Reducing HIV/AIDS transmission among African-American females: is the female condom a solution?
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Rates of HIV/AIDS have increased at an alarming rate among minority women, especially African-American women. Suggestions that have been presented to decrease HIV/AIDS transmission among African-American women include promoting abstinence and the use of the male condom. Little recognition and support have been given for promoting the female condom as a viable solution to combating the HIV/AIDS epidemic. (+info)
Can a comprehensive voucher programme prompt changes in doctors' knowledge, attitudes and practices related to sexual and reproductive health care for adolescents? A case study from Latin America.
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OBJECTIVES: To evaluate whether participation in a competitive voucher programme designed to improve access to and quality of sexual and reproductive health care (SRH-care), prompted changes in doctors' knowledge, attitudes and practices. METHODS: The voucher programme provided free access to SRH-care for adolescents. Doctors received training and guidelines on how to deal with adolescents, a treatment protocol, and financial incentives for each adolescent attended. To evaluate the impact of the intervention on doctors, nearly all participating doctors (n = 37) were interviewed before the intervention and 23 were interviewed after the intervention. Answers were grouped in subthemes and scores compared using nonparametric methods. RESULTS: The initial interviews disclosed deficiencies in doctors' knowledge, attitudes and practices relating to adolescent SRH-issues. Gender and age of the doctor were not associated with the initial scores. Comparing scores from before and after the intervention revealed significant increases in doctors' knowledge of contraceptives (P = 0.003) and sexually transmittable infections (P < 0.001); barriers to contraceptive use significantly diminished (P < 0.001 and P = 0.003); and some attitudinal changes were observed (0 = 0.046 and P = 0.11). Doctors became more aware of the need to improve their communication skills and were positive about the programme. CONCLUSIONS: This study confirmed provider related barriers that adolescents in Nicaragua may face and reinforces the importance of focusing on the quality of care and strengthening doctors' training. Participation in the voucher programme resulted in increased knowledge, improved practices and, to a lesser extent, in changed attitudes. A competitive voucher programme with technical support for the participating doctors can be a promising strategy to prompt change. (+info)
The promises and limitations of female-initiated methods of HIV/STI protection.
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New methods are now available, and others are being developed, that could enable women to take the initiative in preventing sexually transmitted infections. However, attempts to capitalize on "female-controlled" preventive methods thus far have met with limited success. Female-initiated methods were introduced to intervene in the state of gender relations and assist women who are disempowered vis-a-vis their male partners. Paradoxically, however, we underscore that it is the very structure of regional and local gender relations that shapes the acceptability (or lack of acceptability) of these methods. This paper specifically addresses how the structure of gender relations-for better and for worse-shapes the promises and limitations of widespread use and acceptance of female-initiated methods. We draw on examples from around the world to underscore how the regional specificities of gender (in)equality shape the acceptance, negotiation, and use of these methods. Simultaneously, we demonstrate how the introduction and sustained use of methods are shaped by gender relations and offer possibilities for reinforcing or challenging their current state. Based on our analyses, we offer key policy and programmatic recommendations to increase promotion and effective use of women-initiated HIV/STI protection methods for both women and men. (+info)
Influencing sexual practices among HIV-positive Zambian women.
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This study assessed and compared the efficacy of culturally tailored behavioral interventions to increase use and acceptability of sexual barrier products among HIV-positive women in Zambia. It also sought to evaluate cultural preferences as facilitators or impediments to potential use of vaginal chemical barriers for sexual risk reduction within the Zambian context. Women (N=240), recruited from the University Teaching Hospital HIV Voluntary Counseling and Testing Center, were randomized into group or individual intervention arms. Participants attended a baseline assessment, three intervention sessions and follow up assessments at six and 12 months. All participants increased use and acceptability of female condoms and vaginal products and maintained male condom use at six and 12 months. Preliminary data indicated that group participants increased male condom use at six months and trial use and acceptability of female condoms and lubricants predicted their use in the group condition. Results support group interventions to increase sexual barrier use and acceptability in HIV-positive women within the Zambian context. From a public health standpoint, groups may represent a cost-effective and culturally congruent intervention. (+info)
A prospective study assessing the effects of introducing the female condom in a sex worker population in Mombasa, Kenya.
