Controlling HIV in Africa: effectiveness and cost of an intervention in a high-frequency STD transmitter core group.

Since 1985, a population of over 1,000 predominantly HIV-positive female prostitutes residing in a low-income area of Nairobi, has been enrolled in a sexually transmitted disease (STD)/HIV control programme. The major elements of the programme include the diagnosis and treatment of conventional STD, and the promotion of condom use to prevent the transmission of HIV and other sexually transmitted infections. Using estimates of numbers of HIV-seropositive prostitutes, numbers of sexual contacts, susceptibility of clients to HIV, HIV transmission efficiency, rates of condom use and the basic reproductive rate of HIV infection in Kenya, we estimate that the programme is responsible for preventing between 6,000 and 10,000 new cases of HIV infection per year among clients and contacts of clients. The total annual operating cost of the programme is approximately US$77,000 or between US$8.00 and US$12.00 for each case of HIV infection prevented. Programmes to reduce the transmission of HIV and other sexually transmitted infections which are targeted at high-frequency STD transmitters, such as prostitutes, can be effective and relatively inexpensive to undertake. More such programmes should be developed and evaluated in different settings.

Condoms for the prevention of HIV transmission: cultural dimensions.

PIP: Humans being fundamentally polygamous, condoms should be recognized and promoted as central to an integrated approach for family planning, HIV prevention, and the control of sexually transmitted diseases. They must be more widely and effectively distributed and promoted in both more developed and developing nations. Available data on the ability of condoms to stem the transmission of HIV are limited, yet nonetheless indicative of condoms' general protective effect. Comparatively high prevalence and use of condoms are, however, found only in Japan, Sweden, Finland, Denmark, Singapore, and Trinidad and Tobago. Use in the U.S. is under that of a generation ago, while only extremely low levels are found throughout most of Africa, Asia, and South America. The industrialized nations of the West are most readily in the position of affording increased condom prevalence and use through increased manufacturing capacity and intensified promotion of moderate behavioral change among users. The nations of the 3rd World, however, lack the monetary and logistical resources to finance a rapid increase in condom prevalence, and are demanded to focus their energies more than ever where they are most needed, and expected to produce most significant impact. Up to $1 billion/year would be needed from donor agencies to meet universal need for condoms in Africa alone. Simple and cheap though condoms may be, such cost is too high to bear. The use of social marketing is therefore endorsed to target high-risk groups of populations as a means of maximizing resources for greatest potential impact. NGOs will play a major role in condom distribution, and should expect to work with, instead of through, ministries of health.^ieng

Heterosexual transmission of HIV in Greece.

To provide further evidence for the heterosexual transmission of the acquired immunodeficiency syndrome (AIDS) in Greece we examined 53 Greek female steady heterosexual partners of 53 anti-HIV-positive men. Human immunodeficiency virus (HIV) transmission was estimated by the detection of anti-HIV antibodies. Our results showed that 27.8% (5 of 18) of the female partners of bisexuals, 33.3% (2 of 6) of intravenous drug abusers (IVDA), and 100% (4 of 4) of those who had lived for a long time in Africa were found anti-HIV positive. In contrast, only 4% (1 of 25) of the studied sexual partners of hemophiliac carriers were found to be HIV seropositive. The use of condoms seemed to be the most important factor in reducing HIV transmission. According to our results the duration of sexual relationships and the practice of anal intercourse did not increase the possibility of seroconversion. These results confirm the heterosexual transmission of HIV. However, further studies should be conducted to evaluate the relative role of various risk factors and the overall importance of heterosexual spread of HIV infections.

PIP: A serologic study of the 53 female partners of Greek men with confirmed human immunodeficiency virus (HIV) infection, conducted from January 1986-May 1987 in Athens, provided additional evidence for a heterosexual mode of transmission. All 53 females tested had had a steady sexual relationship that exceeded 6 months with their male partner and a limited prior sexual history. Among the seropositive males were 18 bisexuals, 6 intravenous drug abusers, 4 heterosexuals who had resided previously in Africa, and 25 hemophiliacs. 12 (23%) of the 53 female partners were seropositive for antibodies to HIV. The lowest frequency of infection was found among spouses of hemophiliacs (4%); the other prevalence rates were 28% for partners of bisexual men, 33% for partners of intravenous drug abusers, and 100% among the spouses of men who had lived in Africa for a significant time period. The duration of the sexual relationship averaged 32 months among seronegative women and 40 months among seropositive female partners. None of the 12 carriers whose spouses were found to be seropositive had used condoms; in contrast, 37 (90%) of carriers of seronegative spouses had used condoms regularly in the 6-month period preceding the study. The practice of anal intercourse was reported more frequently by seropositive female partners (33%) than seronegative women (24%), but this difference was not significant.

