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Mntonintshi-Mketo LN, Netangaheni RT, Lefoka MH. HIV and sexual risk behaviours by 18-25-year-old youth at Nyandeni Municipality in the Eastern Cape. Health SA 2024; 29:2541. [PMID: 39229314 PMCID: PMC11369564 DOI: 10.4102/hsag.v29i0.2541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/14/2024] [Indexed: 09/05/2024] Open
Abstract
Background The human immunodeficiency virus (HIV) epidemic in South Africa is among the worst in the world; in 2017, 38% of new infections were among young people aged 15-24 years. Estimates for HIV infection in 2020 worldwide indicate that there will be 1.5 million new cases, 10.2 million untreated cases (out of 37.7 million), and 680 000 deaths from acquired immunodeficiency syndrome (AIDS). Despite a 46% decline in new HIV infections among adolescents and youth over the previous 10 years, two of the seven new HIV infections in 2019 occurred in people between the ages of 15 and 24. HIV prevalence among young people has remained unchanged since 2008. This consistent pattern among people under 30 years of age indicates a failure in HIV prevention. Aim The study aimed to explore HIV and sexual risk behaviours by 18-25-year-old youth at Nyandeni Municipality in the Eastern Cape province. Setting The investigation was conducted Nyandeni Municipality in the Eastern Cape province. Methods Qualitative approach was used to explore, describe and investigate the knowledge and attitudes about HIV among the 18-25 years old youth. Results The findings are based on three themes namely, knowledge and attitudes about HIV and AIDS in youth, sexual risk behaviour among youth, and HIV prevention strategies. Conclusion This exploratory investigation confirms that the participants' knowledge is limited by showing that most of them knew very little about HIV and AIDS infection and prevention. Ongoing educational initiatives are required. Contribution Youth experience high HIV incidence because of their knowledge gaps.
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Affiliation(s)
- Lorraine N Mntonintshi-Mketo
- Department of Health Studies, Faculty of Human Sciences, University of South Africa, Pretoria, South Africa
- Department of Sociology, Faculty of Human Sciences, University of South Africa, Pretoria, South Africa
| | - Robert T Netangaheni
- Department of Health Studies, Faculty of Human Sciences, University of South Africa, Pretoria, South Africa
| | - Moganki H Lefoka
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Moran JB, Dunn A, Kim S, Zapolin D, Rivera D, Hoerger M. Community-based N95 distribution during the COVID-19 Omicron BA.1 surge: feasibility, 1-month utilization, and price implications. Transl Behav Med 2023; 13:694-699. [PMID: 37011032 DOI: 10.1093/tbm/ibad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Masks and other non-pharmaceutical interventions can complement vaccines and treatments as a part of multilayered mitigation to reduce the burden of COVID-19 in high-risk settings like surges. Although N95s provide greater protection than cloth and procedure masks against airborne infectious illnesses, few people used N95s historically, potentially due to lack of familiarity and cost. The study was designed to examine the feasibility of distributing N95s during a COVID-19 surge. A follow-up survey summarized mask behavior. The investigators aimed to distribute 2,500 N95s to 500 adults in 5-packs with informational handouts at community locations during the COVID-19 Omicron BA.1 surge in New Orleans, Louisiana. A 1-month follow-up survey assessed utilization, safety perceptions, social diffusion of awareness of N95s, and purchase intentions. The investigators successfully distributed all 2,500 N95s during the peak of the BA.1 surge (December 13, 2021 to January 17, 2022). At 1-month follow-up, 96.7% of participants had tried an N95. They utilized an average of 3.42 (68.4%) of the five N95s, felt safer wearing N95s (Ps < 0.0001), discussed N95s with others (80.4%), and would wear N95s again if free (87.9%). Future utilization intentions were price sensitive. Communities will readily use public health tools like N95s when at risk and offered for free with useful information. Cost was identified as a key barrier to sustained utilization. Findings have immediate public policy implications for reducing national, regional, and organizational surges. The research provides an illustrative example of the importance of behavioral science in responding to public health crises.
