Brief behavioural skills building intervention for female controlled methods of STD-HIV prevention: outcomes of a randomized clinical field trial

Single-Session Behavioral Interventions for Sexual Risk Reduction: A Meta-Analysis

BACKGROUND

Evidence-based, single-session STI/HIV interventions to reduce sexual risk taking are potentially effective options for implementation in resource-limited settings and may solve problems associated with poor participant retention.

PURPOSE

The purpose of the study is to estimate the efficacy of single-session, behavioral interventions in reducing unprotected sex or increasing condom use.

METHODS

Data sources were searched through April 2013 producing 67 single-session interventions (52 unique reports; N = 20,039) that included outcomes on condom use and/or unprotected sex.

RESULTS

Overall, participants in single-session interventions reduced sexual risk taking relative to control groups (d ₊  = 0.19, 95 % CI = 0.11, 0.27). Within-group effects of the interventions were larger than the between-groups effects when compared to controls.

CONCLUSIONS

Brief, targeted single-session sexual risk reduction interventions demonstrate a small but significant effect and should be prioritized.

Perceptions of Safer Sex Negotiation among HIV- and HIV+ Women at Heterosexual Risk: A Focus Group Analysis

Heterosexual women are at increasing risk for HIV, but many are unable to engage in effective safer sex negotiation. The current study examined perceptions of safer sex negotiation using a focus group methodology. Participants were twenty high-risk HIV- and HIV+ women. Participants found it difficult to negotiate safer sex with a relationship partner, because of an inability to see partners they love and trust as risky. Also, although participants perceived condom use to be a personal choice, they believed that few use condoms consistently. Moreover, HIV- women held negative attitudes toward condoms that probably decrease use, whereas HIV+ women had concerns regarding disclosure of status. Clearly, women need safer sex negotiation skills to support the personal choice to use condoms.

Promoting Female Condom Use Among Female University Students in KwaZulu-Natal, South Africa: Results of a Randomized Behavioral Trial

Relatively few interventions have tested the efficacy of female condom promotion either alone or in combination with other barrier methods. We evaluated the efficacy of a two-session (enhanced) cognitive-behavioral intervention (EI) (n = 147) against a one-session control (minimal) educational intervention (MI) (n = 149) to promote female condom (FC) use among female students aged 18-28 at a South African university. We assessed change from baseline to 2.5 and 5 months in number of vaginal intercourse occasions unprotected by male or female condoms in EI versus MI using generalized linear models with a log link function and GEE. Both groups reported significant reductions in number of unprotected vaginal intercourse occasions from baseline to each follow-up, with no significant difference between the two-session and single-session intervention. Introduction of a brief group-based MI FC promotion intervention with FC access holds promise for delivery in clinics and other community venues.

Female Condoms=Missed Opportunities: Lessons Learned from Promotion-centered Interventions

INTRODUCTION

The female condom is a barrier contraceptive device that is underutilized despite its effectiveness at preventing both unintended pregnancy and sexually transmitted infections (STIs). Prior research has highlighted that the underuse of the female condom as a contraceptive option is owing in large part to social stigma, and lacking or incorrect information about the product.

METHODS

In an attempt to better understand the discrepancy between the female condom's documented effectiveness and its general lack of uptake, we conducted a systematic search and qualitatively reviewed 20 published intervention studies that focus on efforts to promote the female condom. The strategies that each intervention used were coded and carefully examined. We obtained information regarding relevant characteristics of the studies, including intervention setting, sampling strategy, participant demographics, and methodology used.

RESULTS

We found that the majority of the studies had significant positive findings concerning the female condom, for example, many were effective at demonstrating participant uptake as well as increasing the number of protected sex acts. Additionally, perceived ability to use the device was a significant predictor of female condom use in multiple studies. Finally, the studies tended to include younger women; only 10.0% (n=2) reported having participants with a mean age older than 30), meaning that older women generally have not been well-served by previous efforts to promote the use of the female condom.

CONCLUSIONS

We offer guidelines for improving female condom uptake and recommendations for future research that seeks to establish and utilize best practice promotional strategies for female condoms.

