Condom use across casual and committed relationships: The role of relationship characteristics.

BACKGROUND: While the existence of a complex variety of casual sexual relationships (CSRs) has been acknowledged, studies rarely describe the prevalence of condom use across these relationships or how their hybrid nature, specifically relationship characteristics, affect condom use. This study aims to describe condom use within committed relationships and various types of casual sexual relationships (CSRs), examining the influence of relationship characteristics on condom use among culturally validated relationship types (committed, friends with benefits, hookups, booty call). METHODS: Emerging adults (N = 728, 18-29 years, M = 22.56; SD = 3.01) completed a survey with four blocks: sociodemographics; brief sexual history; relationships over the previous year; and current relationship, assessing relationship type, ten relationship characteristics (e.g., commitment, emotional and sexual exclusivity, partner acquaintance, sexual involvement) and condom use (vaginal, oral, and anal), operationalized by three measures (use at last encounter, likert-type scale and percentage of use). RESULTS: The results showed patterns in condom use by relationship type and illuminated how relationship characteristics-grouped into three factors: commitment, intimacy, and sexuality-mediate condom use. Condom use was more frequent in vaginal than anal and oral sex, and less frequent in committed relationships. No significant differences were found in condom use in vaginal sex between committed relationships and hookups, with condom in these relationships being significantly lower than in booty call. Intimacy mediated between all contrasts tested and condom use in vaginal sex, while sexuality mediated between committed vs. CSRs and condom use in anal and oral sex. CONCLUSIONS: Findings point to the need of considering the diversity of CSRs for understanding condom use and highlight the role of intimacy as a relevant mechanism associated with condom use in vaginal sex and of sexuality in oral and anal sex, which should be taken into consideration in the tailoring of health promoting efforts.

Development of a HIV Prevention Program to Promote Condom Use Among Iranian Female Sex Workers: Application of An Intervention Mapping Approach.

We used an Intervention Mapping Approach (IMA) to derive multi-level HIV prevention strategies aiming to develop an HIV prevention intervention program among female sex workers (FSWs). We also aimed at pilot testing the effects of the IMA-based "HIV Prevention and Awareness Program (HIV-PAP)" on safe sex behaviors and its determinants among FSWs in Tabriz, Iran. To develop HIV-PAP, we conducted the six-step process of IMA. At Step 1, in a cross-sectional study, 140 FSWs were face-to-face interviewed. At Step 2, the program matrix was provided based on the importance and variability for identifying priority factors. At Steps 3 and 4, the methods and strategies for behavioral change were selected, and the HIV-PAP program components and materials were developed. At Steps 5 and 6, evaluation (as a pilot testing with Static-Group Comparison design) was conducted applying a pre-experimental study, in which 30 FSWs were assigned to intervention (n = 15) and control (n = 15) groups. The intervention group participated in a two-month long program, and one month later, the initial questionnaires were completed by both groups. The respondents (M age: 33.4 years, SD: 9.7) acquired low score (less than 50%) in negotiating for condom use (49.8%) only, and moderate scores (50-65%) in perceived social support (61.6%) and knowledge (60.5%). Adjusted for other variables, the factors (R2 = 32.0%) associated with safe sex behaviors among FSWs were predisposing factors [self-efficacy (ß = 0.331), perceived norms (ß = 0.945), and perceived barriers (ß = 0.258)], condom use negotiation (ß = 1.386), and environmental factors (ß = 0.333). Our IM-based framework had an adequate fit index (χ2 = 130.8, CFI = 0.78). Looking for inter-group comparison after intervention, we found significant mean difference (MD) for knowledge (MD: 2.18; 95% Confidence Interval (CI) - .38 to 4.74, p < 0.05), self-efficacy to use condom (MD: 6.71; 95% CI - 1.85 to 9.29, p < 0.05), perceived risk (MD: 2.03; 95% CI 0.58, to 3.49, p < 0.05), perceived social support (MD: 4.64; 95% CI - 5.37 to 11.31, p < 0.01), and safe sexual behaviors (MD: 7.75; 95% CI - 4.19 to 9.71, p < 0.05). The HIV-PAP showed effectiveness in promoting safe sexual behaviors and their determinants among FSWs. Healthcare providers should better understand the determinants of safe sexual behaviors among FSWs in the settings with legal prohibitions for sex work. In such communities, they should try to either develop or adapt such stage-specific interventions, within which promoting the above-mentioned factors is the core priorities of the program.

Determinants of Intention to Use HIV Pre-exposure Prophylaxis and Condom Use Among a Sample of Cisgender Female Sex Workers Working Mostly Outdoors in Madrid, Spain.

