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Huang JL, Xin X, Ma MJ, Ning Z, Xiao ST, Chen PP. A qualitative study on the clinical safety and user experiences of female condoms for anal intercourse among men who have sex with men in Shanghai, China. Front Public Health 2023; 11:1243891. [PMID: 38074717 PMCID: PMC10701689 DOI: 10.3389/fpubh.2023.1243891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/19/2023] [Indexed: 12/18/2023] Open
Abstract
Objective This qualitative study aimed to understand the clinical safety, efficacy, and receptiveness of using the female condom (FC) during anal intercourse among men who have sex with men (MSM). Methods Subjects for this study were recruited from a two-group crossover trial among MSM in Shanghai. The trial consisted of two phases, each including the use of condoms (FC vs. male condom), questionnaires, and in-depth one-on-one interviews. The two phases were separated by a washout period of 4 weeks. The minimum sample size for this study was determined in accordance with the principle of "information saturation." The qualitative data were organized and analyzed using ATLAS.ti version 7. Results A total of 26 participants from the MSM population were recruited for this study, with 10 assuming the insertive role (i.e., "1"), 8 assuming the receptive role (i.e., "0"), and 8 being versatile (i.e., "0.5"). Each participant completed the crossover trial comprising two phases. The cumulative usage of FCs and male condoms (MCs) amounted to 115 and 127 times, respectively. During the reported sexual encounters, no participants reported incidents of condom rupture, slippage, or other malfunctions. A few participants reported experiencing slight chafing pain, primarily put forward by "0" participants. Apart from those reports, no instances of bleeding, swelling, or allergic reactions were reported. The efficiency of FC in disease prevention, the sexual partner's willingness to use FC, the freshness of FC, and positive sexual experiences were the main reasons for the consistent use of FC for anal sex. Discomfort and pain during sexual activity, the loose design and thick material of FCs, and difficulties in placing FCs were the major obstacles to FC use among MSM. The elements referring to the forehead exhibited varied in importance among "1,", "0," and "0.5" participants. Regarding the willingness to use the FC in the future anal intercourse, 61.54% of participants expressed a positive inclination, 23.08% were uncertain, and 15.38% stated that they would not. "A better sense of security during anal sex" was the main factor affecting willingness among "0" participants and "the sexual pleasure that the FC brought" among "1" participants. Improving the design and technology of FCs and increasing the frequency of use and practice might improve the use skills, which will favor the willingness to use FCs among the MSM population. Conclusion FCs received positive user feedback from study participants, but distinctions were found in individuals in different sexual roles. Large-scale quantitative studies are needed to evaluate the clinical safety of the FC and its effectiveness in preventing the transmission of STDs during anal intercourse.
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Affiliation(s)
- Jia-Lu Huang
- School of Public Health, Dali University, Dali, China
| | - Xin Xin
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Pudong New Area Center for Disease Control and Prevention, Shanghai, China
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Ming-Jun Ma
- School of Public Health, Dali University, Dali, China
| | - Zhen Ning
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Shao-tan Xiao
- Pudong New Area Center for Disease Control and Prevention, Shanghai, China
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
| | - Pan-pan Chen
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Pudong New Area Center for Disease Control and Prevention, Shanghai, China
- Pudong Institute of Preventive Medicine, Fudan University, Shanghai, China
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Beksinska M, Mphili N, Smit J. Functional performance of the Wondaleaf condom: A crossover, noninferiority, randomized clinical trial. Int J STD AIDS 2023; 34:114-121. [PMID: 36426764 DOI: 10.1177/09564624221139899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND New female condom (FC) products wishing to apply for United Nations Population Fund/World Health Organisation (UNFPA/WHO) prequalification are required to conduct a randomized, controlled clinical investigation comparing the new FC to the marketed FC, in order to comply with UNFPA/WHO and International Organization for Standardization (ISO) specifications. We aimed to assess the functional performance, acceptability and safety of the Wondaleaf female condom compared to the control FC2 female condom. METHODS This randomized clinical trial enrolled 220 women in one South African site. The primary outcome of the study was the rate of female condom (FC) failure. Participants were asked to use five of each FC type and to collect information on use in a condom diary at home, and were interviewed after use of each FC type. RESULTS Noninferiority was demonstrated for the Wondaleaf with respect to the reference FC2 for all condom functions. The Wondaleaf was found to be superior to the FC2 reference condom for invagination (p > .000), misdirection (p > .000) and clinical failure (p > .000). Acceptability ratings for a range of features were similar between the two FCs. Few safety events were reported for either device. CONCLUSION The Wondaleaf performs as well as the FC2, and is equally acceptable. Results from this study will inform further refinement of this FC design. Trial registrations: ClinicalTrials.gov Identifier: NCT04076774 https://clinicaltrials.gov/. South African National Clinical Trials Database (SANCTR) number DOH-27-0319-6020.
