Consistent condom use among Botswana's female population and associated factors.

BACKGROUND: Botswana is one of the countries severely impacted by the HIV/AIDS pandemic. Despite an extensive HIV prevention campaign, the incidence of HIV, particularly among women, remains high. Condoms play a significant role in preventing new HIV infections, although men and women do not consistently use them. OBJECTIVE: The study assessed the individual, relationship and community factors associated with consistent condom use among women in Botswana. DESIGN: A cross-sectional study using secondary data drawn from a national survey on Gender-Based Violence Indicators in 2012. METHODS: The primary survey sampled 639 women, aged 18 years and older, using a multistage procedure. The final sample size for the secondary analysis included a total of 480 women who were sexually experienced and had reported using condoms with their male partners. Multivariate logistic regression analysis was employed to assess the association between consistent condom use and the explanatory variables. The multivariate logistic regression adjusted for cluster/community random effects. RESULTS: About 43% of the women used condoms consistently in the past year. Consistent condom use was more likely among women who were employed in the past year (adjusted odds ratio = 1.77; 95% confidence interval = 1.25-2.50). While, women who lived with their partners (adjusted odds ratio = 0.46; 95% confidence interval = 0.28-0.74), had non-Christian beliefs (adjusted odds ratio = 0.52; 95% confidence interval = 0.29-0.92), perceived that their partners would be angry if they ask to use a condom (adjusted odds ratio = 0.19; 95% confidence interval = 0.06-0.58) and perceived that their community says women need their husband's permission to do paid work (adjusted odds ratio = 0.56; 95% confidence interval = 0.38-0.83) were less likely to use condoms consistently. CONCLUSION: Consistent condom use among Botswana's female population is suboptimal. Consistent condom use was higher among women with employment, and lower among women who lived with their partners, had non-Christian beliefs, feared their partners' reaction upon asking for condom use and held inequitable community gender beliefs. To enhance women's consistent use of condoms, friendly condom use information, female economic empowerment strategies and programmes that involve religious leaders and promote progressive and healthy masculine practices in Sexual Reproductive Health/HIV interventions should be considered.

Exploring patterns and determinants of premarital sexual behaviour among Indonesian university students.

This study is aimed to explore the patterns and determinants of premarital sexual behaviour among Indonesian university students. The research was conducted by online survey, a cross-sectional approach (530 students). Research variables include knowledge, attitudes, practices, and demographic variables. Data were analyzed descriptively, using the Chi-Square test, Fisher Exact Test, and logistic regression to investigate the factors associated with premarital practices. The average age of respondents is 19 years old, with a small portion exposed to pornography. The primary source of pornography exposure is online, with the majority of respondents having good knowledge. Half of the respondents have a positive attitude towards reproductive health. A small portion of respondents have engaged in premarital sex, without using condoms, and have changed partners. In addition, exposure to pornography was significantly associated with premarital sexual practice (p=0.000). Collaboration among stakeholders (university, NGOs, lecturers, and students) is needed to enhance students' knowledge, attitudes, and behaviors regarding reproductive health to prevent premarital sexual practices among university students.

Cette étude vise à explorer les modèles et les déterminants du comportement sexuel avant le mariage chez les étudiants universitaires indonésiens. La recherche a été menée par enquête en ligne, une approche transversale (530 étudiants). Les variables de recherche comprennent les connaissances, les attitudes, les pratiques et les variables démographiques. Les données ont été analysées de manière descriptive, à l'aide du test du Chi carré, du test exact de Fisher et de la régression logistique pour étudier les facteurs associés aux pratiques prénuptiales. L'âge moyen des répondants est de 19 ans, avec une petite partie exposée à la pornographie. La principale source d'exposition à la pornographie est en ligne, la majorité des personnes interrogées en ayant de bonnes connaissances. La moitié des personnes interrogées ont une attitude positive envers la santé reproductive. Une petite partie des personnes interrogées ont eu des relations sexuelles avant le mariage, sans utiliser de préservatifs, et ont changé de partenaire. De plus, l'exposition à la pornographie était significativement associée à la pratique sexuelle avant le mariage (p = 0,000). La collaboration entre les parties prenantes (université, ONG, professeurs et étudiants) est nécessaire pour améliorer les connaissances, les attitudes et les comportements des étudiants en matière de santé reproductive afin de prévenir les pratiques sexuelles avant le mariage parmi les étudiants universitaires.

