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Mgwaba MT, Maharaj P. Barriers to condom use in casual sexual relationships known as ukujola in KwaZulu-Natal, South Africa. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2021; 20:192-203. [PMID: 34490834 DOI: 10.2989/16085906.2021.1951310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
South Africa has the largest number of people living with HIV in the world. Of the nine provinces in South Africa, KwaZulu-Natal is the worst affected. HIV is largely transmitted through unprotected penetrative sexual intercourse. Male latex condoms are central to HIV prevention because of their effectiveness in preventing HIV transmission in almost all sexual encounters if used consistently and correctly. There are, however, various barriers to condom use. This study sought to unpack barriers to condom use in the context of ukujola (casual or informal sexual relationships) in a South African, isiZulu-speaking community. A generic qualitative approach was used, drawing on a range of methods - four focus groups and twenty in-depth interviews. The study was conducted exclusively with isiZulu-speaking African participants, aged 21-34 years, from the uMgungundlovu district in KwaZulu-Natal, South Africa. Ukujola relationships encompass all casual relationships, i.e. those in which there has never been involvement of the families. The involvement of families in negotiating ilobolo (bride wealth) is a prerequisite for legitimate relationships, particularly marriage. Multiple concurrent sexual partnerships typically exist in ukujola relationships, and unprotected sex is common. The interviews suggest the existence of various barriers to condom use, including lack of trust, sexual pleasure and alcohol. There is a need for increased HIV prevention campaigns with particular emphasis on consistent condom use.
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Affiliation(s)
- Mbongeleni Thembalihle Mgwaba
- Development Studies, School of Built Environment and Development Studies University of KwaZulu-Natal, Durban, South Africa
| | - Pranitha Maharaj
- Development Studies, School of Built Environment and Development Studies University of KwaZulu-Natal, Durban, South Africa
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Knights N, Stone N, Nadarzynski T, Brown K, Newby K, Graham CA. Feasibility study of the Home-based Exercises for Responsible Sex (HERS) intervention to promote correct and consistent condom use among young women. Pilot Feasibility Stud 2021; 7:145. [PMID: 34311784 PMCID: PMC8314454 DOI: 10.1186/s40814-021-00885-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background Male condoms are effective in preventing common sexually transmitted infections (STIs) and unintended pregnancy, if used correctly and consistently. However, condom use errors and problems are common and young people report negative experiences, such as reduced pleasure. The Kinsey Institute Home-Based Exercises for Responsible Sex (KIHERS) is a novel condom promotion intervention for young women, which aims to reduce condom errors and problems, increase self-efficacy and improve attitudes towards condoms, using a pleasure-focussed approach. The study objective was to test the operability, viability and acceptability of an adapted version of the KIHERS intervention with young women aged 16–25 years in the United Kingdom (UK) (Home-Based Exercises for Responsible Sex-UK (HERS-UK). Methods A repeated-measures single-arm design was used, with a baseline (T1) and two follow-up assessments (T2 and T3), conducted 4 weeks and 8 weeks post intervention over a 3-month period. Participants were provided a condom kit containing different condoms and lubricants and were asked to experiment with condoms alone using a dildo and/or with a sexual partner. Ten process evaluation interviews were conducted post intervention. Results Fifty-five young women received the intervention; 36 (65%) completed T2 and 33 (60%) completed T3. Condom use errors and problems decreased, self-efficacy increased and attitudes towards condoms improved significantly. The proportion of participants who reported using a condom for intercourse in the past 4 weeks increased from T1 (20; 47%) to T2 (27; 87%) and T3 (23; 77%) and using lubricant with a condom for intercourse increased from T1 (6; 30%) to T2 (13; 48%)) and T3 (16; 70%). However, motivation to use condoms did not change. Cronbach’s alpha scores indicated good internal consistency of measures used. Qualitative data provided strong evidence for the acceptability of the intervention. Conclusions HERS-UK was implemented as intended and the recruitment strategy was successful within a college/university setting. This feasibility study provided an early indication of the potential effectiveness and acceptability of the intervention, and the benefits of using a pleasure-focussed approach with young women. Measures used captured change in outcome variables and were deemed fit for purpose. Future research should explore cost-effectiveness of this intervention, in a large-scale controlled trial using a diverse sample and targeting young women most at risk of STIs. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00885-1.