There is scant knowledge regarding pre-exposure prophylaxis (PrEP) use among female sex workers (FSWs) in Europe. Spain recognized FSWs as a population at high risk of acquiring HIV and granted them subsidized access to PrEP when the medication first became nationally available in 2019. Nevertheless, FSWs represented just 0.2% of PrEP users in 2022. A total of 102 HIV-negative FSWs reached through field activities of local NGOs located in Madrid were interviewed between January and March 2022. Participants were selected through convenience sampling over a fixed recruitment period. FSWs completed a 73-item survey with questions about individual, occupational, social, and structural determinants. The objective of this study was to identify (1) the prevalence of intention to use oral PrEP and its determinants, and (2) the prevalence of inconsistent condom use, which is the risk factor that qualifies FSWs for subsidized PrEP in the national health system, and its determinants. Importantly, the study sample overrepresented street-based FSWs (71.6%). A quarter (25.5%) of the study participants used condoms inconsistently. PrEP awareness was low (9.8%), but intention to use PrEP was high (72.5%). Intention to use oral PrEP was significantly associated with feeling protected against HIV by taking PrEP and perceiving insufficient protection by condom use alone. Inconsistent condom use was significantly associated with frequent heroin/cocaine use, having clients who inject drugs, and willingness to take PrEP despite it not protecting 100% against HIV infection. FSWs, in this specific sample, are likely to benefit from targeted PrEP awareness campaigns and implementation projects that prioritize those who use drugs and are more likely to engage in condomless sex.

Female genital mutilation and safer sex negotiation among women in sexual unions in sub-Saharan Africa: Analysis of demographic and health survey data.

BACKGROUND: The practice of female genital mutilation is associated with harmful social norms promoting violence against girls and women. Various studies have been conducted to examine the prevalence of female genital mutilation and its associated factors. However, there has been limited studies conducted to assess the association between female genital mutilation and markers of women's autonomy, such as their ability to negotiate for safer sex. In this study, we examined the association between female genital mutilation and women's ability to negotiate for safer sex in sub-Saharan Africa (SSA). METHODS: We pooled data from the most recent Demographic and Health Surveys (DHS) conducted from 2010 to 2020. Data from a sample of 50,337 currently married and cohabiting women from eleven sub-Saharan African countries were included in the study. A multilevel binary logistic regression analysis was used to examine the association between female genital mutilation and women's ability to refuse sex and ask their partners to use condom. Adjusted odds ratios (aORs) with a 95% confidence interval (CI) were used to present the findings of the logistic regression analysis. Statistical significance was set at p<0.05. RESULTS: Female genital mutilation was performed on 56.1% of women included in our study. The highest and lowest prevalence of female genital mutilation were found among women from Guinea (96.3%) and Togo (6.9%), respectively. We found that women who had undergone female genital mutilation were less likely to refuse sex from their partners (aOR = 0.91, 95% CI = 0.86, 0.96) and ask their partners to use condoms (aOR = 0.82, 95% CI = 0.78, 0.86) compared to those who had not undergone female genital mutilation. CONCLUSION: Female genital mutilation hinders women's ability to negotiate for safer sex. It is necessary to implement health education and promotion interventions (e.g., decision making skills) that assist women who have experienced female genital mutilation to negotiate for safer sex. These interventions are crucial to enhance sexual health outcomes for these women. Further, strict enforcement of policies and laws aimed at eradicating the practice of female genital mutilation are encouraged to help contribute to the improvement of women's reproductive health.

Consistent condom utilization and associated factors among HIV positive clients attending ART clinic at Pawi general hospital, North West Ethiopia.

BACKGROUND: Human immunodeficiency virus (HIV) affects a highly significant number of people and is responsible for the deaths of many people in sub-Saharan African countries alone. The best prevention method for this virus is through consistent condom utilization which can help to prevent drug-resistant HIV infection and acquisition of new infection. Therefore, this study aimed to assess consistent condom utilization and associated factors among HIV-positive individuals attending an antiretroviral therapy clinic at Pawi general hospital, North West Ethiopia in 2020. METHODS: An institutional based cross-sectional study was conducted among 419 HIV-positive individuals who have follow-up in the Pawi general hospital antiretroviral therapy clinics, from January to February 2020. The study subjects were reached using a systematic sampling technique and data were collected using a pretested and structured questionnaire. Data entry and analysis were performed using epi-data version 3.1 and SPSS version 23 respectively. Binary and multivariable analyses with a 95% confidence level were performed. In the final model, variables with P < 0.05 were considered statistically significant. RESULTS: A total of 419 antiretroviral therapy study participants were participated in the study with a response rate of 100%. In this finding, the consistent condom utilization rate was 49.2% [95% CI: 42.2-56.5%]. After controlling for possible confounding factors, the results showed that place of residence [AOR = 2.16, 95% CI: 1.05, 4.45], marital status [AOR = 0.19, 95%CI: 0.05, 0.67], number of partners [AOR = 0.19, 95% CI: 0.07, 0.55] and level of education [AOR = 5.33, 95% CI: 1.57, 18.08] were associated factors of consistent condom utilization. CONCLUSION: Consistent condom utilization among HIV-positive clients attending antiretroviral therapy clinics at Pawi general hospital was low. Residence, marital status, level of education and number of partners were significantly associated factors of consistent condom use. Health education program and counseling services should be started to increase knowledge about way of transmission and appropriate use of condoms, increase self-efficacy towards condom use and reduction in the number of sexual partners.

