Barriers to condom use

Safe sex negotiation and HIV risk reduction among women: A cross-sectional analysis of Burkina Faso 2021 Demographic and Health Survey

Women are biologically more susceptible to the Human Immunodeficiency Virus (HIV) and other sexually transmitted Infections (STIs) because receptive sex is riskier than insertive. Despite condom use being the staple preventive method for HIV infection (over 80% efficacy), in Sub-Saharan African countries like Burkina Faso, a high burden of HIV and the unmet need for condom use coexist. Moreover, even though women in SSA are disproportionately HIV positive, they are reportedly less capable of negotiating condom use for HIV risk reduction. Thus, using the Health Believe Model (HBM), this study explored the factors that influence condom use among women within the context of HIV prevention, with a key interest in condom use negotiation. Using the women's dataset of the 2021 Burkina Faso Demographic and Health Survey and applying logistic regression models, this study examined the factors associated with condom use for HIV risk reduction. Women who had confidence to negotiate condom use with their partners (OR = 1.57, P<0.001, 95%CI: 1.29, 1.91), those with secondary education (OR = 1.38, P<0.05, 95%CI: 1.07 1.77), from richest households (OR = 1.64, P<0.05, 95%CI: 1.08, 2.47), the employed (OR = 1.23, P<0.05, 95%CI: 1.02, 1.49), women with knowledge of sexually transmitted infections (OR = 1.58, P<0.001, 95%CI: 1.26, 1.97), those who have ever been tested for HIV (OR = 1.85, P<0.001, 95%CI: 1.52 2.24), as well as those who knew that a healthy-looking person can have HIV (OR = 2.64, P<0.001, 95%CI: 2.15, 3.24) were all significantly more likely to practice condom use for HIV risk reduction. Also, religion and geographical location of participants significantly predicted condom use for HIV risk reduction in the study context. The ability to negotiate condom use, knowledge of HIV and STIs, the socioeconomic status of women, as well as their geographical location, influence their practice of safer sex for HIV risk reduction in Burkina Faso.

Contraceptive uses among married women in Bangladesh: a systematic review and meta-analyses

BACKGROUND

Although Bangladesh's economy has shown significant improvement over the past two decades, the high population growth rate has hindered development efforts. This study aimed to review the prevalence of different contraceptive methods used among women of reproductive age in Bangladesh, which could help control the population growth rate.

METHODS

We conducted an extensive literature review and meta-analysis of 82 articles, identifying 20 articles for analysis. The analyses included heterogeneity and publication bias in published papers.

RESULTS

The pooled prevalence of various contraceptive methods was as follows: condom use, 7.13%; Female Sterilization, 8.09%; injectables, 12.76%; intrauterine devices (IUDs), 3.76%; male sterilization, 2.34%; periodic abstinence, 6.71%; pills, 33.21%; and withdrawal, 3.27%. Modern contraceptive methods accounted for 62.91% of usage, while traditional methods constituted 8.79%. On average, only 1.95% of women opted for the implant method. The overall prevalence of contraceptive method usage was 59.48%, with 60.59% in urban areas and 54.54% in rural areas. We found statistically significant heterogeneity for all contraceptive methods used by women in Bangladesh. The funnel plot and Egger's test showed no publication bias for any of the contraceptive methods, except condoms (Z = 2.34, P = 0.0194). The contraceptive methods used by women in rural areas also showed publication bias (Z = -3.04, P = 0.0024).

CONCLUSION

A renewed commitment from government bodies and independent organizations is needed to implement and monitor family planning strategies to ensure adherence to and provision of the most appropriate contraceptive method for couples.

Self-reported condom use among Washington State residents prior to and during the COVID-19 pandemic: a cross-sectional analysis of BRFSS data

OBJECTIVES

COVID-19 significantly impacted healthcare access and sexual behaviour, but little is known about how COVID-19 affected condom use. This study aimed to investigate whether self-reported condom use and sex in Washington State changed during pandemic restrictions compared with prepandemic.

DESIGN

Cross-sectional survey data from the Behavioral Risk Factor Surveillance System.

SETTING

Washington State.

PARTICIPANTS

11 684 participants aged 18-65.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was changes in the prevalence of condom use by time of interview pre-COVID-19, before the Washington State lockdown (1 January 2019 to 23 March 2020, n=7708) and during COVID-19, after the first state lockdown (24 March 2020 to 31 December 2020, n=3976). The secondary outcome was changes in the prevalence of reported sex during the same periods. We assessed whether associations differed by rurality and HIV risk behaviour.

RESULTS

Condom use was similar during COVID-19 (37.3%) compared with pre-COVID-19 (37.8%) (adjusted prevalence ratio (PR): 0.98, 95% CI 0.89, 1.01). Associations did not differ by rurality or HIV risk behaviour. Compared with pre-COVID-19 (83.0%), a smaller proportion of respondents reported having sex in the last 12 months during COVID-19 (80.5%), a relative decrease of 3% (PR: 0.97, 95% CI 0.96, 0.99; p<0.001).

CONCLUSIONS

The prevalence of reported sex declined during COVID-19, but condom use remained steady in Washington. As our reproductive health system faces increased challenges, these results may inform future sexual health services.

Condom Use among HIV-Positive Postnatal Women in Primary Health Care Facilities in Tshwane Sub-District 1, Gauteng Province, South Africa

Condoms have been and are still an important part of HIV preventative measures worldwide, and many countries have designed programmes that encourage their use. Consistent and correct condom use among HIV-positive individuals is important in preventing multiple infections. Hence, the uptake and determining factors associated with condom use were investigated in this study. This study was aimed at determining the level of, and factors associated with, condom use among HIV-positive postnatal women in primary health care facilities in Tshwane sub-district 1, Gauteng Province, South Africa. A descriptive cross-sectional study was conducted among 326 HIV-positive postnatal women aged between 15 and 50 years who were conveniently selected and voluntarily participated in the study. A self-developed pretested questionnaire was used to collect data on level of condom use and factors associated with its use from the selected participants. Statistical tests of correlation were then used to determine the association between frequency of condom use during sexual encounter and condom use at last sexual encounter with the independent variables. Regular condom use during sexual encounters was reported by 63.2% of the participants while 83% of the participants reported using a condom at their last sexual encounter. Frequency of condom use during sexual encounter was found to be associated with employment status (p < 0.05), residence (p < 0.001), number of children (p < 0.05), first HIV diagnosis (p < 0.05) and disclosure of HIV status to partner (p < 0.05). Condom use at last sexual encounter was also found to have a significant statistical association with level of education (p < 0.05) and the ability to negotiate condom use (p < 0.001). A good proportion of the participants used condoms regularly. Interventions to improve condom use among this population should focus on female empowerment by investing in their education, and economic empowerment to improve their economic status, which, in turn, would help the women to better negotiate condom use. The other factors mentioned above should also be considered when developing health education policies and programmes about condom use amongst HIV-positive postnatal women.

Psychosocial determinants of consistent condom use among university students in Sudan: findings from a study using the Integrated Change Model

Unprotected sex is common among university students in Sudan, thus increasing risks for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). As little is known about the psychosocial determinants of consistent condom use among this population, this study was designed to identify them. The Integrated Change Model (ICM) was applied in a cross-sectional design to identify in 218 students (aged 18-25 years) from Khartoum which items distinguish condom users from non-condom users. Condom users differed significantly from non-condom users in having more HIV and condom use-related knowledge, higher perception of susceptibility to HIV, reporting more exposure to condom use cues, having a less negative attitude towards condom use (attitude cons), experiencing social support and norms favouring condom use and having higher condom use self-efficacy. Binary logistic regression showed that peer norms favouring condom use in addition to HIV-related knowledge, condom use cues, negative attitude and self-efficacy were the factors uniquely associated with consistent condom use among university students in Sudan. Interventions seeking to promote consistent condom use among sexually active students could benefit from increasing knowledge about HIV transmission and prevention, raising HIV-risk perception, using condom use cues, addressing perceived condom disadvantages and enhancing students` self-efficacy to avoid unprotected sex. Moreover, such interventions should raise students` perceptions of their peers` beliefs and behaviours favouring condom use and seek health care professionals` and religious scholars` support for condom use.

Willingness to Use Male Contraceptive Pill: Spain-Mozambique Comparison

Previous studies have suggested that social and cultural factors significantly influence people's willingness to use the male contraceptive pill, which is in relatively advanced development. The present study aims at comparing Spanish and Mozambican participants level of willingness to take a male contraceptive pill. Factorial designed scenarios were used to collect data on the two population samples (Spain = 402 participants; Mozambique = 412 participants). One-way analysis of variance (ANOVAs) were performed comparing the average scores of Mozambique and Spain at the levels of each modelled factor: The cost of the pills (30 €/USD 20 for 3 months vs. free); Efficacy (99% vs. 95%); Side effects (none, mild and severe); Context (disease, condom abandonment and diversification of contraceptive methods). The two groups found significant differences in the scores for each of the four factors, in light of the socio-cultural differences between the two countries. In the Spanish sample, the main factor affected the willingness to use male contraceptive pill (MCP) were the side effects, while for Mozambican men it was the context. Along with technological change, an ideological-social change in gender roles is required to ensure equity in contraceptive responsibilities and the participation of men at all socio-demographic levels in reproductive health.