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Affiliation(s)
- James B Moran
- Health Education and Behavior Department, University of Florida, Gainesville, Florida 32608, USA
- Department of Psychology, Tulane University, New Orleans, Los Angeles 70118, USA
| | - Addison Dunn
- Department of Psychology, Tulane University, New Orleans, Los Angeles 70118, USA
| | - Seowoo Kim
- Department of Psychology, Tulane University, New Orleans, Los Angeles 70118, USA
| | - Dana Zapolin
- Department of Psychology, Tulane University, New Orleans, Los Angeles 70118, USA
| | - Dulcé Rivera
- Department of Psychology, Tulane University, New Orleans, Los Angeles 70118, USA
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Los Angeles 70118, USA
- Departments of Psychiatry and Medicine, Tulane Cancer Center, and A.B. Freeman School of Business, Tulane University, New Orleans, Los Angeles 70118, USA
- Department of Palliative and Supportive Medicine, University Medical Center of New Orleans, Los Angles 70118, USA
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3
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Liu Y, Yang Y, Fu C, Lin H, Wang T, Wang S, Kuang J, Chen X, Wang J. Loneliness and depressive symptoms among men who have sex with men in China: A cross-sectional study. Front Psychiatry 2023; 14:1179703. [PMID: 37091698 PMCID: PMC10117785 DOI: 10.3389/fpsyt.2023.1179703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Background While psychosocial problems and their related factors in men who have sex with men (MSM) have been well documented in developed countries, there are still not many studies addressing this issue in China and the results are inconsistent. This study aimed to assess the prevalence of loneliness and depressive symptoms among MSM, examine their associated factors, and investigate potential factors moderating the link between depressive symptoms and loneliness. Methods A cross-sectional study was conducted in Taizhou of Zhejiang Province in China between April and November 2021. Loneliness was assessed using the 3-item UCLA Loneliness Scale (UCLA-3), and depressive symptoms were measured using the Patient Health Questionaire-9 (PHQ-9). Data from 655 MSM were eligible for analysis. Logistic regression models were used to examine the associations between independent variables and the outcomes of loneliness and depression. The interaction terms were added in the models to assess the moderating effects. Results Of the MSM sample, 13.28 and 7.48% perceived loneliness and reported moderate-to-severe depressive symptoms, respectively. We found that participants who experienced loneliness were more likely to have younger age (OR 0.44, 95% CI 0.21, 0.93, 15-32 years as reference group), low social support (OR 3.60, 95% CI 2.14, 6.04), low self-esteem (OR 3.03, 95% CI 1.45, 6.32) and moderate-to-severe depressive symptoms (OR 5.45, 95% CI 2.66, 11.15). The participants with moderate-to-severe depressive symptoms were more likely to have low self-esteem (OR 6.78, 95% CI 3.08, 14.95) and feelings of loneliness (OR 5.51, 95% CI 2.66, 11.40). Stratified analyzes showed that the magnitude of the associations between depressive symptoms and loneliness varied in MSM with different age, marital status, and self-esteem. Conclusion Our study suggests that we need to pay attention to feelings of loneliness and depressive symptoms and their closely associated factors such as social support and self-esteem among MSM in China. The MSM who were young, not married, and had low self-esteem were especially vulnerable to the impact of depressive symptoms on loneliness.
