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The female condom: Knowledge, attitude, and willingness to use. The first Italian study

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Abstract

Women account for nearly half the people living with HIV worldwide. This situation makes it necessary to improve prevention actions targeting women: the female condom is a good option. The study was conducted, the first in Italy, in a public AIDS Center on a sample of 162 participants (66.7% female, 33.3% men) who requested the HIV test. The objectives were: assess the current knowledge of the female condom; collect information on opinions, impressions and willingness to use the female condom. Participants were administered a Lickert-scale questionnaire after post-test counselling. The results are in line with international studies and show an early positive response, characterized by interest and openness to innovation, followed by resisting to use the female condom.
419
Ann Ist super sAnItà 2007 | Vol. 43, no. 4: 419-424
reseArch And MethodologIes/rIcerche e MetodologIe
Summary. Women account for nearly half the people living with HIV worldwide. This situation
makes it necessary to improve prevention actions targeting women: the female condom is a good
option. The study was conducted, the rst in Italy, in a public AIDS Center on a sample of 162
participants (66.7% female, 33.3% men) who requested the HIV test. The objectives were: assess
the current knowledge of the female condom; collect information on opinions, impressions and
willingness to use the female condom. Participants were administered a Lickert-scale questionnaire
after post-test counselling. The results are in line with international studies and show an early posi-
tive response, characterized by interest and openness to innovation, followed by resisting to use the
female condom.
Key words: HIV infection, female condom, knowledge, attitude.
Riassunto (Il prolattico femminile: conoscenze, atteggiamenti e disponibilità all’uso. Il primo studio
italiano). Nel mondo quasi la metà delle persone affette da HIV sono donne. Diventa necessario
quindi rafforzare gli interventi preventivi a loro mirati: il prolattico femminile rappresenta una
opportunità. Hanno partecipato allo studio 162 soggetti (66,7% donne, 33,3% uomini) che si erano
rivolti a una Unità Operativa AIDS di una Azienda Sanitaria Locale di Roma per effettuare il test
HIV. Gli obiettivi erano la valutazione del livello di conoscenza sul prolattico femminile e la raccol-
ta di informazioni sulle opinioni, impressioni e disponibilità a utilizzarlo. Nel counselling post-test
è stato somministrato un questionario del tipo scala Likert. L’esito della ricerca è in linea con gli
studi internazionali che mostrano un atteggiamento iniziale positivo, caratterizzato da interesse e
apertura verso la novità, seguito da una resistenza a utilizzarlo.
Parole chiave: infezione da HIV, prolattico femminile, conoscenze, atteggiamenti.
The female condom: knowledge, attitude,
and willingness to use. The rst Italian study
Laura Spizzichino(a), Giovanna Pedone(a), Pietro Gattari(a),
Anna Maria Luzi(b), Pietro Gallo(b), Rudi Valli(b) and Giovanni Rezza(b)
(a)Unità Operativa AIDS, Azienda Sanitaria Locale RME, Rome, Italy
(b)Dipartimento di Malattie Infettive, Parassitarie e Immunomediate,
Istituto Superiore di Sanità, Rome, Italy
INTRODUCTION
Women account for nearly half of all people living
with HIV worldwide: according to WHO estimates, as
of December 2006 there were 17.7 million HIV-positi-
ve women. Compared to 2004 the women living with
HIV in 2006 have increased by over one million. In so-
me regions, such as Eastern Europe, Asia and Latin
America, the proportion of women among HIV-po-
sitive people is in continuous growth, in Sub-Saharan
Africa 59% of HIV-infected adults are women [1].
According to data collected by Centro Operativo
AIDS (COA) which was last updated 31 December
2005, the proportion of women diagnosed with HIV
between 1985 and 2004 has increased progressively:
the male/female ratio which was 3.4 in 1985 had de-
creased to 2.2 by 2004 [2].
This situation makes it necessary to increase measu-
res of prevention which target women, favouring em-
powerment and providing innovative preventive tools.