An extension of the extended parallel process model to promote heart-healthy exercise behavior: An experimental study

Background: The prevalence of heart disease has increased and is a leading cause of death in the U.S. Despite the importance of physical activity, only one-third of adults in the United States meet the amount of physical activity recommended by the Centers for Disease Control and Prevention (CDC). The purpose of this study was to extend the extended parallel process model (EPPM) by adding a 'barrier' (a construct from Health Belief Model) and exploring the roles of threat, efficacy, and barrier on participants' self-efficacy, attitudes, and intentions toward exercise. Methods: A between-subject experimental design was conducted online in 2018 in the U.S. A total of 446 participants were recruited from the Amazon Mechanical Turk age 18 or above. The participants were first provided with stimuli messages about physical activity behaviors. Then participants' responses to self-efficacy, intention, and attitudes toward exercise were assessed. Results: The results found an interaction between efficacy and barrier to participants' attitudes toward exercise [F(1,435)=4.35, P=0.038, η² _part=0.01]. The results also showed that there was a statistically significant effect of barriers on participants' self-efficacy regarding exercise behavior [F(1,442)=4.21, P=0.04, η² _part=0.009]. However, three-way interactions of threat, efficacy, and barrier were not found in attitudes or intentions to exercise. Conclusion: The findings suggested that addressing an individual's perceived barrier regarding a health behavior may lead to an increase in self-confidence ensuing in higher physical activity. Future studies should further explore how addressing barriers may influence other health behaviors to design unique and effective health messages.

Effect of comprehensive knowledge of HIV on risky sexual behaviours associated with HIV transmission among adult Ugandans: a propensity score-matched analysis

OBJECTIVE

To evaluate the effect of comprehensive knowledge of HIV on extramarital sexual relationships and consistent condom use.

DESIGN

Quasi-experimental study.

SETTING

20 880 households, Uganda.

PARTICIPANTS

Married/cohabiting men and women, aged 15-54 years.

METHODS

We applied propensity score-matched analysis and defined comprehensive knowledge of HIV as knowing that consistent use of condoms during sexual intercourse and having just one faithful partner without HIV reduces the chance of getting HIV, knowing that a healthy-looking person can have HIV and rejecting two local misconceptions (HIV can be transmitted by mosquito bites and by sharing food with a person who has HIV). The primary outcome was extramarital sexual relationship defined as involvement in a sexual relationship with a partner other than a spouse or cohabiting partner, within 12 months preceding the survey. The secondary outcome was consistent condom use, defined as using a condom at every sexual intercourse with any non-spouse/non-cohabiting partner over the past 12 months.

RESULTS

Among 18 504 participants matched in a 1:1 ratio, comprehensive knowledge of HIV showed no effect on extramarital sexual relationships (OR 1.03, 95% CI 0.96 to 1.11) but improved consistent condom use among married/cohabiting couples in extramarital sexual relationships (OR 1.18, 95% CI 1.02 to 1.37). Among married/cohabiting men, comprehensive knowledge of HIV had no effect on extramarital sexual relationships (OR 0.95, 95% CI 0.83 to 1.08) but improved consistent use of condoms in extramarital sexual relationships (OR 1.31, 95% CI 1.04 to 1.66). However, among married/cohabiting females, there was no effect on both outcomes.

CONCLUSIONS

Comprehensive knowledge of HIV has no effect on extramarital sexual relationships but increases consistent condom use among those in extramarital sexual relationships. There is a need to consistently provide correct HIV prevention messages among sexually active married/cohabiting couples in Uganda.

Sexual Modesty in Sexual Expression and Experience: A Scoping Review, 2000 - 2021

Sexual modesty is the social, cultural, interpersonal, and psychological systems - defined by the tenets of Script Theory - that regulate individuals' sexual expression and experience at the social, legal, and interpersonal boundaries of acceptable/not-acceptable, private/public, and personal/social. Almost all aspects of sexual expression and experience are touched by the pervasive modesty standards for sexual communication, sexual display, sexual relations, and sexual behaviors. Sexual modesty influences an array of sexual and reproductive health outcomes. Many aspects of sexual modesty are enforced by legal as well as social, cultural, and religious proscriptions, including social shaming and ostracism as well as corporal and capital punishments. The purpose of this paper is to summarize a diverse literature related to sexual modesty from the years 2000 to 2021 in order to clarify its role in sexual health and sexual wellbeing and to identify directions for new research.

Prevalence of Good Condom Usage and Its Association with Condom Use Self-Efficacy among Youth Attending HIV/STDs Clinics in Primary-Care Settings in Malaysia

The low prevalence of condom usage among youth with Human Immunodeficiency Virus/Sexually Transmitted Diseases (HIV/STDs) is a concern. Condom use self-efficacy has been identified as a significant predictor of condom usage. This cross-sectional study examines the prevalence of good condom usage and its association with condom use self-efficacy among Malaysian urban youth, aged between 18 to 24 years old attending HIV/STDs clinics in primary-care settings, Selangor. Utilising the Harmonised Malay version of Condom Use Self-Efficacy Scale (CUSES M-H) questionnaire, the data from 218 responders were analysed using univariate and multiple logistic regression. The prevalence of good condom usage was 61% (95% CI: 54%, 68%). The average mean score of condom use self-efficacy was 3.07. Condom use self-efficacy was divided into four subscales of mechanics, perceived barriers, assertiveness and intoxicants. The assertiveness subscale had the highest average mean score of 3.42, while the intoxicant subscale score had the lowest average mean score of 2.24. Good condom usage was significantly associated with condom use during first sexual intercourse (aOR = 5.81, 95% CI: 1.97, 17.14), duration diagnosis of HIV/STDs of more than 12 months (aOR = 6.40, 95% CI: 2.30, 17.86) and the high assertiveness subscale score (aOR = 1.19, 95% CI: 1.03, 1.36). A behavioural change campaign that targets high-risk youth in primary care settings could promote condom use self-efficacy particularly assertiveness to increase condom usage among the youth.

Trust, Familiarity, Optimism, and Pleasure: Australian Gay Men Accounting for Inconsistent HIV Prevention Practices in the PrEP Era

Despite an increase in the range of effective HIV risk reduction strategies that are available, some gay and bisexual men (GBM) do not use any of them consistently. Understanding why GBM do not always use a protective strategy may help develop more effective responses. Semi-structured interviews with 24 sexually active GBM in Sydney, Australia were conducted and analyzed using thematic analysis. The main characteristics of encounters featuring little or no use of HIV risk reduction strategies were familiarity and trust with partners, pleasure and intoxication, expectations that partners were using HIV pre-exposure prophylaxis or treatment as prevention, and in some cases feelings of inevitability about acquiring HIV. An increase in pleasure and a reduction in anxiety about sex were noted by some GBM who had commenced PrEP. Encouraging GBM to adopt a strategy such as PrEP and to use it consistently may be easier by emphasizing benefits to mental health and the quality of sex and intimacy it can offer. However, even with the increased availability of effective biomedical HIV risk reduction strategies, not all GBM are able to consistently manage HIV risk and some continue to hold optimistic and potentially inaccurate beliefs about sexual partners that may increase HIV risk.

The Associations of Mental Health Disturbances, Self-Esteem, and Partner Violence Victimization with Condom Use in Spanish Adolescents

Risky sexual behaviors, such as not using a condom for preventing sexually transmittable diseases and unwanted pregnancies, are associated with emotional and psychological problems in adolescence, including higher levels of depression, anxiety, stress, and low self-esteem. Adolescents with a history of violence victimization are also at increased risk of engaging in sexual risk behaviors. In this study, we examined the associations between mental health disturbances and partner violence victimization and the non-use of condoms among young people in Spain. We also examined self-esteem as a mediator of mental health problems and unprotected sexual relationships. A cross-sectional study was conducted on a sample of 831 adolescents randomly selected from 25 high schools in Spain. From the initial sample, 285 students (144 men and 141 women) from high schools in Alicante (Spain) who reported having experienced sexual activity with at least one partner were approached. The results showed that one in three adolescents between 14 and 19 years old did not use condoms during sexual intercourse. The factors associated with the non-use of condoms in the estimated models of Poisson robust variance were having a history of physical, psychological, or sexual violence; having been expelled from school because of behavioral problems; and having higher levels of depression, anxiety, and stress and lower levels of self-esteem. Self-esteem was independently associated with the non-use of condoms. Having lower levels of self-esteem increased the risk of not using a condom during participants’ last sexual intercourse. These findings suggest the importance of developing public health strategies for mental health promotion to increase condom use among adolescents.