Evidence of changing sexual behaviours and clinical attendance patterns, alongside increasing diagnoses of STIs in MSM and TPSM.

BACKGROUND: Due to rising numbers of STI diagnosis and increasing prevalence of antimicrobial resistance, we explored trends in STI testing frequency and diagnoses, alongside sexual decision making and attitudes concerning condom use and HIV pre-exposure prophylaxis (PrEP) at a large urban UK sexual health clinic. METHODS: We examined 66 528 electronic patient records covering 40 321 attendees between 2016 and 2019, 3977 of whom were men who have sex with men or trans persons who have sex with men (MSM/TPSM). We also explored responses from MSM/TPSM attendees sent an electronic questionnaire between November 2018 and 2019 (n=1975) examining behaviours/attitudes towards PrEP. We measured trends in STI diagnoses and sexual behaviours including condomless anal intercourse (CAI), using linear and logistic regression analyses. RESULTS: Tests resulting in gonorrhoea, chlamydia or syphilis diagnoses increased among MSM/TPSM from 13.5% to 18.5% between 2016 and 2019 (p<0.001). The average MSM/TPSM STI testing frequency increased from 1.5/person/year to 2.1/person/year (p=0.017). Gay MSM/TPSM had the highest proportions of attendances resulting in diagnoses, increasing from 15.1% to 19.6% between 2016 and 2019 (p<0.001) compared with bisexual/other MSM/TPSM increasing from 6.9% to 14.5% (p<0.001), alongside smaller but significant increases in non-MSM/TPSM from 5.9% to 7.7% (p<0.001).The proportion of MSM/TPSM clinic attendees reporting CAI in the previous 3 months prior to at least one appointment in a given year increased significantly from 40.6% to 45.5% between 2016 and 2019 (p<0.0001) and average number of partners from 3.8 to 4.5 (p=0.002). Of 617 eligible questionnaire responses, 339/578 (58.7%) HIV-negative and 29/39 (74.4%) HIV-positive MSM/TPSM indicated they would be more likely to have CAI with someone on PrEP versus not on PrEP. 358/578 (61.9%) HIV-negative respondents said that PrEP use would make them more likely to have CAI with HIV-negative partners. CONCLUSION: Rising numbers of STI diagnoses among MSM/TPSM are not attributable to increased testing alone. Increased CAI and number of partners may be attributable to evolving sexual decision making among PrEP users and their partners. Proportionally, bisexual/other MSM/TPSM have the steepest increase in STI diagnoses.

Condom application skills and self-efficacy in youth: A systematic review and meta-analysis.

Globally, and in the United States (U.S.) specifically, rates of reported sexually transmitted infections (STIs) have been steadily increasing and are especially high among youth aged 13-25 years. Using condoms correctly and consistently is an effective STI prevention measure for sexually active youth, yet public health endeavors tend to focus only on condom use consistency. Directly measuring condom application is challenging and expensive. Alternative tools evaluate this behaviour, but little evidence exists on the appropriateness of these instruments in measuring application skills. This systematic review and meta-analysis examined the association between condom application skills and self-efficacy. We conducted a search of several databases as well as unpublished works. Studies were included if they were in English, examined youth aged 13-25 years, and were available between 1992 and 2019. The authors screened 630 titles and abstracts for initial inclusion criteria. A full-text review of 30 studies was conducted. The authors included 19 studies in the systematic review and 5 studies were included in the meta-analysis. Both a fixed- and random-effects model (Q = .2321, I2 = 0%) yielded a medium-sized statistically non-significant association (r = 0.217) between skills and self-efficacy. Despite the small sample size, findings suggest that skills and self-efficacy may not be as interchangeable as previously assumed when assessing condom application. Implications for future research are discussed.