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Affiliation(s)
- Yuhan Liu
- NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Yuting Yang
- NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Chaowei Fu
- NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Haijiang Lin
- Taizhou City Center for Disease Prevention and Control, Taizhou, China
| | - Tingting Wang
- Taizhou City Center for Disease Prevention and Control, Taizhou, China
| | - Shanling Wang
- Taizhou City Center for Disease Prevention and Control, Taizhou, China
| | - Jiawen Kuang
- NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Xiaoxiao Chen
- NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
- Taizhou City Center for Disease Prevention and Control, Taizhou, China
- Xiaoxiao Chen,
| | - Jingyi Wang
- NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
- *Correspondence: Jingyi Wang,
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Shi L, Luo J, Chen Y, Chen L, Hu H, Qiu T, Liu X, Xu X, Chen Y, Zhang Z, Zhou Y, Lu J, Fu G. Prevalence of syphilis and chlamydia trachomatis infection among female sex workers in Jiangsu, China: Results from a multicenter cross-sectional and venue-based study. Front Public Health 2022; 10:1018724. [PMID: 36388309 PMCID: PMC9659951 DOI: 10.3389/fpubh.2022.1018724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/14/2022] [Indexed: 01/28/2023] Open
Abstract
Background Female sex workers (FSWs) are considered highly vulnerable to sexually transmitted infections (STIs), but available data on the prevalence of STIs among FSWs in China is limited at a provincial level. This study aimed to evaluate the prevalence of STIs and risk factors among FSWs in Jiangsu, China. Methods We conducted a multicenter cross-sectional study in seven cities of Jiangsu to investigate the prevalence and risk factors associated with HIV and other STIs. Blood and urine were collected to test for HIV, syphilis, Hepatitis C (HCV), Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections. Results We enrolled 3,580 FSWs. The overall prevalence of bacterial STIs was 6.2% (5.4%-7.0%). The prevalence of HIV, syphilis infection, HCV, NG and CT were 0.1% (95%CI, 0.0-0.2), 1.8% (95%CI, 1.4-2.3), 0.3% (95%CI, 0.1-0.5), 0.3% (95%CI, 0.2-0.5) and 4.3% (95%CI, 3.6-5.0), respectively. Most FSWs (85.6%) reported consistent condom use with clients in the past month. Only 10.6% of FSWs reported group sex, and 68.3% self-reported HIV testing in the previous year. According to the multivariable model, having group sex in the past year (aOR, 2.521, 95%CI: 1.366-4.651) and HIV infection (aOR, 26.260, 95%CI: 2.432-283.563) were associated with a higher risk of syphilis infection. Migrants (aOR, 1.669, 95%CI: 1.163-2.395), having a history of STIs in the past year (aOR, 4.601, 95%CI: 1.003-21.118), and NG infection (aOR, 38.549, 95%CI: 11.214-132.514) were associated with a higher risk of CT infection. On the contrary, FSWs aged older than 25 were associated with lower risk of syphilis infection (25-34: aOR, 0.339, 95%CI: 0.151-0.763) and CT infection (25-34: aOR, 0.503, 95%CI: 0.316-0.802; ≥35: aOR, 0.578, 95%CI: 0.362-0.925). Conclusion This study's prevalence rates of syphilis and CT infections show the need to promote comprehensive STIs control and prevention strategies, including behavioral intervention and STIs screening, especially in younger high-risk populations. With the increasing coverage of HIV testing, integrating other STIs screening with HIV testing may be a reasonable way to implement comprehensive STIs control and prevention.