Barriers to condom use in casual sexual relationships known as ukujola in KwaZulu-Natal, South Africa

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.

Prevalence and factors associated with major depression among female sex workers in post-conflict Gulu district: a cross-sectional study

Background

Female sex workers operating in conflict-affected settings could be at a much greater risk of major depression. However, the epidemiology of major depression in this population remains understudied. We aimed to determine the prevalence and the factors associated with major depression among FSWs in the post-conflict Gulu district in Northern Uganda.

Methods

We conducted a cross-sectional study among 300 randomly selected adult female sex workers in Gulu. We utilized a pre-tested semi-structured questionnaire, embedded with MINI 7.0.0, to gather information from each participant through face-to-face interviews. We collected data on socio-demographic characteristics, sex-work-related characteristics, alcohol and drug use, HIV status, and major depression. Then, data were entered into EPI INFO 7 and analyzed using logistic regression with the aid of STATA 14.0.

Results

The mean age (SD) of the study participants was 26.4 (± 6) years, 57.7% attained primary education, 51.7% never married, and 42.1% were living with HIV. The prevalence of major depression among FSWs in the district was 47.7%. In addition, the majority of the FSWs with major depression (91.0%) had either severe (50.4%) or moderate (40.6%) depressive symptoms. Independently, life stress (adjusted OR = 10.8, 95%CI: 5.67–20.57), living with HIV (adjusted OR = 2.25, 95%CI: 1.25–4.05), verbal abuse (adjusted OR = 2.27, 95%CI: 1.27–4.08), and older age (adjusted OR = 1.06, 95%CI: 1.01–1.12) all showed positive associations with major depression. Conversely, provision of sexual services from clients’ homes (adjusted OR = 0.50, 95%CI: 0.25–0.97), use of a non-barrier modern family planning method (adjusted OR = 0.44, 95%CI: 0.24–0.82), and daily intake of alcohol (adjusted OR = 0.50, 95%CI: 0.28–0.88) all showed negative associations with major depression.

Conclusions

There is a high prevalence of major depression among female sex workers in post-conflict Gulu. The high prevalence of major depression underscores the need for government and development partners to urgently and adequately address the mental health needs of female sex workers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11207-8.

Geosocial Networking Dating App Usage and Risky Sexual Behavior in Young Adults Attending a Music Festival: Cross-sectional Questionnaire Study

Background

Despite the prevalent use of geosocial networking dating apps (GNDAs), there is limited research on their impact on sexual health outcomes among young music festivals attendees.

Objective

This study aims to explore the use of GNDAs and risky sexual behaviors of young adults attending a music festival.

Methods

The music festival attendees (N=862) completed a cross-sectional questionnaire study encompassing demographics, dating app use, and risky sexual behaviors in the past year. Associations between these variables were estimated using bivariate and multivariate logistic regression analyses.

Results

Of the respondents, 51.9% (448/862) had used GNDAs in the previous year. Compared with people who had 1 partner, people who had 2-5 sexual partners in the previous year had almost 7 times the odds of using dating apps (odds ratio [OR] 6.581, 95% CI 4.643-9.328) and those who had more than 5 partners had 14 times the odds of using dating apps (OR 14.294, 95% CI 8.92-22.906). Condom users were more likely to be app users (P<.001), as were those who relied on emergency Plan B (P=.002), but people using hormonal contraception were less likely to use dating apps (P=.004). After adjusting for sexual orientation and relationship status, those having casual sex had 3.096 (95% CI 2.225-4.307; P<.001) times the odds of using dating apps and those having multiple sexual partners had 3.943 (95% CI 2.782-5.588; P<.001) times the odds of using dating apps. Similarly, after adjusting for sexual orientation, relationship status, and number of sexual partners, people who had no discussions before having sex about sexually transmitted infections (STIs) or boundaries were more likely to use dating apps (OR 1.755, 95% CI 1.232-2.500; P=.002). Those who perceived the risk of having sex without contraception to be very high had 2.486 (95% CI 2.213-5.096; P=.01) times the odds of using dating apps than those who perceived no risk. Compared with those who perceived no risk, people who thought that the risk of having multiple sexual partners was low to high had 1.871 (95% CI 1.024-3.418; P=.04) times the odds of using dating apps. A significant number of app users (389/440, 88.4%) indicated that GNDAs should promote safe sex.

Conclusions

This study identified that festival goers engaging in certain high-risk sexual behaviors, including casual sex, having multiple sexual partners, and having sex without discussion about STI status and boundaries, are more likely to use dating apps. Festival goers who perceived sex without any form of contraception, having sex while drunk, and having multiple sexual partners as risky were more likely to be app users. Policy makers and GNDA developers should acknowledge the vulnerability of their users to adverse sexual health outcomes and use GNDAs as a platform to promote risk-reduction practices.

Topical microbicides for preventing sexually transmitted infections

BACKGROUND

This is a updated version of our Cochrane Review published in Issue 6, 2012. Sexually-transmitted infections (STIs) continue to rise worldwide, imposing an enormous morbidity and mortality burden. Effective prevention strategies, including microbicides, are needed to achieve the goals of the World Heath Organization (WHO) global strategy for the prevention and control of these infections.

OBJECTIVES

To determine the effectiveness and safety of topical microbicides for preventing acquisition of STIs, including HIV.

SEARCH METHODS

We undertook a comprehensive search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS, CLIB, Web of Science, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and reference lists of relevant articles up to August 2020. In addition, we contacted relevant organisations and experts.

SELECTION CRITERIA

We included randomised controlled trials of vaginal microbicides compared to placebo (except for nonoxynol-9 because it is covered in related Cochrane Reviews). Eligible participants were sexually-active non-pregnant, WSM and MSM, who had no laboratory confirmed STIs.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened and selected studies, extracted data, and assessed risks of bias in duplicate, resolving differences by consensus. We conducted a fixed-effect meta-analysis, stratified by type of microbicide, and assessed the certainty of the evidence using the GRADE approach.

MAIN RESULTS

We included eight trials from the earlier version of the review and four new trials, i.e. a total of 12 trials with 32,464 participants (all WSM). We did not find any eligible study that enrolled MSM or reported fungal STI as an outcome. We have no study awaiting assessment. All 12 trials were conducted in sub-Saharan Africa, with one having a study site in the USA, and another having a site in India. Vaginal microbicides tested were BufferGel and PRO 2000 (1 trial, 3101 women), Carraguard (1 trial, 6202 women), cellulose sulphate (2 trials, 3069 women), dapivirine (2 trials, 4588 women), PRO 2000 (1 trial, 9385 women), C31G (SAVVY) (2 trials, 4295 women), and tenofovir (3 trials, 4958 women). All microbicides were compared to placebo and all trials had low risk of bias. Dapivirine probably reduces the risk of acquiring HIV infection: risk ratio (RR) 0.71, (95% confidence interval (CI) 0.57 to 0.89, I² = 0%, 2 trials, 4588 women; moderate-certainty evidence). The other microbicides may result in little to no difference in the risk of acquiring HIV (low-certainty evidence); including tenofovir (RR 0.83, 95% CI 0.68 to 1.02, cellulose sulphate (RR 1.20, 95% CI 0.74 to 1.95, BufferGel (RR 1.05, 95% CI 0.73 to 1.52), Carraguard (RR 0.89, 95% CI 0.71 to 1.11), PRO 2000 (RR 0.93, 95% CI 0.77 to 1.14), and SAVVY (RR 1.38, 95% CI 0.79 to 2.41). Existing evidence suggests that cellulose sulphate (RR 0.99, 95% CI 0.37 to 2.62, 1 trial, 1425 women), and PRO 2000 (RR 0.95, 95% CI 0.73 to 1.23) may result in little to no difference in the risk of getting herpes simplex virus type 2 infection (low-certainty evidence). Two studies reported data on tenofovir's effect on this virus. One suggested that tenofovir may reduce the risk (RR 0.55, 95% CI 0.36 to 0.82; 224 participants) while the other did not find evidence of an effect (RR 0.94, 95% CI 0.85 to 1.03; 1003 participants). We have not reported the pooled result because of substantial heterogeneity of effect between the two studies (l² = 85%). The evidence also suggests that dapivirine (RR 1.70, 95% CI 0.63 to 4.59), tenofovir (RR 1.27, 95% CI 0.58 to 2.78), cellulose sulphate (RR 0.69, 95% CI 0.26 to 1.81), and (Carraguard (RR 1.07, 95% CI 0.75 to 1.52) may have little or no effect on the risk of acquiring syphilis (low-certainty evidence). In addition, dapivirine (RR 0.97, 95% CI 0.89 to 1.07), tenofovir (RR 0.90, 95% CI 0.71 to 1.13), cellulose sulphate (RR 0.70, 95% CI 0.49 to 0.99), BufferGel (RR 0.97, 95% CI 0.65 to 1.45), Carraguard (RR 0.96, 95% CI 0.83 to 1.12), and PRO 2000 (RR 1.01, 95% CI 0.84 to 1.22) may result in little to no difference in the risk of acquiring chlamydia infection (low-certainty evidence). The evidence also suggests that current topical microbicides may not have an effect on the risk of acquiring gonorrhoea, condyloma acuminatum, trichomoniasis, or human papillomavirus infection (low-certainty evidence). Microbicide use in the 12 trials, compared to placebo, did not lead to any difference in adverse event rates. No study reported on acceptability of the intervention.  AUTHORS' CONCLUSIONS: Current evidence shows that vaginal dapivirine microbicide probably reduces HIV acquisition in women who have sex with men. Other types of vaginal microbicides have not shown evidence of an effect on acquisition of STIs, including HIV. Further research should continue on the development and testing of new microbicides.

