"This Method, I Think, Can Shed New Light": Haitian-American Women's Reflections on Risk, Culture, and Family Planning Decisions From a Short-Term Trial of a Cervical Barrier (Femcap™).

Improving the reproductive health of immigrant populations requires understanding the specific context of risk and need. As part of a field trial of the FemCap™, a woman-initiated cervical barrier contraceptive, we conducted postintervention focus group discussions (FGDs) with 20 women (five FGDs) of Haitian background, the majority of whom were born in Haiti and spoke Haitian Créole at home, at a community health center in south Florida. Participants discussed the role of religion and inequitable gender norms in Haitian traditions about family planning decisions and provided important insights into the gender-power nuances of their partnership dynamics vis à vis the use of female barrier methods. Encouraged by more equitable gender norms in the United States, participants were eager to serve as health education agents, with strong altruistic sentiments toward other Haitian girls and women who they felt could be encouraged to negotiate for greater reproductive decision-making power.

An Exploratory Study of Acculturation and Reproductive Health Among Haitian and Haitian-American Women in Little Haiti, South Florida.

There is unmet contraceptive need among Haitian immigrants and Haitian-American women (Haitian women). The study explored associations of three measures of acculturation with contraceptive/reproductive health history among Haitian women residing in the Little Haiti community of Miami. This was a cross-sectional, exploratory study among 57 Haitian women. We conducted descriptive univariate analyses, then bivariate analyses to investigate the association of acculturation with reproductive health risk behavior including contraceptive use, tampon use, and parity, as well as interest in a female-initiated barrier contraceptive method. The most commonly ever-used contraceptive methods were male condoms (78.9 %) and oral contraceptives (OC 19.3 %). Women who primarily spoke Créole at home were less likely than those who did not to use OC (11.9 vs. 42.9 %, p = .01). Among women who resided in the U.S. ≥10 years, tampon use was 51.9 % compared to 16.7 % among those who were in the U.S. for less time (p = .005). Among U.S. born women, 60 % were tampon users compared to 22.7 % among those born in Haiti (p = .05). Women not speaking primarily Créole at home (p = .06) and those born in U.S. (p = .008) had fewer children. Contraceptive use was low among Haitian women but influenced by acculturation, where greater acculturation was associated with protective reproductive health behavior. Despite traditional norms discouraging contraceptive use, and little experience with female barriers, Haitian women indicated an interest in learning about and using a female-initiated barrier contraceptive. Increasing contraceptive uptake of potential multipurpose technologies is a potential point of intervention for decreasing HIV/STI transmission in this at-risk population.

'Men don't need to know everything': a field trial of a discreet, female-initiated, contraceptive barrier method (FemCap™) among Haitian-American women.

Worldwide, women report the need for safe, non-hormonal, woman-initiated methods of family planning. Cervical barriers provide such technology but are under-researched and under-promoted. In the USA, there are few studies of cervical barriers among women at high unmet need for contraception. A feasibility study of the FemCap™ was conducted among US women of Haitian origin. Participants were heterosexual and seeking to avoid pregnancy. At first visit, participants completed baseline assessments, underwent group counselling and were fitted with FemCap™. Women were asked to insert or use the cap at home. The second visit (2-3 weeks) included an interviewer-administered questionnaire and a focus-group discussion. Participants (n  =  20) were Haitian-born (70%), married (55%) and parous (85%). Their mean age was 32.6 years. Seventy percent reported recent unprotected sex. All women inserted the device at home and 9 women used it during intercourse, including 5 without prior partner negotiation. Of 20 women, 11 liked FemCap™ very much or somewhat; 7 considered it 'OK'; 2 disliked it. Best-liked attributes were comfort, discreet wear and reusability. Difficulties with removal abated over time. Qualitative data revealed a high value placed on lack of systemic side effects. Use of FemCap™ was feasible and acceptable, supporting expansion of research, particularly among relevant populations with unmet need.