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Affiliation(s)
- Lingen Shi
- Institute for STIs and HIV Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China,Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, China
| | - Jun Luo
- Department of Clinical Central Laboratory, Jiangsu Health Vocational College, Nanjing, China
| | - Yuheng Chen
- Institute for STIs and HIV Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Liping Chen
- Institute for STIs and HIV Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Haiyang Hu
- Institute for STIs and HIV Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Tao Qiu
- Institute for STIs and HIV Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xiaoyan Liu
- Institute for STIs and HIV Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xiaoqin Xu
- Institute for STIs and HIV Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yunting Chen
- Institute for STIs and HIV Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Zhi Zhang
- Institute for STIs and HIV Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Ying Zhou
- Institute for STIs and HIV Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jing Lu
- Institute for STIs and HIV Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Gengfeng Fu
- Institute for STIs and HIV Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China,*Correspondence: Gengfeng Fu
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Lefoka MH, Netangaheni TR. A plea of those who are affected most by HIV: The utterances by women who inject Nyaope residing in the City of Tshwane Municipality, Gauteng. Afr J Prim Health Care Fam Med 2021; 13:e1-e9. [PMID: 34476973 PMCID: PMC8424706 DOI: 10.4102/phcfm.v13i1.2416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 11/11/2022] Open
Abstract
Background Nyaope injecting practice brought the field of Human Immunodeficiency Virus (HIV) prevention and Substance Use Disorder (SUD) together. It is complex and requires multidisciplinary approach. Women who use drugs face individual, social, and structural factors that fuel their vulnerability to contract HIV, and other blood-borne infections. Women Who Inject Drugs (WWID) are a subpopulation that is neglected from HIV prevention and SUD treatment interventions, and are hardly the subject of surveys. In order to fully address the HIV epidemic among WWID it is imperative that they become part of the process of finding solutions. Aim This study explored the strategies to curb HIV incidence among Women Who Inject Nyaope (WWIN), residing in City of Tshwane Municipality, Gauteng Province. Setting The research was conducted within COSUP. COSUP was considered more appropriate as it is a harm reduction based organisation. Methods The study utilised the qualitative research approach. Semi structured interviews were conducted with 24 women with a history of injecting Nyaope aged between 19 to 35 years. The data was analysed using thematic data analysis. Results Health intervention, economic intervention and educational intervention was stressed as key strategies to curb HIV among WWIN. Needle exchange programmes, condom distribution, PrEP, HIV Testing and Counselling, employment opportunities, support groups and awareness campaigns if implemented, can yield positive outcomes in curbing HIV among WWID. Conclusion Mechanisms to curb HIV among WWIN exist, and when implemented, they have the potential to address high HIV incidence among women who inject Nyaope.
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Affiliation(s)
- Moganki H Lefoka
- Department of Sociology, Faculty of Human Sciences, University of South Africa, Pretoria.
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6
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Understanding how social norms affect modern contraceptive use. BMC Public Health 2021; 21:1061. [PMID: 34088295 PMCID: PMC8178889 DOI: 10.1186/s12889-021-11110-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/17/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND An aim of this study is to introduce a practitioner-friendly behavior model. Few theories of health behavior explicitly take the effect of social norms on behavior into account. Generally, theories that do take social norms into account assume that the effect of social norms on behavior operates through motivation. We use the Fogg Behavior Model (FBM), a behavior model that is new to public health, to explore whether social norms are associated with modern contraceptive use among Nigerian women, and whether they affect behavior through motivation or through ability. In other words, do social norms that discourage contraception lower women's motivation to use contraception or do they lower women's ability to use contraception. METHODS This study uses data from a cross-sectional household survey of Nigerian women, ages 14-24. The survey collected data on socio-economic and demographic characteristics of women, whether they were sexually experienced, and whether they used contraception. Modern contraceptive use was the outcome of interest for the study. The survey also collected data on social norms around premarital sex and contraceptive use. Multivariate logistic regression was used for the analysis. RESULTS After adjusting for a range of socio-economic and demographic variables, we found that social norms that discourage contraception had a statistically significant negative association with contraceptive use (aOR = 0.90, p < 0.001). The analysis found that the negative association between social norms and contraceptive use remained statistically significant after controlling for motivation but did not remain statistically significant after controlling for ability. CONCLUSION These findings suggest that social norms may affect contraceptive use in Nigeria through ability rather than motivation. In terms of programmatic implications, these finding suggest that public health interventions may be able to counter the negative effects of social norms that discourage contraceptive use by increasing women's ability to practice contraception.