Taking the Maximum Risks for Satisfaction: Understanding the Process of Condom Discontinuation among National Youth Service Corps' Members in Nigeria

Objectives: To examine the process of condom discontinuation among members of the National Youth Service Corps in Nigeria who had been required to take part in a compulsory one year national service right after tertiary graduation. Methods: We used a qualitative research design to achieve this objective. Results: Findings revealed that the motivations for condom discontinuation among our sample include the need to achieve pleasure, the perception of the withdrawal method skill as an alternative to condom use, intimacy and trust among others. Cultural influence such as the promise of marriage and proof of fertility motivated both men and women to discontinue condom use. For many, intermittent condom discontinuation was normal throughout the course of relationships. Also, while verbal communication was more common among males than females, non-verbal communication strategies were employed by more of the females in their condom discontinuation behaviour. Conclusions: Overall, the findings improve our understanding of how condom discontinuation processes occur among young people and concludes that many young people (respondents) are yet to grapple with the potential consequences of unsafe sex.

"Who Are at Higher Sexual Risk?" Latent Class Analysis of Behavioral Intentions among Spanish Adolescents

Consistent condom use tends to be limited in youth, which makes this group especially vulnerable for sexually transmitted infections (STIs) and unplanned pregnancies. It is known that sexual risk may vary as a function of behavioral intentions (e.g., condom use intention or having sex under the influence of alcohol), but no studies have yet characterized the sexual risk profiles considering behavioral intentions. This study utilizes latent class analysis (LCA) to explore the subtyping of behavioral intentions related to sexual risk in a community-based sample of adolescents aged 14 to 16 years from Spain. Multinomial logistic regression was used to assess the association between class membership and participants' sociodemographic variables (sex, age, educational level, socioeconomic status, and family situation), and behavioral variables (sexual experience and percentage of condom use). Among the 1557 participants, four latent classes of risk were identified: "Condom + drugs", "abstinent", "condom + no drugs", and "no condom + drugs". Differences in adolescents' sex, age, educational level, sexual experience, and condom use across latent classes were found. Findings highlight opportunities for psychologists, educators, and health-care providers to promote condom use in adolescents with differing sexual risk profiles. Increased understanding of behavioral intentions among adolescents may help to reduce sexual risk behaviors in this group.

"Condoms Are Boring": Navigating Relationship Dynamics, Gendered Power, and Motivations for Condomless Sex Amongst Adolescents and Young People in South Africa

Condoms remain an important method for preventing HIV prevention and unintentional pregnancies, however their use in South Africa is sub-optimal. We analyzed survey data on reported condom use among 3009 sexually active adolescent girls and young women (AGYW) aged 15-24 years, and qualitative data from interviews and focus group discussions with 237 AGYW and 38 male peers. Our findings describe the current condom use landscape among adolescents and young people in South Africa, illustrating relationship dynamics, gendered power and notions of masculinity which influence condom negotiation and use in young heterosexual South Africans' sexual encounters.

Covariates of Multiplicity of High-Risk Sexual Behavior Among Men in India: Evidence from the Latest Indian Demographic and Health Survey

Modern Indian society has witnessed rapid sociocultural transformation where loosening of cultural values is observed at all levels. In the era of transition, traditional norms and values are changing where young male individuals are found to be associated with high-risk multi-partner sexual behavior. Findings are based on a nationally representative sample of 45,231 and 65,704 men aged 15-54 during the period 2005-2006 and 2015-2016, respectively. The burden of high-risk sexual behaviors among men aged 15-54 years in India over the last decade remains disproportionately higher among younger, unmarried, and urban men, who are mainly from economically better-off households. Despite tremendous efforts of the government of India as well as various state governments in condom promotion as part of the HIV/AIDS prevention program, the improvements in condom use over the last decade are not impressive as it has not yet reached the desired threshold level. The disparities in high-risk sexual behavior among men aged 15-54 years, coming from rich and poor households, have narrowed. The findings of the study also underline an apparent paradox in the relationship between knowledge of HIV/AIDS and indulgence in high-risk sexual behavior and adopting safe sexual practices. It is recommended that all the HIV prevention programs in India should promote the concept of men as the responsible sexual partner. This concept may be promoted among young and unmarried men by reinforcing the shift from violence to respect and projecting the condom as a sexual stimulus rather than a means of disease prevention.

Condom use during COVID-19: Findings from an Australian sample of heterosexual young adults

Condoms are a valuable tool in combating the continued spread of sexually transmitted infections (STIs). Despite the fact that condoms are effective and easily accessible, young adults report inconsistent condom use and young adults represent a disproportionately large amount of new STI cases annually. The Behavioural Immune System theory suggests that health behaviours, such as condom use, are impacted by cognitive activation of perceived threat of disease. The advent of the COVID-19 pandemic may then have unforeseen impacts on condom use and the spread of STIs. The present study investigated changes in condom use during the pandemic, and any associations these changes may have had with perceived vulnerability to COVID-19. An Australian sample of 269 students completed a survey asking them to recall their condom use prior to COVID-19, and then their current condom use. Final analyses included a sample of 149 sexually active heterosexual participants. Results revealed a general decline in condom use. Single and coupled participants both reported less frequent condom use, but this decrease was more pronounced among single people. Gender did not moderate these effects. Surprisingly, diminished condom use was not significantly related to perceived threat of COVID-19. Findings of the present study have concerning implications for sexual health and sexual messaging during pandemics.

Genital Chlamydia Trachomatis Infection: Prevalence, Risk Factors and Adverse Pregnancy and Birth Outcomes in Children and Women in sub-Saharan Africa

Genital Chlamydia trachomatis (CT) has adverse health outcomes for women and children. In pregnant women, the infection causes adverse obstetric outcomes including pelvic inflammation, ectopic pregnancy, and miscarriage. In children, it causes adverse birth outcomes such as skin rash, lesions, limb abnormalities, conjunctivitis, neurological damage, and even death. This article discusses genital CT prevalence, risk factors, and adverse pregnancy and birth outcomes among women and children in sub-Saharan Africa as well as challenges associated with the mitigation of the disease. A comprehensive search of databases including PubMed, ResearchGate, and Google Scholar was conducted using keywords such as genital chlamydia trachomatis, adverse pregnancy outcomes, adverse birth outcomes, and sub-Saharan African. We found that genital CT prevalence rates in some sub-Saharan Africa countries were higher than others and that risk factors such as the lack of condom use, having multiple sexual partners, and low educational levels contribute to the transmission of the infection. We also found that negative cultural practices, illiteracy among women, and the lack of access to screening services during pregnancy are some of the challenges associated with CT mitigation in sub-Saharan Africa. To reduce genital CT transmission in sub-Saharan Africa, efforts must be made by country governments to eliminate negative cultural practices, promote female literacy, and provide access to screening services for pregnant women.

College Women's Experiences of Male Partner Contraceptive Interference: Associations With Intimate Partner Violence and Contraceptive Outcomes

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.

Does Women's Autonomy Matter on Attitude Towards Condom Use in Reducing Risk for HIV Infection Among Married Women in Ethiopia?

Background

Condom utilization remains as the forefront guard to reduce the HIV/AIDS pandemic. However, evidence showed that the dynamics of gendered power, beliefs, and attitudes about condoms and sexuality retards condom use for a large proportion of Africa's people. Therefore, this study aimed to assess the association between women's autonomy in health decision making and attitude to condom use in reducing risk for HIV in Ethiopia using a nationally representative, population-based household survey data.

Methods

A cross-sectional study was carried out using 2016 nationally representative, population-based Ethiopia Demographic and Health Survey. SPSS version 21 was used to analyze the data. Multivariate logistic regression analysis was performed to assess the association between women's autonomy in health decision making and attitude to condom use by controlling confounders. To declare statistically significant associations, adjusted odds ratios (AOR) with 95% confidence interval (CI) were used.

