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Wiyeh AB, Mome RKB, Mahasha PW, Kongnyuy EJ, Wiysonge CS. Effectiveness of the female condom in preventing HIV and sexually transmitted infections: a systematic review and meta-analysis. BMC Public Health 2020; 20:319. [PMID: 32164652 PMCID: PMC7068875 DOI: 10.1186/s12889-020-8384-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/20/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The effectiveness of female condoms for preventing HIV and sexually transmitted infections (STIs) remains inconclusive. We examined the effects of female condoms on the acquisition of HIV and STIs. METHODS We searched four databases, two trial registries, and reference lists of relevant publications in October 2018 and updated our search in February 2020. We screened search output, evaluated study eligibility, and extracted data in duplicate; resolving differences through discussion. We calculated the effective sample size of cluster randomised trials using an intra-cluster correlation coefficient of 0·03. Data from similar studies were combined in a meta-analysis. We performed a non-inferiority analysis of new condoms relative to marketed ones using a non-inferiority margin of 3%. We assessed the certainty of evidence using GRADE. RESULTS We included fifteen studies of 6921 women. We found that polyurethane female condoms (FC1) plus male condoms may be as effective as male condoms only in reducing HIV acquisition (1 trial, n = 149 women, RR 0.07, 95%CI 0.00-1.38; low-certainty evidence). However, the use of FC1 plus male condoms is superior to male condoms alone in reducing the acquisition of gonorrhoea (2 trials, n = 790, RR 0.59, 95%CI 0.41-0.86; high-certainty evidence) and chlamydia (2 trials, n = 790, RR 0.67, 95%CI 0.47-0.94; high-certainty evidence). Adverse events and failure rates of FC1 were very low and decreased during follow up. Although the functionality of newer female condoms (Woman's, Cupid, Pheonurse, Velvet, and Reddy) may be non-inferior to FC2, there were no available studies assessing their efficacy in preventing HIV and STIs. CONCLUSION The use of female plus male condoms is more effective than use of male condoms only in preventing STIs and may be as effective as the male condom only in preventing HIV. There is a need for well conducted studies assessing the effects of newer female condoms on HIV and STIs. PROSPERO REGISTRATION NUMBER CRD42018090710.
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Affiliation(s)
- Alison B. Wiyeh
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington USA
| | - Ruth K. B. Mome
- Ottumwa Regional Health Center, 1001 Pennsylvania Avenue, Ottumwa, IA 52501 USA
| | - Phetole W. Mahasha
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Grants, Innovation and Product Development, South African Medical Research Council, Cape Town, South Africa
| | - Eugene J. Kongnyuy
- School of Global Health and Bioethics, Euclid University, Banjul, Gambia
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Carlos S, Lopez-Del Burgo C, Burgueño E, Martinez-Gonzalez MA, Osorio A, Ndarabu A, Passabosc C, de Irala J. Male condom use, multiple sexual partners and HIV: a prospective case-control study in Kinshasa (DRC). AIDS Care 2016; 29:772-781. [PMID: 27852108 DOI: 10.1080/09540121.2016.1258450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In the Democratic Republic of Congo no previous studies have assessed the factors associated with different patterns of condom use and with multiple sexual partners, and the association between condom use simultaneously taking into account multiple sexual partnerships, and HIV infection. We carried out a prospective case-control study. From December 2010 until June 2012, 1630 participants aged 15-49 getting HIV Voluntary Counseling and Testing in a hospital in Kinshasa were selected. Cases were new HIV diagnosis and controls were HIV-negative participants detected along the study period. We recruited 274 cases and 1340 controls that were interviewed about HIV-related knowledge, attitudes and behaviours. Among cases there was a high prevalence of multiple lifetime and concurrent sexual partnerships (89.8% and 20.4%, respectively) and most cases never used condoms with only 1.5% using them consistently. Condom use and multiple partnerships were associated with male, single and high-educated participants. An association was found between multiple lifetime partners and 'any condom use' (OR = 2.99; 95%CI: 2.14-4.19) but not with consistent use. Both having two or more multiple concurrent sexual partners or not using condoms were variables similarly and highly associated to HIV risk. The association found between having two or more concurrent sexual partners and HIV was slightly higher (OR = 3.58, 95%CI:2.31-5.56) than the association found between never condom use and HIV (OR = 3.38, 95%CI:1.15-9.93). We found a high prevalence of multiple lifetime sexual partners and an extremely high prevalence of inconsistent condom use, both strongly associated with HIV seropositivity. Local programmes would benefit from comprehensive interventions targeting all behavioural and sociocultural determinants.