Magnitude of consistent condom use and associated factors among people living with HIV/AIDS in Ethiopia: Implication for reducing infections and re-infection. A systematic review and meta-analysis.

BACKGROUND: The human immune virus or acquired immune deficiency syndrome, is a major threat to the health of millions of people worldwide. In Ethiopia, there were more than a million people living with HIV/AIDS. The continuous and appropriate use of condoms, particularly among those who have HIV-positive clients, is essential to a comprehensive and long-term approach to avoiding HIV and other STIs as well as unintended pregnancy. But irregular condom use is regularly reported. There is inconsistent reports of the prevalence and correlates of frequent condom use in Ethiopia. This study's goal is to provide an overview of the most recent research on magnitude condom use among people living with HIV in Ethiopia. METHODS: Four databases of PubMed, Science Direct, Scopus, and Google Scholar were used. Finally, 10 studies that satisfied the eligibility criteria were included in the systematic review and meta-analysis. The data were collected using a methodical checklist for data extraction, and STATA 14 was utilized for the analysis. The consistent condom use was reported as use of condom in every sexual encounter preceding the study. The prevalence of consistent condom usage among HIV/AIDS patients was calculated by dividing the total number of patients who regularly used condoms by the total number of HIV/AIDS patients and multiplying that result by 100. The factors associated with a consistent use of condom were described using the pooled odds ratio (OR) and calculated based on binary outcomes from the included primary studies. The statistical significance was determined based on the correlation factor as their confidence level should not include 1. Subgroup analyses by region and publication years were carried out by using a random-effects model. The STATA commands of metan magnitude semagnitude, random xlab(.1,5,10) lcols (authors) by (variables)texts(120) xsize(18) ysize (14) were used to carried out the subgroup analysis. To assess the presence of publication bias, funnel plot, Egger test and Begg's test at 5% significant level were computed. The asymmetry of funnel plot and the Egger test and Begg's test P value of 0 >0.5 showed the absence of publication bias. The Cochrane Q test statistic and I2 tests were used to assess heterogeneity. RESULT: The pooled magnitude of consistent condom use was 50.56% (95%CI: 38.09-63.02). The predictors of consistent condom use includes urban residence (AOR = 3.46; 95% CI: 2.24-5.35), marital status (AOR = 0.33; 95% CI: 0.18-0.61), and HIV disclosure status (AOR = 5.61;95%CI: 2.29-13.73). CONCLUSION: Half of the HIV/AIDS patients in our study regularly used condoms. According to this study, urban residency, disclosure status, and marital status were all associated with consistent condom use among HIV/AIDS patients. Therefore, health education about condom use should be provided to married couples and people living in rural regions. In addition, disclosing HIV status and the necessity of constant condom usage would be crucial for consistent condom use.

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.

Analysis of risky sexual behaviors among male college students who were sexually active in Sichuan, China: a cross-sectional survey.

