Access to condoms for female sex workers in Andhra Pradesh.

BACKGROUND: Condoms are an essential part of comprehensive HIV prevention and care programmes. We report the accessibility of male condoms for female sex workers (FSWs) and the associated characteristics that may play a major role in determining access to condoms for FSWs. METHODS: Confidential interviews of 6509 street- and home-based FSWs in 13 districts of the Indian state of Andhra Pradesh provided data on the number of paying clients and various aspects of access to free condoms and purchase of condoms. Access to condoms was defined as having ever obtained condoms either through free distribution or through purchase. Multivariate analyses were done separately for street- and home-based FSWs to describe correlates of their access to condoms. The requirement of condoms was assessed based on the number of paying clients during the past 15 days. RESULTS: Data on condom access were available for 6465 (99.3%) FSWs. A total of 2850 (44.1%; 95% CI: 36.2%-52.0%) reported accessing free condoms ever and 2336 (36.1%; 95% CI: 30.6%-41.6%) had purchased condoms ever (not mutually exclusive). The primary sources for condoms were non-governmental organization facilities (73.8%) and pharmacies (79.7%) for free and purchased condoms, respectively. A total of 3510 (54.3%; 95% CI: 48.5%-60.1%) FSWs reported no access to free or purchased condoms during the past 15 days, and this no access was significantly higher for those > 30 years of age, with no schooling, street-based FSWs, and with no participation in a FSW support group (p < 0.001 for each in univariate analysis). Participation in a FSW support group was the main predictor of access to free condoms for both types of FSWs during the past 15 days with multivariate analysis. Condom requirements during the past 15 days were met for 67.5% of FSWs who had accessed only free condoms and for 33.8% of those who had accessed only purchased condoms. CONCLUSIONS: One-fourth of FSWs had never accessed condoms, and a little over half of those who had ever accessed reported no access during the past 15 days. Condom requirements were not met for three-fifths of the FSWs. HIV prevention programmes need to Increase access to free condoms for FSWs in Andhra Pradesh as access to condoms is a necessary prerequisite for condom use

Integrating Female Condoms into HIV Prevention Programs: A Case Study of Barriers, Facilitators, and Future Opportunities in Kenya

Female condoms are an important option for dual protection from unintended pregnancy and HIV and other sexually transmitted infections, especially when male condoms cannot be used. Incorporating female condoms into other HIV prevention channels is a potential strategy to increase access for women and men in need of dual protection beyond male condoms. Policies recommend incorporating female condoms into two HIV prevention programs that have gained significant momentum and political support -- prevention of mother-to-child transmission of HIV (PMTCT) and voluntary medical male circumcision (VMMC). However, there is a lack of clarity on how female condoms are being included at the programmatic level

Explaining inconsistencies between data on condom use and condom sales

BACKGROUND: Several HIV prevention programs use data on condom sales and survey-based data on condom prevalence to monitor progress. However, such indicators are not always consistent. This paper aims to explain these inconsistencies and to assess whether the number of sex acts and the number of condoms used can be estimated from survey data. This would be useful for program managers, as it would enable estimation of the number of condoms needed for different target groups. METHODS: We use data from six Demographic and Health Surveys to estimate the total annual number of sex acts and number of condoms used. Estimates of the number of sex acts are based on self-reported coital frequency, the proportion reporting intercourse the previous day, and survival methods. Estimates of the number of condoms used are based on self-reported frequency of use, the proportion reporting condom use the previous day and in last intercourse. The estimated number of condoms used is then compared with reported data on condom sales and distribution. RESULTS: Analysis of data on the annual number of condoms sold and distributed to the trade reveals very erratic patterns, which reflect stock-ups at various levels in the distribution chain. Consequently, condom sales data are a very poor indicator of the level of condom use. Estimates of both the number of sexual acts and the number of condoms used vary enormously based on the estimation method used. For several surveys, the highest estimate of the annual number of condoms used is tenfold that of the lowest estimate. CONCLUSIONS: Condom sales to the trade are a poor indicator of levels of condom use, and are therefore insufficient to monitor HIV prevention programs. While survey data on condom prevalence allow more detailed monitoring, converting such data to an estimated number of sex acts and condoms used is not straightforward. The estimation methods yield widely different results, and it is impossible to determine which method is most accurate. Until the reliability of these various estimation methods can be established, estimating the annual number of condoms used from survey data will not be feasible. Collecting survey data on the number of sex acts and the number of condoms used in a fixed time period may enable the calculation of more reliable estimates of the number of sex acts and condoms used