Accidentes laborales en trabajadores de salud: período 2002- mayo 2003 / Accidents in health workers: period 2002 - may 2003

Los trabajadores de salud se encuentran expuestos a múltiples factores de riesgo laboral. Estudio clínico, transversal, descriptivo, retrospectivo, que incluyó los casos reportados de accidentes laborales al Servicio de Infectología, Hospital de Niños J.M. de los Ríos desde 2002 hasta mayo 2013, incluidos en la base de datos SPSS 13,0 Se reportaron 444 accidentes (100%): enfermeros 189 (42%), personal de limpieza 94 (21,17%), médicos residentes y adjuntos 92 (20,72%) y 14 (3,15%) respectivamente, estudiantes de medicina 27 (6,08%), bioanalistas 19 (4,27%). Ocurrieron 127 casos (28,65%) durante labores de limpieza, toma de muestras 113 (24,45%), administración de medicamentos 81 (18,24%), cateterización de vías periféricas 45 (10,13%), Intervenciones quirúrgicas 33 (7,43%), cateterización de vía central 14 (3,15%), procesamiento de muestras 5 (1,12%). El mecanismo accidental fue principalmente puntura 388 (90,65%) y de estas predominaron las superficiales en 238 (53,60%). La lesión en trabajadores de salud fue principalmente sobre piel sana en 425 (95,72%). El fluido principalmente involucrado fue sangre 406 (91,44%). El uso de guantes se practicó en 197 (44,3%) mientras que 247 (55,7%) no lo utilizaron, con y sin protección ocular 31 (6,98%) y 413 (93%) respectivamente, con y sin bata 29 (6,53%) y 415 (93,47%) respectivamente. El Servicio más accidentado fue Urgencias 78 (17,57%). La fuentefue conocida 319 (71.85%) y desconocida 120 (27,03%). Los reportes de accidentes laborales se han incrementado con los años, la mayoría ocurre en trabajadores de enfermería, durante labores de mantenimiento. No se utilizan métodos de protección de barrera aun conociéndose el status infeccioso del paciente

Health Workers are exposed to multiple risk factors at work. Clinical, transversal, descriptive, retrospective, which included the reported cases of occupational accidents to Infectious Diseases Service, Children’s Hospital JM de los Ríos from 2002 to May 2013, included in the SPSS 13.0 database. 444 accidents reported (100%): 189 nurses (42%), cleaning staff 94 (21.17%), Medical Residents and specialyst 92 (20.72%) and 14 (3.15%) respectively, 27 medical students (6.08%), Bioanalysts 19 (4.27%). There were 127 cases (28.65%) for cleaning labor, sampling 113 (24.45%), medication management, 81 (18.24%), peripheral lines catheterization 45 (10.13%), surgical interventions 33 (7.43%), central venous catheterization 14 (3.15%), processing of samples 5 (1.12%). The mechanism was mainly accidental puncture 388 (90.65%) and of these surface predominated in 238 (53.60%). The Health Workers injury was mainly on healthy skin in 425 (95.72%). The blood flow was primarily involved 406 (91.44%). The use of gloves was performed in 197 (44.3%) while 247 (55.7%) did not use it, with eye protection 31 (6.98%) and without 413 (93%) respectively, with and without gown 29 (6.53%) and 415 (93.47%) respectively. The Emergency Service rougher was 78 (17.57%). The source was known 319 (71.85%) and unknown 120 (27.03%). Occupational accidents reports have increased over the years, most occur in nursing workers during work. Do not use barrier protection methods even knowing the infection status of the patient

Promotion of condom use in a high-risk setting in Nicaragua: a randomised controlled trial.

BACKGROUND: In Latin America, motels rent rooms for commercial and non-commercial sex. We investigated the impact of providing health-education material and condoms on condom use in Managua, Nicaragua. METHODS: In a randomised controlled trial, in 19 motels, we gave condoms on request, made them available in rooms, or gave condoms directly to couples, with and without the presence of health-education material in the rooms. In a factorial design we assessed condom use directly by searching the rooms after couples had left. FINDINGS: 11 motels were used mainly by sex workers and their clients and eight mainly for non-commercial sex. 6463 couples attended the motels in 24 days. On 3106 (48.0%) occasions, at least one used condom was retrieved. Condom use was more frequent for commercial sex than for non-commercial sex (60.5 vs 20.2%). The presence of health-education material lowered the frequency of condom use for commercial sex (odds ratio 0.89 [95% CI 0.84-0.94]) and had no effect on use for non-commercial sex (1.03 [0.97-1.08]). Condom use increased for commercial (1.31 [1.09-1.75]) and non-commercial sex (1.81 (1.14-2.81) if condoms were available in rooms. Directly handing condoms to couples was similarly effective for commercial sex but less effective for non-commercial sex (1.32 [1.03-1.61] vs 1.52 [1.01-2.38]). INTERPRETATION: In Latin America, motels are key locations for promoting the use of condoms. Making condoms available in rooms is the most effective strategy to increase condom use, whereas use of health-education material was ineffective. These findings have important implications for HIV-prevention policies.