The female condom is a relatively new device which
allows women to choose a barrier method of protec-
tion against both unwanted pregnancies and STD
(sexually transmitted diseases) transmission, therefore
constituting a valid alternative to the male condom. It
was made available in Europe for the rst time in 1992
in Great Britain, and has also been approved by the
Food and Drug Administration (FDA) for distribution
in the United States. In Italy it is not yet available [3].
It is a sheath made of polyurethane, with one end
sealed, and is formed by two different sized exible
rings; it has to be inserted into the vagina, and can
be positioned up to 8 hours before sexual intercour-
se, during which it forms a physical barrier between
the penis and the vagina. The smaller ring at the
closed end of the sheath is inserted deeply into the
vagina, while the bigger ring remains to the exterior
and covers the external genitalia [4]. Polyurethane is a
very thin material, stronger than the latex of which ma-
le condoms are made, and can be used with any kind
of lubricant. It conducts heat so well that sexual
Indirizzo per la corrispondenza (Address for correspondence): Laura Spizzichino, Unità Operativa AIDS, Azienda Sanitaria
Locale RME, Via Catone 20, 00192 Rome, Italy. E-mail: lauraspizzichino@gmail.com.
420 Laura Spizzichino, Giovanna Pedone, Pietro Gattari, et al.
sensitivity and natural pleasure are preserved.
Furthermore, it is not affected by changes in tempe-
rature and humidity, produces no side-effects, and
causes no alterations of the vaginal ora nor signi-
cant allergic or dermatological reactions. It can also
be used by people who are allergic to latex. Unlike
the male condom, it doesn’t constrict the penis.
In 2005 only 14 million female condoms were di-
stributed worldwide, compared to 6-9 billion male
condoms. One problem in achieving widespread di-
stribution in national programs has been its cost. In
an effort to address the problem of cost the Female
Health Company has developed a second generation
female condom (FC2). This new version has similar
physical characteristics to the original female con-
dom but is made of synthetic nitrile which utilizes a
more efcient manufacturing process, particularly at
higher volumes [5].
Used correctly, the annual risk rate of unwanted
pregnancies of the device at 5% is lower if compared
to the 6% gure of diaphragm and spermicide use
and is closer to the 3% rate of male condom use.
In vitro studies have shown that the female condom
provides an effective barrier to the passage of even
the smallest STD-causing organisms, including the
HIV virus.
Several clinical studies undertaken since when the
female condom rst appeared have demonstrated
its effectiveness [6-12] and a review of 41 studies
carried out in different countries and cultures have
shown that 50% to 70% of men and women found
the device to be acceptable. Couples participating in
the study reported that the use of the female con-
dom not only didn’t interfere with sexual sensitivity
and natural pleasure, but actually improved com-
munication between men and women about sex [3,
13]. This suggests that although it is useful to im-
plement female condom promotion programs which
target specic population groups, it is also essential
to carry out preliminary studies aimed at assessing
women’s attitudes towards this device.
From 1992 to the present, the female condom does
not seem to have attracted much scientic attention
in our country, in fact studies focusing on this device
have not been conducted either on the general po-
pulation or on vulnerable groups. This fact has lead
our research group to conduct an exploratory study
with the objective of assessing current female con-
dom knowledge in a sample of HIV-negative people,
and to collect information on this group’s opinions
and impressions of the device and how willing they
would be to use it.
MATERIALS AND METHODS
The study was carried out by an AIDS Unit of
the National Health Service (NHS) in Rome from
06/01/2005 to 07/31/2005 with the collaboration of
researchers working at the National Institute of
Health (Istituto Superiore di Sanità). The sample
was comprised of seronegative heterosexual adults
of age 18 or older who were not involved in prostitu-
tion and approached the NHS to have an HIV test.
After post-test counselling, an Italian abridged
version of the US Lickert-scale questionnaire was
administered to participants. The questionnaire was
divided into three sections. The rst section col-
lected demographic data; the second analysed male
condom use and knowledge of the female condom;
the third was compiled only after the participant
had been briefed about the female condom and its
use and was asked about impressions on the device
and willingness to use it.