If the condom fits, wear it: a qualitative study of young African-American men

This is an open access article - Copyright @ 2004 BMJ Publishing GroupObjective: To extend the current knowledge base pertaining to condom failure among young African-American men by assessing their experiences with male condom use. Methods: Qualitative assessments were conducted with 19 African-American men (aged 18–29 years) who had just been diagnosed with an STI and reported using condoms in the previous 3 months. Results: Five categories were identified from the data. These categories pertained to: (1) the “fit and feel” of condoms; (2) condom brand and size; (3) application problems; (4) availability of condoms and lubricants; and (5) commitment to condom use. Common themes included reasons why men believed condoms would break or slip off during sex. Comfort problems, including tightly fitting condoms and condoms drying out during intercourse, were mentioned frequently. Condom associated erection problems were often described. Many men also noted that condom use reduced the level of sexual satisfaction for their female partners. Men noted that finding the right kind of condom was not always easy and it became apparent during the interviews that men typically did not acquire lubrication to add to condoms. Despite their expressed problems with using condoms, men were, none the less, typically emphatic that condom use is an important part of their protective behaviour against STIs. Conclusion: Men were highly motivated to use condoms; however, they experienced a broad range of problems with condom use. With the exception of losing the sensation of skin to skin contact, the vast majority of these problems may be amenable to behavioural interventions.This study was funded by a grant from the National Institutes of Mental Health (1 R21 MH066682-01A1)

Can Condoms Be Compelling? Examining the State Interest in Confiscating Condoms from Suspected Sex Workers

Confiscating condoms from suspected sex workers leaves them at risk for HIV/AIDS, other sexually transmitted diseases, and unwanted pregnancy. Yet, police officers in New York, Washington, D.C., and Los Angeles collect condoms from sex workers to use against them as evidence of prostitution. Sometimes, the condoms are taken solely for the purpose of harassment. These actions put sex workers at risk of contracting sexually transmitted diseases because they may continue to engage in sex work without using protection. In the landmark case of Griswold v. Connecticut, the U.S. Supreme Court established a fundamental privacy right in the use and access of contraceptive devices. While this right has been examined in the context of married couples and individuals, it has not been applied to the confiscation of condoms, a contraceptive device, by police officers. This Note shows that by taking condoms from suspected sex workers, police officers and departments are actually violating sex workers’ constitutional right to privacy, and, therefore, the practice must be abandoned

Can Condoms Be Compelling? Examining the State Interest in Confiscating Condoms from Suspected Sex Workers

Confiscating condoms from suspected sex workers leaves them at risk for HIV/AIDS, other sexually transmitted diseases, and unwanted pregnancy. Yet, police officers in New York, Washington, D.C., and Los Angeles collect condoms from sex workers to use against them as evidence of prostitution. Sometimes, the condoms are taken solely for the purpose of harassment. These actions put sex workers at risk of contracting sexually transmitted diseases because they may continue to engage in sex work without using protection. In the landmark case of Griswold v. Connecticut, the U.S. Supreme Court established a fundamental privacy right in the use and access of contraceptive devices. While this right has been examined in the context of married couples and individuals, it has not been applied to the confiscation of condoms, a contraceptive device, by police officers. This Note shows that by taking condoms from suspected sex workers, police officers and departments are actually violating sex workers’ constitutional right to privacy, and, therefore, the practice must be abandoned

Ignorance Only: HIV/AIDS, Human Rights And Federally Funded Abstinence-Only Programs in the United States