Factors associated with condom use in the male population of Mexico City.

Sexually transmitted diseases (STDs) are an important public health problem, due to their medical, social and economic repercussions. Therefore, more knowledge is needed about the sexual behaviour that promotes their spread, in order to improve control and prevention strategies. Our aim was to determine the frequency of male condom use associated with sexual behaviour factors, a history of and knowledge about STDs in a sample of the male population in Mexico City. During 1994 a cross-sectional epidemiological study was carried out, using multi-stage sampling with conglomerates, in 1377 men from 15 to 49 years old. The mean age was 34.5 years (SD 7.5 years). Mean age at first sexual relations was 17.7 years (SD 2.8 years). The global proportion of condom use during the last sexual relation was 24.6%; use according to type of female sex partner in the last year was 18.8% with regular partners and 62.5% with occasional partners. The principal predictors of male condom use, identified through statistical modelling, were: younger age (<25 years), middle and high education level (>9 years), middle and high socioeconomic level and type of sexual partners (occasional and regular). This population has risk factors for acquiring and transmitting some STDs, such as occasional sexual partners and a history of STDs. Characteristics which are important in relation to male condom use were identified, such as age (younger than 35), education (complete junior high school or more) and type of sexual partners (occasional and regular).

PIP: A cross-sectional epidemiological study was conducted in 1994 to determine the frequency of condom use in Mexico City among sexually active men aged 15-49 years old, and the association with sexual behavior and a history of or knowledge about STDs. The 1377 men interviewed were of mean age 34.5 years, and experienced their first sexual intercourse at mean age 17.7 years. 47% of the men reported using a condom at least once in their lives and 81.6% were married. 79.4% reported having a formal partner, 14.6% had relations with occasional partners, and 6.1% with both regular and informal partners. 26.4% used a condom during their most recent sexual intercourse, 18.8% with formal partners and 62.5% with casual partners. Condom use with formal partners was largely to prevent pregnancy, while condom use with casual partners was to prevent the transmission of STDs. Young and single men were almost twice as likely to use condoms as older married men. The main predictors of male condom use were therefore being under 25 years old, having more than 9 years of formal education, being of middle to high socioeconomic status, and type of sex partners.

Sexual practices and prevalence of HIV, HTLV-I/II, and Treponema pallidum among clandestine female sex workers in Lima, Peru.

BACKGROUND AND OBJECTIVES: A survey was conducted to determine the sexual behavior practices and prevalence of HIV-1, HTLV-I/II, and T. pallidum infections among unlicensed female sex workers (FSWs) in Lima, Peru. GOAL OF THIS STUDY: To assess the role of unlicensed FSWs as a potential source of retroviral and T. pallidum infection. STUDY DESIGN: Female sex workers from 15 brothels were enrolled. Sera samples were obtained and tested for antibodies to HIV-1, HTLV-I, and Treponema pallidum. RESULTS: Of 158 FSWs studied, all were negative for HIV-1, 6 were positive for HTLV-I, and 5 were positive for Treponema pallidum. Of their male clients, 75% used condoms, whereas only 3% reported condom use with their steady partners. When condoms were always used by clients, the history of a sexually transmitted disease was significantly reduced (p < 0.01), and the prevalence of HTLV-I (p < 0.05) and syphilis was lower among these workers. CONCLUSION: Data suggested that the low rate of sexually transmitted diseases among FSWs reflected the high rate of condom use by their male clients.

