for microbicide formulation, and on partner communication around issues of sexuality and prevention of infection.     

Sexually Transmitted Diseases: A Major Threat to Women’s Reproductive Health — Prevention of STDs and AIDS

Prevention of sexually transmitted diseases and AIDS includes not only providing information and promoting the use of condoms but it also involves dealing with the complex issues of attitudes, values, behaviours, and emotions relating to sexuality. Three levels of prevention are defined. Primary prevention aims at promoting individual and collective health in order to reduce the incidence of disease. At this level, Hepatitis B is the only sexually transmitted disease that can be prevented by a vaccine. Secondary prevention involves testing of people exposed to risks, treatment, and contact tracing in order to reduce the prevalence of a disease. Tertiary prevention is designed to reduce the complications and progression of a disease; it is costly and often disappointing. Some situations deserve special considerations: protection of a newborn requires that the pregnant woman be tested for Hepatitis B, Herpes siplex virus to detect primary infection, and HIV. Adolescent patients, street youth, people who have been sexually abused, and intravenous drug users should all receive appropriate counselling and close follow-up. Limits of prevention often appear greater than its successes but it is unavoidable and necessary part of the clinical process.     

A qualitative study of condom use among married couples in Kampala, Uganda

Twenty-five years into the HIV/AIDS epidemic, condom use among married/stable couples remains low and under-researched in developing countries, even countries with high HIV prevalence. Introducing condoms into a long-standing relationship, in spite of HIV risk, is likely to be awkward. We conducted a qualitative study in Kampala, Uganda, with 39 couples reporting 100% condom use in the previous three months. The women were recruited from among women in a clinical trial who were using condoms and whose partners also agreed to participate. Twenty-two of the women and six of the men reported having taken the initiative to suggest condom use; the remaining couples disagreed who raised the subject first. Women used insistence, refusal to have sex, persuasion, and condoms for family planning or to protect children, which helped to deflect distrust and get their partner to agree. Some men resisted initially but their reactions were often more positive than expected. Men's reasons for accepting condoms were to please their partner, protect her from HIV, protect their children, protect themselves and, in some cases, continue having other partners. Although condom use is a couple behaviour, an encouraging environment and condom availability are all crucial to increasing condom use by couples in settings like Uganda.     

Fruity, fun and safe: creating a youth condom brand in Indonesia

DKT Indonesia, a social marketing enterprise, undertook research among young people in Indonesia to develop a strategy to heighten understanding of safer sex and increase the availability and use of condoms among sexually active youth. The centerpiece of this campaign was the launch in 2003 of Fiesta condoms, with a range of flavours, colours, shapes and pricing aimed to appeal to young people. Working with key commercial and NGO partners, distribution has focused on places where young people often congregate and shop. The campaign relies heavily on the media, including TV commercials, radio talk shows, print media and mobile text messaging. DKT has also partnered with MTV, the Staying Alive campaign and other NGO and private sector partners to educate young people on a range of reproductive and sexual health issues. Based on retail audits and focus group discussions, the Fiesta brand has been a success. In three years, it has gained a 10% share of the condom market and helped to increase overall condom sales by 22%. Young people identify Fiesta as "their" brand and have started to use Fiesta condoms in significant numbers.     

Dual protection: more needed than practised or understood

Although non-barrier contraceptive use has become a global norm, unprotected sex in relation to sexually transmitted infections remains the norm almost everywhere. Dual protection is protection from unwanted pregnancy, HIV and other sexually transmitted infections, and is a form of safer sex for heterosexual couples that is more needed than practised or understood. This paper draws on a review of the literature in family planning, obstetrics and gynaecology, and AIDS-related journals from 1998 to early 2005. Definitions of dual protection, found mainly in family planning literature, are very narrow. Condoms remain the mainstay of dual protection, but the aim of this paper is to provide an expanded list of dual protection methods to show that there is a range of options. These include non-penetrative sex and the increasing use of condoms with the back-up of emergency contraception on the part of young people. The fact that people may fail to use dual protection consistently and correctly is not a valid reason not to promote it. It is never too late for those providing family planning and STI/HIV prevention services to start promoting condoms and dual protection. In the long-term, the development of highly efficacious and highly acceptable methods of dual protection is an urgent research priority, starting with a wider range of condoms that will appeal to more people.     

Unsafe condoms and other unsafe sex accessories

Condoms remain the sole effective method of prevention of HIV. However, in some places--including Cambodia and China--condoms have been modified to add so-called pearls, hard rubber studs or even bristles that are painful and dangerous to the receptive partner, causing injury to the vagina and anus. Such injuries contribute to the transmission of disease, so these condoms are not useful for prevention of STIs or HIV. In addition to unsafe condoms, accessories such as the "tiger's moustache" penis ring have bristles and are as dangerous in the same way as unsafe condoms. Public health officials have outlawed the sale of unsafe condoms in Thailand, a step that should be taken in all places where both they and other unsafe accessories are available.     

Pleasure and prevention: when good sex is safer sex

Most sexual health education programmes use fear and risk of disease to try to motivate people to practise safer sex. This gives the impression that safer sex and pleasurable sex are mutually exclusive. Yet there is growing evidence that promoting pleasure alongside safer sex messaging can increase the consistent use of condoms and other forms of safer sex. To this end, the Pleasure Project created The Global Mapping of Pleasure, a document that identifies projects and organisations worldwide that put pleasure first in HIV prevention and sexual health promotion, and sexually provocative media that include safer sex. This article summarises some of the findings of this mapping exercise and what we learned about incorporating pleasure from it. We found that there are a variety of organisations, including religious and youth groups, and HIV/AIDS organisations and NGOs, promoting pleasurable safer sex. The techniques they use include promoting sexual techniques and dialogue about sex, teaching married couples how to have better sex and putting images of desire in sexual education materials. This paper focuses on ways of eroticising female and male condoms as examples of effective ways of using pleasure in HIV prevention and sexual health promotion.     

浅析天然乳胶避孕套监管中的注意事项

天然乳胶避孕套冒牌贴牌多,监管部门多,监管难度大,本文详细阐述了避孕套监管的现状及加强监管的建议。