Sexual health interventions delivered to participants by mobile technology: a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: The use of mobile technologies to prevent STIs is recognised as a promising approach worldwide; however, evidence has been inconclusive, and the field has developed rapidly. With about 1 million new STIs a day globally, up-to-date evidence is urgently needed. OBJECTIVE: To assess the effectiveness of mobile health interventions delivered to participants for preventing STIs and promoting preventive behaviour. METHODS: We searched seven databases and reference lists of 49 related reviews (January 1990-February 2020) and contacted experts in the field. We included randomised controlled trials of mobile interventions delivered to adolescents and adults to prevent sexual transmission of STIs. We conducted meta-analyses and assessed risk of bias and certainty of evidence following Cochrane guidance. RESULTS: After double screening 6683 records, we included 22 trials into the systematic review and 20 into meta-analyses; 18 trials used text messages, 3 used smartphone applications and 1 used Facebook messages as delivery modes. The certainty of evidence regarding intervention effects on STI/HIV occurrence and adverse events was low or very low. There was moderate certainty of evidence that in the short/medium-term text messaging interventions had little or no effect on condom use (standardised mean differences (SMD) 0.02, 95% CI -0.09 to 0.14, nine trials), but increased STI/HIV testing (OR 1.83, 95% CI 1.41 to 2.36, seven trials), although not if the standard-of-care control already contained an active text messaging component (OR 1.00, 95% CI 0.68 to 1.47, two trials). Smartphone application messages also increased STI/HIV testing (risk ratio 1.40, 95% CI 1.22 to 1.60, subgroup analysis, two trials). The effects on other outcomes or of social media or blended interventions is uncertain due to low or very low certainty evidence. CONCLUSIONS: Text messaging interventions probably increase STI/HIV testing but not condom use in the short/medium term. Ongoing trials will report the effects on biological and other outcomes.

Beliefs and misconceptions about contraception and condom use among adolescents in south-east Nigeria.

BACKGROUND: Misconceptions about the usefulness of condoms and other contraceptives still expose many unmarried adolescents to the risk of unwanted teenage pregnancies and sexually-transmitted infections (STIs). This study explored beliefs and misconceptions about condoms and other contraceptives among adolescents in Ebonyi state, south-east Nigeria. METHOD: A qualitative study was undertaken in six local government areas in Ebonyi state, southeast Nigeria. Data were collected within a period of one month from in and out-of-school adolescents aged 13-18 years using twelve focus group discussions (FGD). The data were analyzed using the thematic framework approach. RESULT: Majority of the adolescents were knowledgeable about methods of contraception, how they are used and their modes of action. They were also knowledgeable about the dual effects of condoms in prevention of pregnancy and STIs. However, some misconceptions that were expressed by some adolescents were that pregnancy could be prevented by the use of (i) hard drugs, (ii) laxatives, (iii) white chlorine, and (iv) boiled alcoholic beverages. Condoms were described by some adolescent boys as reusable. Condoms were also perceived by some adolescents to reduce sexual pleasure, and this opinion was mostly held by boys. Coitus interruptus (withdrawal method) was therefore considered more preferable than condoms for prevention of pregnancy. CONCLUSION: Although majority adolescents have knowledge about contraception and condom use, some misconceptions still persist. These misconceptions put many adolescents at increased risk for pregnancy and STIs which are detrimental to their health and wellbeing. Concerted efforts should be made through educational and behaviour change interventions in schools and within communities to debunk persisting misconceptions about contraception including the use of condom, and properly educate adolescents on safe sex practices. Adolescents engage in unprotected sexual intercourse and other risky sexual behaviours because of some mistaken beliefs and wrong impressions about how to prevent unwanted pregnancy. These risky sexual behaviours predispose adolescents to sexually transmitted infections, unsafe abortion and other reproductive health problems. In this qualitative study, we explored some of these mistaken beliefs about condoms and other methods of preventing pregnancy. During focus group discussions, adolescents identified modern contraceptive methods, and described their modes of action and how they are used. They also discussed their contraceptive preferences and perceived effects of condoms on sexual pleasure. Although some of these adolescents were able to correctly mention various types of contraceptives and their modes of action, there were numerous wrong impressions. Hard drugs, laxatives, white chlorine and boiled alcoholic beverage were listed as emergency contraceptive methods. Emergency pills were perceived to work by flushing away spermatozoa from a girl's system after sexual intercourse. Male condoms were perceived to be potentially dangerous because they could break and enter into the body of the female sexual partner. Some adolescent boys had the notion that particular brands of male condoms could be washed and reused. Notions about condom use and sexual pleasure varied for girls and boys. Some adolescent girls perceived that condom use during sex increases sexual pleasure because of the assurance of being protected from STIs and pregnancy. Adolescent boys were of the opinion that condoms interfere with the pleasure of direct 'flesh to flesh' contact during sex. There was a general belief that contraceptive use in early age reduces fertility prospects for boys and girls. Mistaken beliefs about methods of preventing pregnancy persist among adolescents, and this raises concerns about the quality of information they receive. Concerted efforts should be made to debunk these wrong beliefs and properly educate adolescents on safe sex practices.

The effects of psychological inoculation on condom use tendencies and barriers; a randomized controlled trial.