PIP: A survey was conducted to determine the prevalence of HIV-I, human T cell leukemia virus I and II (HTLV-I/II), and Treponema pallidum infection and the associated risk factors for the transmission of these sexually transmitted diseases (STDs) among unlicensed female sex workers (FSWs) in Lima, Peru, to further define their role as a potential source of infection. Unlicensed FSWs from 15 brothels were enrolled in this study from March to June 1994. Serum samples were collected and tested for antibodies to HIV-I, HTLV-I, HTLV-II, and Treponema pallidum. Results revealed that of the 158 FSWs studied, all were negative for HIV-I; 6 were positive for HTLV-I, and 5 had T. pallidum antibodies. Of their male clients, 75% had used condoms for the past 6 months, whereas only 3% reported condom use with their steady partners. Among the workers who stated that condoms were always used, the frequency of a history of STDs, including genital ulcers and inguinal adenopathies, was lower compared to occasional users. Similarly, the prevalence of HTLV-I infection and syphilis was lower among these workers. In conclusion, the study results suggested that the low rate of STDs among FSWs reflected a high rate of condom use.

Country watch: Nicaragua.

PIP: The Association of Workers for Education, Health and Social Integration (TESIS) works with commercial sex workers to control HIV and sexually transmitted diseases in Nicaragua through free condom distribution and education. Education includes group work, individual counseling, and demonstrations of correct condom use. Condoms are also distributed to the motels frequented by commercial sex workers. When the Condom Social Marketing (CSM) project in Central America started, it sold condoms of the same quality as the ones offered by TESIS; thus the condom donors reduced their donations, and in turn, TESIS lost its normal quota for free condom distribution. Because of this situation, TESIS dealt with a condom promotion scheme at a lower cost for the poorest women. Condom quality did not deteriorate as products only came with simpler packaging. TESIS fills the gap which CSM missed.^ieng

Factors associated with changes in sex behaviour among drug users in Puerto Rico.

Despite available strategies to prevent sex risk behaviours in Puerto Rico, heterosexual transmission of HIV continues to increase. Since 1990, heterosexual contact has been the fastest growing infection risk category among the island's general population, and the primary transmission route for women and children. To understand change in sex risk behaviours and factors related to change, 911 drug injectors and 359 crack smokers were recruited from the San Juan metropolitan area following a stratified cluster design. This study comprised a total of 1,004 (79.1%) drug users who were assessed at follow-up. Abstinence from sex behaviour increased from 54.6% to 61.1% (p < 0.01), use of condoms during vaginal sex also increased from 26.4% to 36.9% (p < 0.01). In multivariate analysis, significant predictors of abstinence were gender, injection drug use, HIV seropositivity and not having a steady partner. Predictors of using condoms during vaginal sex were HIV seropositivity, STD diagnosis and participation in an HIV preventive programme. These findings indicate that additional HIV preventive efforts are needed to reduce sex risk behaviours among drug users who have a steady sex partner, as well as among drug users who are HIV-negative.

PIP: Factors associated with changes in HIV risk behaviors were investigated in a prospective study of 911 injecting drug users and 359 crack smokers recruited on the basis of a stratified cluster design in metropolitan San Juan, Puerto Rico, in 1992-93. The findings presented in this paper are based on the 1004 drug users (79.1%) who were available for a follow-up interview 6 months after the baseline interview. Respondents were randomly assigned to receive a standard HIV prevention intervention (pretest counseling, optional HIV testing, and provision of HIV results) or the standard intervention plus a site-specific enhanced intervention entailing access to condoms and needle hygiene equipment, development of a personal risk reduction plan and training in the skills required to implement it, and ongoing contact with outreach workers. Overall, abstinence from sexual behavior increased from 54.6% at baseline to 61.1% at follow-up (p 0.01) while condom use during vaginal sex rose from 26.4% to 36.9% (p 0.01). In multivariate analysis, significant predictors of abstinence were male gender, injecting drug use, a positive HIV test at baseline, and not having a steady partner. Significant predictors of condom use were HIV seropositivity and a sexually transmitted disease diagnosis. Participation in the enhanced compared to the standard HIV prevention program was associated with an odds ratio of 1.29 (95% confidence interval, 0.95-1.74) for abstinence and 1.97 (95% confidence interval, 1.18-3.29) for condom use in vaginal sex.

Female condom acceptability among sex workers in Costa Rica.