Results

The present study enrolled 6787 weighted samples of married women. The study showed that the odds of attitude toward condom use were 1.39 times (AOR: 1.39; 95% CI: 1.04-1.85) higher among women who decide for their health care compared to its counterparts. Also, the odds of attitude toward condom use were positively associated among women who conquered higher education (AOR: 1.97; 95% CI: 1.17-3.33), who had the richest wealth index quintile (AOR: 1.45; 95% CI: 1.01-2.07), and who had ever been tested for HIV (AOR: 1.31; 95% CI: 1.09-1.57). However, the odds of attitudes toward condom use were negatively associated among Muslims (AOR: 0.58; 95% CI: 0.46-0.74) and Protestant religion (AOR: 0.69; 95% CI: 0.54-0.88) followers.

Conclusion

The study culminates that women's autonomy in health decision making improves attitudes toward condom use during sex for HIV prevention in Ethiopia. Besides, women's higher education gets better wealth index, and HIV testing perks up the attitudes toward condom use; but religious affiliation deters it. Therefore, efforts need to be done in promoting women's autonomy along with empowering women in education, economic as well as HIV detection. Furthermore, designing interventions that address primary prevention strategies like using condoms consistently along with addressing religious affiliation can have a significant effect on curtailing HIV/AIDS scourge.

Sexual Behaviours and Practices before and after Phase I/II HIV Vaccine Trial: A Qualitative Study among Volunteers in Dar es Salaam Tanzania

There is limited information about sexual behavior among volunteers who participated in phase I/II human immunodeficiency virus (HIV) vaccine trial. This article describes the sexual behavior, practices before, and after participation in phase I/II HIV vaccine trial in Dar es Salaam, Tanzania. We conducted a qualitative descriptive study involving volunteers who participated in the phase I/II vaccine trial between 2007 and 2010. Purposeful sampling was used to recruit potential informants. Twenty-four in-depth interviews were conducted. The audio-recorded interviews were transcribed verbatim and analyzed using a thematic content analysis approach. The findings revealed that before participation in the HIV vaccine trial, informants were engaging in unprotected multiple sexual relationships. After the completion of the HIV vaccine trial, informants reported strengthened marital relationships, increased understanding of safer sexual practices, and HIV testing. However, the informants reported challenges regarding vaccine-induced seropositivity that adversely affected their sexual and marital relationships. Some informants re-engaged in risky sexual practices because they perceived the experimental vaccine was protective. The informants suggested having continued interventions within the community to enhance safer sexual practices. Participation in phase I/II HIV vaccine trials may positively and negatively influence changes in volunteers' sexual behaviors and practices. The trial interventions appear to improve compliance with safer sexual practices. However, the reported vaccine-induced seropositivity and the perception that experimental vaccines are protective need further appropriate interventions.

What About Methods for Men? A Qualitative Analysis of Attitudes Toward Male Contraception in Burkina Faso and Uganda

CONTEXT

Male contraceptive options are limited; however, product development efforts tend to focus on female methods. Research on attitudes toward methods for men-particularly in regions of low contraceptive prevalence, such as Sub-Saharan Africa-could inform the development of new male methods.

METHODS

Qualitative data were taken from focus group discussions with 80 men aged 23-67 and 398 women aged 15-50 conducted in Burkina Faso and Uganda in 2016. Transcripts were analyzed thematically to explore support among men and women for male contraceptive methods, and to extract suggestions about ideal method characteristics.

RESULTS

Male and female participants in both countries expressed support for new male contraceptive options; more positive attitudes were expressed in Uganda than in Burkina Faso. Participants of both sexes recognized that male methods could reduce the family planning burden on women and offer men greater control over their fertility; however, some had concerns about side effects and thought that men would not use contraceptives. Relationship characteristics, such as polygamous unions, were cited as possible challenges. In both countries, various delivery methods (e.g., creams or jellies, injections and implants) and durations (from short-acting to permanent) were proposed.

CONCLUSIONS

The acceptability of new male methods among most participants in the two countries indicates a potential demand for male contraceptives. Options should include a variety of method characteristics to maximize choice, engage men, and support men and women's contraceptive needs.

Associated factors and sex differences in condom non-use among adolescents: Brazilian National School Health Survey (PeNSE)

Background

Condom non-use among sexually active adolescents is a major cause of unintended pregnancy and sexually transmitted infections. In order to promote condom use, it is essential to understand factors associated with condom non-use.

Aim

Our aim was to evaluate sex differences and associated factors of condom non-use based on the nationally representative Brazilian National School Health Survey.

Methods

The study participants were 100,962 adolescents 13–18 years old, 9th graders from both public and private schools throughout Brazil. The following factors were considered as explanatory group variables for the outcome of condom non-use among adolescents: school and health service, sexual behavior, substance use, and self-reported body and health perception. Poisson regression model was performed.

Results

Of the total students, 28% (n = 28,157) had had sexual intercourse at least once. (boys, 37.1%; girls, 19.5%). Of these, 69.2% had used condoms the last time they had intercourse (girls: 68%; boys: 69.9%). The variables associated with condom non-use for both sexes were not having accessed a health service or approached a health professional for health-related care; not having received pregnancy prevention counseling or guidance on AIDS or STI prevention at school; early sexual initiation; no additional contraception method; substance use; feeling alone; not being satisfied with their own body; feeling fat or thin; and poor self-reported health. The number of sexual partners was also associated with condom non-use; however, contrasting behavior was indicated between sexes. A higher number of sexual partners indicated less use of condoms among girls, while for boys, a higher number of sexual partners indicated higher condom use.

Conclusion

High condom non-use appears to be associated with lack of health care access and sexual health education, poor sexual practices, substance use, and poor self-perception, indicating areas for health promotion programs.

Disparities in characteristics in accessing public Australian sexual health services between Medicare-eligible and Medicare-ineligible men who have sex with men

OBJECTIVES

Accessible health services are a key element of effective human immunodeficiency virus (HIV) and sexually transmitted infection (STI) control. This study aimed to examine whether there were any differences in accessing sexual health services between Medicare-eligible and Medicare-ineligible men who have sex with men (MSM) in Melbourne, Australia.

METHODS

We conducted a retrospective, cross-sectional study of MSM attending Melbourne Sexual Health Centre between 2016 and 2019. Demographic characteristics, sexual practices, HIV testing practices and STI diagnoses were compared between Medicare-eligible and Medicare-ineligible MSM.

RESULTS

We included 5,085 Medicare-eligible and 2,786 Medicare-ineligible MSM. Condomless anal sex in the past 12 months was more common in Medicare-eligible compared to Medicare-ineligible MSM (74.4% vs. 64.9%; p<0.001) although the number of partners did not differ between groups. There was no difference in prior HIV testing practices between Medicare-eligible and Medicare-ineligible MSM (76.1% vs. 77.7%; p=0.122). Medicare-ineligible MSM were more likely to have anorectal chlamydia compared to Medicare-eligible MSM (10.6% vs. 8.5%; p=0.004).

CONCLUSIONS

Medicare-ineligible MSM have less condomless sex but a higher rate of anorectal chlamydia, suggesting they might have limited access to STI testing or may be less willing to disclose high-risk behaviour. Implications for public health: Scaling up access to HIV and STI testings for Medicare-ineligible MSM is essential.

Health beliefs and barriers related to HIV prevention and screening among students of the University of Vlora: a cross-sectional study

Background

Previous researchers have found that young university students can have a high level of knowledge about HIV/AIDS infection, but they are still not utilizing the existing HIV prevention methods. As a result there is a need to determine which factors and barriers influence the use of existing HIV screening and prevention methods among students of the University of Vlora in Albania.

Methods

This was a cross-sectional study conducted among university students in the district of Vlora, Albania from April to June 2018. Stratified, multi-stage sampling technique was used to select randomly study subjects. A structured, self-administered questionnaire was used for data collection. Bivariate and multivariate logistic regression analysis was employed to reflect the relationship between variables.

Results

The mean age of the participants (710) was 20.85 ± 2.1 years. 38% of them believe that chances of getting HIV would not stop them to have sexual intercourse with more than one partner, 69% report that using a condom seems like an insult to their partner. 78% of the students with sexual experience didn’t used Voluntary Counseling and Testing services. The students from the rural area (AOR = 0.50, 95% CI [0.30–0.82]) and those of first academic year (AOR second/first year =2.31, 95% CI [1.33–3.99], AOR third/first year =1.18, 95% CI [0.65–2.13]) were less likely to use HIV service.

Conclusions

The findings reveal that health beliefs and barriers are good predictors of the preventive behaviours toward HIV infection. The survey has provided evidence to suggest that creating awareness about HIV prevention among student community, especially those from non-health sciences and rural areas could contribute to increased uptake of the VCT services, the condom use and to reduce the identified stigmatizing barriers.