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Affiliation(s)
- Nicola Knights
- Centre for Sexual Health Research, Department of Psychology, University of Southampton, Southampton, UK
| | - Nicole Stone
- Centre for Sexual Health Research, Department of Psychology, University of Southampton, Southampton, UK
| | - Tom Nadarzynski
- School of Social Sciences, University of Westminster, London, UK
| | - Katherine Brown
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Katie Newby
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Cynthia A Graham
- Centre for Sexual Health Research, Department of Psychology, University of Southampton, Southampton, UK.
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Katz J, Sutherland MA. College Women's Experiences of Male Partner Contraceptive Interference: Associations With Intimate Partner Violence and Contraceptive Outcomes. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:4350-4374. [PMID: 29294796 DOI: 10.1177/0886260517715600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Many young adult women experience interpersonal barriers to protecting their sexual health. The focus of the current study was on contraceptive interference (CI), defined as partner behaviors that prevent effective contraception use before or during sex. We investigated whether CI tends to co-occur with intimate partner violence (IPV) and whether past CI is negatively associated with women's contraceptive outcomes. We also investigated perceived reasons for partner CI. Data were collected from sexually active female undergraduates (N = 146) who had ended a (hetero)sexual relationship lasting at least 1 month. Participants provided self-report data on past relationships with male "target" partners who either did or did not enact CI, IPV within the same relationship, contraceptive use at last sex (with most recent partner), and condom negotiation efficacy (on day of study). About 25% of the sample reported past CI. Results revealed positive associations between target partner CI and psychological abuse, severe physical assault, and attempted or completed sexual assault by that same partner. Past CI was negatively associated with condom negotiation self-efficacy but not contraceptive use at last sex. All women perceived that CI was motivated by an intent to promote his pleasure, and only a few women perceived that CI was motivated by an intent to promote pregnancy. These results suggest that women's experiences of CI reflect broader disempowerment within the dyadic context. Furthermore, these results suggest that research on CI behaviors as well as intentions underlying these behaviors will improve our understanding of how and why IPV affects women's reproductive and sexual health.
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Sarigül F, Sayan M, İnan D, Deveci A, Ceran N, Çelen MK, Çağatay A, Özdemir HÖ, Kuşcu F, Karagöz G, Heper Y, Karabay O, Dokuzoğuz B, Kaya S, Erben N, Karaoğlan İ, Ersöz GM, Günal Ö, Hatipoğlu Ç, Kutlu SS, Akbulut A, Saba R, Şener A, Büyüktuna SA. Current status of HIV/AIDS-syphilis co-infections: a retrospective multicentre study. Cent Eur J Public Health 2019; 27:223-228. [PMID: 31580558 DOI: 10.21101/cejph.a5467] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/22/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. METHODS A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. RESULTS Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+ ≤ 350 mm3 reached 46%, 17% of the patients received antiretroviral therapy and neurosyphilis association reached 9%. CONCLUSION Although HIV/AIDS-syphilis co-infection status appeared high in heterosexuals, MSM had a moderate level increase in cases. Our results suggested syphilis co-infection in HIV/AIDS cases should be integral part of monitoring in a national sexual transmitted diseases surveillance system. However, our data may provide base for HIV/syphilis prevention and treatment efforts in the future.