Communicating AIDS information to Hispanics: the importance of language and media preference.

Though Hispanics are the fastest-growing minority group in the United States and have a high cumulative incidence of acquired immunodeficiency syndrome (AIDS), very little data are available concerning attitudes and beliefs concerning AIDS in this population. In January 1988, 216 Hispanics from three clinics in Oregon participated in a survey regarding AIDS information acquisition and knowledge. Overall, respondents reported receiving more information about AIDS from broadcast media such as television (42.6%) and radio (19.9%) and less from print media such as newspapers (18.5%) and pamphlets (17.6%). Respondents whose primary language was Spanish tended to have fewer information sources and relied relatively more on broadcast media than on print media. Though over 90% of the sample believed AIDS could be transmitted sexually, only 50% thought condoms could prevent transmission. Compared to primarily English speakers, respondents whose primary language was Spanish were more likely to believe that AIDS could be casually transmitted and less likely to believe that condoms could prevent transmission. This study suggests that more information delivered in an effective manner, both culturally and linguistically, is needed.

Contraceptive use in women with bacterial vaginosis.

The aim of the study was to investigate if bacterial vaginosis (BV) is associated with use of specific contraceptives. Women at family planning and youth clinics (n = 956), among whom 131 had BV, were subjects for structured in-depth interviews including current and previous contraceptive use. Variables measuring sexual risk-taking were ascertained. Current users of contraceptives were compared with non-users. Both oral contraceptive (OC) and condom use showed a significant protective effect against BV, adjusted for possible confounders (odds ratios were 0.4 and 0.3, respectively). Intrauterine device use (IUD) showed no association with BV. Women with BV had less often used any contraceptives, including condom, at their sexual debut than the women in the comparison group. In this study, OC and condom use seemed to exert a protective effect against BV, whereas no effect for IUD use was found.

PIP: To determine whether bacterial vaginosis (BV) is associated with use of specific contraceptive methods, 956 women from family planning and youth clinics at 3 Swedish hospitals were enrolled in a cohort study. 131 women had at least 3 of the 4 clinical signs of BV: a homogenous gray vaginal discharge, a vaginal pH of 4.7, a positive amine test, and the presence of "clue" cells. Age at first intercourse was 16 years among those with and without BV; however, 8.4% of women with BV, compared with only 1.7% of controls, had had more than 1 sex partner in the last 6 months. Other factors associated with BV were more than 10 lifetime sex partners, non-use of contraception at first intercourse, a history of sexual abuse, an induced abortion, smoking, and alcohol consumption. After adjustment for sexual risk-taking, there was a significant negative association between BV and oral contraceptive (OC) use (odds ratio [OR], 0.4; 95% confidence interval [CI], 0.2-0.8). There was also a significant negative association with condom use (OR, 0.3; 95% CI, 0.1-0.9). There was no association between BV and IUD use, before or after adjustment for confounding factors. Insufficient numbers of diaphragm or spermicide users were available for analysis. The finding of an apparently protective effect against BV of OCs and condoms lacks a biological explanation at present, although it is speculated that OC use increases the glycogen content of vaginal epithelial cells, in turn inhibiting the in vitro growth of certain bacteria.

Use of condoms as contraceptive and disease preventive measures among residents of Jos, northern Nigeria.