Consistent condom use among men who pay for sex in sub-Saharan Africa: Empirical evidence from Demographic and Health Surveys

BACKGROUND

Paying for sex has often been associated with risky sexual behavior among heterosexual men, and men who pay for sex are considered as a bridging population for sexually transmitted infections. Consistent condom use during paid sex is essential for reducing sexually transmitted infections, including HIV/AIDS. In this study, we assessed the prevalence and predictors of consistent condom use among men who pay for sex in sub-Saharan Africa.

MATERIALS AND METHODS

We pooled data from 29 sub-Saharan African countries' Demographic and Health Surveys. A total of 3,353 men in sub-Saharan Africa who had paid for sex in the last 12 months preceding the surveys and had complete information on all the variables of interest were used in this study. The outcome variable for the study was consistent condom use for every paid sex in the last 12 months. Both bivariate and multivariable logistic regression analyses were carried out. Results were presented as adjusted odds ratios with their corresponding 95% confidence intervals. Statistical significance was declared at p< 0.05.

RESULTS

Overall, the prevalence of consistent condom use during paid sex in sub-Saharan Africa was 83.96% (CI = 80.35-87.56), ranging from 48.70% in Benin to 98% in Burkina Faso. Men aged 35-44 [AOR, 1.39 CI = 1.04-1.49], men in the richest wealth quintile [AOR, 1.96 CI = 1.30-3.00], men with secondary level of education [AOR, 1.69 CI = 1.17-2.44], and men in Burkina Faso [AOR = 67.59, CI = 8.72-523.9] had higher odds of consistent condom use during paid sex, compared to men aged 15-19, those in the poorest wealth quintile, those with no formal education, and men in Benin respectively. Conversely, Muslim men had lower odds [AOR = 0.71, CI = 0.53-0.95] of using condom consistently during paid sex, compared to Christian men.

CONCLUSION

Empirical evidence from this study suggests that consistent condom use during paid sex encompasses complex social and demographic characteristics. The study also revealed that demographic characteristics such as age, wealth quintile, education, and religion were independently related to consistent condom use for paid sex among men. With sub-Saharan Africa having the highest sexual and reproductive health burden in the world, continuous application of evidence-based interventions (e.g., educational and entrepreneurial training) that account for behavioural and social vulnerabilities are required.

Migrant Women's Access to Sexual and Reproductive Health Services in Malaysia: A Qualitative Study

Providing sexual and reproductive health (SRH) services to migrant workers is key to fulfilling sustainable developmental goals. This study aims to explore key informants’ views on the provision of SRH services for migrant women in Malaysia, exploring the provision of SRH education, contraception, abortion, antenatal and delivery, as well as the management of gender-based violence. In-depth interviews of 44 stakeholders were conducted from July 2018 to July 2019. Data were thematically analysed. Migrant workers that fall pregnant are unable to work legally and are subject to deportation. Despite this, we found that insufficient SRH information and contraceptive access are provided, as these are seen to encourage promiscuity. Pregnancy, rather than sexually transmitted infection prevention, is a core concern among migrant women, the latter of which is not adequately addressed by private providers. Abortions are often seen as the only option for pregnant migrants. Unsafe abortions occur which are linked to financial constraints and cultural disapproval, despite surgical abortions being legal in Malaysia. Pregnant migrants often delay care-seeking, and this may explain poor obstetric outcomes. Although health facilities for gender-based violence are available, non-citizen women face additional barriers in terms of discrimination and scrutiny by authorities. Migrant women face extremely limited options for SRH services in Malaysia and these should be expanded.

Depression and Incident HIV in Adolescent Girls and Young Women in HIV Prevention Trials Network 068: Targets for Prevention and Mediating Factors

The human immunodeficiency virus (HIV) epidemic among adolescent girls and young women (AGYW) in sub-Saharan Africa is a critical public health problem. We assessed whether depressive symptoms in AGYW were longitudinally associated with incident HIV, and identified potential social and behavioral mediators. Data came from a randomized trial of a cash transfer conditional on school attendance among AGYW (ages 13-21 years) in rural Mpumalanga Province, South Africa, during 2011-2017. We estimated the relationship between depressive symptoms and cumulative HIV incidence using a linear probability model, and we assessed mediation using inverse odds ratio weighting. Inference was calculated using the nonparametric bootstrap. AGYW with depressive symptoms had higher cumulative incidence of HIV compared with those without (risk difference = 3.5, 95% confidence interval (CI): 0.1, 7.0). The strongest individual mediators of this association were parental monitoring and involvement (indirect effect = 1.6, 95% CI: 0.0, 3.3) and reporting a partner would hit her if she asked him to wear a condom (indirect effect = 1.5, 95% CI: -0.3, 3.3). All mediators jointly explained two-thirds (indirect effect = 2.4, 95% CI: 0.2, 4.5) of the association between depressive symptoms and HIV incidence. Interventions addressing mental health might reduce risk of acquiring HIV among AGYW.

Exploring Determinants of Condom Use among University Students in Sudan

Increasing numbers of university students in Sudan are at risk of contracting HIV because of their engagement in condomless sex. A comprehensive and culturally accepted condom promotion program could potentially reduce this threat substantially. However, little is known about the sociocognitive determinants of condom use in this population: information that is required to develop such HIV prevention programs. Therefore, in August 2014, we conducted 30 semi-structured individual interviews with male and female students (both currently sexually active and nonactive) to explore determinants of condom use based on the I-Change model. Data were analyzed using Nvivo 10. The results suggest that barriers to condom use among university students include misconceptions about condom use, negative attitudes toward condom use, lack of social support, low self-efficacy to use condoms, and poor action planning. Sexual health promotion should, therefore, address these aspects to successfully promote condom use among sexually active students and subsequently reduce the risk of HIV transmission.

Predictors and Barriers to Condom Use in the African Cohort Study

Consistent condom use is an inexpensive and efficacious HIV prevention strategy. Understanding factors associated with condom use and barriers to use can inform strategies to increase condom uptake. The ongoing African Cohort Study prospectively enrolls adults at 12 clinical sites in Uganda, Kenya, Tanzania, and Nigeria. At enrollment, participants are asked about condom use at last sex with a regular partner. Robust Poisson regression models were used to evaluate predictors of self-reported condom use. Participants who reported not using condoms were asked to provide reasons. From January 2013 to September 2019, 2482 participants reported having at least one regular sexual partner in the preceding 6 months. Of those, 1577 (63.5%) reported using a condom at last sex. Condom use was more common among older participants, males, HIV-infected participants, and those with an HIV-infected partner. Married participants, those with a partner of unknown HIV status, and those reporting alcohol use were less likely to report condom use at last sex. Condom use at last sex also varied significantly by clinical site. Partner disapproval or refusal to use a condom was a consistent driver of disparities in condom use among participants who were HIV infected, female, and aged 18-24 years. Effective HIV prevention programs should integrate condom education with the tools necessary to negotiate condom use with regular partners.

Pleasure and PrEP: Pleasure-Seeking Plays a Role in Prevention Choices and Could Lead to PrEP Initiation

Pleasure-seeking plays a role in prevention (means choices and use), and in the sexual quality of life of men who have sex with men (MSM). Since HIV is a major threat to MSM health, new means of prevention, like pre-exposure prophylaxis (PrEP), must meet the needs of MSM to be fully efficient. Using a psychosocial approach, we examined how pleasure-seeking plays a role in participation of MSM in “ANRS-IPERGAY,” a community-based trial on sexual health which included sexual on-demand PrEP. Thirteen semistructured collective interviews were conducted with 45 participants. First, we analyzed participants’ search for new prevention means due to previous failures in condom use. We found that participants perceived condoms as a barrier—both materially and symbolically—to pleasure and desire, causing anxiety and stress considering sexual intercourse. Second, we explored representations and attitudes concerning pleasure within the context of PrEP. We found that PrEP allowed participants to freely choose their desired sexual positions and to better enjoy intimacy. Third, we studied the sexual quality of life for PrEP users in ANRS-IPERGAY and found an improvement. Thanks to the community-based design of the trial, this new prevention tool became a means to develop agency and empowerment for participants, not only in negotiating individual prevention but also in opposing the normative and stigmatizing discourse on sexuality and HIV. In conclusion, pleasure-seeking appears to be an essential element of sexual fulfillment that needs to be integrated as a positive notion in the study of HIV prevention.

Knowledge, information needs and behavior regarding HIV and sexually transmitted infections among migrants from sub-Saharan Africa living in Germany: Results of a participatory health research survey

BACKGROUND

A total of 3,419 new HIV diagnoses were reported in Germany in 2016, with migrants from sub-Saharan Africa (misSA) accounting for 14.1%. To understand the driving factors behind the epidemiological situation, we conducted a quantitative cross-sectional survey on knowledge, attitudes, behavior, and practices regarding HIV and sexually transmitted infections (STIs) among misSA living in six German cities utilizing participatory health research.