BACKGROUND: Males have accounted for a significant share of new HIV infections among young people in the recent years. This study aimed to identify the factors associated with risky sexual behaviors, including early sexual debut, multiple sexual partnership and condomless sex, among sexually active male college students and provide implications for tailored health interventions. METHODS: The cross-sectional study was conducted from December 2020 to December 2021 in 16 colleges that were located in Sichuan Province, one of the high-risk areas in China. Overall 1640 male college students who reported sexually experienced were analyzed in this study. Multivariable logistic regression analysis was applied to determine factors associated with early sexual debut, multiple sexual partnership and condomless sex. RESULTS: The average age of included male students was 19.95 ± 1.56. Of them, 27.74% initiated sexual behavior early, 48.60% reported multiple sexual partnership, and 16.52% did not use condoms at the latest sexual intercourse. Students who were younger (age ≤ 19, AOR = 7.60, 95%CI: 4.84-11.93; age20-21, AOR = 3.26, 95%CI: 2.04-5.21) and self-identified as sexual minorities (AOR = 2.38, 95%CI: 1.69-3.36) were more likely to have early sexual debut. The odds of having multiple sexual partners were higher among those who were ethnic minorities (AOR = 1.79, 95%CI: 1.33-2.41) and accepted extramarital sex (AOR = 1.33, 95%CI: 1.03-1.71). The likelihood of engaging in condomless sex at the latest sexual intercourse was lower among those who had sufficient knowledgeable about HIV (AOR = 0.63, 95%CI: 0.44-0.89), were very confident in condom use efficacy (AOR = 0.26, 95%CI: 0.16-0.43) and confident (AOR = 0.48, 95%CI: 0.34-0.69). Early sexual debut was positively associated with multiple sexual partnership (AOR = 3.64, 95%CI: 2.82-4.71) and condomless sex at the latest intercourse (AOR = 1.53, 95%CI: 1.07-2.20), respectively. CONCLUSION: Early sexual debut, multiple sexual partnership and condomless sex were of considerable concern among male college students. Comprehensive sex education curricula were advised by developing customized information on HIV prevention, sexuality and empowering students with assertiveness and negotiation skills with regard to condom use during and before college.

Measuring HIV outcomes for adolescent girls and young women programs in Africa: Using the polling booth survey technique.

INTRODUCTION: Adolescent girls and young women (AGYW) remain highly vulnerable to the risk of acquiring HIV (Human immunodeficiency virus). This study was conducted to measure behavioral, biomedical and structural outcomes for the Global Fund funded AGYW programmes in five African countries with high burden of HIV including Botswana, Cameroon. Lesotho, Malawi and Namibia. METHODS: The study used a mixed methods approach to collect behavioral, structural and biomedical outcome data. Quantitative data were collected through 418 Polling Booth Survey (PBS) sessions from 4,581 AGYWs. Participants were recruited through a community-based multistage sampling technique using sampling weights for urban and rural communities. 23 Focus Group Discussions (FGD) were conducted to understand barriers to use of HIV prevention programme and community recommendations for improved coverage. Ethical approvals were obtained from the ethics review board in all five countries. RESULTS: More than 50% of the respondents from all five countries reported to be sexually active, and at least 30% or more of those who were sexually active had multiple sex partners. There were wide variations between the countries in condom use with a non-marital sexual partner which ranged between 66% in Namibia to 42% in Cameroon. Cameroon (44%) had high percentage of AGYWs with independent income source while school drop-outs were higher in Malawi (55.5%) and Lesotho (46.6%). Nearly 1/4th of AGYWs in all countries, except Namibia, reported experiencing intimate partner violence. Nineteen percent of the respondents were pregnant in the last 12 months, and 50% of those pregnancies were unplanned. Lesotho had the highest proportion of AGYW (90.5%) ever tested for HIV, followed by Malawi (87.5%), Botswana (75%), Cameroon (69%) and Namibia (62.6%). DISCUSSION: There is diversity across the countries, with country-wise and age-wise variations in results. In all countries, the AGYW programme will benefit from a more targeted approach to reach out to the most vulnerable AGYW, strengthening structural interventions, strengthening linkage to PrEP (Pre-Exposure Prophylaxis) and ART (Antiretroviral Therapy) for those who are living with HIV and a strong linkage with reproductive health services. The assessment helped countries to understand the gaps and opportunities to improve the HIV prevention programme with AGYW.

HIV status and contraceptive use in Zimbabwe among sexually active adolescent girls and women: Secondary analysis of Zimbabwe Demographic Health survey data.

