HIV Prevention Knowledge Base
Behavioral Interventions: Comprehensive Condom Use Programs
Social Network-Based Interventions to Promote Condom Use: A Systematic Review
This review compiles evidence from 11 studies on social network-based condom promotion interventions. All of the studies used social networks as defined by the study participants themselves, and 10 out of 11 studies measured significant improvements in condom use. Only three of the studies (among drug users in Thailand, Roma men in Bulgaria, and high-risk women in Baltimore, Maryland, in the United States) had biological outcomes, and the primary outcome of condom use varied greatly by timeframe. Eight of the nine studies with controls showed a substantial improvement in at least one condom measure among intervention groups versus controls. The authors conclude that social network-based HIV prevention interventions can increase condom use and reduce other HIV risk behaviors.
Effectiveness of HIV Prevention for Youth in Sub-Saharan Africa: Systematic Review and Meta-Analysis of Randomized and Nonrandomized Trials
This systematic review and meta-analysis assessed 28 interventions for reported condom use and condom use intentions. It revealed that sexual behavior, whether risky or not, did not increase after sex education and condom promotion. However, only condom use by males at last sex increased, and the interventions did not result in positive changes to sexual behavior. The design of many studies was suboptimal, and the heterogeneity of studies suggests a lack of consensus on interventions and research into their efficacy.
Reduction in Risk-Taking Behaviors Among MSM in Senegal Between 2004 and 2007 and Prevalence of HIV and Other STIs. ELIHoS Project, ANRS 12139
This study compares prevalence data for HIV and sexually transmitted infections before and after the implementation of prevention campaigns targeting men who have sex with men (MSM) in Senegal, a group with high HIV prevalence and a high rate of risky sexual behaviors. Frequency of sexual practices remained unchanged, but condom use in male-to-male sexual encounters increased markedly. HIV prevalence remained the same, but prevalence of gonorrhea halved. Using the same sampling method in both surveys meant that the data could be meaningfully compared, but the authors caution that the results cannot be considered representative of the MSM population in Senegal, because the snowball sampling method likely caused selection bias.
Effects of Structural Intervention on Increasing Condom Availability and Reducing Risky Sexual Behaviours in Gay Bathhouse Attendees
An intervention in Taiwanese gay bathhouses to ensure availability and accessibility of condoms was successful in increasing use of condoms, according to this study. Bathhouse attendees were recruited before the intervention and were then surveyed six months later to assess whether or not greater access to condoms inside the bathhouses reduced unprotected sex and cut prevalence rates of HIV and sexually transmitted infections. Among attendees at bathhouses in the intervention group, self-reported consistent condom use during anal sex increased, but prevalence of HIV and sexually transmitted infections remained unchanged. It is important to ensure distribution of condoms in areas of the bathhouses where sexual encounters take place, the authors comment.
The UALE Project: Decline in the Incidence of HIV and Sexually Transmitted Infections and Increase in the Use of Condoms Among Sex Workers in Guatemala
This intervention offered commercial sex workers in Guatemala biannual screening for HIV and sexually transmitted infections (STIs), condom education, and training in condom negotiation skills, and also comprised activities to reduce the criminalization of sex workers. It resulted in higher consistent usage of condoms with new and regular clients, as well as lower rates of HIV and STIs, according to this paper. The authors attribute the reduction in STIs and HIV to increased condom use. The study may be subject to bias due to the potential for greater loss to follow-up for subgroups at higher risk of HIV, as well as recall bias and misreporting.
The Efficacy of Female Condom Skills Training in HIV Risk Reduction Among Women: A Randomized Controlled Trial
This randomized controlled trial of 400 Californian women examined the impact of a four-session female condom skills training intervention. Women received instructions in female condom use including self-efficacy training at baseline and supplies of male and female condoms during the study period. Information on condom use was gathered using computer-assisted self-interviews at baseline and at three and six months. At follow-up, female condom use among the intervention group participants increased and the absolute difference in at least one incidence of condom usage was over 20 percent higher in the intervention group versus the control group at both time points. However, there was no difference in male condom use. The study showed that women in the intervention group exhibited safer sexual practices without reducing baseline male condom use, suggesting the intervention can be an effective supplement to other prevention strategies.