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Affiliation(s)
- Figen Sarigül
- Infectious Disease and Clinical Microbiology Department, Antalya and Research Hospital, Health Sciences University, Antalya, Turkey
| | - Murat Sayan
- PCR Unit, Clinical Laboratory, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.,Research Centre of Experiment Health Sciences, Near East University, Nicosia, Northern Cyprus
| | - Dilara İnan
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Aydin Deveci
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Samsun 19 Mayis University, Samsun, Turkey
| | - Nurgül Ceran
- Infectious Disease and Clinical Microbiology Department, Istanbul Haydarpasa Numune Education and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Mustafa Kemal Çelen
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Diyarbakir University, Diyarbakir, Turkey
| | - Atahan Çağatay
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hülya Özkan Özdemir
- Infectious Disease and Clinical Microbiology Department, Bozyaka Education and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Ferit Kuşcu
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Gül Karagöz
- Infectious Disease and Clinical Microbiology Department, Istanbul Umraniye Education and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Yasemin Heper
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Bursa University, Bursa, Turkey
| | - Oğuz Karabay
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Başak Dokuzoğuz
- Infectious Disease and Clinical Microbiology Department, Ankara Numune Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Selçuk Kaya
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Nurettin Erben
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Eskisehir University, Eskisehir, Turkey
| | - İlkay Karaoğlan
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Gülden Munis Ersöz
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Özgür Günal
- Infectious Disease and Clinical Microbiology Department, Samsun Education and Research Hospital, Health Sciences University, Samsun, Turkey
| | - Çiğdem Hatipoğlu
- Infectious Disease and Clinical Microbiology Department, Ankara Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Selda Sayin Kutlu
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ayhan Akbulut
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Rabin Saba
- Infectious Disease and Clinical Microbiology Department, Private Medstar Antalya Hospital, Antalya, Turkey
| | - Alper Şener
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Onsekiz Mart University, Canakkale, Turkey
| | - Seyit Ali Büyüktuna
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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Evaluation of the Condom Barriers Scale for Young Black Men Who Have Sex With Men: Reliability and Validity of 3 Subscales. Sex Transm Dis 2017; 44:91-95. [PMID: 28081044 DOI: 10.1097/olq.0000000000000562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reliable and valid scale measures of barriers to condom use are not available for young black men who have sex with men (YBMSM). The purpose of this study was to evaluate the Condom Barriers Scales for application with YBMSM. METHODS A clinic-based sample of 600 YBMSM completed a computer-assisted self-interview. The primary measure was a 14-item abbreviated version of the Condom Barriers Scale. Reliability and criterion validity were assessed. RESULTS All 3 subscales were reliable: partner-related barriers (Cronbach α=0.73), sensation-related barriers (α=0.70), and motivation-related barriers (α =0.81). A complete absence of barriers was common: 47.0% (partner-related), 30.7% (sensation-related), and 46.5% (motivation-related). Dichotomized subscales were significantly associated with reporting any condomless insertive anal sex (all Ps < 0.001) and any condomless receptive anal sex (all Ps < 0.001). The subscales were significantly associated with these measures of condomless sex preserved at a continuous level (all Ps <0.001, except for sensation barriers associated with condomless receptive anal sex = 0.03). Further, the subscales were significantly associated with reporting any condom use problems (all Ps <0.001) and a measure of condomless oral sex (all Ps <0.001, except for partner-related barriers=0.31). Finally, the sensation-related barriers subscale was significantly associated with testing positive for Chlamydia and/or gonorrhea (P=0.049). CONCLUSIONS The 3 identified subscales yielded adequate reliability and strong evidence of validity, thereby suggesting the utility of these brief measures for use in observational and experimental research with YBMSM.
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Psychometric Properties of the Condom Use Barriers Scale for Adolescents. SPANISH JOURNAL OF PSYCHOLOGY 2017; 20:E73. [DOI: 10.1017/sjp.2017.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractInconsistent condom use in young people is related to the perceived barriers to their use. The psychometric properties and factor structure of the new Condom Use Barriers Scale for Adolescents (CUBS-A) are analyzed. Concurrent validity was assessed by the Attitude towards condom use subscale of the validated HIV-AS test and the percentage of condom use variable. A total of 629 Spanish adolescents whose mean age was 15.17 (SD = 1.09; 51.5% boys) participated. Exploratory factor analysis supported a 15–item instrument with four factors: negotiation skills, perceived feelings, negative aspects of condoms, and disruption of the sexual experience, which explained 41.89% of the total variance (KMO = .84; χ2 = 1071.93; p < .001). The results show high internal consistency (α = .86) and a good fit of the data to the model (NNFI = .93; CFI = .95; IFI = .95; RMSEA = .04). Its total score and most of its factors show acceptable correlation with the percentage of condom use, values that support the criterial validity (p ≤ .05). Gender differences were found in most subscales (p ≤ .001). The CUBS-A is a valid and reliable new instrument for assessing perceived barriers in adolescents for using condoms to protect themselves during sexual intercourse.