HIV prevention interventions to reduce racial disparities in the United States: a systematic review

Racial and ethnic minorities are disproportionately affected by HIV/AIDS in the United States despite advances in prevention methodologies. The goal of this study was to systematically review the past 30 years of HIV prevention interventions addressing racial disparities. We conducted electronic searches of Medline, PsycINFO, CINAHL, and Cochrane Review of Clinical Trials databases, supplemented by manual searches and expert review. Studies published before June 5, 2011 were eligible. Prevention interventions that included over 50% racial/ethnic minority participants or sub-analysis by race/ethnicity, measured condom use only or condom use plus incident sexually transmitted infections or HIV as outcomes, and were affiliated with a health clinic were included in the review. We stratified the included articles by target population and intervention modality. Reviewers independently and systematically extracted all studies using the Downs and Black checklist for quality assessment; authors cross-checked 20% of extractions. Seventy-six studies were included in the final analysis. The mean DB score was 22.44--high compared to previously published means. Most of the studies were randomized controlled trials (87%) and included a majority of African-American participants (83%). No interventions were designed specifically to reduce disparities in HIV acquisition between populations. Additionally, few interventions targeted men who have sex with men or utilized HIV as a primary outcome. Interventions that combined skills training and cultural or interactive engagement of participants were superior to those depending on didactic messaging. The scope of this review was limited by the exclusion of non-clinic based interventions and intermediate risk endpoints. Interactive, skills-based sessions may be effective in preventing HIV acquisition in racial and ethnic minorities, but further research into interventions tailored to specific sub-populations, such as men who have sex with men, is warranted.

Sexual risk reduction interventions for patients attending sexually transmitted disease clinics in the United States: a meta-analytic review, 1986 to early 2009

Sexually transmitted disease (STD) patients are more likely to experience a future STD including human immunodeficiency virus (HIV). The aim of this study was to examine the efficacy of behavioral interventions to reduce sexual risk behavior and incident STDs among patients attending STD clinics in the United States. A meta-analysis of 32 studies with 48 separate interventions targeting STD patients (N = 67,538) was conducted. Independent raters coded study, sample, and intervention characteristics. Effect sizes, using both fixed- and random-effects models, were calculated. Potential moderators of intervention efficacy were assessed. Relative to controls, intervention participants increased their condom use and had fewer incident STDs, including HIV, across assessment intervals (d (+)s ranging from 0.05 to 0.64). Several sample (e.g., age and ethnicity) and intervention features (e.g., targeting intervention to a specific group) moderated the efficacy of the intervention. Behavioral interventions targeted to STD clinic patients reduce sexual risk behavior and prevent HIV/STDs. Widespread use of behavioral interventions in STD clinics should be a public health priority.

Effectiveness of a video-based motivational skills-building HIV risk-reduction intervention for female military personnel

Anecdotal evidence suggests that the HIV/AIDS prevalence rates in several African armed forces are high, with gender inequality rendering female military personnel more vulnerable to the disease. The objective of this study was to replicate a successful videotape-based HIV prevention intervention among Nigerian female military personnel in an effort to establish the cross-cultural stability, feasibility and cost-effectiveness of this approach in resource-limited countries. Enlisted women (N346) were recruited from two cantonments in Southwestern Nigeria and randomly assigned to either (a) a 5-session video-based, small group, cognitive-behavioral, HIV prevention intervention, or (b) a 5-session, video-based, contact-matched, HIV education control condition. Participants provided self-report of their HIV/AIDS-related knowledge and sexual behaviors at baseline, 3 and 6 months after completing the intervention. The results indicate that the motivational skills-building intervention did not improve participants' knowledge of HIV/AIDS any better than did the HIV education control condition at each assessment period, but it significantly increased condom use among women in this group by 53.6% at 3-month follow-up. HIV preventive behaviors among women in the motivational skills-building intervention group improved significantly, being 2 and 3 times more, compared to women in the HIV education control group at 3-month and 6-month follow-up assessments. The intervention also significantly improved behavioral intentions of participants as well as reduced alcohol use before sex by 25%, after 3 months; and number of sexual partners by 12% after 6 months. Women in the intervention group were five times more likely than women in HIV education control group to suggest that their new male partners use condom. These findings indicate that a videotape-based, HIV prevention intervention is a feasible and effective approach to HIV prevention among female military personnel from sub-Saharan Africa.