OBJECTIVE: Condom use prevents the contraction of the HIV. Research shows limited effects of education on increasing condom use. Psychological inoculation (PI) has been found to be more effective in this domain, however, its mechanism is unknown. This study examined effects of PI versus education on condom use barriers and tendencies, and its relations with cognitive dissonance, using a fully automatized online system. DESIGN: The study was a randomized controlled trial (RCT) and included 149 students from a German University randomly assigned to PI or a control condition. MAIN OUTCOME MEASURES: An indirect condom use test (I-CUTE), a condom use barriers questionnaire, self-reported condom use, and cognitive dissonance estimations were all assessed at baseline and one-month post-intervention. RESULTS: PI significantly increased I-CUTE scores when participants had sexual relations. Control participants increased in self-reported condom use and on I-CUTE scores in people without sexual relations. No changes in barriers were seen in either group. The cognitive dissonance tended to be higher in PI participants as compared to control participants. CONCLUSIONS: PI increases I-CUTE scores compared to controls (based on effect sizes), and significantly in those with sexual relations. The role of relationship status and the mechanisms of PI should be further examined.

"I'd Rather Use a Refuse Bag:" A Qualitative Exploration of a South African Community's Perceptions of Government-Provided Condoms and Participant-Preferred Solutions.

Despite South Africa experiencing one of the largest HIV epidemics in the world, condom use has decreased since 2008. However, condoms are the only low-cost HIV prevention technology widely available in South Africa. This study aims to explore a South African community's perceptions of condoms, recent condom use decrease, and suggestions for increasing condom use. In 2014, we conducted seven focus groups (n = 40 men) and 20 in-depth interviews (n = 9 men, n = 11 women) with participants aged ≥ 18 years recruited from four urban settlement health clinics in Cape Town, South Africa. Data were collected, coded, and analysed using a general inductive approach. Participants perceived government-provided condoms negatively, with themes including "disgust" for condom physical properties, concerns with social status associated with free condoms, and performance concerns. There was an intersection of themes surrounding masculinity, condom use, and sexual pleasure. Solutions to increase condom use included improving the quality and variety of free condoms and rebranding free condoms. Participants suggested that condoms are distributed with novel attributes (e.g., more colors, smells/flavors, sizes, and in-demand brands) and that government programs should consider offering all brands of condoms at no or low cost. This study suggests a substantial rethinking of condom branding for government-provided condoms. Our findings suggest that condom dissemination and promotion programs should proactively address public concerns regarding condoms. Existing societal and structural norms such as hegemonic masculinity must also be addressed using gender-transformative interventions. We also strongly suggest the creation of a Male Condom Acceptability Scale to understand condom users' needs.

The MOSEXY trial: mobile phone intervention for sexual health in youth-a pragmatic randomised controlled trial to evaluate the effect of a smartphone application on sexual health in youth in Stockholm, Sweden.

An estimated 350 million cases of STIs occur globally each year. In Sweden, Chlamydia is the most common STI with approximately 30 000 cases annually, disproportionally affecting youth. National surveys report low condom use among youth. Smartphone coverage is high among this tech-savvy group. In collaboration with youth, we developed an interactive smartphone application comprising games, peer experiences and information snippets to promote condom use. OBJECTIVES: To evaluate in a randomised controlled trial, the effectiveness of this smartphone application to improve condom use among youth in Stockholm, Sweden. METHODS: This two-arm, individually randomised controlled trial was implemented through the Youth Health Clinics (YHC) in Stockholm, Sweden. Youth aged 18-23 years, who owned a smartphone and had ≥2 sexual partners during the past 6 months were eligible. The intervention delivered the interactive elements described above over 180 days. The control group received a 'dummy' application. Both groups received standard of care at the YHC. The primary outcome was proportion of consistent (100%) self-reported condom use at 6 months. Secondary outcomes included self-reported number of partners, occurrence of STIs/pregnancy and STI tests during the study period. An intention-to-treat approach was used. RESULTS: 214 and 219 youth were randomised to the intervention and control groups, respectively. Consistent condom use was reported for 32/214 (15.0%) in the intervention group and for 35/219 (16.0%) in the control group (OR 0.9, 95% CI 0.5 to 1.6). No significant differences in secondary outcomes were seen. CONCLUSION: We were unable to detect an effect of the intervention. Future research should focus on targeting different subgroups within the overall risk group, with tailored mHealth interventions. The potential for such interventions in settings where sexual health services are unavailable should be evaluated. TRIAL REGISTRATION NUMBER: ISRCTN13212899.

Cocaine use in university students: relationships with demographics, mental health, risky sexual practices, and trait impulsivity.