The effectiveness, acceptability and protective aspects of condoms as both contraceptive and disease control measures was evaluated in 168 male residents of Jos in Nigeria. They were aged between 15 and 40 years and were attending the Family Planning Clinic of the Jos University Teaching Hospital. The results showed that the majority (87.5%) of our patients were in the 21 to 30 years age group and most of the clients had used condoms for between 1 to 5 years. A good number of our clients (40.5%) used condom because it protects them against venereal disease while others felt it was safe and effective. The Family Planning Clinic was the main source of knowledge of the condom among our clients (42.9%), and the condom was rated as good or excellent by 137 (81.5%) clients. The only side effect of condom usage which featured prominently among our clients was reduced sexual excitement. The results were compared with studies carried out elsewhere. It was concluded that the condom could be an acceptable and effective form of contraception in this population. The users must, however, be highly motivated so as to use it during every act of coitus for optimal efficacy.

PIP: The effectiveness, acceptability, and protective aspects of condoms as both contraceptive and disease control measures was evaluated in 168 male residents of Jos in Nigeria. They were between 15-40 years of age and attended the Family Planning Clinic of the Jos University Teaching Hospital. The results showed that the majority (87.5%) of these patients were between 21-30 years of age and most had used condoms for between 1-5 years. A good number (40.5%) used condoms because of the protection against venereal disease while many others felt it was safe and effective. The Family Planning Clinic was the main source of knowledge concerning the condom (42.9%) and the condom was rated as good or excellent by 137 clients (81.5%). The only side effect seen with the condom was reduced sexual excitement: this was a predominant manifestation. Results were compared with studies carried out elsewhere. It was concluded that the condom should be an acceptable and effective form of contraception in this population. The users must, however, be highly motivated to use it during every act of coitus for optimal efficacy.

Condom and nonoxynol-9 use and the incidence of HIV infection in serodiscordant couples in Zambia.

We aimed to measure the effectiveness of latex condoms and of nonoxynol-9 [N-9] spermicides, in preventing HIV transmission in heterosexual serodiscordant couples in Lusaka. Each couple was examined at clinic visits scheduled at 3-month intervals for one year or more per couple, or until seroconversion or discontinuation. Couples were given condoms and their choice of 3 N-9 products and advised to use both at every intercourse. Sexual exposure was ascertained from coital logs that recorded coitus and barrier method use. HIV serological testing was done at each clinic visit (ELISA and Western blot if positive). One hundred and ten discordant couples were followed for a mean of 17.6 months. Seventy-eight per cent of coital episodes were protected by condoms, 85% by spermicides and 6.4% were unprotected. Fourteen seroconversions occurred (8.7 infections per 100 couple-years [c-y]). The rate was higher among seronegative men than seronegative women. Among couples who reported using condoms at every intercourse the infection rate was 2.3/100 c-y, compared with 10.7/100 c-y among couples using condoms less consistently (rate ratio [RR] 0.2; 95% confidence interval [CI] 0-1.6). Among couples who reported using N-9 at every intercourse, the seroconversion rate was 6.9/100 c-y; among couples who reported less than full-time N-9 use, the rate was 8.9/100 c-y (RR 0.8; 95% CI 0.2-2.8). Among the subset of female seronegatives, the N-9 RR was 0.5 (95% CI 0.1-3.8). But when we calculated HIV rates according to N-9 consistency in coital acts when condoms were not used, there was no evidence of protection with higher N-9 use. Consistent use of latex condoms reduces the incidence of HIV infection, but the association between N-9 spermicides and HIV is less clear. The current study could not provide compelling data on the impact of N-9 spermicide use on risk of HIV infection. The study's small size, as well as the consistency of concurrent condom use, limited our inferences. Available spermicide products must be studied further.

PIP: The protective effect of consistent condom use against HIV transmission in HIV-serodiscordant couples has been documented. Unknown, however, is the anti-HIV effect of nonoxynol-9 use. This issue was addressed in a survey of 110 HIV-discordant couples from Lusaka, Zambia, who were willing to use condoms/spermicide, maintain a coital log, and return for follow-up visits every 3 months for at least 1 year. 80 of these couples (73%) had a seropositive man and 30 (27%) had a seropositive woman. The mean duration of follow-up was 17.6 months. Of the total of 15,148 recorded coital episodes, 10% were protected by condoms only, 17% by nonoxynol-9 only, 66% by both condoms and nonoxynol (according to the study protocol), and 6% were unprotected by any barrier method. Consistent barrier method use declined with duration of follow-up. There were 14 seroconversions (8.9 infections/100 couple-years), including 8 initially seronegative men and 6 initially seronegative women. Among couples who used condoms 0-50%, 51-75%, 76-99%, and 100% of the time, the seroconversion rates were 20.8, 10.1, 7.3, and 2.3/100 couple-years, respectively. Seroconversion rates were 6.9 and 8.9/100 couple-years among those reporting consistent and inconsistent use, respectively, of nonoxynol-9. Although this study failed to provide evidence that nonoxynol-9 use confers significant protection against HIV infection, its small size and the consistency of concurrent male condom use limited inferences.