BACKGROUND: Understanding the pattern of contraceptive use among women living with HIV is critical for formulating relevant public health interventions to improve the uptake and use of reliable methods in this population. This helps to reduce the incidence of unintended pregnancies. OBJECTIVE: In this secondary data analysis, we aimed to describe contraceptive use by HIV-positive and HIV-negative sexually active adolescent girls and women, using data from the Zimbabwe Demographic and Health Survey (2015-16). METHOD: We used statistical analysis to determine the association between the use of various methods of contraception and HIV status using the Zimbabwe Demographic and Health Survey, 2015-16 data. RESULTS: Overall, the contraceptive use prevalence in this study was 60%. Sexually active adolescent girls and women on the Pill and injections were less likely to be HIV-positive compared with those not using any method of contraception (odds ratio (OR)=0.54, 95% confidence interval (CI) (0.45 - 0.64), p=0.001; and OR=0.75, 95% CI (0.59 - 0.96), p=0.020, respectively). Those using either a male or female condom were more likely to be HIV-positive, OR=3.36, 95% CI (2.63 - 4.28), p=0.001. CONCLUSIONS: This study revealed that there is still a considerable unmet need for contraception among the study population, highlighting the need to devise strategies to increase contraception uptake among women. Statistically significant differences were noted in the use of condoms, with those who are HIV-positive having a higher use of condoms compared with those who are HIV-negative. This may reflect that HIV-positive individuals have received appropriate counselling messages on the need to use barrier methods.

Factors associated with casual sexual behavior among college students in Zhejiang Province, China: A cross-sectional survey.

This study aimed to analyze the characteristics and risk factors associated with casual sexual behavior among sexually active college students and to contribute to AIDS prevention and control efforts among this demographic. A cross-sectional survey was conducted using a stratified cluster sampling technique. Self-reported sexually active college students were selected as respondents from 11 cities in Zhejiang Province from October 8 to November 30, 2018. A questionnaire was used to collect variables such as demographic information, sexual attitudes, intervention acceptance, and self-efficacy of condom use. Univariate and multivariate analyses were performed. Among 3,771 college students who reported engaging in sexual activity, 675 (17.90%) reported engaging in casual sexual encounters. The multivariate analysis revealed multiple factors associated with casual sexual behavior among students: being male, originating from a city/town, having pursued HIV testing education in the last year, seeking HIV risk self-assessment within the last year, accepting to engage in one-night stand behavior, accepting to partake in commercial sexual activity, having conducted HIV antibody tests within the last year, homosexual partner or homosexual/heterosexual partner, demonstrating self-efficacy in condom usage, and monthly living expenses falling within the range of 1001-1500 yuan. Additionally, students with knowledge that appearance does not determine HIV infection, a proclivity for seeking HIV counseling and testing following high-risk sexual behavior and awareness that the centers for disease control provides HIV diagnosis were found to have significant associations with casual sexual activity. Casual sex is significantly prevalent among college students, with male, students from urban areas, those who accepted to engage in one-night stand behavior and partook in commercial sexual activity demonstrating a higher propensity for such behavior. This tendency can be attributed to several factors including a more liberal sexual attitude, a rudimentary understanding of HIV risk, and a low adoption rate of HIV testing. Therefore, it is imperative to enhance HIV prevention and education among college students.

Detectability of semen remained in a condom under various conditions.