The efficacy of HIV/STI behavioral interventions for African American females in the United States: a meta-analysis

OBJECTIVES

We evaluated the efficacy of HIV behavioral interventions for African American females in the United States, and we identified factors associated with intervention efficacy.

METHODS

We conducted a comprehensive literature review covering studies published from January 1988 to June 2007, which yielded 37 relevant studies. Data were analyzed using mixed-effects models and meta-regression.

RESULTS

Overall, behavioral interventions had a significant impact on reductions in HIV-risk sex behaviors (odds ratio [OR] = 0.63; 95% confidence interval [CI] = 0.54, 0.75; n = 11 239; Cochrane Q(32) = 84.73; P < .001) and sexually transmitted infections (STIs; OR = 0.81; 95% CI = 0.67, 0.98; n = 8760; Cochrane Q(16) = 22.77; P = .12). Greater intervention efficacy was observed in studies that specifically targeted African American females used gender- or culture-specific materials, used female deliverers, addressed empowerment issues, provided skills training in condom use and negotiation of safer sex, and used role-playing to teach negotiation skills.

CONCLUSIONS

Behavioral interventions are efficacious at preventing HIV and STIs among African American females. More research is needed to examine the potential contribution of prevention strategies that attend to community-level and structural-level factors affecting HIV infection and transmission in this population.

Behavioral interventions for African Americans to reduce sexual risk of HIV: a meta-analysis of randomized controlled trials

CONTEXT

African Americans constitute 13% of the US population yet account for nearly 50% of new HIV infections. Implementation of efficacious behavioral interventions can help reduce infections in this vulnerable population.

OBJECTIVES

To examine the efficacy of behavioral interventions to reduce HIV for African Americans among 78 randomized controlled trials that sampled at least 50% African Americans (N = 48,585, 81% African American), measured condom use or number of sexual partners, and provided sufficient information to calculate effect sizes.

METHODS

Independent raters coded participant characteristics, design and methodological features, and intervention content. Weighted mean effect sizes, using both fixed- and random-effects models, were calculated; positive effect sizes indicated more condom use and fewer sexual partners.

RESULTS

Compared with controls, participants who received an HIV risk reduction intervention improved condom use at short-term, intermediate, and long-term assessments; change was better among men who have sex with men and people already infected with HIV, and when interventions provided intensive content across multiple sessions. Intervention participants reduced their number of sexual partners in interventions with intensive interpersonal skills training and in younger samples, especially at delayed intervals.

CONCLUSIONS

Sexual risk reduction interventions for African Americans increased condom use without increasing the number of sexual partners. Translating these interventions and further enhancing them continue as a high priority.

Reducing cultural barriers to substance abuse treatment among Asian Americans: a case study in New York City

This article addresses the issue of underutilization of treatment services by Asian Americans. Although Asian Americans continue to be the fastest growing ethnic minority in New York City, they are reported to underutilize substance abuse treatment services. However, much of the underutilization may be attributed to cultural and language barriers hindering them from seeking help and support. Past literature indicates that when culturally appropriate services are available, service utilization tends to increase among Asian Americans. This study tested strategies to enhance the continuum of care in the Asian community by adapting a well-documented generic early intervention model in a culture-specific setting. The results of this study indicate that these models may be successfully adapted to culturally specific settings such as Asian American communities. When culturally competent services combined with case management and motivational interviewing are provided, there tends to be an increase in Asian clients' chance of accomplishing treatment goals.

Randomized trial of a community-based alcohol-related HIV risk-reduction intervention for men and women in Cape Town South Africa

BACKGROUND

HIV is devastating southern Africa and alcohol use is closely related to HIV transmission risks.

PURPOSE

The current study tested the efficacy of a brief single-session HIV-alcohol risk-reduction intervention for men and women who drink at informal alcohol serving establishments (i.e., shebeens) in South Africa.

METHODS

A randomized community field trial recruited men (N = 117) and women (N = 236) through outreach and chain referrals. Participants received either: (a) 3-h theory-based behavioral HIV-alcohol risk-reduction intervention that focused on skills training for sexual negotiation and condom use or (b) 1-h HIV-alcohol information/education control group. Participants were followed up for 3 and 6 months post-intervention with 89% retention.