Acceptability and Use of Sexual Barrier Products and Lubricants Among HIV-Seropositive Zambian Men
This study describes an intervention to provide Zambian HIV-positive and serodiscordant couples with male and female condoms and a variety of lubricants to assess their acceptability. It found that male condom use, already high at baseline, increased during the 6-month intervention and that the increase was sustained at 12 months. Female condom use also increased during the intervention, and men’s attitudes shifted away from a cultural preference for dry sex. Use of lubricants was influenced by the need for communication between partners about sex, and interventions that encourage communication could be useful, the authors note. Gender roles pitting men as the sexual decision makers must be taken into account in such HIV prevention interventions.
Smarter Programming of the Female Condom: Increasing Its Impact on HIV Prevention in the Developing World
This study looks at the relative effectiveness of female condoms as a HIV prevention strategy within the range of HIV prevention options. The study includes a comparative review of 14 female condom programs across 10 countries in the developing world as well as a wider literature review and interviews with stakeholders. There was also a cost-effectiveness analysis. This report found that female condoms are significantly less cost-effective than male condoms. Female condoms are not cost-effective for female sex workers due to the very high rate of substitution for male condoms; for women with regular sexual partners, they are not cost-effective because of the high cost relative to male condoms, the study found. However, the authors note that cost-effectiveness is not the sole criterion for funding decisions, that female condoms have utility in protecting women whose male sexual partners cannot or will not use a male condom, and that the benefits to women’s empowerment are implied by female condom programming, but difficult to quantify.
Temporal Trends in Sexually Transmitted Infection Prevalence and Condom Use Following Introduction of the Female Condom to Madagascar Sex Workers
This study looked at the impact among 1,000 sex workers in Madagascar of adding female condoms to male condom distribution. The study ran for 18 months, comprising 6 months when only male condoms were available to participants followed by 12 months when both types were available. Every two months, the women provided information on condom use and they were tested for sexually transmitted infections (STIs) every six months. Adding female condoms increased condom use from 78 percent of sex acts at the 6-month mark to 83 and 88 percent at 12 and 18 months, respectively. Over the same timeframe, prevalence of STIs also declined a fifth from 50 percent at month 6 to 40 percent at the 18-month mark. The authors conclude that female condom promotion has its place in the context of programs that first achieve maximum outcome from male condom programming, but that condom promotion is not sufficient on its own to control HIV and STIs.
Evaluation of the 100% Condom Program in Thailand
This report describes in detail Thailand’s 100% Condom Program and evaluates its success in significantly increasing consistent condom use in commercial sex settings, in turn dramatically reducing rates of sexually transmitted infections. Factors affecting the success of the program include the wide extent of implementation of all components of the program, the degree of collaboration between stakeholders, and taking account of different types of commercial sex establishments and their varying needs. This success story can be built upon by improving condom access in indirect sites of commercial sex, given that surveillance had found the number of such sites increasing in 2000 when Thailand’s program was evaluated.
Condoms "Contain Worms" and "Cause HIV" in Tanzania: Negative Condom Beliefs Scale Development and Implications for HIV Prevention
Condoms are a cornerstone of HIV prevention, yet the demand for and use of condoms remains low despite the high HIV and AIDS prevalence rates in certain countries. Negative rumors about condoms abound, and negative beliefs act as barriers to the intention to use condoms consistently and correctly. This study used the Negative Condom Belief Scale in Tanzania to quantitatively measure how negative beliefs affect willingness to use condoms. The cross-sectional study was conducted in the Maasai regions of Tanzania. About 360 individuals were randomly selected based on geographical and household clusters. Face-to-face interviews were conducted in the local language. The survey contained questions on socio-demographic variables, HIV risk perception, and HIV knowledge. Thirty semi-structured qualitative interviews were conducted to develop the scale. Six commonly held beliefs emerged, including that new condoms contain worms, that these worms infect individuals with HIV, and that condom use can cause cancer. The dependent variable measured was “willingness to use a condom.” It was found that between 35 and 53 percent of individuals in the survey agreed with the six negative condom rumors. Having a negative condom score on the Condom Beliefs Scale was a significant predictor of an individual’s willingness to use a condom; other predictors were the ability to acquire a condom privately and condom self-efficacy. The results indicate a high level of negative beliefs about condom use and illustrate how those beliefs translate into reduced likelihood of actual condom use.