Condom knowledge, history of use, and attitudes among chemically addicted populations.

The need for behavioral change of risky sexual practices has been of the highest priority since the onset of the AIDS epidemic. The major focus of education for safe sex has been emphasis on condom use. We surveyed 124 individuals applying to treatment for various chemical dependencies and 60 individuals applying for non-chemical-dependency medical treatment on various aspects of condom knowledge, history of use, and attitudes. Respondents reported that AIDS has motivated them to increase their use of condoms, however, only 13.9% always use them. Education is needed in the areas of increasing protection. Along with the use of a condom, the need for a reservoir tip and the risks associated with multiple sex partners should be stressed.

PIP: This report contains the findings of a survey designed to investigate the knowledge of condoms, history of use, and attitudes among chemically attitudes among chemically addicted populations. The study took place in the Division of Alcohol and Drug Dependence of the SUNY Health Science Center at Brooklyn, Department of Psychiatry, Kings Country Addictive Disease Hospitals. Researchers interviewed 124 individuals seeking treatment for chemical dependency, as well as 60 individuals applying for non-chemical dependency treatment to serve as controls. 25% of those interviewed reported intravenous injection as their primary route of drug administration, 25% reported smoking crack of sniffing cocaine, 17.4% cited alcohol abuse. The remaining 32.6% made up the control group. In a few instances, drug users scored better than the controls on condom knowledge, but overall, the survey found no significant differences in the level of knowledge about AIDS and condoms use among the drug, alcohol, and control groups. As expected, the survey found that those individuals who have a history of condom use scored higher on the knowledge quiz than those with less experience. Very few individuals in any of the groups mentioned monogamy as a strategy for risk reduction, or mentioned multiple sex partners as high-risk activity. While sensitivity and embarrassment did not play a significant role in condom use frequency, 26.1% of those interviewed agreed with the statement "If my partner doesn't mention using a condom neither will I." 32% of males and 57.1% of females reported having has a sex partner refuse to use a condom. These findings, the report explains, suggest the need to address sexually risky behavior within the chemically addicted populations.

Contraceptive practices of patients referred for colposcopy with an abnormal cervical smear.

This study examined the contraceptive practices of 100 patients referred for colposcopy because of an abnormal cervical smear. At presentation 49% were using oral contraception but 94% had taken the pill at some time. Eight of the 10 patients using barrier methods were relying on condoms: in at least seven of the eight cases an abnormal cervical smear preceded condom usage. Thus, the method of contraception used when cervical neoplasia develops may differ from the method used when the patient presents for colposcopy. Although consistent with previous studies suggesting that the incidence of cervical neoplasia is increased in women using oral contraception, the risk of neoplasia is more likely to be explained by the degree of exposure of the cervix to an infectious carcinogen or to the immunosuppressive effects of seminal plasma. We suggest that future studies of the epidemiology and natural history of cervical neoplasia should include a detailed contraceptive history.

AIDS risk estimate may help you answer family planning questions.

PIP: A newly developed risk assessment instrument can help family planning clinicians to answer their clients' questions about whether they are likely to develop acquired immunodeficiency syndrome (AIDS). The client's sexual history is used as the basis for estimating the degree of risk. The risk of human immunodeficiency virus (HIV) infection is, according to this instrument, 1 in 50'000,000 if a condom was used and 1 in 5,000,000 if a condom was not used following 1 sexual encounter with a partner whose HIV serostatus is unknown but who is hot in a group at high risk of AIDS. The HIV risk is 1 in 110,000 if a condom was uses and 1 in 16,000 if a condom was not used following 500 sexual encounters with a partner whose serostatus is unknown but who is not in a high-risk group. On the other hand, the risk of HIV infection is 1 in 10,000-100,000 if a condom was used and 1 in 1000-10,000 if a condom was not used after 1 sexual encounter with a partner whose HIV status is unknown and who is in a high-risk group. This risk increases to 1 in 21-210 if a condom was used and to 1 i3-23 if a condom was not used following 500 sexual encounters with a partner whose HIV status is unknown and who is in a high-risk group. Finally, the risk of HIV infection following 1 sexual encounter with a partner who is HIV seropositive is 1 in 110,000 if a condom was used and 1 in 500 if a condom was not used. Despite the protective effects of condoms against AIDS, the best preventive measure is selection of low-risk partners.^ieng