This study measured short-term female condom acceptability among 51 female sex workers in San José, Costa Rica. Each woman was trained in use of the female condom and was asked to use the device if clients refused to use male condoms during a 2-week study period (male condoms were also distributed). Two follow-up visits with short interviews were scheduled, including questions on general reaction to the female condom by the participants and their clients, ease and comfort of use, and preferences for male or female devices. At the first follow-up visit, 51% of the women reported they "liked the female condom very much" and 45% reported they "liked it somewhat." Similar results were reported after the second follow-up phase. Sixty-seven percent of the participants preferred the female condom over the male condom, and, according to the the women, over half of their clients liked the female condom "very much" or "somewhat." The most common problems during the first phase were difficulty to insert (61%) and discomfort (43%). However, during the second study phase a reduction in these problems (22% and 25%, respectively) and other use-related problems were noted. Although this new method is not yet available throughout Costa Rica, these results should encourage sexually transmitted diseases and HIV service organizations to make this method accessible to women.

PIP: Costa Rica has an estimated population of 3.2 million people. Contraceptive prevalence in the country was 75% in 1993, 99% of married or cohabiting women have heard about male condoms, and 96% know where to get them, but only 16% use them. Other barrier methods are either not widely used or are unavailable. Barrier contraceptive methods, however, are the only type of contraceptives which can be used to reduce the risk of contracting sexually transmitted diseases, including HIV. Even though female condoms are not yet widely available throughout Costa Rica, a study was conducted to assess short-term female condom acceptability among 51 female prostitutes in San Jose, Costa Rica. Each woman was trained how to use the female condom and asked to use it if clients refused to use male condoms during the 2-week study period. At the first of 2 scheduled follow-up visits, 51% of the women reported that they were thoroughly satisfied with the female condom, while 45% reported liking it somewhat. Similar results were reported after the second follow-up visit. 67% of the participants preferred the female condom over the male condom and the women reported that more than half of their clients liked the female condom either very much or somewhat. The most common problems encountered during the first phase of the study were difficulty in inserting the condom (61%) and discomfort (43%). However, the levels of these problems fell to 22% and 25%, respectively, during the second phase of study, while other use-related problems were noted. Study findings highlight the need to make female condoms more widely available in Costa Rica.

Measuring condom use among sex workers in the Dominican Republic.

The purpose of this paper is to assess the internal consistency of self-reported condom use among sex workers in Puerto Plata and Santo Domingo, Dominican Republic. We examined the responses to questions about condom use among 4 cross-sectional samples of sex workers. We compared measures based on: (1) questions using always-to-never scales; (2) questions about use with the past 5 clients; and (3) questions about use in the past week obtained from a retrospective coital log. In each sample, more women reported 'always' using condoms with clients than with each of the past 5 clients. In 3 of the 4 samples, only about half of the women who reported 'always' using condoms used condoms with the most recent 5 clients and with all clients in the past week. Internal consistency was significantly higher when the comparison was limited to use with the most recent 5 clients and use in the past week. Self-reported measures of condom use can be difficult to interpret. Assessing the internal consistency of several measures of use provides insight into the strengths and weaknesses of each measure.

PIP: Although evaluations of interventions to curtail the spread of HIV rely, to a large extent, on self-reported changes in behavior, the validity of self-reported condom use is difficult to assess. The internal consistency of self-reported condom use was investigated among four convenience samples of commercial sex workers in Puerto Plata (n = 408) and Santo Domingo (n = 604), Dominican Republic, interviewed before and after targeted HIV/AIDS educational programs. Three measures of condom use were assessed: 1) a measure based on reported frequency of use with new clients and regular clients using an always-to-never scale, 2) a measure of use with the most recent 5 clients, and 3) a measure based on a retrospective coital log of use with clients in the past 7 days. In each sample, more women reported "always" using condoms with clients than with each of the past 5 clients. The largest discrepancy was found in the second Puerto Plata sample, where 153 women (76%) reported always using condoms with clients, but only 96 women (47.5%) reported using condoms with each of the past 5 clients. "Sometimes" users were significantly more consistent in their responses than "always" users. Internal consistency was significantly improved (83-89%) when the comparison was limited to use with the most recent 5 clients and use in the past week.

Condom use increasing.