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Affiliation(s)
- Mags Beksinska
- Match Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, 37708University of the Witwatersrand, Durban, South Africa
| | - Nonhlanhla Mphili
- Match Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, 37708University of the Witwatersrand, Durban, South Africa
| | - Jenni Smit
- Match Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, 37708University of the Witwatersrand, Durban, South Africa
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Kelvin E, Patel V, Mirzayi C, Anastos K, Grov C. Lifetime prevalence and correlates of female condom use for anal sex in a geographically diverse sample of Men who have sex with men (MSM) in the United States. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2020; 32:331-341. [PMID: 34141047 PMCID: PMC8205508 DOI: 10.1080/19317611.2020.1813860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Examine use of the female condom (FC) for anal sex among Men who have sex with men (MSM) in the United States (US). METHODS An online survey among 3,837 MSM. RESULTS 5.2% had used the FC for anal sex. Use was higher among those who had used the FC for vaginal sex (OR=14.39, p<0.001), those with multiple partners, (OR=2.68, p=0.004), and those who were HIV-positive (OR=2.07, p<0.001) or on PrEP (OR=2.66, p<0.001). CONCLUSIONS FC use for anal sex was associated with risk of HIV infection/transmission and may be a risk reduction strategy used by MSM in the US.
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Affiliation(s)
- Elizabeth Kelvin
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, USA
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, USA
| | - Viraj Patel
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York USA
| | - Chloe Mirzayi
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York USA
| | - Christian Grov
- CUNY Institute for Implementation Science in Population Health, City University of New York, New York, USA
- Department of Community Health and Social Science, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York USA
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Rhodes SD, Alonzo J, Mann L, Freeman A, Sun CJ, Garcia M, Painter TM. Enhancement of a Locally Developed HIV Prevention Intervention for Hispanic/Latino MSM: A Partnership of Community-Based Organizations, a University, and the Centers for Disease Control and Prevention. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:312-32. [PMID: 26241382 PMCID: PMC4537171 DOI: 10.1521/aeap.2015.27.4.312] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Hispanic/Latino men who have sex with men (MSM) in the United States are disproportionately affected by HIV and other sexually transmitted diseases (STDs); however, no efficacious behavioral HIV/STD prevention interventions are currently available for use with this vulnerable population. We describe the enhancement of HOLA en Grupos, a community-based behavioral HIV/STD prevention intervention for Spanish-speaking Hispanic/Latino MSM that is currently being implemented and evaluated in North Carolina with support from the Centers of Disease Control and Prevention (CDC). Our intervention enhancement process included incorporating local data on risks and context; identifying community needs and priorities; defining intervention core elements and key characteristics; developing a logic model; developing an intervention logo; enhancing intervention activities and materials; scripting intervention delivery; expanding the comparison intervention; and establishing a materials review committee. If the CDC-sponsored evaluation determines that HOLA en Grupos is efficacious, it will be the first such behavioral HIV/STD prevention intervention to be identified for potential use with Hispanic/Latino MSM, thereby contributing to the body of evidence-based resources that may be used for preventing HIV/STD infection among these MSM and their sex partners.