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Affiliation(s)
- Silvia Carlos
- a Preventive Medicine and Public Health Department , University of Navarra , Pamplona , Spain.,b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality , University of Navarra , Pamplona Spain
| | - Cristina Lopez-Del Burgo
- a Preventive Medicine and Public Health Department , University of Navarra , Pamplona , Spain.,b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality , University of Navarra , Pamplona Spain
| | - Eduardo Burgueño
- d CEFA-Monkole , Kinshasa , Democratic Republic of the Congo.,e Department of Family Medicine and Primary Health Care , UPC - Protestant University in Congo, Kinshasa , Democratic Republic of the Congo
| | - Miguel Angel Martinez-Gonzalez
- a Preventive Medicine and Public Health Department , University of Navarra , Pamplona , Spain.,b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,f CIBER Fisiopatología de la Obesidad y Nutrición (CIBER obn), Spanish Government (ISCIII) , Madrid , Spain
| | - Alfonso Osorio
- b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality , University of Navarra , Pamplona Spain.,g School of Education and Psychology , University of Navarra , Pamplona , Spain
| | - Adolphe Ndarabu
- h Monkole Hospital , Kinshasa, Democratic Republic of the Congo
| | - Clément Passabosc
- i Department of Ophthalmology , Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - Jokin de Irala
- a Preventive Medicine and Public Health Department , University of Navarra , Pamplona , Spain.,b IdiSNA, Navarra Institute for Health Research , Pamplona , Spain.,c Institute for Culture and Society (ICS), Education of Affectivity and Human Sexuality , University of Navarra , Pamplona Spain
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Wang X, Liu M, Cheng Y. Acceptability of Phoenurse female condom and second-generation Femidom female condom in Chinese women. J Obstet Gynaecol Res 2016; 42:1567-1574. [PMID: 27444262 DOI: 10.1111/jog.13080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/07/2016] [Indexed: 11/30/2022]
Abstract
AIM To compare the acceptability of Phoenurse female condom (PFC) and second-generation Femidom female condom (FC2) among Chinese women. METHODS A randomized, cross-over clinical trial was carried out in women aged 20-49 years seeking family service in Qingdao, China, between April and October 2013. Women were classified into two groups using a computer-generated randomized sequence. Participants completed questionnaires at baseline and after using 10 of each type of female condom (FC). RESULTS Of 290 women, 247 (85.2%) believed that FC could protect against sexually transmitted diseases and HIV. A total of 152 (52.5%) thought that the female condom (FC) contraceptive failure rate was higher, and 107 (36.9%) thought that FC could be reused before they participated in this study. After the study, 135 (46.6%) and 39 women (13.4%) would have been happy to use FC2 and PFC, respectively. Significant difference was noted between PFC and FC2 for the features color, lubrication and overall fit, rather than length, appearance, smell and application method. A total of 68 (23.5%) and 140 women (49.5%) liked FC2's color and lubrication better than PFC (44, 15.2%; 99, 34.6%). Also, 158 women (54.5%) preferred the overall fit of FC2 compared with PFC (143, 49.5%; P < 0.05). CONCLUSION Participants did not have sufficient knowledge about the contraceptive effect and use of FC. Lubrication means the smooth degree of using FC. Length means the size of FC. Appearance means the users' overall impression of the FC.