METHODS

Participants were recruited by peer researchers. Levels of knowledge, information needs, and preferred methods of information dissemination were analyzed to inform future prevention planning. Additionally, we analyzed sexual behavior and other risk factors for contracting HIV and STIs. The results may facilitate the formulation of targeted prevention messages in the future.

RESULTS

We included 2,432 participants in the analysis. General knowledge about HIV was adequate, as 86.9% were aware of the presented information. Statements about HIV co-infections were prior knowledge for 53.4% of the participants and about German HIV policies and HIV testing for 54.7%. Knowledge about other STIs differed, ranging from 69.6% who have ever heard of gonorrhea to 23.8% who have ever heard of genital warts. Groups with particular knowledge gaps were i) younger misSA, ii) recent migrants, iii) misSA without regular access to the German health care system, iv) misSA of lower socioeconomic status, and v) misSA with Muslim religious affiliation. The majority of participants reported information needs (72.8%), and 71.3% wanted to obtain this information from health professionals. Male misSA were more likely to report five or more sexual partners compared to females. Less than half of participants reported always using condoms with non-steady sexual partners (46.8%). Reasons for not using condoms differed between males and females. A considerable proportion of females (16.3%) and males (6.8%) experienced sexualized violence. More than one fourth of women (26.9%) were affected by female genital mutilation/cutting.

DISCUSSION

Future prevention planning should focus on sub-groups with particular knowledge gaps, recognizing their preferred methods of information dissemination. Prevention messages for male misSA should focus on their own risk perception and for female misSA on empowerment, e.g. to negotiate condom use.

Factors associated with condom use among HIV-positive women living in Atlanta, Georgia

Objectives

Consistent condom use is essential to reducing heterosexual transmission of HIV. African Americans are disproportionately affected by HIV in the United States despite comprising a small percentage of the population. Our objectives were to evaluate factors associated with self-reported condom use in a cohort of predominantly African American women receiving HIV care in Atlanta, Georgia.

Methods

A cross-sectional study of reproductive knowledge, attitudes, and practices among adult, sexually-active, HIV-positive women attending the Grady Infectious Disease Clinic in Atlanta, Georgia was conducted from July, 2013 to November, 2014 to evaluate factors associated with self-reported condom use. Primary outcomes included: condom use at last vaginal intercourse and consistent condom use with vaginal intercourse over the last six months. Descriptive, bivariable, and multivariable logistic regression analyses were performed.

Results

Of 187 women enrolled, 170 reported having vaginal intercourse in the last six months. Seventy-four percent used condoms at last vaginal intercourse, whereas 53% reported consistent condom use over the last six months. In adjusted analyses, factors associated with condom use at last intercourse included decreased frequency of sex, no history of drug use, and confidence to discuss condom use with sexual partners (p<0.05). Factors associated with consistent condom use in the past six months were older age, being single/dating, and confidence to discuss condom use with sexual partners. History of drug use, having HIV-positive partners, and unprotected anal intercourse were associated with inconsistent use (p<0.05).

Conclusions

Improved strategies are needed to educate women on the importance of safe sexual practices and condom negotiation. Healthcare providers should strive to have an open dialogue with patients about condom use, whether they engage in anal sex, and its risks.

"I am aware of the risks, I am not changing my behaviour": risky sexual behaviour of university students in a high-HIV context

Unprotected sexual activity increases the risk of pregnancy and HIV and AIDS. More than three decades into the AIDS pandemic, the condom remains the most effective strategy for protecting against the dual risks of pregnancy and HIV and AIDS, but data from national surveys suggest that condom use among young people aged 15-24 is on the decline in South Africa. This study uses qualitative data from 20 in-depth interviews and one focus group to examine the risk behaviours of university students aged 18-24 years old, with particular emphasis on understanding the decline in the use of condoms. It is well documented that South Africa has one of the highest prevalence rates of HIV and AIDS in the world, however the findings of this study suggest that even though students were well informed about the perceived risks associated with unsafe sexual behaviours, they continue to engage in risk behaviours including unprotected sexual intercourse, multiple sexual partners and the use of alcohol. Male students were more likely than female students to report risky sexual behaviours. Condom use is occurring but not consistently. The majority of students did not use condoms during their first sexual encounter because of a lack of preparedness. Negative attitudes towards condoms continue to discourage students from using them consistently, especially those provided by the government. In light of this, it is recommended that rigorous efforts are directed towards challenging inaccurate perceptions about, and attitudes towards, condom use to promote consistency.

Contraceptive discontinuation: frequency and associated factors among undergraduate women in Brazil

BACKGROUND

In Brazil, high contraceptive prevalence rates coexist with high rates of unintended pregnancies. Contraceptive discontinuation may explain this context, but few studies have focused on highly educated young women in countries with low unmet need for modern contraception. This paper explores frequency and associated factors of contraceptive discontinuation among undergraduate students in Brazil within 12-months.

METHODS

This retrospective cohort study was conducted among a probability sample of 1679 undergraduates of São Paulo University. Data were collected online using a contraceptive calendar. We examined factors related to monthly discontinuation of oral pills and male condoms using Generalized Estimating Equation models.

RESULTS

Altogether, 19% of oral pill users and 48% of male condom users discontinued their method for method-related reasons within 12-months, and 18% of oral pill users and 15% of male condom users abandoned/or switched to less effective methods. Women in casual relationships were at increased odds of oral pill (OR = 1.4 [1.1-1.8]) and male condom discontinuation (OR = 1.3 [1.0-1.7]), and at increased odds of switching from oral pill to less effective or no method (OR = 1.4 [1.1-1.7]). Other associated factors were method specific. Women from lower socioeconomic status or who had multiple lifetime partners were more likely to discontinue or abandon the oral pill, while more sexually experienced women were less likely to discontinue the male condom.

CONCLUSION

Frequent method discontinuation in Brazil calls for greater attention to the difficulties women face when using short acting methods. Discontinuation was associated with type of partner and sexual experience highlighting the changing contraceptive needs of women at the early stages of their professional careers.

Condom Availability Programs in Schools: A Review of the Literature

OBJECTIVE

This review synthesizes findings from the peer-reviewed evaluation literature on condom availability programs (CAPs) in secondary schools.

DATA SOURCE

Peer-reviewed evaluation literature indexed in MEDLINE, EMBASE, PsychINFO, ERIC, CINAHL, Sociological Abstracts, SCOPUS, and POPLINE.

STUDY INCLUSION AND EXCLUSION CRITERIA

Manuscripts had to be, written in English, and report evaluation data from a US school-based CAP.

DATA EXTRACTION

Articles were coded independently by 2 authors. Discrepancies were resolved through open discussion.

DATA SYNTHESIS

We grouped findings into outcome evaluation and process evaluation findings. Outcome evaluation findings included sexually transmitted infections (STIs), pregnancy rates, condom use, contraception use, sexual risk, and substance use. Process evaluation findings included awareness of CAPs, attitudes toward CAPs, attitudes toward condoms, and receipt of education and instruction.

RESULTS

Of the 138 citations reviewed, 12 articles published between 1995 and 2012 met the inclusion criteria, representing 8 programs. Evaluations indicate CAPs yield condom acquisition rates between 23% and 48%, have mixed results related to condom use, and are not associated with increases in sexual and other risk behaviors. One program found CAPs were associated with a decrease in a combined rate of chlamydia and gonorrhea. One program found no association between CAPs and unintended pregnancy. Students' attitudes toward CAPs were favorable and awareness was high.

CONCLUSIONS

Condom availability programs are accepted by students and can be an appropriate and relevant school-based intervention for teens. Condom availability programs can increase condom use, but more evaluations are needed on CAP impact on rates of HIV, STIs, and unintended pregnancy.

Pre-exposure Prophylaxis Among Men Who have Sex with Men: Dual Motivational Model of Intention to Use Pre-exposure Prophylaxis

Men who have sex with men (MSM) account for most new HIV infections in the United States. Despite representing a fraction of the population, MSM make up an estimated 65% of new infections. To address this epidemic, pre-exposure prophylaxis (PrEP) is recommended to supplement condom use. Despite its effectiveness, PrEP uptake among MSM is low. Few studies have employed theoretical approaches to understand PrEP use intention. Incorporating factors like safe sex fatigue, expectation of better sexual experiences, and perceived risk are proposed in this dual motivational path model of PrEP use intention. This model hypothesized that PrEP use intention is influenced by two key pathways: (1) protection motivation pathway, and (2) sexual expectancy pathway. Data were collected using social networking applications from 402 MSM. The model was tested using structural equation modeling. We elaborate the complex decision-making process proposed by this novel theoretical model and discuss its practical implications.