RESULTS

The risk-reduction intervention demonstrated significantly less unprotected intercourse, alcohol use before sex, numbers of sex partners, partners met at drinking establishments and greater condom use relative to the control group. However, intervention effects were moderated by alcohol use; lighter drinkers demonstrated significantly more intervention gains than heavier drinkers in the risk-reduction condition. Intervention effects occurred at 3 months follow-up and dissipated by 6 months.

CONCLUSIONS

A brief HIV risk-reduction intervention reduced sexual-risk behaviors among drinkers in South Africa. However, intervention effects were weakest for those who drink heaviest. Our results provide a basis for establishing HIV prevention in alcohol serving establishments in South Africa. Research is needed to identify multi-level intervention models that can reduce risks among heavier drinkers and sustain behavior changes over time.

The efficacy of female condom skills training in HIV risk reduction among women: a randomized controlled trial

OBJECTIVES

We evaluated the efficacy of skills training designed to increase female condom use among women.

METHODS

We conducted a randomized controlled trial of 409 women, recruited from family planning clinics in northern California, who were randomly assigned to the experimental 4-session female condom skills training intervention or the comparison 4-session women's general health promotion intervention. Participants received condom use instructions at baseline and male and female condoms during the study. They completed audio computer-assisted self-interviews at baseline and at 3 and 6 months.

RESULTS

At 3 and 6 months, women in the experimental group were more likely than those in the comparison group to have used the female condom at least once in the prior 3 months. The increase in the percentage of sexual acts protected by female condoms from baseline to the 6-month follow-up was greater for the experimental group. The percentage of sexual acts during which any condom was employed was higher in the experimental group at 6 months. There were no group differences in male condom use.

CONCLUSIONS

Outcomes suggest that skills training can increase female condom use and protected sexual acts without reducing male condom use among women.

Evaluating a two-step approach to sexual risk reduction in a publicly-funded STI clinic: rationale, design, and baseline data from the Health Improvement Project-Rochester (HIP-R)

BACKGROUND

Sexually transmitted infection (STI) clinics provide an opportune setting for HIV prevention efforts. This randomized controlled trial evaluated a unique, two-step approach to sexual risk reduction at a publicly-funded STI clinic.

METHODS

During an initial visit, patients completed an audio-computer assisted self-interview (ACASI), were randomized to and received one of two brief interventions, obtained medical care, and completed a post-assessment. Next, two-thirds of the patients were assigned to attend an intensive sexual risk reduction workshop. At 3, 6, and 12 months, patients completed additional ACASIs and provided urine specimens to assess behavior change and incident STIs.

RESULTS

During a 28-month interval, 5613 patients were screened, 2691 were eligible, and 1483 consented to participate and were randomized; the modal reason for declining was lack of time (82%). Consenting patients included 688 women and 795 men; 64% of participants were African-American. The sample was low-income, with 57% reporting an annual income of less than $15,000; most participants (62%) had a high school education or less, and 51% were unemployed. Sexual risk behavior was common, as indicated by multiple sexual partners (mean=32.8, lifetime; mean=2.8, past 3 months), unprotected sex (mean=17.3 episodes, past 3 months), and prior STIs (mean=3.3, lifetime; 23% at baseline). Bivariate analyses confirmed our prediction that HIV-related motivation and behavioral skills would be related to current sexual risk behavior. All patients received a brief intervention; patient satisfaction ratings were uniformly high for both interventions (all means >or=3.7 on 4-point scales). Fifty-six percent of invited patients attended the intensive workshop, and attendance did not differ as a function of brief intervention. Patient satisfaction ratings were also uniformly positive for the workshop interventions (all means >or=3.6). Return to follow-up assessments exceeded 70%.

CONCLUSIONS

Results demonstrate that implementing an HIV preventive program in a busy, public clinic is feasible and well-accepted by patients. Ongoing evaluation will determine if the interventions reduce sexual risk behavior and lower incident STIs.

Randomised controlled trial of alternative male and female condom promotion strategies targeting sex workers in Madagascar

OBJECTIVES

To assess whether individual clinic-based counselling as a supplement to peer education for male and female condom promotion leads to greater use of protection and lower STI prevalence among sex workers in Madagascar already exposed to intensive male condom promotion.

