The female condom: beyond acceptability to public health impact

Structural issues affecting creation of a community action and advocacy board

The most effective woman-initiated method to prevent HIV/sexually transmitted infections is the female condom (FC). Yet, FCs are often difficult to find and denigrated or ignored by community health and service providers. Evidence increasingly supports the need to develop and test theoretically driven, multilevel interventions using a community-empowerment framework to promote FCs in a sustained way. We conducted a study in a midsized northeastern US city (2009-2013) designed to create, mobilize and build capacity of a community group to develop and implement multilevel interventions to increase availability, accessibility and support for FCs in their city. The Community Action and Advocacy Board (CAAB) designed and piloted interventions concurrently targeting community, organizational and individual levels. Ethnographic observation of the CAAB training and intervention planning and pilot implementation sessions documented the process, preliminary successes, challenges and limitations of this model. The CAAB demonstrated ability to conceptualize, plan and initiate multilevel community change. However, challenges in group decision-making and limitations in members' availability or personal capacity constrained CAAB processes and intervention implementation. Lessons from this experience could inform similar efforts to mobilize, engage and build capacity of community coalitions to increase access to and support for FCs and other novel effective prevention options for at-risk women.

Acceptability in microbicide and PrEP trials: current status and a reconceptualization

PURPOSE OF REVIEW

Assessment of acceptability is a central component of most oral PrEP and microbicide trials. In this paper we review current definitions and frameworks employed in acceptability research, discuss findings from recent studies of product acceptability and summarize trends in acceptability research. We conclude by offering a new framework for investigating product acceptability within clinical trials, one which considers product acceptability to be conceptually distinct from adherence.

RECENT FINDINGS

Although numerous studies have investigated product acceptability, a consensus is lacking regarding the definition and operationalization of the concept. In addition fewer than half of the studies reviewed investigated actual candidate products. To the extent that an overall measure of acceptability is considered, the consensus is that most participants find the products acceptable. However, it is the rare study that investigates whether product adherence is associated with acceptability.

SUMMARY

Given that adherence is critical to the success of clinical trials, it is important to identify the extent to which acceptability is a factor in product usage and to ascertain which dimensions of acceptability - product attributes, dosing regimen, delivery mechanism, use attributes, partner's attitudes, effect of product on the sexual encounter, product-related norms - if any, affect adherence.

Opportunities for woman-initiated HIV prevention methods among female sex workers in southern China

Rapid changes in China over the past two decades have led to significant problems associated with population migration and changing social attitudes, including a growing sex industry and concurrent increases in STIs and HIV. This article reports results of an exploratory study of microbicide acceptability and readiness and current HIV prevention efforts among female sex workers in two rural and one urban town in Hainan and Guangxi Provinces in southern China. The study focused on these women's knowledge and cultural understandings of options for protecting themselves from exposure to STIs and HIV, and the potential viability and acceptability of woman-initiated prevention methods. We report on ethnographic elicitation interviews conducted with women working within informal sex-work establishments (hotels, massage and beauty parlors, roadside restaurants, boarding houses). We discuss implications of these findings for further promotion of woman-initiated prevention methods such as microbicides and female condoms among female sex workers in China.

Long-term female condom use among vulnerable populations in Brazil

We carried out an evaluative study on factors associated with long-term use of female condoms for STI/HIV prevention. A total of 255 women and 29 men who were using female condoms for at least 4 months participated in qualitative/quantitative interviews. The study was conducted in six Brazilian cities. Four primary themes were identified as influencing acceptability and adoption of the female condom: (1) personal "assistance" (counseling) during the early adoption phase; (2) safety; (3) pleasure; and (4) increased sense of power for safer sex negotiation. Alternate use of male and female condoms was the norm among participants, but for approximately one third of the sample, the female condom was the preferred option for safer sex. The study findings suggest that providing clients with explicit and sustained intervention strategies may have a decisive influence on long-term adoption of female condoms.

The Sociocultural Context of Condom Use Within Marriage in Rural Lebanon

Prevalence rates for condom use are low across the Middle East despite limited alternate contraceptive options and growing awareness of sexually transmitted diseases (STDs) and HIV/AIDS. Virtually no research exists to explain this situation and to guide policy development or effective interventions. An analysis of 25 focus-group discussions with married women and men, interviews with service providers, and a survey of 589 women of childbearing age in a rural district of southern Lebanon reveal that a broad and complex set of sociocultural factors influence condom use. In the study area, 7 percent of married women currently use condoms, 24 percent reported ever use, and inconsistent use is common. Condoms are preferred primarily for their lack of physiological side effects. Five factors were found to impede method adoption and sustained use. These include various encumbering beliefs, reduced sexual pleasure, adverse experiences, gender-related fears and tensions, and a residual social stigma attached to condoms. Several strategies are suggested to increase and improve condom use. These issues will assume greater importance as fertility declines further in the region, demand for contraception continues to increase, and STDs and HIV/AIDS become more deeply rooted, as has occurred in other parts of the world.

Patterns and predictors of female condom use among ethnically diverse women attending family planning clinics

BACKGROUND

The female condom is a viable option for women to protect themselves from HIV infection and other sexually transmitted diseases.

GOAL

The goal was to examine the level of female condom use and factors associated with frequency of use among US women living in San Francisco and Oakland, California.

STUDY DESIGN

Of 238 women recruited from family planning clinics from July 1998 to April 1999, 206 were interviewed at both baseline and 3-month follow-up (a 92% retention rate).

RESULTS

We observed a significant increase in vaginal sexual acts protected by the female condom during the study but no reduction in male condom use. Overall, 82% of women reported using a female condom at least once, but the proportion of sexual acts protected by the female condom was only 17%. Multivariate analyses showed that female condom use was associated with suggesting female condom use to one's partner, less concern about device appearance, and a partner's positive attitude about the female condom.

CONCLUSION

Our data indicate that female condom use supplements male condom use and leads to an increase in protected sex. The results also suggest that attitudinal and communication factors can increase female condom use.