Women were also questioned if they were interested
in using this new tool. If they agreed, they received a
package which contained three female condoms and
instructions for use. Correct use and insertion were
also explained directly by trained staff.
Finally, women willing to use the female condom
were asked to come back within three months in or-
der to refer about their experience, whether or not
they had decide to use it. Information were gathered
using a different Lickert-scale questionnaire derived
from Neiland’s study.
Data collected was inserted into a database, analy-
sed and processed using the Epi-Info Software of
Disease Control & Prevention, Atlanta (USA).
The female condoms used for the present study we-
re supplied free of charge and distributed exclusively
by the Female Health Company of London (UK).
RESULTS
The participants recruited were 162. The women
were 66.7% of the total, of whom 56.5% were in the
20-29 year age group and 26.9% were 30-39 (mean
age 29.3); 51.9% of the males were in the 20-29 year
age group and 27.8% were 30-39 (mean age 31.5).
From the educational point of view, 61.1% of ma-
les and 63.0% of females had a secondary school
degree, while 24.1% of males and 23.1% of females
were university educated; 87.0% of both sexes we-
re unmarried. Occupationally, 30.9% of males and
38.3% of females were students; 23.6% of males
and 29.9% of females were ofce workers/clerks and
14.6% of males and 6.5% of females were professio-
nals (Table 1).
About 18.5% of males and 13.9% of females repor-
ted a consistent use of male condom, while 14.8% of
males and 16.7% of females had never used it.
An extremely small number of participants ap-
proximately a fourth of each gender group – had ever
heard of the female condom.
Of those who had heard of the device, the main
sources of information were magazines or newspa-
pers (57.2% of males and 44.5% of females), friends
(35.7% of males and 22.2% of females), and televi-
sion (7.1% of males and 25.9% of females).
Nearly all participants regarded the female condom
both as a method of preventing unwanted pregnancies
as an alternative to the male condom (90.7% of males
and 87.0% of females) and as protection against STDs,
421
the feMAle condoM
HIV included (92.6% of males and 87.1% of fema-
les). Note that these rates are comparable.
Only a fourth of the participants stated that the
female condom was not more difcult to use than
the male condom. A good rate of men (11.1% com-
pared to 2.8% of women) did not express their opi-
nion; 59.2% of men and 37.1% of women stated that
the female condom would make it more difcult for
the woman to reach orgasm, while 42.6% of males
and 31.5% of females thought that it would have ne-
gative effects on the man’s orgasm (Table 2).
Overall, 18.5% of males and 27.8% of females sta-
ted they would not use the female condom even if it
were available in Italy. The reasons given for this are
shown in Table 3.
Finally, 67.6% of the women agreed to use the fe-
male condom – four women less than those who had
initially stated willingness to use it if it were on sale.
In the follow-up study, only 6 women out of the 73
who received the package containing three female
condoms came back to report on their experience;
2 women out of 6 didn’t use it because they had not
had sexual intercourses during the study period (3
months). The 4 women who used it reported they felt
more protected against both STDs, including HIV,
and unwanted pregnancies. They also appreciated
the fact that they themselves had been responsible
for the protection. Three women out of 4 felt em-
barrassed to use it, having chosen to put it on in the
presence of their partner before sexual intercourse.
Finally, answers to questions concerning sexual
pleasure and willingness to use the device again re-
ceived disparate answers which could not be classi-
ed (unpublished data).
DISCUSSION
Our data show that in Italy the existence of the
female condom is practically unknown; in fact, ve-
ry few participants had received any information on
the female condom through magazines, newspapers,
TV or friends, and none had ever seen one.