Guidelines can help patients reduce risk of STD infection.

PIP: Malcolm G. Freeman, professor of obstetrics and gynecology at Emory University, has compiled the following 10 guidelines on reducing the risk of contracting sexually transmitted diseases: 1) avoid outside sources of infection through longterm, monogamous relationships; 2) be aware of the dangers of unprotected oral, anal, and genital contact with unknown sexual partners; 3) use a condom during sexual intercourse with anyone other than a regular, exclusive partner to avoid contact with semen, urethral discharge, or skin lesions; 4) be aware of the principles of proper condom use put the condom on early in sexual foreplay, hold the condom in place during withdrawal from the vagina to prevent leakage of semen, and discard the condom after 1 use; 5) avoid oral-anal contact with any partner; 6) use a condom during penile-anal contact, even in exclusive relationships; 7) follow digital-anal or instrumental-anal contact with soap and water washing before further oral or genital contact; 8) avoid deep oral-oral contact with salivary exchange with casual sex partners to reduce the risk of transmission of acquired immunodeficiency syndrome (AIDS); 9) be aware of the difficulties of reducing infection risk from oral contact with the vulva and vagina; and 10) never assume that periodic health examinations ensure a person's safety as a partner, since many carriers of sexually transmitted diseases are asymptomatic.^ieng

[Love me with a condom]. / Amame con condon.

PIP: The origin of the term condom is not known, but it may have been derived from the Latin word condus meaning receptacle. Or it may have been names for an English physician named Condom, although there is no proof of this. Potential users should not be put off by a misperception of the word condom as vulgar. The 1st condoms were made of animal intestines and were designed to prevent spread of sexually transmitted diseases. They decreased sensitivity and could not be mass produced. The 1839 discovery of a process for vulcanizing rubber permitted widescale production of condoms for the 'st time in the later 1800s. Although condoms are not completely safe wither as a contraceptive or a preventive measure, they offer more advantages than disadvantages. They reduce sensitivity and interrupt lovemaking, but their use can be converted into an element of erotic play. The condom should be placed on the erect penis and carefully unrolled to the base. The condom should be carefully removed after ejaculation to ensure that no liquid escapes. Condoms offer protection against the life threatening AIDS virus and against unwanted pregnancy. They have the further advantage of requiring male participation and thus of fostering greater egalitarianism in family planning and contraception. Condom use is slowly gaining ground. 10 years ago a person seeking condoms in a Mexican pharmacy had to request them, but today they are sold in supermarkets and on pharmacy display racks. Channels for free distribution of condoms should be increased to remove the financial constraint on their acceptance.^ieng

AIDS in Africa: evidence for heterosexual transmission of the human immunodeficiency virus.

PIP: The sex and age distribution of acquired immunodeficiency syndrome (AIDS) in Africa (i.e., a l:l male-female ration and a concentration in the 30-39-year age group) are similar to those recorded for other sexually transmitted diseases, both in developed and developing countries. In Africa, AIDS shows a pattern of heterosexual transmission, and prevalence rates are highest among younger, sexually active women who have sexual relations with older men. 61% of African women with AIDS compared with 36% of male victims are unmarried. Prostitutes have consistently shown the highest rates of human immunodeficiency virus (HIV) infection--27-88% in various studies. In most areas of Africa, female prostitutes and men and women with a history of multiple sex partners in the previous 5 years contribute the majority of AIDS cases. 35% of AIDS patients also report having had at least 1 sexually transmitted disease in the 3 years preceding diagnosis. The high correlation between HIV seropositivity and genital ulcers suggests that the disruption of genital epithelial integrity may promote the transmission of HIV infection during vaginal intercourse. 2 additional factors--blood transfusions and exposure to blood- contaminated needles and syringes--are amplifying the dissemination of AIDS into the general population of Africa. Encouraging are findings among prostitutes that HIV transmission can be eliminated by consistent condom use and significantly reduced even when condoms are used in only half of sexual encounters. Africa presents numerous cultural, social, and economic obstacles to the effective prevention and control of AIDS. Integration of programs aimed at reducing risk factors into existing health and educational projects is necessary, as is the full support of government agencies.^ieng

The truth about condoms.

