Correlates of condom use among male high school students in Nairobi, Kenya

Application of electrospun fibers for female reproductive health

Here, we present the current challenges in women's reproductive health and the current state-of-the-art treatment and prevention options for STI prevention, contraception, and treatment of infections. We discuss how the versatile platform of electrospun fibers can be applied to each challenge, and postulate at how these technologies could be improved. The void of approved electrospun fiber-based products yields the potential to apply this useful technology to a number of medical applications, many of which are relevant to women's reproductive health. Given the ability to tune drug delivery characteristics and three-dimensional geometry, there are many opportunities to pursue new product designs and routes of administration for electrospun fibers. For each application, we provide an overview of the versatility of electrospun fibers as a novel dosage form and summarize their advantages in clinical applications. We also provide a perspective on why electrospun fibers are well-suited for a variety of applications within women's reproductive health and identify areas that could greatly benefit from innovations with electrospun fiber-based approaches.

A Risk-based Model for Predicting the Impact of using Condoms on the Spread of Sexually Transmitted Infections

We create and analyze a mathematical model to understand the impact of condom-use and sexual behavior on the prevalence and spread of Sexually Transmitted Infections (STIs). STIs remain significant public health challenges globally with a high burden of some Sexually Transmitted Diseases (STDs) in both developed and undeveloped countries. Although condom-use is known to reduce the transmission of STIs, there are a few quantitative population-based studies on the protective role of condom-use in reducing the incidence of STIs. The number of concurrent partners is correlated with their risk of being infectious by an STI such as chlamydia, gonorrhea, or syphilis. We develop a Susceptible-Infectious-Susceptible (SIS) model that stratifies the population based on the number of concurrent partners. The model captures the multi-level heterogeneous mixing through a combination of biased (preferential) and random (proportional) mixing processes between individuals with distinct risk levels, and accounts for differences in condom-use in the low- and high-risk populations. We use sensitivity analysis to assess the relative impact of high-risk people using condom as a prophylactic intervention to reduce their chance of being infectious, or infecting others. The model predicts the STI prevalence as a function of the number of partners of an individual, and quantifies how this distribution of effective partners changes as a function of condom-use. Our results show that when the mixing is random, then increasing the condom-use in the high-risk population is more effective in reducing the prevalence than when many of the partners of high-risk people have high risk. The model quantifies how the risk of being infected increases for people who have more partners, and the need for high-risk people to consistently use condoms to reduce their risk of infection.

Perceived Risk of HIV Infection and Associated Factors among Secondary School Students in Wakiso District, Uganda

Introduction. HIV/AIDS remain a major public health problem in Uganda and 4% of individuals aged between 15 and 24 years are living with HIV. Few studies have examined HIV risk perception among adolescents in Uganda.Methods. We conducted a cross-sectional study among 379 secondary school students using multistage sampling techniques. Data were collected using an interviewer-administered questionnaire. Descriptive and logistic regression analyses were conducted.Results. One hundred ninety-one (49.6%) of the respondents perceived themselves to be at risk of contracting HIV, 174 (45.9%) had ever had sex, and 139 (80.4%) had first sexual encounter at 16 years or less. Only 49% of respondents who had sex within 12 months used a condom. Being older than 17 years, knowing someone who died of HIV, early sexual debut, and having ever had sex were associated with perceived risk of contracting HIV. After multivariate analysis, knowledge of someone who died of HIV (Adjusted Odds Ratio (AOR) 16, 95% CI 1.49–171.97) remained statistically significant.Conclusion. Many secondary school students perceived themselves to be at risk of contracting HIV; this perception is associated with knowing someone who died of HIV/AIDS. There is a need to strengthen HIV risk reduction interventions in Wakiso secondary schools.

Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study

Background

Young women in Kenya experience a higher risk of mistimed and unwanted pregnancy compared to older women. However, contraceptive use among youth remains low. Known barriers to uptake include side effects, access to commodities and partner approval.

Methods

To inform a youth focussed behaviour change communication campaign, Population Services Kenya developed a qualitative study to better understand these barriers among young women. The study was carried out in Nyanza, Coast, and Central regions. Within these regions, urban or peri-urban districts were purposively selected based on having contraceptive prevalence rate close to the regional average and having a population with low socioeconomic profiles. In depth interviews were conducted with a sample of sexually active women aged 15–24, both users and non-users, that were drawn from randomly selected households.

Results

All the respondents in the study were familiar with modern methods of contraception and most could describe their general mechanisms of action. Condoms were not considered as contraception by many users. Contraception was also associated with promiscuity and straying. Fear of side effects and adverse reactions were a major barrier to use. The biggest fear was that a particular method would cause infertility. Many fears were based on myths and misconceptions. Young women learn about both true side effects and myths from their social networks.