Table 1 | Demographic distribution of the participants
Characteristics Total population n. = 162 (%)
Gender Male Female Total
54 (33.3) 108 (66.7) 162
Age group
< 20
20-29 years
30-39 years
40-69 years
Total
2 (3.7)
28 (51.9)
15 (27.8)
9 (16.6)
54 (100.0)
5 (4.6)
61 (56.5)
29 (26.9)
13 (12.0)
108 (100.0)
7 (4.3)
89 (54.9)
44 (27.2)
22 (13.6)
162 (100.0)
Education
Junior high school
High school
University degree
Total
8 (14.8)
33 (61.1)
13 (24.1)
54 (100.0)
15 (13.9)
68 (63.0)
25 (23.1)
108 (100.0)
23 (14.2)
101 (62.3)
38 (23.5)
162 (100.0)
Civil status
Unmarried
Married
Cohabitant
Divorced
Legally separated
Widow/Widower
Total
47 (87.0)
2 (3.7)
0 (0.0)
2 (3.7)
3 (5.6)
0 (0.0)
54 (100.0)
94 (87.1)
4 (3.7)
1 (0.9)
3 (2.8)
5 (4.6)
1 (0.9)
108 (100.0)
141 (87.1)
6 (3.7)
1 (0,6)
5 (3.1)
8 (4.9)
1 (0.6)
162 (100.0)
Occupation
Unemployed
Retired
Student
Office-worker
Manager
Business owner
Entertainment sector
Professional
Undocumented workers
Craftsman
Journalist
Teacher
Military
Total
2 (3.6)
1 (1.8)
17 (30.9)
13 (23.6)
2 (3.6)
4 (7.3)
3 (5.6)
8 (14.6)
0 (0.0)
1 (1.8)
2 (3.6)
0 (0.0)
2 (3.6)
54 (100.0)
5 (4.7)
0 (0.0)
41 (38.3)
32 (29.9)
1 (0.9)
2 (1.9)
6 (5.6)
7 (6.5)
5 (4.7)
2 (1.9)
1 (0.9)
5 (4.7)
0 (0.0)
108 (100.0)
7 (4.3)
1 (0.6)
58 (35.8)
45 (27.8)
3 (1.9)
6 (3.7)
9 (5.5)
15 (9.2)
5 (3.1)
3 (1.9)
3 (1.9)
5 (3.1)
2 (1.2)
162 (100.0)
422 Laura Spizzichino, Giovanna Pedone, Pietro Gattari, et al.
Most of the male and female participants, having
been shown a female condom for the very rst time,
seemed rather worried that it would be difcult to
use. This could be overcome with appropriate trai-
ning programs. In fact, a correct and consistent use
has been reported to produce an increase in the le-
vel of acceptance among women by helping them to
overcome previous obstacles [14-16].
Training should also seek both to give women rea-
sons for using the condom and to increase their abi-
lity to negotiate sex, thus also taking into account
the cultural characteristics of the different targets
involved.
For example, in Kenya and Zimbabwe the fema-
le condom promotion campaigns have particularly
stressed the contraceptive function rather than the
protective one, thus giving women in those countries
more chances of convincing their sexual partners to
accept the female condom since in those cultures the
use of STD prevention devices indicates sexual pro-
miscuity and indelity [3].
From the point of view of sexual pleasure and or-
gasm for both males and females, men showed to be
more pessimistic than women. This could be due to
both lack of knowledge and prejudice, since different
studies have proven that the female condom has no ne-
gative effects on the quality of sexual intercourse [3].
Most adults interviewed showed to be willing to
use the female condom or to try it if it was on sale
in Italy. A wider availability could promote the plan-
Table 2 | Attitudes towards female condoms
Attitudes Total population n. = 162 (%)
Gender Male Female Total
54 (33.3) 108 (66.7) 162
Do you think that they give better protection against
unwanted pregnancies than male condoms?
Totally agree
Partially agree
Mostly disagree
Totally disagree
Don’t know
Total p = 0.33
33 (61.1)
16 (29.6)
1 (1.9)
4 ( 7.4)
0 (0.0)
54 (100.0)
58 (53.7)
36 (33.3)
7 (6.5)
4 (3.7)
3 (2.8)
108 (100.0)
91 (56.2)
52 (32.1)
8 (4.9)
8 (4.9)
3 (1.9)
162 (100.0)
Do you think that they are more difficult to use than male
condoms?