BACKGROUND: Cocaine is increasingly used on a recreational basis by the general population with potential implications for mental health. The aim of this study was to assess how common cocaine use is, and its mental health associations, in a large sample of university students. METHODS: Approximately 10 000 university students were invited to take part in an online survey, which assessed the use of cocaine (ever or past year), alcohol and drug use, mental health issues, and impulsive and compulsive tendencies. Group differences in demographic and clinical characteristics were characterized. RESULTS: A total of 3520 university students (57.7% female) completed the survey. Of these, 110 students (3.1%) reported using cocaine in the preceding year, and a further 163 students (4.6%) reported historical use more than a year ago. Cocaine use was associated with more years as a student, lower grade point averages, more use of other drugs, riskier sexual practices, post-traumatic stress disorder, attention deficit hyperactivity disorder, treatment for psychological/emotional problems (including taking prescribed medication), and trait impulsivity. Of these associations, the link with trait impulsivity had the largest effect size. CONCLUSION: History of cocaine use appears relatively common in university students; and has a number of untoward associations in terms of mental health, use of other substances, and risky sexual practices. The most marked finding (in terms of effect size) was the link between cocaine use and trait impulsivity, supporting the importance of this construct in seeking out candidate vulnerability markers for use of cocaine and other drugs. Future work should use longitudinal designs to further characterize the nature of these associations.

Início da atividade sexual e sexo protegido em adolescentes / Comienzo de la actividad sexual y sexo protegido en adolescentes / Initiation of sexual activity and protected sex in adolescents

Resumo Objetivos Identificar a prevalência do início da atividade sexual em adolescentes e a prática de sexo seguro entre os mesmos. Método Estudo transversal realizado com 499 adolescentes, em Pouso Alegre, Minas Gerais, de fevereiro a abril de 2017, por meio de um questionário autoaplicado e semiestruturado, contemplando iniciação, práticas sexuais, conhecimento sobre contracepção, prevenção de infecções sexualmente transmissíveis e participação em atividades educativas sobre o tema. Os dados foram analisados por estatística descritiva, as diferenças estatísticas avaliadas pelo teste X2 de Pearson. Resultados A prevalência da atividade sexual foi 47,3%, com idade média da sexarca de 14,1 anos, e tendência de iniciação sexual precoce no sexo masculino. Um terço das primeiras relações sexuais foram desprotegidas (33,9%). As participantes do sexo feminino apresentavam maior conhecimento a respeito de contracepção e prevenção de doenças, menor adesão ao uso de preservativos e maior utilização de contraceptivos orais e de emergência. Conclusão e implicações para a prática O estudo mostrou início precoce de vida sexual entre adolescentes, e um terço das relações sexuais sem proteção. Há necessidade de ações de saúde e educação que garantam a aquisição de conhecimento e acesso a métodos contraceptivos.

Resumen Objetivos Identificar la prevalencia de la actividad sexual en adolescentes y la práctica de sexo seguro entre ellos. Método Estudio transversal realizado con 499 adolescentes, de febrero a abril de 2017, por medio de un cuestionario autoadministrado y semiestructurado, que abarca la iniciación sexual y las prácticas, conocimiento sobre métodos anticonceptivos, prevención de infecciones de transmisión sexual y participación en actividades educativas sobre el tema. Los datos se analizaron mediante estadística descriptiva y las diferencias estadísticas se evaluaron mediante la prueba X2 de Pearson. Resultados La prevalencia de la actividad sexual fue del 47,3%, con una edad promedio de la primera relación sexual de 14,1 años y una tendencia a la iniciación sexual temprana entre los participantes masculinos. Un tercio de las primeras relaciones sexuales fueron desprotegidas (33,9%). Las mujeres participantes tenían mayor conocimiento sobre los métodos anticonceptivos y prevención de enfermedades, menos adherencia al uso del condón y mayor uso de anticonceptivos orales y de emergencia. Conclusión e implicaciones para la práctica El estudio mostró un inicio temprano de la vida sexual entre un grupo de adolescentes y un tercio de las relaciones sexuales sin protección. Se advierte la necesidad de llevar a cabo acciones en materia de salud y educación que garanticen la adquisición de conocimiento y el acceso a métodos anticonceptivos.

Abstract Objective Identify the prevalence of sexual activity initiation in adolescents and the practice of safe sex among them. Method A cross-sectional study carried out with 499 adolescents in Porto Alegre, Minas Gerais, from February to April 2017, using a self-administered and semi-structured questionnaire, covering sexual initiation and practices, knowledge about contraceptive methods, prevention of sexually transmitted infections and participation in educational activities on the theme. The data were analyzed using descriptive statistics and the statistical differences were assessed using Pearson's X2 test. Results The prevalence of sexual activity was 47.3%, with a mean age of 14.1 years old at first sexual intercourse, and a tendency for early sexual initiation in the male gender. One third of the first sexual intercourses were unprotected (33.9%). Female participants had greater knowledge about contraceptive methods and disease prevention, lower adherence to condom use and greater use of oral and emergency contraceptives. Conclusion and implications for the practice The study showed an early initiation of sexual life among adolescents, and one third of unprotected sexual intercourses. There is a need for health and education actions that guarantee the acquisition of knowledge and access to contraceptive methods.