Conclusion

Findings from this research confirm that awareness and knowledge of contraception do not necessarily translate to use. The main barriers to modern contraceptive uptake among young women are myths and misconceptions. The findings stress the influence of social network approval on the use of family planning, beyond the individual’s beliefs. In such settings, family planning programming should engage with the wider community through mass and peer campaign strategies. As an outcome from this study, Population Services Kenya developed a mass media campaign to address key myths and misconceptions among youth.

Chowa G. HIV risk among young Ghanaians in high school: validation of a multidimensional attitude towards condom use scale

Condom use remains low among sexually active youth in sub-Saharan Africa. Theoretical and empirical evidence suggests that attitudes towards condom use are important predictors of actual condom use. However, few attempts have been made to systematically develop a valid scale that measures attitudes towards condom use among youth, particularly high school students in sub-Saharan Africa. Using the health belief model, we developed an instrument that measures such attitudes. We analysed survey data collected from 6252 Ghanaian junior high school students. We assessed construct validity using confirmatory factor analysis. Results indicate that attitudes towards condom use among young Ghanaians are best represented by a multidimensional construct. Young Ghanaians differentiate constructs related to perception of benefits and barriers to condom use, as well as perception of severity and susceptibility to HIV. This instrument offers a valid tool for assessing high school students' attitudes towards condom use and their HIV risk.

Putting the C back into the ABCs: a multi-year, multi-region investigation of condom use by Ugandan youths 2003-2010

A major strategy for preventing transmission of HIV and other STIs is the consistent use of condoms during sexual intercourse. Condom use among youths is particularly important to reduce the number of new cases and the national prevalence. Condom use has been often promoted by the Uganda National AIDS Commission. Although a number of studies have established an association between condom use at one’s sexual debut and future condom use, few studies have explored this association over time, and whether the results are generalizable across multiple locations. This multi time point, multi district study assesses the relationship between sexual debut and condom use and consistent use of condoms thereafter. Uganda has used Lot Quality Assurance Sampling surveys since 2003 to monitor district level HIV programs and improve access to HIV health services. This study includes 4518 sexually active youths interviewed at five time points (2003–2010) in up to 23 districts located across Uganda. Using logistic regression, we measured the association of condom use at first sexual intercourse on recent condom usage, controlling for several factors including: age, sex, education, marital status, age at first intercourse, geographical location, and survey year. The odds of condom use at last intercourse, using a condom at last intercourse with a non-regular partner, and consistently using a condom are, respectively, 9.63 (95%WaldCI = 8.03–11.56), 3.48 (95%WaldCI = 2.27–5.33), and 11.12 (95%WaldCI = 8.95–13.81) times more likely for those individuals using condoms during their sexual debut. These values did not decrease by more than 20% when controlling for potential confounders. The results suggest that HIV prevention programs should encourage condom use among youth during sexual debut. Success with this outcome may have a lasting influence on preventing HIV and other STIs later in life.

Riesgo sexual en adolescentes según la edad de debut sexual

En España los jóvenes debutan sexualmente antes que en otros países; sin embargo, poco se sabe de la relación entre la edad de debut sexual y el comportamiento sexual en esta población. Se analizan las prácticas sexuales y el uso del preservativo según la edad de debut sexual en adolescentes españoles sexualmente experimentados (N = 351); la edad media fue 15.9 años (DT = .75, rango: 14-18). Se establecieron tres grupos a partir de la edad de debut sexual informada: debut sexual temprano (anterior a los 15 años), promedio (15 años) y tardío (posterior a los 15 años). El grupo con debut sexual temprano practicó en mayor medida masturbación mutua, coito vaginal y sexo oral, con un número de parejas sexuales superior al resto. El uso del preservativo en la primera relación sexual, el porcentaje de uso y el uso consistente del preservativo fue inferior en el grupo debut sexual temprano respecto a los otros dos. El debut sexual anterior a los 15 años se asoció con mayor riesgo de contraer infecciones sexuales por déficit en el uso del preservativo y mayor exposición sexual. Los hallazgos de este estudio sugieren que la edad de debut sexual tiene implicaciones en la salud sexual de los jóvenes.