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Lejelind E, Westerling R, Sjögren Fugl-Meyer K, Larsson K. Condom use among Swedes while traveling internationally: A qualitative descriptive study. Nurs Health Sci 2017; 19:257-263. [PMID: 28371120 DOI: 10.1111/nhs.12341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/15/2016] [Accepted: 01/21/2017] [Indexed: 11/29/2022]
Abstract
This study explores factors influencing condom use among Swedish women and men who visited a sexual health clinic after unprotected sex during international travel. Semi-structured interviews were conducted with 25 women and 25 men. The data were analyzed using conventional content analysis. The informants' narratives were categorized as strategies and barriers. Strategies found were: risk assessment, testing, and treatment for sexually transmitted infections. The barriers were characterized as technical and personal or emotional. The findings indicate that sexual behavior may be different while traveling internationally, and that a release of social constraints and increased alcohol consumption were risk factors for practicing unprotected sex. Some of the strategies may be appropriate for the prevention of sexually transmitted infections, but several strategies and most barriers were used to explain why unprotected sex was practiced. Thus, people need the opportunity to reconsider strategies and strengthen confidence in their ability to use condoms. An individual-based approach employed within routine health care may support the practice of safer sex and prevent further transmission of sexually transmitted infections.
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Affiliation(s)
- Eva Lejelind
- Department of Dermatology and Venereology, Uppsala University Hospital, Uppsala, Sweden
| | - Ragnar Westerling
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Kerstin Sjögren Fugl-Meyer
- Department of Neurology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Department of Social Work, Karolinska University Hospital, Stockholm, Sweden
| | - Kjerstin Larsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Neurology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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Nelson DB, Lepore SJ, Mastrogiannis DS. Childhood Sexual Violence and Consistent, Effective Contraception Use among Young, Sexually Active Urban Women. Behav Sci (Basel) 2015; 5:230-46. [PMID: 26010318 PMCID: PMC4493446 DOI: 10.3390/bs5020230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/13/2015] [Indexed: 11/16/2022] Open
Abstract
Unintended pregnancy (UP) is a significant public health problem. The consistent use of effective contraception is the primary method to prevent UP. We examined the role of childhood sexual and physical violence and current interpersonal violence on the risk of unintended pregnancy among young, urban, sexually active women. In particular, we were interested in examining the role of childhood violence and interpersonal violence while recognizing the psychological correlates of experiencing violence (i.e., high depressive symptoms and low self-esteem) and consistent use of contraception. For this assessment, 315 sexually active women living in Philadelphia PA were recruited from family planning clinics in 2013. A self-administered, computer-assisted interview was used to collect data on method of contraception use in the past month, consistency of use, experiences with violence, levels of depressive symptoms, self-esteem and sexual self-efficacy, substance use and health services utilization. Fifty percent of young sexually active women reported inconsistent or no contraception use in the past month. Inconsistent users were significantly more likely to report at least one prior episode of childhood sexual violence and were significantly less likely to have received a prescription for contraception from a health care provider. Inconsistent contraception users also reported significantly higher levels of depressive symptoms and significantly lower levels of self-esteem. The relation between childhood sexual violence and UP remained unchanged in the multivariate models adjusting for self-esteem or depressive symptoms. These findings highlight the long-term consequences of childhood sexual violence, independent of current depressive symptoms and low self-esteem, on consistent use of contraception.
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Affiliation(s)
- Deborah B Nelson
- Temple University College of Public Health 1301 Cecil B. Moore Avenue Ritter Annex Room 905, Philadelphia, PA 19122, USA.
| | - Stephen J Lepore
- Temple University College of Public Health 1301 Cecil B. Moore Avenue Ritter Annex Room 957, Philadelphia, PA 19122, USA
| | - Dimitrios S Mastrogiannis
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, 820 South Wood Street, M/C 808 Chicago, IL 60612, USA
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