Totally agree
Partially agree
Mostly disagree
Totally disagree
Don’t know
Total p = 0.10
18 (33.3)
16 (29.6)
5 (9.3)
9 (16.7)
6 (11.1)
54 (100.0)
47 (43.5)
27 (25.0)
18 (16.7)
13 (12.0)
3 (2.8)
108 (100.0)
60 (40.1)
43 (26.5)
23 (14.2)
22 (13.6)
9 (5.6)
162 (100.0)
Do you think they make female orgasm more difficult to
achieve?
Totally agree
Partially agree
Mostly disagree
Totally disagree
Don’t know
Total p = 0.0020
16 (29.6)
16 (29.6)
7 (13.0)
5 (9.3)
10 (18.5)
54 (100.0)
11 (10.2)
29 (26.9)
16 (14.8)
36 (33.3)
16 (14.8)
108 (100.0)
27 (16.7)
45 (27.8)
23 (14.2)
41 (25.3)
26 (16.0)
162 (100.0)
Do you think they make male orgasm more difficult to achieve?
Totally agree
Partially agree
Mostly disagree
Totally disagree
Don’t know
Total p = 0.24
14 (25.9)
9 (16.7)
10 (18.5)
21 (38.9)
0 (0.0)
54 (100.0)
19 (17.6)
15 (13.9)
17 (15.7)
50 (46.3)
7 (6.5)
108 (100.0)
33 (20.4)
24 (14.8)
27 (16.7)
71 (43.8)
7 (4.3)
162 (100.0)
Do you think that they give a better protection against
STDs, HIV included?
Totally agree
Partially agree
Mostly disagree
Totally disagree
Don’t know
Total (p = 0.52)
35 (64.8)
15 (27.8)
1 (1.9)
3 (5.5)
0 (0.0)
54 (100.0)
61 (56.5)
33 (30.6)
6 (5.5)
5 (4.6)
3 (2.8)
108 (100.0)
96 (59.3)
48 (29.6)
7 (4.3)
8 (4.9)
3 (1.9)
162 (100.0)
423
the feMAle condoM
ning and development of female condom promotion
programs which would target women in general and
not only high risk sub-groups.
It was also interesting to analyse the reasons why
people don’t want to use it. Women reported more
objective difculties (“difcult insertion” and “trou-
ble during sexual intercourse”), while men reported
reasons having more to do with psychological issues.
Therefore, it could be argued that while female dif-
culties could be more easily overcome by instruction
and frequent use of the female condom, the male
hurdles could be more complex to overcome and
could ultimately negatively inuence use of the de-
vice in couples. Promotional programs should there-
fore be designed to reach out to males in particular,
as is clearly suggested by international guidelines
[17]. Although the device is physically used by fema-
les, sexual intercourse involves decisions which must
be taken by both members of the couple.
Almost all the women who were described the de-
vice showed a certain dose of curiosity, interest and
willingness, and accepted to try it after having been
shown the condom.
It appears extremely important not only to widely
publicize the female condom, but also to help women
overcome the initial barriers and motivate them to use
the device in groups where it is possible for them to
discuss the difculties and successes they encounter.
Another motive that the amount of women who
did return after the rst phase of the study was so
high could be due to the fact that during the time
frame given they did not have sexual intercourse or
could not convince their sexual partners to accept
its use. In fact, as opposed to previous studies in
which high risk female groups such as sex workers
were chosen [14, 18], in this study women from a low
risk group took part. This decision was taken since
there was no initial training period involved and an
incorrect use of the device would increase the risk
of exposure to HIV and other STDs among partici-
pants who are already highly exposed.
However, the outcome of the study is in line with
international studies which also conrm an early
positive response, characterized by interest, curiosi-
ty and openness to innovation, followed by a resi-
stance to use the device.