PIP: Condom use is central to the prevention of AIDS among people at risk for contracting HIV. As such, condom use is increasing dramatically even though many men say that they do not like using them. Condom sales through social marketing campaigns have increased dramatically in some countries, where tens of millions of condoms are sold annually. For example, during the period 1991-96, annual social marketing sales increased about five-fold in Ethiopia to 21 million, and nine-fold in Brazil to 27 million. These sales reflect the success of condom social marketing campaigns in making condoms accessible and largely affordable. There is also a greater general awareness of AIDS than there used to be, and communication campaigns have shown that condoms are an effective solution. More condoms still need to be used in the ongoing struggle against HIV/AIDS. The author discusses the factors which affect the limited acceptance of condoms, condom use outside of marriage, social marketing, and family planning programs.^ieng

Behavior affects consistent use.

PIP: Condoms must be used correctly and consistently in order to prevent sexually transmitted diseases (STDs) and pregnancy. However, consistent use demands sustained behavior patterns. In a project with International Planned Parenthood Federation affiliates in Brazil, Honduras, and Jamaica, the counseling of women has moved away from emphasizing contraceptive methods, side effects, and correct use, to the more broad context of women's sexuality and risk of STD infection as a means of promoting behavior change. Providers use a sexuality-based approach in which they confer with women about their current sex partners, past partners, whether their partners travel for work, whether they think their partners may have other sex partners, and how those factors relate to the risk of STD infection. The project has also aggressively taught men about STDs and condom use, and involves men in counseling. One study has found that people who choose condoms as their main contraceptive method need more counseling than people who use condoms as a backup method, since primary users may have underestimated the difficulty of using condoms at every act of sexual intercourse. Furthermore, counseling appears to increase condom use when it involves both men and women in a monogamous relationship.^ieng

Mothers can play big role in kids' condom use.

PIP: The US Centers for Disease Control and Prevention (CDC) estimate that half of all HIV infections in the US occur among people under age 25 years. HIV infection is the 6th leading cause of death among people aged 15-24 years. There are also 3 million other cases of STDs among teenagers every year, and up to 1 million US teens become pregnant annually. Research conducted by the CDC has found that teens whose mothers discussed condoms with them prior to their first sexual intercourse were 3 times more likely to use them than were teens who never discussed condoms with their mothers or who did so only after their first intercourse. Findings are based upon interviews with 372 sexually-active teens aged 14-17 years in New York, Alabama, and Puerto Rico, more than two-thirds of whom had discussed condoms with their mothers. Early discussion also increased condom use during subsequent episodes of sexual intercourse. When condoms were used at first intercourse, adolescents were 20 times more likely to use them during future episodes of sexual intercourse.^ieng

Influence of HIV positive status on sexual behavior among males.

OBJECTIVE: To compare HIV seronegative (HIV-) and HIV seropositive (HIV+) males in terms of sexual behavior with female and male partners of different types. METHOD: Cross-sectional study. From August 1994 to February 1995, a sample of 236 respondents (150 HIV- and 86 HIV+) recruited from public health centers in the State of S. Paulo (Brazil), answered a questionnaire, including questions on demographic aspects, HIV and AIDS related knowledge, sexual orientation, use of alcohol and other drugs, sexual behavior with regular and casual female and male partners, and perceived risk of HIV infection. Sexual behavior with regular and casual female and male partners within the previous three months, was investigated. RESULTS: A lower proportion of HIV+ engaged in sexual contact with regular female partners (p < .01) and in vaginal intercourse with this type of partner (p < .01). A lower proportion of HIV+ engaged in overall sexual activity (p < .001) and reported lower frequency of penetrative sexual practices (p < .05). A high level of condom use with female and male partners was identified with no significant differences being found between the two serostatus groups. Some risky sexual behavior was identified, however, especially with regular partners, suggesting that some men were continuing to practice unsafe sex. CONCLUSIONS: The high level of condom use identified suggests that safer sex advice has been taken up. Condom use was not universal, however, and some men continue to place themselves at risk, especially with regular partners. Prevention programs should strive not only to encourage HIV- to practice safer sex, but also to encourage HIV+ to do so in order to prevent further transmission of the virus.

