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Power J, Kauer S, Fisher C, Bourne A. Acceptance and use of condoms among school-aged young people in Australia. Sex Health 2024; 21:SH23173. [PMID: 38507903 DOI: 10.1071/sh23173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Despite availability of vaccines or medical prophylaxis for some sexually transmissible infections (STIs), promoting condom use remains an important public health strategy for the prevention of STIs. Recent research shows that regular condom use among young people in Australia has declined over the past decade, while the rate of common STIs has increased. METHOD In this paper, we report findings from a large survey of school-aged young people in Australia (14-18years old) in which we looked at the association between condom use and positive feelings about sex, beliefs about social acceptability of condoms and confidence talking with partners about sex and condoms. RESULTS Communication and relational factors supported more consistent condom use. Participants were more likely to regularly use condoms if they discussed condom use with a sexual partner, perceived condom use to be easy (a measure that included perceived ease of discussing condoms with a partner) and perceived condom use to offer social or relational benefits, including perceiving condom use as a demonstration of care for a partner. Young men were more likely to report positive feelings about sex and regular condom use than young women. Young women were less likely than young men or trans and non-binary young people to report regular condom use. CONCLUSIONS The study shows the importance of supporting young people to build confidence expressing sexual needs and wants with partners. Public health approaches to STI prevention need to consider condom promotion in the context of young people's contemporary sexual, gendered and relationships cultures.
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Affiliation(s)
- Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building Nr6, Bundoora, Vic. 3086, Australia
| | - Sylvia Kauer
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building Nr6, Bundoora, Vic. 3086, Australia
| | - Christopher Fisher
- Victoria University, VU Online, PO Box 14428, Melbourne, Vic. 8001, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Building Nr6, Bundoora, Vic. 3086, Australia; and Kirby Institute, UNSW, Wallace Wurth Building (C27), UNSW, Kensington, Sydney, NSW, 2052, Australia
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Loh M, Niu L, Arden M, Burk RD, Diaz A, Schlecht NF. Long-acting reversible contraception and condom use: A cohort study of female adolescents and young adults in New York City. Contraception 2023; 125:110081. [PMID: 37263371 DOI: 10.1016/j.contraception.2023.110081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVES This study aimed to determine whether condom use varied between adolescents and young women using long-acting reversible contraception (LARC) vs non-LARC hormonal methods and assess if the initiation of LARC was associated with lower condom use. STUDY DESIGN This study used data from a large longitudinal study of sexually active females aged 13-25 years. Questionnaires assessed contraception, condom use, sexual history, and partner characteristics at the baseline visit and every 6 months. Log-binomial regression analyses examined associations between hormonal contraceptive methods and condom use, and the moderating effects of age and number of sexual partners. Exploratory analyses compared condom use based on partner characteristics. RESULTS Of 1512 participants, 1116 reported LARC or non-LARC hormonal method use during any study visit. Among baseline and new LARC users, 75.7% and 84.7% reported intrauterine device (IUD) use, respectively. Condom use at baseline among hormonal non-LARC users (37.5%) was significantly higher (p < 0.01) than LARC users (23.5%). Condom use among LARC vs non-LARC users was moderated by age in that LARC was associated with lower condom use among participants aged 13-18 years, but not those aged 19-25 years. Number of sexual partners was not a significant moderator. Among participants with increased sexually transmitted infection (STI) risk based on partner characteristics, LARC users had lower condom use compared to non-LARC users. CONCLUSIONS Condom discontinuation was common following initiation of LARC and hormonal non-LARC methods. However, condom use was lower in LARC users at baseline, among younger adolescents, and if partners had risk factors for STIs. IMPLICATIONS Condom discontinuation following initiation of highly effective contraception increases the risk of STI. Young women using LARC may be at greater risk than non-LARC users given lower condom use despite having partners with risk factors for STIs. Condom use counseling for STI protection is critical for adolescents.