When designing and planning female condom pro-
motional activities, the opinions of health workers
involved in the study must not be ignored and should
be taken into account. A study on a female condom
promotion campaign carried out in rural commu-
nities in Kenya [19] showed that it was the health
workers themselves who supported the women in
the use of hormonal contraceptives, sustaining that
the female condom was more suitable for women
without a partner or prostitutes, and therefore they
did not recommend its use [20].
In conclusion, although our ndings are not en-
couraging, we believe that the female condom re-
mains an option to be considered for the prevention
of HIV infection among women even in our coun-
try. Promotional strategies and training activities
should be designed to increase the willingness to use
the device in settings in which valid alternatives to
male condom use are necessary.
Acknowledgments
We would like to thank The Female Health Company, Chicago
IL/London UK for having supplied our study with female con-
doms. We also thank Torsten B. Neiland and Kyung-Hee Choi
of the Center for AIDS Prevention Studies, University of San
Francisco, California, for having allowed us to use the abridged
version of the questionnaire they validated.
Received on 22 February 2007.
Accepted on 25 June 2007.
Table 3 | Reasons for unwillingness to use female condoms (more than one answer)
Reasons Male % Female % Total %
Difficult insertion 2 13.3 13 35.2 15 28.8
Uneasiness during intercourse 1 6.7 11 29.7 12 23.1
Preference for male condom 2 13.3 5 13.5 7 13.5
Psychological barriers 9 60.0 4 10.8 13 25.0
Lack of trust as far as protection is concerned 1 6.7 3 8.1 4 7.7
Preference for unprotected sex with HIV-seronegative partners 0 0.0 1 2.7 1 1.9
Total 15 100.0 37 100.0 52 100.0
p = 0.01.
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Tweedy KG, Welsh MJ. Female condom introduction and
sexually transmitted infection prevalence: results of a com-
munity intervention trial in Kenya. AIDS 2001;15:1037-44.
... 18 In spite of these findings, the authors of the first family condom study in Italy using a Lickert-scale questionnaire after post-test counselling consider that promotional strategies and training activities should be designed to increase willingness to use the female condom. 19 Research done in ...
... The determination of knowledge was, therefore, done using six questions based on the conclusions and findings of various previous studies as discussed in the literature review. 6,18,19 'Knowledgeable on female condom use' was determined if a participant correctly answered four or more questions of the six knowledge questions. 'Not knowledgeable' was determined if a participant answered fewer than four of the six knowledge questions correctly. ...
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The female condom is the only current method for female partners to simultaneously prevent both pregnancy and sexually transmitted infections. Studies of various contraceptive methods suggest that providers’ acceptance and endorsement may be a key factor in their clients’ uptake and continued use of a method. Our aim in this study was to assess the relationship between nurses’ knowledge of and their willingness to promote female condom use in 18 public healthcare facilities within the Johannesburg District. The mean score of correct answers of 398 nurses completing an anonymous, self-administered, six-item questionnaire was 4 out of a maximum of 6. Data analysis included the use of descriptive statistics and a chi-square test. It was found that 79% of participants were knowledgeable but only 59% were willing to promote female condom use. There was no association between knowledge of and willingness to promote female condom use. The following significant associations with knowledge and willingness to promote female condom use were found: family planning experience, being employed by a local government authority, working in a primary care clinic and having had informal training on female condom use. Informal training of nurses within the family planning unit in the clinics has the potential to improve nurses’ knowledge and willingness to promote female condom use. Significance: • This is the first study conducted in South Africa on the knowledge of and willingness of healthcare providers to promote female condom use. • An effective strategy is needed to motivate healthcare workers to promote female condom use with their patients. • Informal training of nurses within the family planning unit has the potential to improve nurses’ knowledge of and willingness to promote female condom use.
... Observations from the present study were also underscored by Spizzichino et al. [26] in their study done in Italy in 2001 where they found 71.4% women had heard the device from mass media (magazines or newspapers and television) and few from friends (22.2%). Spizzichino et al. [26] at also noted that female condom was regarded as a method of preventing unwanted pregnancies (87.0%) and protection against STIs infection. ...