PIP: Findings are presented from a cross-sectional study comparing the sexual behavior of HIV-seronegative and HIV-seropositive men with male and female sex partners, with particular focus upon the practice of safer sex in both groups of men. The 150 HIV-seronegative and 86 HIV-seropositive participating males were recruited between August 1994 and February 1995 from public health centers in the state of Sao Paulo, Brazil, where they responded to a questionnaire. The men were 15-69 years old, of mean age 30 years. 78% were single, 14.4% were married/living together, 6.4% were separated/divorced, and 1.3% were widowers. 36% defined themselves as heterosexuals, 11.4% as bisexuals, and 36.4% as homosexuals, while 16.1% used other expressions. Compared to HIV-seronegative men, a smaller proportion of HIV-seropositive men had sexual contact with regular female partners and engaged in vaginal intercourse with that type of partner. Similarly, a smaller proportion of HIV-seropositive men engaged in overall sexual activity and reported a lower frequency of penetrative sexual practices. A high level of condom use with male and female sex partners was identified with no significant differences being found between the 2 serostatus groups. However, some risky sexual behavior was identified, especially with regular partners, suggesting that some men were continuing to have unsafe sex. HIV prevention programs should encourage both HIV-seronegative and HIV-seropositive men to practice safer sex.

No added STD protection from spermicidal condoms.

PIP: An epidemiologic study conducted by Family Health International and Profamilia (Dominican Republic) found that condoms treated with the spermicide nonoxynol-9 offer no greater protection against sexually transmitted diseases (STDs) than regular condoms. Enrolled in the randomized controlled study were 635 female sex workers recruited from STD clinics in Santo Domingo. Participants were scheduled to return for follow-up visits every 2 weeks for 24 weeks or until gonorrhea or chlamydial cervicitis developed; only about 17% of women in both the nonoxynol-9 condom group and the plain condom group completed the study. Although nonoxynol-9 condoms did not cause irritation, they were not associated with significant reductions in cervical or vaginal infections. This study was limited, however, by the potential for selection bias associated with the high drop-out rate and the small amount of spermicide used in the treated condoms. A nonoxynol-9 gel for gonorrhea, chlamydia, and HIV protection is under development. Since current nonoxynol-9 condoms are more expensive than regular condoms and have a shorter shelf-life, family planning programs may want to reconsider their use until more research evidence is available.^ieng

AIDS and condoms in Brasilia: a telephone survey.

A telephone survey was conducted to measure AIDS knowledge, media usage and condom attitudes and behaviors among 500 adults aged 18 to 49 in Brasilia, as well as to evaluate the feasibility of the telephone survey method in a developing country. The response rate was 91.6%. Respondents had good knowledge about correct modes of HIV transmission and prevention but also believed HIV was transmitted through blood donation, public toilets, swimming pools, and mosquito bites. TV and newspapers were the most important sources of information on health matters and AIDS, though health workers were considered the most credible sources of such information. Only 19% of sexual encounters in the 4 weeks prior to the survey included condoms. Single and younger respondents and those with more positive attitudes used condoms more frequently. More work is needed to identify appropriate messages to motivate people to use condoms. Telephone surveys regarding AIDS and sexual attitudes and behaviors are feasible in Brasilia, a planned community with universal telephone coverage.

PIP: This study examines the knowledge, attitudes, and behavior of AIDS and condom use in Brazil. Data were obtained during March-April 1994 from 500 completed telephone interviews among a sample of adults 18-49 years old living in the Plano Piloto sector of Brasilia, Brazil. The survey was conducted about 2 months after a national television and radio campaign on AIDS prevention, use of condoms, and avoidance of sharing syringes or needles. The questionnaire was based on questions from the Global Program on AIDS protocol. 99% of the sample reported that AIDS was one of the most important health problems facing Brazil today. The other health problems mentioned were cancer, famine, and cholera. 27% did not consider themselves at risk of AIDS. 2% considered themselves at great risk. The rest believed they had a small to moderate risk. 93% were aware that people with AIDS might appear healthy looking. 95% indicated sexual contact as a mode of transmission. 34% reported condom use as a means of avoiding AIDS transmission. 19% reported sexual abstinence as a preventive measure. 15% reported that people should inform others of their AIDS status as a way to avoid transmitting AIDS. 41% knew someone with AIDS. Less educated respondents held more inaccurate beliefs about the general means of transmission, but there were no educational differences about safe activities involving specific contact with persons infected with AIDS. Most misinformation pertained to public toilets, blood donations, use of swimming pools, and mosquito bites. 89% believed in a high risk at dental clinics used by AIDS patients. 72% were regular television users. Television and newspapers were the most important sources of information on AIDS and health. Only 19% used condoms in sexual activity occurring in the prior 4 weeks. Psychosocial factors were more important than demographic factors in predicting condom use.

Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents.

Data from a 1993-1994 survey of 150 black and Hispanic teenagers were used to examine differences in HIV risk-related behavior between young women who have a first sexual partner three or more years older than themselves and those whose first partner is their age. Compared with teenagers whose first partner had been roughly their age, the 35% of adolescents with an older partner had been younger at first intercourse (13.8 years vs. 14.6) and less likely to use a condom at first intercourse (63% vs. 82%). They also were less likely to report having used a condom at last intercourse (29% vs. 44%) or having used condoms consistently over their lifetime (37% vs. 56%) or in the previous six months (44% vs. 66%). Some 38% of teenagers with an older first partner had ever been pregnant, compared with 12% of those with a peer-age first partner. The mean number of partners and history of sexually transmitted diseases did not differ between the two groups.

Survey of condom-related beliefs, behaviors, and perceived social norms in Mexican migrant laborers.

This study reports findings from a survey of condom-related beliefs, behaviors, and perceived social norms in Mexican migrant laborers that live and work in the United States for extended periods of time. Snowball sampling was used to recruit 501 Mexican migrants from five "sending towns" in Jalisco, Mexico, with historically high rates of out-migration to the United States. Results showed that subjects reported few negative beliefs about condom use and high efficacy to use condoms in challenging sexual situations but social norms sanctioning condoms were limited. Results also revealed mixed knowledge of HIV transmission, poor knowledge of condom use, and higher condom use with occasional versus regular sex partners. Forty-four percent of male migrants reported sex with prostitutes while in the U.S., with married men reporting less condoms use with prostitutes than single men. It was concluded that condom promotion efforts with Mexican migrants should concentrate on men to encourage consistent use with occasional sex partners, including prostitutes. AIDS prevention education should be provided with sensitivity to the language needs, limited education, and extreme social and geographic marginality of this highly underresearched Latino population.

Estimates and explanations of gender differentials in contraceptive prevalence rates.

This article examines gender differentials in the reporting of contraceptive use and offers explanations regarding the sources of these differences. Data from five countries where DHS surveys were conducted recently among men and women are used in exploring these differences. The gap exists in all five countries, with men (or husbands) reporting greater practice of contraception than women (or wives). Results from the bivariate analysis suggest that the gap is attributable to polygyny and to gender differences in how the purpose of contraception is understood, rather than to male extramarital sexual relations. Additionally, gender differences in the definition of certain contraceptive methods and differences in the interpretation of questions about contraception contribute to the observed gap. These findings are also consistent with results of the multivariate analysis.

PIP: An analysis of Demographic and Health Survey data from Central African Republic, Ghana, Haiti, Kenya, and Zimbabwe revealed large gender differentials in the reporting of contraceptive use. In all five countries, men/husbands reported greater practice of contraception than women/wives. This gap ranged from 5 percentage points in Ghana to 25 percentage points in Kenya. The reporting of contraceptive use by only one partner of a couple may result from multiple sexual relationships, secret contraceptive use, or differential perceptions of what constitutes contraception. In these five countries, most of the gender gap was associated with condoms, abstinence, and (in Zimbabwe) the pill. An analysis of these differentials suggests more overreporting of current use among husbands than underreporting among wives. To the extent that polygynous men are more likely than their wives to report use of methods of which the wife would have equal or more knowledge than the husband (e.g., the pill), a polygyny effect is indicated in Zimbabwe. The results for Ghana and Kenya (the only surveys where information on knowledge of the ovulatory cycle is available for husbands) suggest the gap in reporting of periodic abstinence results mainly from husband's inaccurate knowledge of the reproductive cycle and this method. Finally, if all the gaps in condom use between marital partners are attributed to the assumption of the differential role of condom use (pregnancy and sexually transmitted disease prevention), this factor would explain 12% (Haiti) to 38% (Ghana and Zimbabwe) of the net gap in contraceptive prevalence rate estimates. More detailed questioning on the use of condoms and periodic abstinence would improve the reliability of these surveys.