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Abstract
This paper reviews the current epidemics of human immunodeficiency virus (HIV) infection in China, particularly the globally available prevention strategies developed and implemented. This review focuses on HIV prevention measures in general, such as education, testing, and counseling and in specific responses to transmission modes, such as blood safety, harm reduction for people who inject drugs, and condom promotion to reduce sexual transmission. We also assess newly developed prevention measures, such as prevention treatment, pre-exposure prophylaxis, post-exposure prophylaxis, male circumcision, and promising potential future preventions, including microbicides and vaccines. Based on this assessment, we provide recommendations for their implementation in China. We conclude that there is no magic bullet for HIV prevention, particularly sexual transmission of the disease, but only a combination of these prevention strategies can control the HIV epidemic.
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Abstract
Rates of sexual activity, pregnancies, and births among adolescents have continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and sexually transmitted infections (STIs). This technical report discusses the new data and trends in adolescent sexual behavior and barrier protection use. Since 2017, STI rates have increased and use of barrier methods, specifically external condom use, has declined among adolescents and young adults. Interventions that increase availability of or accessibility to barrier methods are most efficacious when combined with additional individual, small-group, or community-level activities that include messages about safer sex. Continued research informs public health interventions for adolescents that increase the consistent and correct use of barrier methods and promote dual protection of barrier methods for STI prevention together with other effective methods of contraception.
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Affiliation(s)
- Laura K Grubb
- Departments of Pediatrics and Public Health and Community Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
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9
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Mahapatra B, Walia M, Patel SK, Battala M, Mukherjee S, Patel P, Subramanium B, Atmavilas Y, Saggurti N. Sustaining consistent condom use among female sex workers by addressing their vulnerabilities and strengthening community-led organizations in India. PLoS One 2020; 15:e0235094. [PMID: 32609731 PMCID: PMC7329078 DOI: 10.1371/journal.pone.0235094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 06/08/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Between 2014 and 2017, a program aimed at reducing HIV risk and promoting safe sex through consistent use of condoms sought to work through addressing social and economic vulnerabilities and strengthening community-led organizations (COs) of female sex workers (FSWs). This study examines if the program was effective by studying relationship between strengthening of COs, vulnerability reduction, and sustaining of consistent condom use behavior among FSWs. Methods We used a longitudinal study design to assess the change in outcomes. A three-stage sampling design was used to select FSWs for the study. Panel data of 2085 FSWs selected from 38 COs across five states of India was used to examine the change in various outcomes from 2015 (Survey Round 1) to 2017 (Survey Round 2). The CO level program pillar measuring institutional development assessed performance of COs in six domains critical for any organization’s functionality and sustainability: governance, project management, financial management, program monitoring, advocacy and networking, and resource mobilization. Overall, 32 indicators from all these domains were used to compute the CO strength score. A score was computed by taking mean of average dimension scores. The overall score was divided into two groups based on the median cutoff; COs which scored below the median were considered to have low CO strength, while COs which scored above or equal to median were considered to have high CO strength. Multivariable regression modeling techniques were used to examine the effect of program pillars on outcome measures. Results Analyses showed a significant improvement in the strength of the COs over time; percentage of COs having high strength improved from 50% in 2015 to 87% in Round 2. The improvement in CO’s strength increased financial security (Adjusted Odds Ratio [AOR]: 2.18, p<0.01), social welfare security (AOR: 1.71, p<0.01), and socio-legal security (AOR: 2.20, p<0.01) among FSWs. Further, improvement in financial security led to significant increase in consistent condom use with client among FSWs (AOR: 1.69, p<0.01) who were members of COs having high strength. Sustained consistent condom use was positively associated with young age (<30 years), ability to negotiate with clients for condom use, membership in self-help groups, high self-efficacy, self-confidence, and client solicitation in streets and brothels. Conclusions Improving financial security and strengthening FSW led CO can improve sustained and consistent condom use. In addition, the program should focus on enhancing ability of FSWs to negotiate with clients for condom use, promote membership in self-help groups and target FSWs who are 30 years or older, and soliciting from homes to sustain consistent condom use across all FSWs.