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Affiliation(s)
- Scott D. Rhodes
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine
| | - Jorge Alonzo
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine
| | - Lilli Mann
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine
| | - Arin Freeman
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Christina J. Sun
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine
| | - Manuel Garcia
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine
| | - Thomas M. Painter
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
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Rodriguez K, Ventura-DiPersia C, LeVasseur MT, Kelvin EA. Inconsistencies on U.S. Departments of Health Websites Regarding Anal Use of the Female Condom. AIDS Behav 2015; 19:1141-9. [PMID: 25369888 DOI: 10.1007/s10461-014-0933-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The female condom (FC) is FDA approved to prevent pregnancy and sexually transmitted infections during vaginal intercourse, but not for use during anal intercourse. Studies suggest that a sizeable proportion of men who have sex with men use the FC for anal intercourse despite lack of safety and efficacy information. We reviewed Department of Health (DOH) websites for U.S. states (n = 50) and major municipalities (population >500,000; n = 29) regarding anal use of the FC. Forty-eight (60.8 %) websites mentioned the FC, of which only 21 (45.8 %) mentioned anal use. Of those that mention anal use, 8 (38.1 %) supported, 13 (61.9 %) were neutral, and 1 (4.8 %) discouraged this use. Ten websites (47.6 %) provided instructions for anal use of the FC-ranging from removal of the inner ring, leaving the inner ring in place, and either option. In the absence of safety and efficacy data, U.S. DOH websites are providing different and often contradictory messages about the FC for anal sex.
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Maksut JL, Eaton LA. Female Condoms=Missed Opportunities: Lessons Learned from Promotion-centered Interventions. Womens Health Issues 2015; 25:366-76. [PMID: 26048756 DOI: 10.1016/j.whi.2015.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 01/14/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Jessica L Maksut
- Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut.
| | - Lisa A Eaton
- Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut
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Abstract
Condoms remain the most effective barrier against the sexual transmission of the human immunodeficiency virus (HIV). Male condoms have proven to be 80% to 90% effective, and female condoms have similar results. Poor adherence and improper use limit their effectiveness. In addition to condoms, microbicides are a promising barrier against HIV transmission. More than 50 candidate topical microbicide compounds have undergone preclinical or clinical testing in the last 10 years, but there are currently no US Food and Drug Administration (FDA)-approved compounds. Rectal microbicides are also being developed, as anal receptive sex is an effective mode of HIV transmission.
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Affiliation(s)
- Ellen F Eaton
- Division of Infectious Disease, University of Alabama, Birmingham, 229 Tinsley Harrison Tower, 1720 Second Avenue South, Birmingham, AL 35294, USA.
| | - Craig J Hoesley
- Division of Infectious Disease, University of Alabama, Birmingham, 229 Tinsley Harrison Tower, 1720 Second Avenue South, Birmingham, AL 35294, USA
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Calabrese SK, Reisen CA, Zea MC, Poppen PJ, Bianchi FT. The pleasure principle: the effect of perceived pleasure loss associated with condoms on unprotected anal intercourse among immigrant Latino men who have sex with men. AIDS Patient Care STDS 2012; 26:430-5. [PMID: 22663165 DOI: 10.1089/apc.2011.0428] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Sexual pleasure has been identified as an important consideration in decision-making surrounding condom use. We examined the impact of perceived pleasure loss associated with condom use on recent history of insertive and receptive unprotected anal intercourse (UAI) among Latino men who have sex with men (MSM) living in the United States. A total of 482 Dominican, Colombian, and Brazilian immigrant MSM were surveyed regarding sexual attitudes and practices via computer-assisted self-interviewing technology with audio enhancement (ACASI). Participants rated the pleasure they derived from protected and unprotected anal intercourse in each position (insertive and receptive) and also reported their HIV status, relationship status, and recent sexual history. Men who had engaged in both positions, with and without condoms (n=268), perceived a greater pleasure loss associated with condoms during anal intercourse in the insertive versus receptive position. Logistic regression analyses controlling for HIV status, relationship status, and age revealed that men who perceived greater pleasure loss from condoms were more likely to have engaged in UAI over the past 3 months (n[insertive]=297; n[receptive]=284). Findings indicate that the pleasure loss associated with condoms may be a key deterrent for their use in either sex position among Latino MSM. Therefore, pleasure needs to be prioritized in the development of condoms and other sexual safety measures as well as in the promotion of their use.
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Affiliation(s)
| | - Carol A. Reisen
- The George Washington University, Washington, District of Columbia
| | | | - Paul J. Poppen
- The George Washington University, Washington, District of Columbia
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