Some research has identified the prevalence and motivation of using condoms by assailants during sexual assault cases proving the necessity of analyzing condom trace evidence. The majority of the papers published have discussed forensic analysis of lubricants from condoms retrieved at sexual assault scenes but those discussing the identification of semen from condoms are rare. Therefore, the present study aims to provide insight into the detectability of the semen that remained in a condom, to examine the effect of exposure time, environmental conditions, and condom type, and ultimately to determine the capability of the AP test and Microscopic examination for identification of this sample type. In the study, samples were collected from three male donors after being instructed on the proper way of collecting the semen sample. The received samples from the donors were checked first by microscopic examination to observe the sperm to confirm that the sample being handled was semen. After confirmation, samples were transferred to 4 prepared condoms (brands: dkt xxx and Manforce) and kept in conditions i.e. two condoms in a refrigerator maintained from 2 to 10°C and other ones at ambient temperature (weather status: summer season of average 39°C). The samples were analyzed into two batches, the first analysis batch was conducted after the samples were exposed to the conditions within 11-60 days. After analysis from the first batch, the samples were continuously kept in the same condition for the consecutive second batch conducted when the samples reached 40-90 days. This study has determined that semen remaining in a condom can be detected and each test studied is appropriate according to the exposure stage, i.e., time and conditions of exposure. It has been found that nonmotile spermatozoa can be observed when semen remains in the condom for a few days. However, if the sample reaches approximately 25 days at room temperature above 25°C or 54 days below 10°C, the semen may dry out limiting the effectiveness of microscopic examination. Despite this, even semen that remained in a condom for up to 90 days can be identified by Acid Phosphatase. Results on condom type used reveal that condom constituents can crossreact with semen but none of them can limit the semen identification with Acid Phosphatase.

Changes in contraceptive behavior in Czechia.

The rapid increase in the proportion of women using hormonal contraception in the 1990s was positively reflected in a rapid decline in the number of abortions. Czechia was unique not only among Eastern European countries, but also worldwide. At the same time the decline in the prevalence of hormonal contraception from a peak of almost 50 % in 2007 to 30 % in 2021 meant a slowing and gradual halt in the further decline in abortions. The results of the GGP 2020-2022 survey in Czechia showed that the lower use of hormonal contraception among women was only partly offset by the increased use of other reliable methods of protection against unintended pregnancy (e.g. condom use). The largest decline in the use of hormonal contraceptives in the form of the pill occurred among the youngest women aged 18-27 years, from 76 to 37 %, which was partly reflected in the more intensive use of condoms (an increase from 21 to 35% in the 18-27 age group), but is worrying, that this age group saw the largest increase in the use of less reliable methods (withdrawal from 11 to 22 % and an increase in the use of the barren days method from 1 to 6 %) and also the largest increase in the proportion of women using neither method (from 7 to 17 %). The lowest proportion of female hormonal pill users was found among female with higher education. However an important finding is that when less reliable methods are used, there is an effort to combine at least two methods. Women have a more important role in determining how to protect themselves from unintended pregnancy.

Advancing Programme Science approaches to understand gaps in HIV prevention programme coverage for key populations in 12 Nigerian states: findings from the 2020 Integrated Biological and Behavioural Surveillance Survey.

INTRODUCTION: Effective HIV prevention programme coverage is necessary to achieve Nigeria's goal of ending the epidemic by 2030. Recent evidence highlights gaps in service coverage and utilization across the country. The Effective Programme Coverage framework is a Programme Science tool to optimize a programme's population-level impact by examining gaps in programme coverage using data generated through programme-embedded research and learning. We apply the framework using Integrated Biological and Behavioural Surveillance Survey (IBBSS) data from Nigeria to examine coverage of four prevention interventions-condoms, HIV testing, and needle and syringe programmes (NSP)-among four key population groups-female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID) and transgender people. METHODS: Data from Nigeria's 2020 IBBSS, implemented in 12 states, were analysed to examine HIV prevention programme coverage among key populations. For each key population group and prevention intervention of interest, weighted IBBSS data were used to retrospectively generate coverage cascades that identify and quantify coverage gaps. Required coverage targets were informed by targets articulated in Nigeria's National HIV/AIDS Strategic Framework or, in their absence, by guidelines from policy normative bodies. Availability-, outreach- and utilization coverage proxy indicators were defined using variables from IBBSS data collection tools. Sankey diagrams are presented to visualize pathways followed by participants between coverage cascade steps. RESULTS: Required coverage targets were missed for HIV testing and NSP among all key population groups. Condom availability coverage surpassed required coverage targets among FSW and MSM, while utilization coverage only among FSW exceeded the 90% required coverage target. Outreach coverage was low for all key population groups, falling below all required coverage targets. CONCLUSIONS: Our findings identify critical gaps in HIV prevention programme coverage for key populations in Nigeria and demonstrate non-linear movement across coverage cascades, signalling the need for innovative solutions to optimize coverage of prevention services. Programme-embedded research is required to better understand how key population groups in Nigeria access and use different HIV prevention services so that programmes, policies and resource allocation decisions can be optimized to achieve effective programme coverage and population-level impact.