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Affiliation(s)
| | | | | | | | | | - Prachi Patel
- Catalyst Management Services, Bengaluru, Karnataka, India
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10
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Jabr AM, Di Stefano M, Greco P, Santantonio T, Fiore JR. Errors in Condom Use in the Setting of HIV Transmission: A Systematic Review. Open AIDS J 2020. [DOI: 10.2174/1874613602014010016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The efficacy of condom use in declining HIV transmission may be compromised by their incorrect usage. Much focus has been paid on the regularity of condom usage but consumer mistakes and challenges must be considered. Breakage, slipping, leakage, incomplete use and other problems during the sexual event may compromise the protective role of the condom.
Objective:
To evaluate through a systematic review of published data, the type, and incidence of error and problems in condom use, and their possible role in reducing the preventive action of condoms.
Methods:
A systematic literature search for peer-reviewed articles published between January 2000 and January 2019, issued in English in peer-reviewed journals, and reporting the occurrence of condom errors/problems among HIV high-risk populations.
Results:
Twenty studies representing nine countries met the inclusion criteria. The most predominant mistakes associated with condom use included condom breakage, slippage, delayed condom application, early removal, issues related to erection loss and difficulties with fit and feel were reported, failure to squeeze out air, use of expired condoms, reuse of condom, and wearing the condom outside out were other issues noticed.
Conclusions:
Condom use problems and mistakes are prevalent across the globe. Educational efforts are needed to empower HIV the at-risk population with confidence and knowledge to improve correct condom use and increase preventive activity
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Traeger MW, Schroeder SE, Wright EJ, Hellard ME, Cornelisse VJ, Doyle JS, Stoové MA. Effects of Pre-exposure Prophylaxis for the Prevention of Human Immunodeficiency Virus Infection on Sexual Risk Behavior in Men Who Have Sex With Men: A Systematic Review and Meta-analysis. Clin Infect Dis 2019; 67:676-686. [PMID: 29509889 DOI: 10.1093/cid/ciy182] [Citation(s) in RCA: 298] [Impact Index Per Article: 59.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/28/2018] [Indexed: 11/12/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is effective in reducing HIV risk in men who have sex with men (MSM). However, concerns remain that risk compensation in PrEP users may lead to decreased condom use and increased incidence of sexually transmitted infections (STIs). We assessed the impact of PrEP on sexual risk outcomes in MSM. Methods We conducted a systematic review of open-label studies published to August 2017 that reported sexual risk outcomes in the context of daily oral PrEP use in HIV-negative MSM and transgender women. Pooled effect estimates were calculated using random-effects meta-analysis, and a qualitative review and risk of bias assessment were performed. Results Sixteen observational studies and 1 open-label trial met selection criteria. Eight studies with a total of 4388 participants reported STI prevalence, and 13 studies with a total of 5008 participants reported change in condom use. Pre-exposure prophylaxis use was associated with a significant increase in rectal chlamydia (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19-2.13) and an increase in any STI diagnosis (OR, 1.24; 95% CI, .99-1.54). The association of PrEP use with STI diagnoses was stronger in later studies. Most studies showed evidence of an increase in condomless sex among PrEP users. Conclusion Findings highlight the importance of efforts to minimize STIs among PrEP users and their sexual partners. Monitoring of risk compensation among MSM in the context of PrEP scale-up is needed to assess the impact of PrEP on the sexual health of MSM and to inform preventive strategies.