Programs teaching teenagers to "just say no" to sex before marriage are threatening adolescent health by censoring basic information about how to prevent HIV/AIDS, Human Rights Watch charged in a new report released today. The forty-seven page report focuses on federally funded "abstinence-only-until-marriage" programs in Texas, where advertising campaigns convey the message that teenagers should not use condoms because they don't work. Some school-based programs in Texas do not mention condoms at all. Federal health agencies share the broad scientific consensus that condoms, when used correctly, are highly effective in preventing the transmission of HIV. Yet the U.S. government currently spends more than $100 million each year on "abstinence-only-until-marriage" programs, which cannot by law "promote or endorse" condoms or provide instruction regarding their use. The Bush administration is advocating a 33 percent increase in funding for these programs

Effectiveness of Male Condoms: Frequently Asked Questions

More than two decades of research and experience have provided new insights into the role of male condoms for contraception and HIV prevention. However, given that the number of people infected and living with HIV continues to grow, it is essential to reassess what we have learned about HIV prevention. This is especially true regarding condoms, the controversial mainstay of HIV prevention programs. Opinions on condoms are often based on ideology rather than evidence, though evidence has accumulated steadily. The following is a list of frequently asked questions and answers about condom efficacy

Two heads are better than one: The association between condom decision-making and condom use errors and problems

This is an open access article - Copyright @ 2008 BMJ Publishing GroupObjectives: This exploratory study compared the frequency of condom use errors and problems between men reporting that condom use for penile–vaginal sex was a mutual decision compared with men making the decision unilaterally. Methods: Nearly 2000 people completed a web-based questionnaire. A sub-sample of 660 men reporting that they last used a condom for penile–vaginal sex (within the past three months) was analysed. Nine condom use errors/problems were assessed. Multivariate analyses controlled for men’s age, marital status, and level of experience using condoms. Results: Men’s unilateral decision-making was associated with increased odds of removing condoms before sex ended (adjusted odds ratio (AOR) 2.51, p=0.002), breakage (AOR 3.90, p=0.037), and slippage during withdrawal (AOR 2.04, p=0.019). Men’s self-reported level of experience using condoms was significantly associated with seven out of nine errors/problems, with those indicating less experience consistently reporting more errors/problems. Conclusions: Findings suggest that female involvement in the decision to use condoms for penile–vaginal sex may be partly protective against some condom errors/problems. Men’s self-reported level of experience using condoms may be a useful indicator of the need for education designed to promote the correct use of condoms. Education programmes may benefit men by urging them to involve their female partner in condom use decisions.Funding for this project was provided by the Canada Research Chair in Social Justice and Sexual Health at the University of Windsor, and the Rural Center for AIDS/STD Prevention and The Kinsey Institute for Research in Sex, Gender, and Reproduction at Indiana University

Reasons for Non-use of Condoms in Eight Countries in Sub-Saharan Africa

Objective: To determine why sexually experienced males and females from multiple countries in sub-Saharan Africa do not use condoms.Methods: We used data from sample surveys conducted in eight countries in sub-Saharan Africa. Respondents were asked about their use of condoms and their reasons for not using a condom in last sex with a marital, a regular (non-marital) or a casual partner. Respondents' reasons for not using a condom are shown by type of partner and by gender. Results: Males and females most frequently reported trusting their partner as the main reason for not using a condom in last sex with a marital or a regular (non-marital) partner. This suggests that low personal risk perception is the most important reason for not using a condom with a marital or a regular partner. A dislike of condoms is the most frequently cited reason for not using a condom with a casual partner. Respondents rarely cited the price of condoms as a barrier to condom use. Lack of condom availability was also rarely cited as a reason for not using a condom, except to some degree by males in casual partnerships. The latter may be because of the unplanned nature of casual sex activity, rather than because condoms are not available. Conclusions: Behavior change campaigns encouraging sexually experienced people to accurately assess their personal risk of acquiring HIV should be complemented with marketing campaigns emphasizing the positive attributes of condoms