One potentially important antecedent of experiencing problems with condom use during penile-vaginal sex is the amount of time that men (and perhaps women) allow for condom application. To examine whether men reporting that ample time was available to apply a male condom (the last time a condom was used for penile-vaginal sex) were also less likely to report problems with condom use such as breakage, slippage and erection difficulties during that sexual event.
A convenience sample of men (n = 440) was recruited via advertisements in newspapers (two urban and one small town) and a blog on the website of a condom sales company. Men completed a questionnaire posted on the website of The Kinsey Institute for Research in Sex, Gender, and Reproduction. Inclusion criteria were that participants were: at least 18 years old; used condoms for penile-vaginal intercourse in the past 3 months; and able to read English.
In controlled, event-specific analyses, men reporting that they did not have sufficient time for condom application were ~three times more likely to report breakage and approximately 2.4 times more likely to report slippage. In addition, men who reported that they lacked time for condom application were approximately 2.4 times more likely to experience any of nine sexual problems, 3.4 times more likely to report difficulty with erection, 2.1 times more likely to report reduced sexual pleasure, 2.2 times more likely to report reduced sexual pleasure of their female partner and 2.6 times more likely to report that the condom irritated their partner's vagina.
This is the first study using an event-specific analysis to examine the effect of not having enough time for condom application on condom breakage, slippage and several outcomes related to sexual pleasure. Sexually transmissible infections and pregnancy prevention messages should include recommendations to men to take their time applying condoms.
"In addition, these young women are likely to be found in brothels, where there was almost a 5-fold risk of breakage, than among women who entertained their clients in public places. This is an unexpected result, as we had believed that breakage was more likely to occur in less structured situations, such as having sex standing up, furtively or hurriedly, or in the dark . Neither of these factors (age and brothel work) has been associated with breakage in other studies, but this is possibly because we had a large randomly sampled group in our study, whereas other studies may have focused on more homogeneous groups of respondents. "
[Show abstract][Hide abstract] ABSTRACT: Condoms are effective in preventing the transmission of HIV and other sexually transmitted infections, when properly used. However, recent data from surveys of female sex workers (FSWs) in Karnataka in south India, suggest that condom breakage rates may be quite high. It is important therefore to quantify condom breakage rates, and examine what factors might precipitate condom breakage, so that programmers can identify those at risk, and develop appropriate interventions.
We explored determinants of reported condom breakage in the previous month among 1,928 female sex workers in four districts of Karnataka using data from cross-sectional surveys undertaken from July 2008 to February 2009. Using stepwise multivariate logistic regression, we examined the possible determinants of condom breakage, controlling for several independent variables including the district and client load.
Overall, 11.4% of FSWs reported at least one condom break in the previous month. FSWs were much more likely to report breakage if under 20 years of age (AOR 3.43, p = 0.005); if divorced/ separated/widowed (AOR 1.52, p = 0.012); if they were regular alcohol users (AOR 1.63, p = 0.005); if they mostly entertained clients in lodges/rented rooms (AOR 2.99, p = 0.029) or brothels (AOR 4.77, p = 0.003), compared to street based sex workers; if they had ever had anal sex (AOR 2.03, p = 0.006); if the sex worker herself (as opposed to the client) applied the condom at last use (AOR 1.90, p < 0.001); if they were inconsistent condom users (AOR 2.77, p < 0.001); and if they had never seen a condom demonstration (AOR 2.37, p < 0.001).
The reported incidence of condom breakage was high in this study, and this is a major concern for HIV/STI prevention programs, for which condom use is a key prevention tool. Younger and more marginalized female sex workers were most vulnerable to condom breakage. Special effort is therefore required to seek out such women and to provide information and skills on correct condom use. More research is also needed on what specific situational parameters might be important in predisposing women to condom breakage.
BMC Public Health 12/2011; 11 Suppl 6(Suppl 6):S14. DOI:10.1186/1471-2458-11-S6-S14 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Lives Saved Tool (LiST) model was developed to estimate the impact of the scale-up of child survival interventions on child mortality. New advances in antimalarials have improved their efficacy of treating uncomplicated and severe malaria. Artemisinin-based combination therapies (ACTs) for uncomplicated Plasmodium falciparum malaria and parenteral or rectal artemisinin or quinine for severe malaria syndromes have been shown to be very effective for the treatment of malaria in children. These interventions are now being considered for inclusion in the LiST model. However, for obvious ethical reasons, their protective efficacy (PE) compared to placebo is unknown and their impact on reducing malaria-attributable mortality has not been quantified.
We performed systematic literature reviews of published studies in P. falciparum endemic settings to determine the protective efficacy (PE) of ACT treatment against malaria deaths among children with uncomplicated malaria, as well as the PE of effective case management including parenteral quinine against malaria deaths among all hospitalized children. As no randomized placebo-controlled trials of malaria treatment have been conducted, we used multiple data sources to ascertain estimates of PE, including a previously performed Delphi estimate for treatment of uncomplicated malaria.
Based on multiple data sources, we estimate the PE of ACT treatment of uncomplicated P. falciparum malaria on reducing malaria mortality in children 1-23 months to be 99% (range: 94-100%), and in children 24-59 months to be 97% (range: 86-99%). We estimate the PE of treatment of severe P. falciparum malaria with effective case management including intravenous quinine on reducing malaria mortality in children 1-59 months to be 82% (range: 63-94%) compared to no treatment.
This systematic review quantifies the PE of ACT used for treating uncomplicated malaria and effective case management including parenteral quinine for treating severe P. falciparum malaria for preventing malaria mortality in children <5. These data will be used in the Lives Saved Tool (LiST) model for estimating the impact of scaling-up these interventions against malaria. However, in order to estimate the reduction in child mortality due to scale-up of these interventions, it is imperative to develop standardized indicators to measure population coverage of these interventions.
BMC Public Health 04/2011; 11 Suppl 3(Suppl 3):S14. DOI:10.1186/1471-2458-11-S3-S14 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of the study was to obtain a better understanding of the relative importance of personal factors, male partner factors and situational factors, in determining condom breakage in a population of female sex workers (FSWs) in Bangalore.
The authors conducted a cross-sectional study that included a face-to-face interview and condom application test, with 291 randomly selected FSWs in Bangalore, India, in early 2011.
Ninety-seven per cent of respondents noted condom use at last sex; 34% reported a condom breakage in the last month. Combining individual, situational and partner aspects of condom breakage into one logistic regression model and also controlling for client load, the authors found that partner and situational factors were dominant since the only significant predictors of condom breakage included being a paying client (adjusted odds ratio 4.61, 95% CI 1.20 to 17.58, p=0.025), the condom being too small for the penis (adjusted odds ratio 2.29, 95% CI 0.97 to 5.40, p=0.056) or too big for the penis (adjusted odds ratio 4.29, 95% CI 1.43 to 12.80, p=0.009) and rough sex (adjusted odds ratio 6.39 CI 3.55 to 11.52, p<0.001).
Condom use among Bangalore FSWs is now very high. However, condom breakage is still a not uncommon event and puts women and their clients at unnecessary risk of infection. It may be difficult to eliminate the problem completely, but every effort should be made to discuss with sex workers the findings of this survey that point to possible personal markers of risk seen in the univariate analysis and to highlight the importance of avoiding rough sex and of ensuring the condom fits the client.
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