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Affiliation(s)
- Michael W Traeger
- Disease Elimination Program, Public Health Discipline, Burnet Institute.,School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Sophia E Schroeder
- Disease Elimination Program, Public Health Discipline, Burnet Institute.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Edwina J Wright
- Disease Elimination Program, Public Health Discipline, Burnet Institute.,School of Public Health and Preventive Medicine, Monash University.,Department of Infectious Diseases, The Alfred and Monash University.,Peter Doherty Institute of Infection and Immunity, University of Melbourne
| | - Margaret E Hellard
- Disease Elimination Program, Public Health Discipline, Burnet Institute.,School of Public Health and Preventive Medicine, Monash University.,Department of Infectious Diseases, The Alfred and Monash University
| | - Vincent J Cornelisse
- Department of Infectious Diseases, The Alfred and Monash University.,Central Clinical School, Monash University, Melbourne.,Melbourne Sexual Health Centre, Carlton, Victoria, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Public Health Discipline, Burnet Institute.,Department of Infectious Diseases, The Alfred and Monash University
| | - Mark A Stoové
- Disease Elimination Program, Public Health Discipline, Burnet Institute.,School of Public Health and Preventive Medicine, Monash University
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Esmaeili A, Shokoohi M, Danesh A, Sharifi H, Karamouzian M, Haghdoost A, Shahesmaeili A, Akbarpour S, Morris MD, Mirzazadeh A. Dual Unsafe Injection and Sexual Behaviors for HIV Infection Among People Who Inject Drugs in Iran. AIDS Behav 2019; 23:1594-1603. [PMID: 30460664 DOI: 10.1007/s10461-018-2345-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We used two national surveys (2010: N = 1597; 2013: N = 1057) of people who inject drugs (PWID) in past-month to assess the prevalence and population size of PWID with either safe or unsafe injection and sex behaviors, overall and by HIV status. In 2013, only 27.0% (vs. 32.3% in 2010) had safe injection and sex, 24.6% (vs. 23.3% in 2010) had unsafe injection and sex, 26.4% (vs. 26.5% in 2010) had only unsafe injection, and 22.0% (vs. 18.0% in 2010) had unsafe sex only. Among HIV-positive PWID in 2013, only 22.1% (~ 2200 persons) had safe injection and sex, 14.2% (~ 1400 persons) had unsafe injection and sex, 53.1% (~ 5200 persons) had unsafe injection, and 10.6% had unsafe sex (~ 1100 persons). Among HIV-negative PWID in 2013, only 27.5% (~ 22,200 persons) had safe injection and sex, 25.9% (~ 20,900 PWID) had unsafe injection and sex, 23.2% (~ 18,700 persons) had unsafe injection, and 23.3% (~ 18,800 persons) had unsafe sex. HIV-positive and -negative PWID in Iran continue to be at risk of HIV acquisition or transmission which calls for targeted preventions services.
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Affiliation(s)
- Aryan Esmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
| | - Ahmad Danesh
- Golestan Research Center of Psychiatry, Golestan University of Medical Sciences, Gorgan, Golestan, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - AliAkbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Samaneh Akbarpour
- Center for Disease Control (CDC), Ministry of Health and Medical Education, Tehran, Iran
| | - Meghan D Morris
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Ali Mirzazadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
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13
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McCool-Myers M. Implementing condom distribution programs in the United States: Qualitative insights from program planners. EVALUATION AND PROGRAM PLANNING 2019; 74:20-26. [PMID: 30802814 DOI: 10.1016/j.evalprogplan.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/27/2019] [Accepted: 02/09/2019] [Indexed: 06/09/2023]
Abstract
With the growing number of sexually transmitted infections (STIs) among young people (15-24) in the US, condom distribution programs (CDP) remain an integral part of prevention strategies. The objective of the study was to gather qualitative insights from CDP planners to inform effective CDP implementation. Ten semi-structured interviews with program planners were conducted via telephone (response rate of 58.8%). Condom distribution channels included site-based distribution (n = 6), web-based distribution (n = 4), and distribution via Uber (n = 1). Site-based distribution programs had distribution networks ranging from 100 to 3500 sites in a given jurisdiction. Planners of site-based CDPs experienced challenges with ensuring quality control at sites and supplying condoms to sites. Web-based CDPs allow individuals to order free condoms online. These CDP planners reported growing demand for this discreet service, particularly among young people. Web-based CDPs leveraged e-mail surveys to collect data on sexual behavior and behavior change, yielding response rates as high as 63%. All CDPs emphasized the importance of supplying a variety of products. Total supplies distributed (male condoms, internal condoms, lubricant sachets) ranged from 16,000 to 45 million per year. Novel channels of distribution should be explored to ensure reach to adolescents and young adults.