"I Don't Believe That One": A Qualitative Study of Undetectable = Untransmittable Views Among Older Adults Living With HIV in South Carolina.

ABSTRACT: Undetectable = Untransmittable (U = U) means that people with HIV who achieve and maintain an undetectable viral load have effectively zero risk of sexually transmitting the virus to others. However, research on how U = U is perceived by older adults living with HIV (OAH) is currently lacking. This study explored U = U views among OAH. From October 2019 to February 2020, we conducted open-ended interviews with 24 OAH recruited at an HIV clinic in South Carolina. Interviews were audio-recorded and transcribed. We employed thematic analysis in this study. Three themes emerged from the analysis: (a) Conflicting beliefs in U = U; (b) Use condoms regardless; and (c) Fear of HIV reinfection. Despite strong scientific evidence supporting U = U, some OAH do not believe in U = U. This lack of belief could deprive OAH of the benefits U = U offers. Therefore, it is vital to educate OAH about U = U to enhance their understanding and belief in U = U.

Risk-stratified analysis of sex risk behaviors and correlates among school-going adolescents in Argentina: insights from a national survey.

OBJECTIVES: This study was conducted to address a critical gap in understanding adolescent sexual health risks in Argentina, a country that has undergone substantial socio-economic changes that made significant strides in education and healthcare. METHODS: A secondary data analysis of the 2018 Argentina Global School-based Student Health Survey was performed. In this study, 23,262 sexually active adolescents were categorized into four risk groups based on the predicted granular risk: number of sexual partners and condom use in their last sexual encounter. RESULTS: Males and older adolescents were more prone to high-risk sexual behaviors. Additionally, key psychosocial factors such as loneliness, anxiety, experiences of violence, and school absenteeism were significantly associated with high-risk sexual behaviors. Early alcohol use and recent experiences of hunger were also identified as strong predictors of heightened sexual risk behaviors. Conversely, positive parental engagement and awareness exhibited protective factors. CONCLUSIONS: These findings highlight the necessity for policy interventions that focus on mental health support, parental involvement, and awareness of adolescent issues and activities.

Trends in different contraception methods among women attending the Melbourne Sexual Health Centre from 2011 to 2020.