Evidence-based modeling of combination control on Kenyan youth HIV/AIDS dynamics.

We formulate a sex-structured deterministic model to study the effects of varying HIV testing rates, condom use rates and ART adherence rates among Adolescent Girls and Young Women (AGYW) and, Adolescent Boys and Young Men (ABYM) populations in Kenya. Attitudes influencing the Kenyan youth HIV/AIDS control measures both positively and negatively were considered. Using the 2012 Kenya AIDS Indicator Survey (KAIS) microdata we constructed our model, which we fitted to the UNAIDS-Kenya youth prevalence estimates to understand factors influencing Kenyan youth HIV/AIDS prevalence trends. While highly efficacious combination control approach significantly reduces HIV/AIDS prevalence rates among the youth, the disease remains endemic provided infected unaware sexual interactions persist. Disproportional gender-wise attitudes towards HIV/AIDS control measures play a key role in reducing the Kenyan youth HIV/AIDS prevalence trends. The female youth HIV/AIDS prevalence trend seems to be directly linked to increased male infectivity with decreased female infectivity while the male youth prevalence trend seems to be directly associated with increased female infectivity and reduced male infectivity.

Condom use: a less travelled route among minibus taxi drivers and their taxi queens in KwaZulu-Natal, South Africa.

BACKGROUND: Despite significant gains in the HIV epidemic in South Africa, with reduction in mortality and elimination of vertical transmission, national HIV prevalence remains high, with women rather than men continuing to bear higher burden of the disease. Population subgroups, through ignorance, disbelief or recklessness, continue to engage in risky sexual behaviour. A substantial proportion of minibus taxi drivers engage in risky sex, seldom seeing themselves at risk for STIs or HIV/AIDS. These taxi drivers have been linked with so-called taxi queens, with whom they engage in transactional and intergenerational relationships. OBJECTIVES: The study explored condom use and condom negotiation strategies among taxi drivers and taxi queens in Kwa- Zulu-Natal, South Africa. METHODS: Applying explorative qualitative design, we conducted focus group discussion and individual interviews among participants who were purposively recruited in KwaZulu-Natal. RESULT: Qualitative data analysis revealed that condom use and negotiation are sources of conflict for the participants. In addition, the strategies employed by participants to ensure condom usage are not always sustainable and are likely to be problematic due to a variety of complex factors. CONCLUSION: Our study concludes by recommending a nested public health response that takes cognizance of factors that promote sustainable condom use strategies among this population subgroup.

Behavioral Profiles and Attitude toward Condom Use among College Students in Southwest Ethiopia.

BACKGROUND: Unsafe sexual behavior among adolescents still represents a public health challenge. To have safe sex, effective condom utilization is needed. Condom use remains relatively low among adolescents in sub-Saharan Africa. Even though adolescents have good knowledge about condom use, they are still engaged in risky sexual behavior. OBJECTIVE: To assess condom use and attitude toward condom use among college students in southwest Ethiopia. METHODS: A cross-sectional study was conducted among 453 students at Mizan-Aman Polytechnic College in southwest Ethiopia. Data were collected using a structured self-administered questionnaire. The collected data were entered using EpiData version 4.2.0.0 and analyzed using SPSS version 20 statistical software. Binary logistic regression was computed. Independent variables with a p value of less than 0.05 in the multivariable logistic regression model were considered significant. RESULTS: Of the 453, 180 were sexually active. Among those sexually active, 119 (66.1%) used condoms in their last sexual intercourse. The proportion of positive attitude toward condom use was 53.4%, and the mean attitude score for condom use was 28.6 (±9.99 SD) ranging from 10 to 50. The study also found that being male (AOR = 1.77, 95% CI [1.19-2.65]), rural resident (AOR = 2.20, 95% CI [1.47-3.30]), ever had sex (AOR = 1.87, 95% CI [1.23-2.85]), and knowledge of STIs (AOR = 1.66, 95% CI [1.10-2.51]) were factors associated with a positive attitude toward condom use. CONCLUSION: The proportion of positive attitude toward condom use among college students in Ethiopia was low. The study also found that being male, rural resident, ever had sex, and knowledge of STIs were factors associated with a positive attitude toward condom use. Therefore, strengthening information, education, and communication (IEC) on condom self-efficacy; providing condoms on campuses; and imparting education about sexually transmitted infections for young adults are central for improving condom use and attitudes toward condom use. Besides, inculcating sexual and reproductive health in the educational curriculum plays paramount importance.