Factors Associated with Sexual Risks and Risk of STIs, HIV and Other Blood-Borne Viruses Among Women Using Heroin and Other Drugs: A Systematic Literature Review

This systematic literature review identified factors associated with sexual risks related to sexually transmitted infections (STI), HIV and other blood-borne viruses (BBV) among women using heroin and other drugs. The search strategy included five databases (PubMed, EMBASE, PsycNET, Web of Science, Scopus), and PsycEXTRA for grey literature. Out of the 12,135 publications screened, 30 peer-reviewed articles were included. Most publications were cross-sectional (n = 25), quantitative (n = 23) and included 11,305 women. Factors identified were: (1) socio-demographics; (2) gender roles and violence against women; (3) substance use; (4) transactional sex; (5) partner characteristics, partner's drug use, and context of sex; (6) preferences, negotiation and availability of condoms; (7) HIV status and STIs; (8) number of sexual partners; (9) love and trust; (10) reproductive health and motherhood; and (11) risk awareness and perception of control. Overall, this review highlights important implications for future research and practice, and provides evidence for developing STI/BBV preventive strategies.

Policy environment impacting the societal harm caused by alcohol in India: protocol for a scoping review

INTRODUCTION

The aim of this review is to provide the first consolidation of the policy environment surrounding alcohol-related societal harm in India giving researchers and policy-makers a clearer base for future reforms. This review is also an important adaptation on the scoping review method for policy reviews in low-resource settings that may serve as an example for other policy reviews in similar settings.

METHODS AND ANALYSIS

We will undertake a scoping review with policy relevant adaptations in order to map the alcohol-related policy environment in India. Following the six-step approach put forward by ArskeyandO'Malley and refined by Levac, we will first undertake an academic scoping search to identify relevant knowledge already existing in the literature about the policy environment in India. We will then use the knowledge that appears in this search iteratively, as is true to the scoping method, to develop a more targeted search of grey literature and Indian government websites for Indian policy documents. These documents will be analysed using qualitative methods to synthesise the current alcohol policy environment in India.

ETHICS AND DISSEMINATION

This study will only use already published information and therefore does not require an ethics review. We will circulate this protocol and the final report to policy researchers in similar settings who could make use of our adaptation of the scoping review method for a low-resource setting. We will also publish our findings in a peer-review journal.

A strategic action framework for multipurpose prevention technologies combining contraceptive hormones and antiretroviral drugs to prevent pregnancy and HIV

OBJECTIVE

Multipurpose prevention technologies (MPTs) are an innovative class of products that deliver varied combinations of human immunodeficiency virus (HIV) prevention, other sexually transmitted infection (STI) prevention, and contraception. Combining separate strategies for different indications into singular prevention products can reduce the stigma around HIV and STI prevention, improve acceptability of and adherence to more convenient products, and be more cost-effective by addressing overlapping risks.

METHODS

This article outlines a strategic action framework developed as an outcome of a series of expert meetings held between 2014 and 2016. The meetings focused on identifying opportunities and challenges for MPTs that combine hormonal contraception (HC) with antiretroviral drugs into single products. The framework aims to present an actionable strategy, by addressing key research gaps and outlining the key areas for progress, to guide current and future HC MPT development.

RESULTS

We identified eight primary action areas for the development of impactful HC MPTs, and includes aspects from epidemiology, pharmacology, clinical trial design, regulatory requirements, manufacturing and commercialisation, behavioural science, and investment needs for research and development.

CONCLUSION

Overall, the challenges involved with reconciling the critical social-behavioural context that will drive MPT product use and uptake with the complexities of research and development and regulatory approval are of paramount importance. To realise the potential of MPTs given their complexity and finite resources, researchers in the MPT field must be strategic about the way forward; increased support among policy-makers, advocates, funders and the pharmaceutical industry is critical.

Exploring barriers to consistent condom use among sub-Saharan African young immigrants in Switzerland

No study to date has focused on barriers to condom use specifically among young immigrants to Europe from sub-Saharan Africa. Based on a qualitative study in sociology, this paper explores generational differences in barriers to condom use between first-generation immigrants (born in Africa and arrived in Switzerland after age 10) and second-generation immigrants (born in Switzerland to two native parents or arrived in Switzerland before age 10). Results are based on in-depth, semistructured individual interviews conducted with 47 young women and men aged 18 to 25 to understand how individual, relational, and cultural dimensions influence sexual socialization and practices. Six main barriers to consistent condom use were identified: reduced pleasure perception, commitment and trust, family-transmitted sexual norms and parental control, lack of accurate knowledge on HIV transmission, lack of awareness about HIV in Switzerland, and gender inequalities. The three first barriers concerned both generations of immigrants, whereas the three last revealed generational differences. These findings can help sexual health providers identify social causes for young sub-Saharan immigrants not using condoms. The findings also highlight the necessity of offering accurate, accessible, and adapted information to all young immigrants, as well as the particular importance of addressing families' lack of discussions about sex, understanding the sexual norms transmitted by parents, and taking into consideration cultural differences among young people born in immigration countries.

Contraceptive, condom and dual method use at last coitus among perinatally and horizontally HIV-infected young women in Atlanta, Georgia

Objective

To evaluate factors within the social-ecological framework associated with most or moderately effective contraception, condom and dual method use at last coitus among young, HIV-infected women in Atlanta.

Methods

This is a cross-sectional study conducted from November, 2013 until August, 2015 at the Grady Infectious Disease Clinic in Atlanta, Georgia. We recruited perinatally and horizontally HIV-infected women of ages 14–30 years to complete an audio computer-assisted self-interview. We evaluated factors within a social-ecological framework associated with most or moderately effective contraceptive use (hormonal contraception or an IUD), condom use, and dual method use (use of condom and most or moderately effective contraceptive) at last coitus.

Results

Of 103 women enrolled, 74 reported a history of sexual activity. The average age was 22.1; 89% were African American, 52% were perinatally infected, 89% received combination antiretroviral therapy, and 63% had undetectable viral loads. At last coitus, 46% reported most or moderately effective contraception, 62% reported condom use and 27% reporting dual-method use. The odds of most or moderately effective contraceptive use was significantly reduced among those with detectable viral loads (versus undetectable viral loads; aOR 0.13 [0.04, 0.38]). Older age (aOR 0.85 [0.74, 0.98] and more frequent coitus (>once/week versus < = once/week; aOR 0.24 [0.08, 0.72]) was significantly associated with reduced condom use. Having a detectable viral load (versus undetectable viral loads; aOR 0.13 [0.03, 0.69]) and more frequent coitus (>once/week versus < = once/week; aOR 0.14 [0.03,0.82]), was associated with reduced dual method use, while being enrolled in school (aOR 5.63 [1.53, 20.71]) was significantly associated with increased dual method use.

Conclusions

Most or moderately effective contraception, condom and dual method use remained inadequate in this cohort of young HIV-infected women. Individual-level interventions are needed to increase the uptake of dual methods with user-independent contraceptives.

Determinants of condom use among parous women in North Central and South Western Nigeria: a cross-sectional survey

Objectives

There appears to be an increasing trend of condom use for pregnancy prevention among nulliparous and multiparous women in developing countries. Drawing from a cross-sectional survey involving 1227 women selected using a 3-stage cluster random sampling technique, the study examines the rates of condom use and its determinants among parous women in three states in North Central and South Western Nigeria.

Results

The rate of condom use among parous women was 13.8% and 23.2% among women using any form of contraceptives. After adjusting for confounding factors (religion and marital status, socioeconomic status and access to a health facility in the resident community), women aged 26–35 (AOR 2.7; CI 1.6–4.5), urban residence (AOR: 3.6; CI 2.2–5.8), no income (AOR: 2.7; CI 1.4–4.9), living in Ekiti State (AOR: 1.8; CI 1.2–2.8) and having a tertiary level of education (AOR: 4.5; CI 1.3–15.6) were the independent predictors of condom use. There is an increasing trend of condom use among parous women.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3573-5) contains supplementary material, which is available to authorized users.

#CondomEmoji

Purpose

The purpose of this paper is to explore participants’ attitudes and receptivity to a #CondomEmoji campaign insofar as investigating whether attitudes and receptivity were important predictors for brand impression and intention to buy.

Design/methodology/approach

This study involved 206 research participants who live in Jakarta and Surabaya and who answered online questionnaires to measure attitudes, receptivity to #CondomEmoji advertising, brand impression and intention to buy condoms. Questionnaires were circulated on several social media platforms and instant messaging apps. The participants were asked to watch the #CondomEmoji advertising video before proceeding to fill out the questionnaires.

Findings

Research findings suggested that participants mostly held negative attitudes and receptivity to the campaign. Non-sexually active participants were more likely to perceive the advertising as offensive. Attitudes and receptivity were good predictors for brand impression, yet attitude was not significantly attributed to intention to buy condoms. The result was stronger in sexually active participants.

Research limitations/implications

Non-sexually active young people need to be more informed about healthy sexual behavior so that they would not feel embarrassed to discuss and ask about sexual behavior. A socially acceptable condom-use advertising campaign needs to be conducted to lessen the resistance of conservative audiences.

Originality/value

This paper offers an insight into how conservative audiences may respond to social-media-based campaign of safer sex.