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Affiliation(s)
- Miranda Loh
- Department of Pediatrics, Mount Sinai Adolescent Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Li Niu
- Faculty of Psychology, Beijing Normal University, Beitaipingzhuang, Haidian District, Beijing, China
| | - Martha Arden
- Department of Pediatrics, Mount Sinai Adolescent Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Robert D Burk
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States; Department of Pediatrics (Genetics), Albert Einstein College of Medicine, Bronx, NY, United States; Department Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, United States; Department Gynecology & Women's Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Angela Diaz
- Department of Pediatrics, Mount Sinai Adolescent Health Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nicolas F Schlecht
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States; Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
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Bell SFE, Harvey C, Mack F, Lambert S, Lazarou M, Strom K, Dean JA. Rethinking referral pathways: qualitative evaluation of general practice networks to increase access to intrauterine contraception. Fam Pract 2022; 39:1109-1115. [PMID: 35485435 PMCID: PMC9680659 DOI: 10.1093/fampra/cmac040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Long-acting reversible contraceptives are recommended first-line contraception; however, intrauterine device (IUD) uptake remains low in Australia. OBJECTIVES To describe the outcomes of an independent evaluation of the General Practitioner IUD Insertion Network (GPIIN), a project designed to address access barriers through formalized referral pathways between general practitioners (GPs) inserting IUDs and noninserters. METHODS An independent qualitative pragmatic inductive evaluation, involving 14 in-depth interviews with GPIIN members, was conducted 18 months post-GPIIN implementation in 2 Australian jurisdictions to identify and explore critical success factors and limitations of the model. RESULTS Local GP-to-GP IUD referral networks were considered a useful model to assist affordable and timely IUD access, improve noninserters' IUD knowledge and inserters' reflection on best practice. However, pathway simplification is needed to determine optimal integration of the concept into pragmatic GP-to-GP referral arrangements. CONCLUSIONS GPIIN provides an opportunity to improve IUD access in Primary Health Care. Further consideration of organizations best positioned and resourced to facilitate sustainable delivery and coordination is necessary.
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Affiliation(s)
- Sara F E Bell
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Caroline Harvey
- Iris Education, Eldridge Street, Toowong, Queensland, Australia
| | - Fiona Mack
- Iris Education, Eldridge Street, Toowong, Queensland, Australia
| | - Stephen Lambert
- Iris Education, Eldridge Street, Toowong, Queensland, Australia
| | - Mattea Lazarou
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Kay Strom
- Iris Education, Eldridge Street, Toowong, Queensland, Australia
| | - Judith A Dean
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
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Watchirs Smith L, Liu B, Degenhardt L, Richters J, Bateson D, Yeung A, Guy R. Identifying gaps in dual protection from sexually transmissible infections and unintended pregnancies among Australian women: an observational study. Sex Health 2021; 18:475-486. [PMID: 34863328 DOI: 10.1071/sh21151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022]
Abstract
Background Dual protection refers to the simultaneous prevention of sexually transmissible infection (STI) and unintended pregnancies. Optimal contraception and STI prevention strategies sometimes fail to align. Methods Using data from a large nationally representative population-based survey, we analysed the contraception and STI prevention behaviours at the last vaginal intercourse among 2420 heterosexually active women aged 16-34years who had participated in the Second Australian Study of Health and Relationships, 2012-13. Results At their last vaginal intercourse, most women (95%) used contraception and half (49%) used condoms, either as a sole multipurpose method or in conjunction with another type of contraception. Condom use was highest (72%) among women whose most recent partner was a casual or occasional partner, followed by women with a regular partner (59%) and women with a cohabiting regular partner (40%). One-third of the women (34%) used condoms as a sole method, and 14% used oral contraceptives together with a condom. Few women used implants or intrauterine devices (8%) and, among them, very few women also used condoms (<1%). Among the women who used a condom at their last vaginal intercourse, 49% reported both the correct use for STI prevention and consistent condom use during the previous 6months. Among women using condoms, correct and consistent use was also highest among women whose most recent partner was a casual or occasional partner (76%). Conclusions Although almost all women used contraception and half used dual protection, few benefited from the protective effects of using condoms together with highly effective contraception.