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OBJECTIVE: To assess the impact and costs of adding female condoms to a male condom promotion and distribution peer education programme for sex workers in Mombasa, Kenya. DESIGN: A 12 month, prospective study of 210 female sex workers. METHODS: We interviewed participants about their sexual behaviour every 2 months for a total of seven times and introduced female condoms after the third interview. We also collected cost data and calculated the cost and cost effectiveness of adding the female condom component to the existing programme. RESULTS: Introduction of the female condom in an HIV/AIDS prevention project targeting sex workers led to small, but significant, increases in consistent condom use with all sexual partners. However, there was a high degree of substitution of the female condom for male condoms. The cost per additional consistent condom user at a programme level is estimated to be 2160 dollars (1169 pounds sterling, 1711 euros) (95% CI: 1338 to 11 179). CONCLUSIONS: The female condom has some potential for reducing unprotected sex among sex workers. However, given its high cost, and the marginal improvements seen here, governments should limit promotion of the female condom in populations that are already successfully using the male condom. More research is needed to identify effective methods of encouraging sex workers to practise safer sex with their boyfriends. (+info)
Efficacy of the male latex condom and of the female polyurethane condom as barriers to semen during intercourse: a randomized clinical trial.
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In this 2000-2001 study, the authors compared the effectiveness of the male latex condom and the female polyurethane condom by assessing frequency and types of mechanical failure and by evaluating semen exposure during use. Eligible women from Birmingham, Alabama, were randomly assigned to begin the study with 10 male condoms and then switch to 10 female condoms (n = 55), or vice versa (n = 53), and were trained to use both types. Data collection included questionnaires for each condom use and measurement of prostate-specific antigen in specimens of vaginal fluid taken before and after intercourse. Participants returned 700 male condoms and 678 female condoms, and they reported mechanical problems for 9% and 34%, respectively. Moderate-high postcoital prostate-specific antigen levels (> or = 22 ng/ml) were detected in 3.5% of male condom uses and 4.5% of female condom uses (difference = 1%, 95% confidence interval: -1.6, 3.7). Moderate-high prostate-specific antigen values (> or = 22 ng/ml) were more frequent with mechanical problems (male condom, 9.6%; female condom, 9.4%) but less frequent with other problems (3.0% and 0.9%) or correct use with no problems (2.7% and 2.5%). This study indicates that although mechanical problems are more common with the female condom than with the male condom, these devices may involve a similar risk of semen exposure. Objectively assessed semen exposure is associated with self-reported mechanical problems. (+info)
Randomised controlled trial of alternative male and female condom promotion strategies targeting sex workers in Madagascar.
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OBJECTIVES: To assess whether individual clinic-based counselling as a supplement to peer education for male and female condom promotion leads to greater use of protection and lower STI prevalence among sex workers in Madagascar already exposed to intensive male condom promotion. METHODS: In two public dispensaries in Madagascar, a total of 901 sex workers were randomly allocated between two alternative male and female condom promotion INTERVENTIONS: peer education only, or peer education supplemented with individual clinic-based counselling. Participants were followed for 12 months. Every 2 months they made clinic visits, where they were interviewed on condom use. Peer educators counselled all participants on condom use as they accompanied their assigned participants to study visits. Participants assigned to receive the supplemental intervention were counselled by a trained clinician following study interviews. Participants were tested and treated for chlamydia, gonorrhoea and trichomoniasis every 6 months. We used logistic regression to assess whether the more intensive intervention was associated with reduced STI prevalence. Use of protection with clients and non-paying partners was assessed by study arm, site, and visit. RESULTS: There was no statistically significant association between study arm and aggregated STI prevalence. No substantial differences in levels of reported protection were noted between study groups. CONCLUSIONS: This study found little evidence for gains from more thorough clinical counselling on male and female condom use. These findings suggest that less clinically intensive interventions such as peer education could be suitable for male and female condom promotion in populations already exposed to barrier method promotion. (+info)
Acceptability of hypothetical microbicides among women in sex establishments in rural areas in Southern China.
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OBJECTIVES AND GOAL: The objectives of this study were to measure the potential acceptability of a hypothetical microbicide among women in sex establishments in rural areas of Southern China and demographic, behavioral, and social context factors likely to affect microbicide acceptability. STUDY DESIGN: This was a cross-sectional survey, using a quota sampling, among 300 women from sex establishments in 3 rural towns. An interviewer-administered standardized questionnaire was used to measure the acceptability score of hypothetical microbicides' characteristics, as well as sexual relationships and behaviors and other contextual factors. RESULTS: Findings showed a generally positive response to microbicides, indicated by an acceptability index score of 2.89 (SD, 0.56, scale of 1-4) in the overall sample. Multivariate analysis shows that the acceptability score varied significantly by study sites, type of sex-work establishments, marital status, sex partner type, vaginal product experience, locus of control by partners, and locus of control by chance. CONCLUSIONS: Microbicides may be acceptable among sex workers in rural settings in China; however, contextual factors should be carefully considered in education and promotion of microbicides in the future. (+info)