OBJECTIVES: The efficacy and availability of contraception have changed in the last several decades; however, unintended pregnancies continue to be an issue in Australia. This study aimed to describe trends in contraception in women attending a sexual health service over 9 years. STUDY DESIGN: Repeated cross-sectional study. METHODS: Women aged 16-49 years attending Melbourne Sexual Health Centre between 2011 and 2020 were included. Women were asked what methods of contraception they currently use. Contraception were categorised into long-acting reversible contraception (LARC; e.g. intrauterine devices and implants classified as highly effective), moderately effective contraception (e.g. oral contraception pill), less effective contraception (e.g. condom and withdrawal) and no contraception, as defined by US Centers for Disease Control and Prevention guidelines. Multivariable logistic regression was used to examine the factors associated with the use of moderate-high-efficacy contraception. RESULTS: A total of 38,288 women were included with a median age of 25 (interquartile range: 22-29). Between 2011 and 2020, there was a decreasing trend in condom (63.3%-56.1%; Ptrend <0.001) and oral contraception (27.2%-20.5%; Ptrend <0.001) use, whilst there was an increasing trend in the use of LARCs: implant (4.6%-6.0%; Ptrend = 0.002) and intrauterine device (2.8%-11.8%; Ptrend <0.001). Increasing age was associated with decreased odds of using moderate-high-efficacy contraception (Ptrend <0.001). Compared with Oceanian-born women, Asian (adjusted odds ratios [aOR] = 0.63, 95% confidence interval [CI]: 0.56-0.72) and Middle Eastern-born women (aOR = 0.60, 95% CI: 0.48-0.74) had lower odds of using moderate-high-efficacy contraception, whilst European (aOR = 1.23, 95% CI:1.07-1.41) and North American-born women (aOR = 1.51, 95% CI: 1.22-1.87) had higher odds of using moderate-high-efficacy contraception. CONCLUSIONS: Between 2011 and 2020, LARC use has increased, whilst less effective contraceptives, such as condom and oral contraception, have decreased among women at Melbourne Sexual Health Centre. Further research is required to understand age and ethnic disparities in contraception methods for future family planning programmes.

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.

Condom use increased after a peer group intervention implemented by community volunteers in Malawi.

BACKGROUND: HIV prevention remains a global priority, especially in sub-Saharan Africa. Our research team previously developed an evidence-based peer group program for HIV prevention called Mzake ndi Mzake (Friend to Friend). A community-engaged collaboration adapted the program for community ownership and implementation. Here we report whether this HIV prevention program, implemented by community volunteers, increased condom use among sexually active individuals in rural Malawi. METHODS: Three communities sequentially rolled out the program. Effectiveness was evaluated using a stepped wedge design. Repeated surveys 11-13 months apart were conducted between 2016 and 2019. At Time 1, no community had offered the intervention. At Time 2, the first community had offered the intervention and two had not (control group). At Time 3, two communities had offered the intervention and one had not (control group). We used two condom use indicators; condom use frequency in the last 2 months (N = 771) and condom use at last sex (N = 880). The analytical sample included all sexually active persons answering that question at one or more time points. Mixed-effects cumulative logit and Generalized Estimating Equation (GEE) models were used to model the two condom indicators over time, controlling for demographic factors, UNAIDS HIV knowledge, safer sex self-efficacy and partner communication. RESULTS: This peer group intervention implemented by trained community volunteers increased both condom use indicators at Times 2 and 3. In the final adjusted models with non-significant factors removed, condom use in the last two months increased for the intervention group vs. control group [Time 2: Adjusted Odds Ratio (AOR) = 1.59 (1.15, 2.21); Time 3: AOR 2.01 (1.23, 3.30)]. Similarly, condom use at last sex increased for the intervention group vs. control group [Time 2: AOR = 1.48 (1.08, 2.03); Time 3: AOR 1.81 (1.13, 2.90)]. Other significant predictors of greater condom use were also described. Although the intervention increased UNAIDS HIV knowledge, knowledge did not predict condom use. CONCLUSIONS: In this community-engaged implementation study, an evidence-based peer group program for HIV prevention increased condom use when delivered by trained community volunteers. Community ownership and program delivery by trained volunteers offer an innovative and cost-effective strategy to address ongoing HIV prevention needs without overburdening healthcare systems in sub-Saharan Africa. TRIAL REGISTRATION: Clinical Trials.gov NCT02765659 Registered May 6, 2016.

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.

Differences in condom access and use and associated factors between persons with and without disabilities receiving social cash transfers in Luapula province, Zambia-A cross-sectional study.