PIP: At present, condoms represent the best means for couples who are at risk of acquired immunodeficiency syndrome (AIDS) and sexually transmitted diseases (STDs) to prevent infection. In addition to protecting against infection and pregnancy, condoms have the advantages of accessibility, low cost, and male involvement. Consistent condom use has been shown to reduce human immunodeficiency virus (HIV) transmission from 82% to 17%. However, this study of heterosexual transmission of HIV found that 79% of the couples using condoms experienced breakage at least once in the 18-month study period and another 8% experienced at least 1 episode of leakage. The heterosexual partners of HIV-positive individuals were least likely to seroconvert if abstinence was practiced (none of 12). Of the 18 couples who used condoms consistently, 3 (17%) seroconverted during the 18 months. In the 17 couples who either used condoms erratically or did not use them at all, 14 (84%) became seropositive during the study period. Latex condoms, particularly in conjunction with spermicide, appear to be the best choice if prevention of infection is a priority. Condoms should be used by such individuals even if they are already using sterilization, oral contraceptives, or any other means of birth control to prevent pregnancy. In the US, condom use has increased from 12% in 1982 to 16% in 1986; in xonrear, 1% or less of married women of reproductive age in 36 of 66 developing countries surveyed in 1987 reported condom use. It is recommended that family planning programs and health agencies encourage more widespread condom use by making condoms available to clients free or at the lowest possible cost, offering clients sufficient quantities of condoms, instructing clients in their proper use, assisting clients in enlisting partner cooperation in condom use, and providing community education to overcome barriers to use of this method.^ieng

Lifting of ban on advertisement of condoms, 1988.

The Government of Singapore has decided to allow the advertising of condoms in order to help stop the spread of AIDS.

[Prostitutes of the east sector of Santiago: characteristics and pathology of sexual transmission]. / Las prostitutas del sector oriente de Santiago: características y patología de trasmision sexual.

We studied the frequency of venereal disease in 329 prostitutes working at massage parlours in Santiago. The mean age was 24 years and half of them had high school or university studies. In spite of frequent sexual contacts averaging 2.8 per day, the prevalence of significant venereal disease was not high in this group. Notably, AIDS infection was not detected. Vaginitis due to Trichomonas or Candida infection was the commonest problem and this was half as frequent among gum preservative users. Marital condition, age, obstetrical history and other variables were not related to genital infection.

PIP: A sample of 329 prostitutes from the eastern area of Santiago, Chile, who attended the Dermatology Service of the Salvador Hospital in January-February 1988 were studied to determine the current incidence of sexually transmitted disease among prostitutes. Approximately 600 prostitutes attend the service for required monthly health examinations. The 329 women worked in established locales such as saunas, massage parlors, and nightclubs. None were uncontrolled street prostitutes. The average age was 24.3 years. 68% were single, 17% were separated, and 15% were married. Only 14% had no more than primary education, and half had high school or college educations. The average parity was 1.52. 83% used contraception. 31% used oral contraceptives (OCs), 21% used injectables, 24% used IUDs, and 7% used other methods. The average number of sexual contacts per day was 2.87. 54% always used condoms, 36% occasionally did so, and 10% never did so. The estimated number of monthly sexual contracts/woman was 65. 22% of the women had some sort of genital pathology. No cases of HIV infection were seen. 9.7% were diagnosed with trichomonas, 4.6% with unspecified vulvovaginitis, 3.3% with candidiasis, 1.8% with syphilis, 1.5% with gonorrhea, .9% with condyloma acuminata, and .3% with active herpes. The frequency of vaginitis did no appear to be associated with the number of sexual contacts, but other pathologies were more common in women with more partners. Women who always used condoms were only half as likely to have genital pathologies or vaginitis as women who never used condoms.