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Affiliation(s)
| | - Bette Liu
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Juliet Richters
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Deborah Bateson
- Family Planning NSW, Sydney, NSW, Australia; and Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Anna Yeung
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Rebecca Guy
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
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Steiner RJ, Pampati S, Kortsmit KM, Liddon N, Swartzendruber A, Pazol K. Long-Acting Reversible Contraception, Condom Use, and Sexually Transmitted Infections: A Systematic Review and Meta-analysis. Am J Prev Med 2021; 61:750-760. [PMID: 34686301 PMCID: PMC9125421 DOI: 10.1016/j.amepre.2021.04.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/14/2021] [Accepted: 04/21/2021] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Given mixed findings regarding the relationship between long-acting reversible contraception and condom use, this systematic review and meta-analysis synthesizes studies comparing sexually transmitted infection‒related outcomes between users of long-acting reversible contraception (intrauterine devices, implants) and users of moderately effective contraceptive methods (oral contraceptives, injectables, patches, rings). METHODS MEDLINE, Embase, PsycINFO, Global Health, CINAHL, Cochrane Library, and Scopus were searched for articles published between January 1990 and July 2018. Eligible studies included those that (1) were published in the English language, (2) were published in a peer-reviewed journal, (3) reported empirical, quantitative analyses, and (4) compared at least 1 outcome of interest (condom use, sexual behaviors other than condom use, sexually transmitted infection‒related service receipt, or sexually transmitted infections/HIV) between users of long-acting reversible contraception and users of moderately effective methods. In 2020, pooled ORs were calculated for condom use, chlamydia/gonorrhea infection, and trichomoniasis infection; findings for other outcomes were synthesized qualitatively. The protocol is registered on the International Prospective Register of Systematic Reviews (CRD42018109489). RESULTS A total of 33 studies were included. Long-acting reversible contraception users had decreased odds of using condoms compared with oral contraceptive users (OR=0.43, 95% CI=0.30, 0.63) and injectable, patch, or ring users (OR=0.58, 95% CI=0.48, 0.71); this association remained when limited to adolescents and young adults only. Findings related to multiple sex partners were mixed, and only 2 studies examined sexually transmitted infection testing, reporting mainly null findings. Pooled estimates for chlamydia and/or gonorrhea were null, but long-acting reversible contraception users had increased odds of trichomoniasis infection compared with oral contraceptive users (OR=2.01, 95% CI=1.11, 3.62). DISCUSSION Promoting condom use specifically for sexually transmitted infection prevention may be particularly important among long-acting reversible contraception users at risk for sexually transmitted infections, including adolescents and young adults.
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Affiliation(s)
- Riley J Steiner
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sanjana Pampati
- Oak Ridge Institute for Science and Education, Atlanta, Georgia
| | - Katherine M Kortsmit
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole Liddon
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea Swartzendruber
- Department of Epidemiology & Biostatistics, University of Georgia College of Public Health, Athens, Georgia
| | - Karen Pazol
- Division of Human Development and Disability, Centers for Disease Control and Prevention, Atlanta, Georgia
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Murphy N, Williams H, Nguyen J, McNamee K, Coombe J, Hocking J, Vaisey A. Condom use in young women using long-acting reversible contraception (LARC): a qualitative study. CULTURE, HEALTH & SEXUALITY 2021; 23:1153-1164. [PMID: 32644012 DOI: 10.1080/13691058.2020.1758344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
Young women in Australia disproportionately experience unintended pregnancy and sexually transmissible infections (STIs). As the promotion of highly effective pregnancy prevention methods such as long-acting reversible contraception (LARC) increases, concurrent use of condoms with LARC remains optimal for pregnancy and STI prevention. There is little data exploring condom use behaviour in young Australian women using LARC. In this qualitative study we interviewed twenty women using LARC about their experiences of making decisions regarding condom use. We used inductive thematic analysis to identify factors influencing participant decision-making. We found that while LARC had an impact on condom use and sexual practices, decisions regarding condom use were influenced by multiple factors including mood, menstrual changes related to LARC, and relationship dynamics. Participants' views of 'safe sex' extended beyond pregnancy and STI protection, to include desired outcomes such as pleasure, consent and communication. Access to STI testing and treatment was key to how participants managed STI risk. Findings highlight the need for a more comprehensive approach to safer sex health promotion, and the importance of ensuring STI testing and treatment services continue to be available and accessible to all young people.
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Affiliation(s)
- Nabreesa Murphy
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Henrietta Williams
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Melbourne, Victoria, Australia
| | - Julie Nguyen
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kathleen McNamee
- Family Planning Victoria, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alaina Vaisey
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Views and experiences of the female condom in Australia: An exploratory cross-sectional survey of cisgender women. PLoS One 2021; 16:e0246664. [PMID: 33606704 PMCID: PMC7894813 DOI: 10.1371/journal.pone.0246664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/24/2021] [Indexed: 11/19/2022] Open
Abstract
Background The female condom is the only female-initiated form of protection against unintended pregnancy and sexually transmissible infections (STIs). However, use of this method in Australia is low. To better understand women’s views and experiences of the female condom, we conducted an interventional cross-sectional study. Methods Cisgender women ≥16 years, heterosexually active and living in New South Wales were recruited through social media advertisements and email invitations to clients of a family planning service. Eligible participants were provided with three female condoms and invited to complete a follow-up survey. Survey responses for women who attempted to use at least one female condom were summarised using counts and proportions. Results We recruited 556 women; few (30/556) had used the female condom before the study. There were 284 women who used, or attempted to use, a female condom during the study and completed the follow-up survey. Fifty-one percent (104/205) reported experiencing some difficulty in insertion, although only 46% (130/284) had seen an instructional demonstration. Approximately half (105/204) of women rated the sensation and comfort of the female condom as the same or better than the male condom, and 66% (137/204) reported that it provided the same or better lubrication. Approximately half of women said they would consider using the female condom again for STI prevention (51% (133/260)) or contraception (40% (103/260)), or would recommend to others (43% (112/260)). Conclusion Findings highlight the need for increased health promotion and education regarding use of the female condom. To increase access it will be important to address method cost and availability in Australia. Future research should explore other perspectives of this method, including among the LGBTIQ+ community.