METHODS

In two public dispensaries in Madagascar, a total of 901 sex workers were randomly allocated between two alternative male and female condom promotion

INTERVENTIONS

peer education only, or peer education supplemented with individual clinic-based counselling. Participants were followed for 12 months. Every 2 months they made clinic visits, where they were interviewed on condom use. Peer educators counselled all participants on condom use as they accompanied their assigned participants to study visits. Participants assigned to receive the supplemental intervention were counselled by a trained clinician following study interviews. Participants were tested and treated for chlamydia, gonorrhoea and trichomoniasis every 6 months. We used logistic regression to assess whether the more intensive intervention was associated with reduced STI prevalence. Use of protection with clients and non-paying partners was assessed by study arm, site, and visit.

RESULTS

There was no statistically significant association between study arm and aggregated STI prevalence. No substantial differences in levels of reported protection were noted between study groups.

CONCLUSIONS

This study found little evidence for gains from more thorough clinical counselling on male and female condom use. These findings suggest that less clinically intensive interventions such as peer education could be suitable for male and female condom promotion in populations already exposed to barrier method promotion.

Conceptualizing the Influence of Social Agents of Behavior Change: A Meta-Analysis of the Effectiveness of HIV-Prevention Interventionists for Different Groups

A meta-analysis of 166 HIV-prevention interventions tested theoretical predictions about the effects of experts, lay community members, and similar and dissimilar others, as agents of change. In general, expert interventionists produced greater behavior change than lay community members, and the demographic and behavioral similarity between the interventionist and the recipients facilitated behavioral change. Equally importantly, there were differences across groups in the efficacy of various sources, especially among populations of low status and/or power. These findings support the hypothesis that unempowered populations are more sensitive to characteristics of the interventionists who can facilitate access to various resources. In addition, they suggest the need to ensure the availability of health professionals from diverse demographic and behavioral backgrounds.

The relationship between HIV/Sexually Transmitted Infection risk and alcohol use during commercial sex episodes: results from the study of female commercial sex workers in the Philippines

The HIV/Sexually Transmitted Infection (STI) risk associated with alcohol use between female commercial sex workers (FCSWs) and their customers has been understudied. We examined this relationship for 1,114 FCSWs aged 15-54 with data collected during the baseline study period (1994 to 1998) in four southern provinces of the Philippines. Two alcohol-related risk situations during commercial sex episodes were examined: prior alcohol use by an FCSW and perceived intoxication in a customer. The influence of sociodemographic variables on sexual risk behaviors was also studied. Multiple sexual risk behaviors were observed with more frequency for FCSWs if alcohol was used before commercial sex or if the episode involved a customer perceived to be intoxicated. Forty-two percent of FCSWs who had sex with an intoxicated customer were STI positive, significantly more than FCSWs who did not have sex with an intoxicated customer (28%, p < .01). Similar significant differences were found for FCSWs who did not consume alcohol before having sex and were STI positive (29%) versus FCSW who did consume alcohol before sex and were STI positive (33%, p < .01). Our analyses reinforce accumulating evidence in the field that sexual risk reduction interventions need to go beyond the behaviors of individual FCSWs to meet the layering of risks such as observed in this study. Multilevel strategies targeting customer substance use and other situational and structural factors have proven to be pivotal mediators in our other research with this population. These experiences and the limitations of this study are discussed.

Results of a randomised trial of male condom promotion among Madagascar sex workers

OBJECTIVES

To test the effect of supplementing peer promotion of male condom use with clinic based counselling, measured in terms of STI prevalence and reported male condom use.

METHODS

1000 female sex workers in Madagascar were randomised to two study arms: peer education supplemented by individual risk reduction counselling by a clinician (peer + clinic) versus condom promotion by peer educators only (peer only). STI testing was conducted at baseline and 6 months. Behavioural interviews were administered at baseline, 2, 4, and 6 months.