Surveying the condom scene.

PIP: The US Agency for International Development (AID) provides half a billion condoms--1/3 of the total used--to developing countries this year. However, this amount is not even equivalent to 1 condom/year for each man in the 15-49-year age group. The condom promotion campaigns currently being launched in countries throughout the world in response to the treat of acquired immunodeficiency syndrome (AIDS) can be effective only if supplies are increased. Researchers are working to develop new condoms that are cheaper than those currently available yet of uniformly high quality. A major line of defense against condom failure is to ensure adequate production standards. The World Health Organization's Global Program on AIDS is drafting guidelines for procuring and testing condoms to assist countries in meeting the increased demands generated by AIDS prevention programs. Even high-quality condoms can break in use, however, unless short storage times, improve storage conditions, and regular testing of stocks are implemented. Now that laboratory studies have demonstrated conclusively that latex condoms can provide protection against sexually transmitted diseases and several studies have demonstrated a strong association between condom use and protection from human immunodeficiency virus (HIV) infection, a resurgence in use of this method is expected in both developed and developing countries. The condom also has a 97% theoretical effectiveness against pregnancy.^ieng

The expanding role of the female condom.

PIP: Studies conducted since the introduction of female condoms in the market in 1996 as a strong, soft, transparent polyurethane sheath to protect against HIV/AIDS infection was reported to gain a wide range of acceptability. Men favored its use compared to male condoms since it does not interrupt sexual activity and feels more similar to unprotected sex. Results from international studies on the efficacy of female condoms include: 1) ability to prevent unwanted pregnancies; 2) ability to prevent transmission of sexually transmitted diseases and HIV; 3) expansion of choice in increasing protection; 4) acceptability of the female condom to a wide range of men and women; 4) safety of the product; 5) easier use through constant practice; 6) provision of additional emotional comfort, sense of security and control; 7) cost-effectiveness as a prevention program; and 8) the need for a more strategic introduction in other countries. The establishment of the Female Condom Programming Guide assists with design and implementation of strategies, as well as catalyzing of new ideas and expanding of good practices in female condom programs. This article emphasizes the significance of female condom as an important technology that plays a vital role in the reproductive health programs and needs to be introduced strategically in order to provide the greatest and most cost-effective public health impact.^ieng

Association of contraceptives and HIV-1 infection in Thai female commercial sex workers.

We conducted a case-control study to evaluate the association between contraceptive methods and HIV infection among Thai female commercial sex workers in Khon Kaen and Lumpang provinces, Thailand; 118 cases of HIV-1 infected sex workers were eligible for inclusion and 258 HIV-1 negative women were recruited as controls during the period of October 1, 1993 to December 31, 1994. Cases and controls were matched by age, education, parity, age at first exposure to commercial sex, number of clients per night, duration of work and sexual practice during menstruation. The ratio of case per control was 1:2. Both cases and controls were interviewed and underwent blood testing by a team of investigators. The study revealed no significant association between oral pill, injection, other contraceptives and HIV-1 infection. However, condom usage showed a significant protective effect. It is suggested that these contraceptives in this high-risk group of women do not increase the risk of HIV infection. In contrast, the use of condoms could reduce the risk of HIV infection.

PIP: The authors conducted a case-control study to evaluate the association between contraceptive methods and HIV infection among Thai female commercial sex workers in Khon Kaen and Lumpang provinces, Thailand; 118 cases of HIV-1-infected sex workers were eligible for inclusion and 258 HIV-1-negative women were recruited as controls during the period of October 1, 1993, to December 31, 1994. Cases and controls were matched by age, education, parity, age at first exposure to commercial sex, number of clients per night, duration of work, and sexual practice during menstruation. The case/control ratio was 1:2. Both cases and controls were interviewed and underwent blood testing by a team of investigators. The study revealed no significant association between oral pills, injections, other contraceptives and HIV-1 infection. However, condom usage showed a significant protective effect. It is suggested that these contraceptives in this high-risk group of women do not increase the risk of HIV infection. In contrast, the use of condoms could reduce the risk of HIV infection.