Condoms "contain worms" and "cause HIV" in Tanzania: Negative Condom Beliefs Scale development and implications for HIV prevention

Condom promotion remains a key component of HIV prevention programs, complimenting recent successes in biomedical HIV prevention. Although condom use has increased in much of East Africa, it remains substantially below optimal levels. Negative rumors about condoms have been documented in East Africa, yet the prevalence and effects of belief in the negative rumors have not been explored. This study evaluated levels of belief in negative rumors about condoms, developed a Negative Condom Beliefs Scale, and assessed its accuracy in predicting willingness to use condoms. A cross-sectional, cluster survey (n = 370) was conducted representing adults in two rural districts in Northern Tanzania in 2008. Item agreement ranged from 35 to 53% for the following rumors regarding condoms: causing cancer, having holes, containing HIV, having worms, and the worms causing HIV. Items loaded on a single latent factor and had high internal consistency and convergent validity. In a multivariate model, negative condom score (AOR = 0.67, 95% CI = 0.6, 0.8) was the strongest single predictor of willingness to use condoms, followed by greater perceived anonymity in acquiring condoms (AOR = 4.36, 95% CI = 2.2, 8.6) and higher condom self-efficacy (AOR = 4.24, 95% CI = 2.0, 8.9). Our findings indicate high levels of subscription to negative beliefs about condoms, with two out of three respondents affirming belief in at least one negative condom rumor. This study highlights the relation between condom rumor beliefs and willingness to use condoms, and indicates avenues for future research and means for improving the design of HIV prevention programs.

Condoms in sub-Saharan Africa

Sub-Saharan Africa (SSA) is the region with the world’s highest rates of HIV and other sexually transmissible infections (STIs), yet numerous studies show that condom use is generally rare. This suggests a need for a better understanding of how condoms fit within sexual practices and relationships in SSA. This paper seeks to address this need by reviewing research published between the late 1980s and 2011 on use and factors influencing use of male condoms in SSA. What is evident from this research is that condom use involves complex social and interpersonal dynamics, with structural and cultural conditions exerting an influence through framing social cognitions and setting boundaries on autonomy that make the apparently irrational choice of eschewing condoms a rational decision. The influences of poverty; relationships with parents, peers and partners; limited, insufficient or absent information especially in rural areas and among men who have sex with men; gender and sexual norms, and the dynamics of gendered power; and beliefs and attitudes about HIV, condoms and sexuality all have been shown to work against condom use for a large proportion of Africa’s people. However, promising results are shown in trends towards increased condom use among single women in numerous countries, increasing acceptance and use of condoms among some university students, successes in producing potentially sustainable condom use resulting from select interventions, and resistance to succumbing to the dominant gender–power dynamics and structural–cultural impediments that women in groups have mobilised.

Making sense of condoms: social representations in young people's HIV-related narratives from six African countries

Condoms are an essential component of comprehensive efforts to control the HIV epidemic, both for those who know their status and for those who do not. Although young people account for almost half of all new HIV infections, reported condom use among them remains low in many sub-Saharan African countries. In order to inform education and communication efforts to increase condom use, we examined social representations of condoms among young people aged 10-24 in six African countries/regions with diverse HIV prevalence rates: Swaziland, Namibia, Kenya, South-East Nigeria, Burkina Faso, and Senegal. We used a unique data source, namely 11,354 creative ideas contributed from these countries to a continent-wide scriptwriting contest, held from 1(st) February to 15(th) April 2005, on the theme of HIV/AIDS. We stratified each country sample by the sex, age (10-14, 15-19, 20-24), and urban/rural location of the author and randomly selected up to 10 narratives for each of the 12 resulting strata, netting a total sample of 586 texts for the six countries. We analyzed the narratives qualitatively using thematic data analysis and narrative-based methodologies. Differences were observed across settings in the prominence accorded to condoms, the assessment of their effectiveness, and certain barriers to and facilitators of their use. Moralization emerged as a key impediment to positive representations of condoms, while humour was an appealing means to normalize them. The social representations in the narratives identify communication needs in and across settings and provide youth-focused ideas and perspectives to inform future intervention efforts.

Intimate partner violence perpetration and condom use-related factors: associations with heterosexual men's consistent condom use

Intimate partner violence victimization has been linked to sexual HIV risk behavior among heterosexual women. The unique role of perpetration of intimate partner violence (IPV) in sexual risk behavior among men has not been studied as well. Based on interviews with 518 heterosexual men recruited via street-intercept between 2005 and 2007 in New York City, we assessed the relationship between perpetration of IPV against a main female partner and inconsistent condom use with that same partner, while controlling for condom use-related factors. Multivariate logistic regression revealed that men who perpetrated physical IPV were half as likely to report consistent condom use as compared with men who did not use violence, while controlling for sociodemographic, condom use-related and other factors. Physical IPV perpetration by heterosexual men makes an independent contribution to consistent condom use. Designing interventions for heterosexual men that simultaneously address both IPV and sexual risk behaviors is critical.