RESULTS

At baseline, women in the peer only arm had prevalences of 16.0%, 23.6%, and 12.1% for chlamydia, gonorrhoea, and trichomoniasis respectively, with an aggregate prevalence of 38.2%. Baseline STI prevalences for the peer + clinic arm were slightly lower and 34.1% in aggregate. At 6 months, aggregate STI prevalence increased in the peer only arm to 41.4%, whereas the aggregate prevalence diminished slightly to 32.1% in the peer + clinic arm. In logistic regression analyses, the estimated odds ratios (ORs) for chlamydia, gonorrhoea, trichomoniasis, and aggregate STI were 0.7 (95% confidence interval 0.4 to 1.0), 0.7 (0.5 to 1.0), 0.8 (0.6 to 1.2), and 0.7 (0.5 to 0.9) respectively, comparing the peer + clinic arm with the peer only arm. The logistic regression OR for reported condom use with clients in the past 30 days increased from 1.1 at 2 months to 1.8 at 6 months, comparing the peer + clinic arm with the peer only arm, and was 1.4 overall (1.1 to 1.8). Adjustment for baseline factors changed the regression results little.

CONCLUSIONS

The impact of male condom promotion on behaviour can be heightened through more concentrated counselling on risk reduction. Persistently high STI prevalence despite increases in reported condom use by sex workers supports the need for multidimensional control programmes.

Do main partner conflict, power dynamics, and control over use of male condoms predict subsequent use of the female condom?

This study assessed hypotheses that measures of power and control over male condom (MC) use would predict use of the female condom (FC) among women with main partners from two public STD clinics (n = 616). The women (mean age 24 years, 87% African American) were enrolled in an intervention study to promote barrier contraceptive use and were interviewed at baseline and at 6 monthly follow-up visits. Seven baseline predictor variables were assessed: her having requested MC use, his having objected, her having wanted a MC used but not asking, percentage of MC use, perceived control over MC use, anticipated consequences of refusing unprotected sex, and physical violence. In the first Poisson regression analysis, none of the hypothesized predictors was significantly associated with FC use during follow up. In the second regression analysis, which assessed the influence of the hypothesized set of predictors on follow-up FC use in situations when MCs were not used, we found two effects. Either no or inconsistent MC use before study entry was associated with less subsequent FC use; women who reported, at study entry, having more control over MC use were more likely to use FCs during follow up. We found no evidence of adoption of the FC by women in relationships marked by history of conflict over the MC, circumstances in which alternatives are most needed. On the contrary, we found that women with a history of control and consistent use of MCs were the most likely users of FCs when MCs were not used.

Female-condom use in a gender-specific family planning clinic trial

OBJECTIVES

We evaluated female-condom use among women participating in an HIV/STD intervention designed to reduce unprotected sex and expand prevention strategies.

METHODS

Women (n = 360) were recruited from a family-planning clinic and were randomized into an 8- or 4-session intervention group or a control group. We conducted follow-up interviews at 1, 6, and 12 months.

RESULTS

At 1 month, the odds ratios of first-time female-condom use were 9.49 (95% confidence interval [CI] = 4.01, 22.20) in the 8-session group and 4.39 (95% CI = 1.84, 10.49) in the 4-session group relative to controls. Repeated use (n = 21) was predicted by perceived ability to use, by self and partner satisfaction, by dislike of male condoms, and by previous diaphragm use.

CONCLUSIONS

Gender sensitive cognitive-behavioral interventions can influence women to try the female condom. To increase long-term use, interventions may need to include self-insertion practice and involvement of male partners.

Methodological challenges in research on sexual risk behavior: I. Item content, scaling, and data analytical options

Investigation of sexual behavior involves many challenges, including how to assess sexual behavior and how to analyze the resulting data. Sexual behavior can be assessed using absolute frequency measures (also known as counts) or with relative frequency measures (e.g., rating scales that range from never to always). We discuss these 2 assessment approaches in the context of research on HIV risk behavior. We conclude that these 2 approaches yield nonredundant information and, more important, that only data yielding information about the absolute frequency of risk behavior have the potential to serve as valid indicators of HIV contraction risk. However, analyses of count data may be challenging because of non-normal distributions with many outliers. Therefore, we identify new and powerful data analytical solutions that have been developed recently to analyze count data and discuss limitations of a commonly applied method (viz., analysis of covariance using baseline scores as covariates).