Association between Psychological Factors and Condom Use with Regular and Nonregular Male Sexual Partners among Chinese MSM: A Quantitative Study Based on the Health Belief Model.

OBJECTIVE: The Chinese men who have sex with men (MSM) population is suffering from a high HIV infection rate owing to unprotected anal sex. The Health Belief Model (HBM) has been proven to be an effective frame associated with behavior maintenance. Based on HBM, we analyzed the beliefs associated with consistent condom use behavior with regular and nonregular partners among MSM to better provide targeted interventions and services. METHODS: A study was conducted in Sichuan Province, China, from November 2018 to April 2019, and 801 eligible participants were recruited by snowball sampling. Sociodemographic characteristics, AIDS-related characteristics, sexual behaviors, condom use behavior, and dimensions of HBM were investigated. Univariate, single multivariate, and summary multivariate models were employed to analyze the factors associated with consistent condom use. RESULTS: Of all participants, 39.1% and 53.6% had had anal sex with regular and nonregular partners in the last six months, respectively. Only 56.5% of them had used condoms consistently with regular partners, and only 60% of them had used condoms consistently with nonregular partners. When taking consistent condoms use with regular partners as the dependent variable, the dimensions of perceived threats (ORM = 1.28, 95% CI: 1.10, 1.49), perceived barriers (ORM = 0.70, 95% CI: 0.60, 0.82), self-efficacy (ORM = 1.23, 95% CI: 1.14, 1.32), and cues to action (ORM = 1.21, 95% CI: 1.02, 1.43) showed significant associations with the dependent variable. When taking consistent condoms use with nonregular partners as the dependent variable, the dimensions of perceived barriers (ORM = 0.77, 95% CI: 0.67, 0.89), self-efficacy (ORM = 1.22, 95% CI: 1.13, 1.32), and cues to action (ORM = 1.53, 95% CI: 1.30, 1.80) showed significant associations with the dependent variable. CONCLUSIONS: More attention should be focused on how to decrease the obstructive factors of condom use, how to improve the confidence of condom use, and how to layout more cues to action to promote consistent condom use behavior with regular and nonregular partners during anal sex among Chinese MSM.

Sexually transmitted infections in seafarers: 2020's perspectives based on a literature review from 2000-2020.

BACKGROUND: Seafarers are a special population. The issue of sexually transmitted diseases among seafarers is as old as navigation itself, and is a public health issue and a matter of concern for seafarers themselves. The purpose of this article is to review the literature on sexually transmitted infections (STIs) in professional seafarers in the 21st century, with a view to guiding maritime physicians in their practice. MATERIALS AND METHODS: This is a Medline® and Scopus® literature review covering publications between 01/01/2000 and 31/12/2019. Out of the 224 articles, 26 were selected. RESULTS: This review showed that at the beginning of the 21st century, attention has been focused mainly on human immunodeficiency virus (HIV). Few seroprevalence data were available. Between 10% and 91% of seafarers had been tested for STIs. Several risk behaviours were identified: out of 4022 seafarers surveyed, 34.3% said they had several sexual partners; out of 3722 seafarers surveyed, 19.5% engaged with sex workers; out of 3493 seafarers surveyed, 63.3% did not always use condoms, while 58.0% were aware of the relevance of this protection. There was a lot of misunderstanding about STIs: 28.3% of seafarers believed that a healthy-looking person could not be HIV-positive. CONCLUSIONS: The main pathology studied was HIV. Many seafarers had no specific training and only learned about STIs and HIV through media such as television. Maritime doctors could use new technologies to disseminate the right information on STI prevention.

HIV infections among female sex workers in Mombasa, Kenya: current prevalence and trends over 25 years.

Over 20 years, interventions have targeted HIV among female sex workers (FSWs) in Kenya given their central role in new infections. To determine the effects of these interventions, we assessed the prevalence and correlates of HIV among a random sample of FSWs and modelled prevalence estimates from studies since 1993. FSWs aged 16-34 years were enrolled through multi-stage sampling. Regression models identified correlates of HIV infection. Generalised linear mixed modelling estimated temporal changes in prevalence between 1993 and 2016. 882 FSWs were enrolled. Prevalence rose from 3.6% among 16-20-year-olds to 31.6% among 31-34-year-old FSWs. Those aged 31 to 34 years had greater odds of HIV compared to those 16 to 20 years (AOR 14.2, 95% CI, 5.5-36.8). Infection was less prevalent among FSWs with tertiary education compared to those with primary or no education (AOR 0.23, 95% CI, 0.07-0.78). There was an overall 30% reduction in prevalence from 1993 to 2016 with an average annual decline of 3%. About one in ten FSWs in Mombasa are currently infected with HIV. Considering FSWs' central role in sustaining population-level infections, these initiatives require continued support, focusing on reducing transmission from older FSWs and those with less education.