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Affiliation(s)
- Xianmi Wang
- Social Work Department, China Women's University, Beijing, China. .,Peking Union Medical College, Beijing, China. .,Social Medicine Center, National Research Institute for Family Planning, Beijing, China.
| | - Meng Liu
- Social Work Department, China Women's University, Beijing, China
| | - Yimin Cheng
- Social Medicine Center, National Research Institute for Family Planning, Beijing, China
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Holt M, Lea T, Kippax S, Kolstee J, Ellard J, Velecky M, Murphy D, de Wit J. Awareness and knowledge of HIV pre-exposure prophylaxis among Australian gay and bisexual men: results of a national, online survey. Sex Health 2016; 13:SH15243. [PMID: 27098165 DOI: 10.1071/sh15243] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/06/2016] [Indexed: 11/23/2022]
Abstract
Background: Expanded access to HIV pre-exposure prophylaxis (PrEP) is being actively debated in Australia. Awareness and knowledge of this HIV-prevention method have not been assessed in detail in the primary affected population, gay and bisexual men. Methods: Awareness and knowledge of PrEP were assessed among Australian gay and bisexual men, who were asked to complete a national, anonymous, online survey in 2015. Associations with PrEP awareness were identified with multivariate logistic regression and associations with PrEP knowledge were identified using multivariate linear regression. Results: Among 1251 participants, 954 (77%) were aware of PrEP. The most common sources of information were gay community media, Australian websites and friends. Awareness of PrEP was independently associated with older age, living in a capital city, having a university degree, being tested for HIV, being HIV-positive, having condomless anal intercourse with regular male partners, and ever having taken post-exposure prophylaxis. Men in monogamous relationships were less likely to be aware of PrEP. Among men who were aware of PrEP, the mean PrEP knowledge score was 6.8 out of 13. Relatively few participants knew that taking PrEP involved regular clinical monitoring and that in Australia PrEP was only recommended for people at risk of HIV. Better knowledge was independently associated with living in a capital city, having a university degree, being in full-time employment, being HIV-positive, and ever having taken post-exposure prophylaxis or PrEP. Conclusions: To assist in appropriate PrEP uptake, we recommend educating gay and bisexual men about current Australian prescribing guidelines and how PrEP is accessed in Australia.
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Thorson A, Formenty P, Lofthouse C, Broutet N. Systematic review of the literature on viral persistence and sexual transmission from recovered Ebola survivors: evidence and recommendations. BMJ Open 2016; 6:e008859. [PMID: 26743699 PMCID: PMC4716240 DOI: 10.1136/bmjopen-2015-008859] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The main aim of this article is to present a comprehensive, systematic review on evidence of sexual transmission from Ebola survivors and persistence of Ebola virus in body fluids of relevance to sexual transmission, and additionally to review condom effectiveness against sexual transmission of Ebola. DESIGN We performed a systematic review of viral persistence in body fluids of relevance to sexual transmission of Ebola survivors and evidence of sexual transmission of Ebola, and carried out a targeted review of condom effectiveness. RESULTS We identified nine published original articles presenting results on persistence of Ebola virus in relevant body fluids, or reporting suspect sexual transmission from Ebola survivors. We also included unpublished reports from the current 2014/2015 Ebola epidemic in West Africa. We found no articles reporting on condom effectiveness, but have included a targeted review on general condom efficacy and effectiveness. CONCLUSIONS We conclude that the risk of sexual transmission from people who have recovered from Ebola cannot be ruled out. We found the longest duration of persistent Ebola RNA in a relevant body fluid from a survivor, to be reported from a man in Sierra Leone who had reverse transcriptase PCR (RT-PCR) positive semen 284 days after symptom onset. In line with current WHO recommendations. We recommend that men are offered the possibility to test their semen regularly for presence of Ebola RNA from 3 months post-symptom onset. Safe sex practices including sexual abstinence, or else condom use, are recommended by WHO until semen has tested negative twice, or in absence of testing for at least 6 months post-symptom onset. Based on evidence reviewed, we conclude that male and female latex condoms offer some protection against EBOV compared to no condom use. Survivors should be offered access to care and prevention, in order to provide them with possibilities to mitigate any risks that may occur, and efforts should be linked to destigmatising activities.
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Affiliation(s)
- Anna Thorson
- World Health Organization (WHO), Geneva, Switzerland
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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