Persons with disabilities are disadvantaged in accessing sexual and reproductive health services, including condoms. In this study, we investigated whether condom access and use and their associated factors differed between persons with and without disabilities. We used data from adults in households receiving the Government of Zambia social cash transfers (SCT) in four districts of Luapula province. Condom access and use was the outcome. Disability, defined by the Washington Group Short Set Questions on Disability, was the main predictor. We performed logistic regression analyses to determine the associations between condom access and use and disability. In multivariable analyses, we controlled for covariates including age, sex, marital status, poverty status, HIV testing, and receiving the SCT. The sample comprised 1,143 people aged 16-49, with a median age of 21 years (interquartile range 18-28); 57.4% (n = 656) were female, 86.5% (n = 989) accessed and used condoms, and 17.9% (n = 205) were disabled, rating themselves with a 3 or a 4 on a scale of 1 = "not limited" to 4 = "cannot at all" in performing any of the six daily functions (seeing, hearing, walking, cognition, self-care, or communicating). Nearly sixty percent(58.5% (n = 120)) of persons with disabilities were female, 79.5% (n = 163) reported being very poor, 87.8% (n = 180) reported receiving SCT, and 86.3% (n = 177) reported accessing and using condoms. Condom access and use did not differ between persons with and without disabilities (adjusted odds ratio: 1.09; 95% confidence interval [CI]: 0.60-1.98]). We found no differences between persons with and without disabilities in condom access and use. We established that individual-level factors such as age, sex, marital status, and knowledge of being HIV positive might play a more important role in condom access and use than disability. Condom promotion interventions should account for these factors.

A 3D-printed condom intrauterine balloon tamponade: Design, prototyping, and technical validation.

Post-partum haemorrhage is among the main causes of (preventable) mortality for women in low-resource settings (LRSs), where, in 2017, the mortality ratio was 462 out of every 100 000 live births, over 10 times higher than for high-resource settings. There are different treatments available for post-partum haemorrhage. The intrauterine balloon tamponade is a medical device that proved to be a simple and cost-effective approach. Currently, there are several balloon tamponades available, with different design and working principles. However, all these devices were designed for high-resource settings, presenting several aspects that could be inappropriate for many lower-income countries. This paper presents the results of a preclinical study aiming at informing the design, prototyping and validation of a 3D-printed intrauterine balloon tamponade concept, contributing towards the United Nation's Sustainable Development Goal 3: Good health and Well-being. Frugal engineering concepts and contextualised design techniques were applied throughout, to define the design requirements and specifications. The performance of the final prototype was validated against the requirements of the UK National Health System (NHS) technical guidelines and relevant literature, measuring the water leak and pressure drop over time, both open air and in a approximate uterus model. The resulting prototype is made up of six components, some of which are easy to retrieve, namely a water bottle, a silicone tube and an ordinary condom, while others can be manufactured locally using 3D printers, namely a modified bottle cap, a flow stopper and a valve for holding the condom in place. Validation testing bore promising results with no water or pressure leak open air, and minimal leaks in the approximate uterus model. This demonstrates that the 3D printed condom-based intrauterine balloon tamponade is performing well against the requirements and, when compared to the state of the art, it could be a more appropriate and more resilient solution to low-resource settings, as it bypasses the challenges in the supply of consumables and presents a greener option based on circular economy.

An Evaluation of TransLife Care: A Locally Developed Structural HIV Prevention Intervention for Transgender Women in Chicago, Illinois.

Transgender women are disproportionately impacted by HIV infection. We report herein the findings of a pre-post evaluation of the TransLife Care (TLC) project in Chicago, Illinois, on behaviors associated with HIV transmission among transgender women. Participants who received any TLC component versus those who did not were compared using mixed-effects logistic regression with random intercepts across follow-up time points. Ninety-seven participants aged 18 to 59 (median age 24) enrolled; 76.3% were transgender women of color. There was a decrease in condomless sex without consistent PrEP use at 8 months, which was not significantly different between those who did and did not receive the TLC intervention, controlling for calendar time. Evidence does not indicate that the TLC reduces condomless sex without PrEP protection among urban transgender women. However, given the preponderance of evidence of the influence of structural barriers on condomless sex, future research should continue to test the efficacy of structural interventions.