The female condom: attitudes and experiences among HIV-positive heterosexual women and men

The female condom is a potentially effective method for the prevention of HIV, other sexually transmitted disease, and pregnancy. This study describes attitudes toward and experiences with the female condom of 89 HIV-positive individuals (n = 56 women; n = 33 men) reporting heterosexual behavior. Qualitative interviews were conducted to inform the design and implementation of a cognitive-behavioral risk-reduction and health-promotion intervention. Most respondents (n = 78) had seen or heard of the female condom. However, relatively few (n = 14 women; n = 5 men) had used it at least once. Reactions from both women and men across user groups, regardless of favorable or unfavorable attitude or experience with the female condom, centered around a similar set of factors: aesthetics, difficulties with the male condom, male partner reaction, beliefs about efficacy, and lack of training. These findings underscore the need for additional research and comprehensive education efforts aimed at both technical use and communication skills-building in order to realize the potential of the female condom as an alternative barrier method.

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.

Women, sex, and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research

This article is focused on examining social and contextual factors related to HIV-risk behavior for women. Specifically, this article has three main purposes: to review the literature on selected social and contextual factors that contribute to the risk for the heterosexual transmission of HIV and AIDS, to review and conduct a meta-analysis of HIV-prevention interventions targeting adult heterosexual populations, and to suggest future directions for HIV-prevention intervention research and practice. Results suggest that the HIV-prevention interventions reviewed for this article had little impact on sexual risk behavior, that social and contextual factors are often minimally addressed, and that there was a large gap between research and the practice of HIV-prevention intervention.

Acceptability of the female condom among sex workers in Thailand: results from a prospective study

BACKGROUND

The female condom may provide women with the first female-controlled barrier method that is effective against sexually transmitted diseases, including HIV infection.

GOAL

This study evaluated the acceptability of the female condom among sex workers in Thailand.

STUDY DESIGN

Data on use and acceptability of the female condom were collected using a structured questionnaire during an 8-week follow-up.

RESULTS

Analyses included 148 women who were still in follow-up at week 8. Sex workers used, on average, 2.8 female condoms per week. The overall satisfaction rate with the female condom was 68%, although, among users, 31% had difficulties in device insertion, 37% had pain from the inner ring, and 22% reported itching sensations. The main reason for using the female condom in the future was its perceived safety, and the main reason for not using it would be the client's refusal.

CONCLUSION

Two-thirds of the sex workers were satisfied with the female condom. Difficulties at insertion, discomfort during use, and clients' attitude were potential obstacles to the use of the female condom in the future.

Long-term effectiveness of a peer-based intervention to promote condom and contraceptive use among HIV-positive and at-risk women

OBJECTIVE

The authors used data from a larger study to evaluate the long-term effects of a peer advocate intervention on condom and contraceptive use among HIV-infected women and women at high risk for HIV infection.

METHODS

HIV-infected women in one study and women at high risk for HIV infection in a second study were selected from the Women and Infants Demonstration Project and assigned to a standard or an enhanced HIV prevention treatment group. The enhanced intervention included support groups and one-on-one contacts with peer advocates tailored to clients' needs. The authors interviewed women at baseline and at 6-, 12- and 18-months, and measured changes in consistency of condom and contraceptive use and in self-efficacy and perceived advantages and disadvantages of condom and contraceptive use.

RESULTS

Of HIV-infected women, the enhanced group had improved consistency in condom use, increased perceived advantages of condom use, and increased level of self-efficacy compared with the standard group. Of women at risk, the enhanced intervention group at six months maintained consistent condom use with a main partner and perceived more benefit of condom use compared with the standard group. These differences diminished at 12 months.

CONCLUSIONS

The enhanced intervention was generally effective in the HIV+ study. In the at-risk study, however, intervention effects were minimal and short-lived. Factors related to the theory, intervention design, and sample characteristics help explain these differences.

Increasing asthma knowledge and changing home environments for Latino families with asthmatic children

We tested an asthma education program in 204 underserved Latino families with an asthmatic child. The education program consisted of one or two sessions delivered in each family's home in the targeted participant's preferred language by a bilingual, bicultural educator. We encouraged, but did not require, attendance by the child. The curriculum was culturally-tailored, and all participants received education on understanding asthma, preventing asthma attacks, and managing asthma. Outcomes included change in asthma knowledge and change in home environment asthma management procedures. Asthma knowledge increased significantly (39 to 50% correct from pre- to post-test, P < 0.001) and participants made significant changes to the child's bedroom environment (mean number of triggers decreased from 2.4 to 1.8, P < 0.001; mean number of controllers increased from 0.7 to 0.9, P < 0.001). The results support the value of asthma education and its importance in the national agenda to reduce health disparities among minorities.