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Affiliation(s)
- Megan McCool-Myers
- Emory University, School of Medicine, Jane Fonda Center for Adolescent Reproductive Health, 46 Armstrong Street SE, Atlanta, GA, 30303, United States.
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14
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Agha S, Tollefson D, Paul S, Green D, Babigumira JB. Use of the Fogg Behavior Model to Assess the Impact of a Social Marketing Campaign on Condom Use in Pakistan. JOURNAL OF HEALTH COMMUNICATION 2019; 24:284-292. [PMID: 30945612 DOI: 10.1080/10810730.2019.1597952] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Fogg Behavior Model (FBM) is a new framework which posits that behavior happens when three factors - motivation, ability, and a prompt - occur in the same moment. The FBM categorizes people into four groups based on motivation and ability and posits that those with high motivation and high ability will adopt a behavior when prompted. Two rounds of panel survey data from 617 married men in urban Pakistan were used to test this hypothesis. Multilevel mixed-effects logistic regression was used for the analysis. The results show the relationships between ability, motivation, the prompt and condom use to be as hypothesized by the FBM. After adjustment for a range of variables including fertility desires, education, and household wealth, the odds of condom use among men with high motivation and high ability were 34 times higher than the odds of condom use among men with low motivation and low ability. Moreover, the association between the prompt and condom use operated through increased motivation and ability. The FBM has potential for use in the design and evaluation of behavior change interventions in developing countries.
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Affiliation(s)
- Sohail Agha
- a Bill and Melinda Gates Foundation, Integrated Delivery Team , Seattle , WA , USA
| | - Deanna Tollefson
- b University of Washington, Strategic Analysis, Research, and Training (START) Center , Seattle , WA , USA
| | - Shadae Paul
- b University of Washington, Strategic Analysis, Research, and Training (START) Center , Seattle , WA , USA
| | - Dylan Green
- b University of Washington, Strategic Analysis, Research, and Training (START) Center , Seattle , WA , USA
| | - Joseph B Babigumira
- b University of Washington, Strategic Analysis, Research, and Training (START) Center , Seattle , WA , USA
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15
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Francis DB, Noar SM, Fortune DA, Adimora AA. "Be Straight Up and So Will He": Evaluation of a Novel HIV Prevention Condom Distribution and Health Communication Intervention Targeting Young African American Females. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:137-151. [PMID: 29688776 PMCID: PMC6476563 DOI: 10.1521/aeap.2018.30.2.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This study evaluated a novel 3-month campus-based HIV prevention condom distribution and health communication intervention for African American females attending a historically Black college in North Carolina. The theoretical framework for study incorporated the integrative model of behavioral prediction and the theory of gender and power. The intervention provided free condoms via condom dispensers with point-of-access messaging on the dispensers. We assessed 195 individuals before and 118 three months after the intervention. Almost 90% of participants were exposed to the intervention. Forty-four percent used the dispensers, 70% of whom reported using the condoms for sexual intercourse. Perceptions of condom availability and accessibility increased significantly after the intervention. In a multiple regression analysis controlling for covariates, dispenser use was significantly associated with greater condom use. These findings show the promise of a low-cost, broad-reach HIV/STI prevention intervention for young African American women.
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Affiliation(s)
- Diane B Francis
- Manship School of Mass Communication, Louisiana State University, Baton Rouge, Louisiana
| | - Seth M Noar
- School of Media and Journalism, University of North Carolina at Chapel Hill, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Deborah A Fortune
- Department of Public Health Education, North Carolina Central University, Durham, North Carolina
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