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Harris ML, Coombe J, Forder PM, Lucke JC, Bateson D, Loxton D. Young Women's Complex Patterns of Contraceptive Use: Findings from an Australian Cohort Study. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:181-190. [PMID: 33191577 DOI: 10.1363/psrh.12158] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 01/27/2020] [Accepted: 07/19/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT Unintended pregnancy is common among young women. Understanding how such women use contraceptives- including method combinations-is essential to providing high-quality contraceptive care. METHODS Data were from a representative cohort of 2,965 Australian women aged 18-23 who participated in the 2012-2013 Contraceptive Use, Pregnancy Intention and Decisions baseline survey, had been heterosexually active in the previous six months, and were not pregnant or trying to conceive. Latent class analysis was employed to characterize women's contraceptive choices; multinomial logistic regression was used to evaluate correlates of membership in the identified classes. RESULTS The vast majority of women (96%) reported using one or more contraceptives, most commonly short-acting hormonal methods (60%), barrier methods (38%), long-acting contraceptives (16%) and withdrawal (15%). In total, 32 combinations were reported. Four latent classes of method use were identified: no contraception (4% of women); short-acting hormonal methods with supplementation (59%, mostly the pill); high-efficacy contraceptives with supplementation (15%, all long-acting reversible contraceptive users); and low-efficacy contraceptive combinations (21%); supplementation usually involved barrier methods or withdrawal. Class membership differed according to women's characteristics; for example, women who had ever been pregnant were more likely than other women to be in the no-contraception, high-efficacy contraceptive or low-efficacy contraceptive combination classes than in the short-acting hormonal contraceptive class (odds ratios, 2.0-3.0). CONCLUSIONS The complexity of women's contraceptive choices and the associations between latent classes and such characteristics as pregnancy history highlight the need for individualized approaches to pregnancy prevention and contraceptive care.
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Affiliation(s)
- Melissa L Harris
- Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Newcastle, Australia
| | - Jacqueline Coombe
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Peta M Forder
- Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Newcastle, Australia
| | - Jayne C Lucke
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | | | - Deborah Loxton
- Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Newcastle, Australia
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Muzny CA, Van Gerwen OT, Kissinger P. Updates in trichomonas treatment including persistent infection and 5-nitroimidazole hypersensitivity. Curr Opin Infect Dis 2020; 33:73-77. [PMID: 31789671 PMCID: PMC7371247 DOI: 10.1097/qco.0000000000000618] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to update information on treatment of Trichomonas vaginalis. T. vaginalis is estimated to be the most common treatable sexually transmitted infection. In the world and is associated with poor birth outcomes, cervical cancer, sperm motility and morphology issues, and HIV acquisition and transmission. RECENT FINDINGS The efficacy of the recommended 2-g oral single-dose metronidazole (MTZ) for the treatment of T. vaginalis in women has recently been challenged. Two recent multicentered randomized trials and a meta-analysis have demonstrated that the 7-day dose of MTZ 500 mg twice daily was nearly two times more efficacious at clearing infection compared with the 2-g dose. Partner treatment is also essential, since up to 70% of male sexual partners can be infected and rescreening of treated women at 3 months is also recommended given the high repeat infection rates. Future studies should examine the importance of treating asymptomatic T. vaginalis, best treatment for men, the influence of the microbiome on treatment efficacy and different formulations of intravaginal treatments for hypersensitivity. SUMMARY 7-day 500 mg twice daily MTZ should be used as the first line treatment for T. vaginalis-infected women.
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Affiliation(s)
- Christina A. Muzny
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Olivia T. Van Gerwen
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Patricia Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
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