... Observations from the present study were also underscored by Spizzichino et al. [26] in their study done in Italy in 2001 where they found 71.4% women had heard the device from mass media (magazines or newspapers and television) and few from friends (22.2%). Spizzichino et al. [26] at also noted that female condom was regarded as a method of preventing unwanted pregnancies (87.0%) and protection against STIs infection. The variation on sources of information on female condom from health workers in the present study and those reviewed might be even health workers in Tanzania have low knowledge on female condom or Tanzania students rare visit health centers where they could get information on female condom and other related health issues. ...
... The female condom could be less lucrative when bought or sold in sale spots, where most folks would prefer to buy iii. Male counterparts could be reticent to adopt the female condom [36] Mass media as the major source providing knowledge on the female condom in this study, was also underscored by reporters in Italy [37], in Nigeria [31] and Tanzania [38,39]. Televisions, radios, newspapers and magazines are available and easily accessible in most urban towns and homes in Cameroon, and they are influential in disseminating information on the female condom. ...
... Majority of the respondents in this study had unfavourable attitudes towards the female condom. These results contradict those obtained in studies done in Zimbabwe [16], Nigeria [31], Rwanda [44] and Italy [37], where respondents manifested favourable attitudes towards the female condom. This could be the result of failure of the female condom social marketing programme in improving the attitudes of the youth in Kumba, regarding the female condom. ...
... However, most of them knew its role in preventing STIs (77%), and protecting against unwanted pregnancies. This rate was 61% in the spizzichino series [13] . Similarly, the oiler in 2013 [12] and kessler in 2005 [14] reported 59% and 70% for knowledge of Pf as a contraceptive method. ...
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Introduction: The female condom is a polyurethane sheath that fits into the vagina before the sexual act, protecting the woman against both sexually transmitted infections, including HIV, and unwanted pregnancies. Objectives. We assessed the attitudes and practices of the female condom among female students in three faculties at the University of Douala. Methods: We conducted a prospective, cross-sectional and analytical study of female students aged at least 21 years old and willing to participate in the study. We excluded those who were not sexually active, as well as those whose cards were poorly completed. A pre-tested and questionnaire was used to collect socio-demographic characteristics, attitudes and practical knowledge of female condom students. The rating tables have been established. Data was analyzed using SPSS version 2.0 software. Results: A total of 320 students were enrolled in the study. The average age was 23.6 ± 4 years old. The majority of participants were single. 74.4% were poorly knowledgeable, 17.5% had average knowledge, and 0.3% had good knowledge of female students. The attitude regarding the female condom was unfavorable at 83.3% and indeterminate at 16.2%. The female condom use rate was 8.4% with a user satisfaction rate of 7.4%. Conclusion: Students in these 3 faculties have poor knowledge of the female condom. Their attitude is unfavorable, and its use infrequent and unsatisfactory
... (Adeokun et al., 2002;Agha & Van Rossem, 2002) y muy pocos de ellos han recurrido a muestras occidentales. De modo que se disponen de pocos estudios con muestras occidentales, en su mayoría realizados con mujeres norteamericanas (Lawson et al., 2003), siendo muy escasos los llevados a cabo en Europa (Gollub, bros, Sovouillan Waterlot, & Coruble, 2002;Spizzichino et al., 2007), y menos aún en nuestro país (Lameiras, Saco, Failde, & Rodríguez, 2006;Núñez, 2006). ...
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The female condom (FC) is among the barrier method that provides double protection against unwanted pregnancy and sexually transmitted infections, including HIV and AIDS. Globally, by the year 2012, the distribution of the female condom had increased to 60 million units per year. In South Africa, policymakers recognize the role of female condoms and have included them in the policy for contraception and dual protection. The female condom was introduced in Kenya 25 years ago but the utilization rates are still low at a prevalence rate of 10.8% (Boraya et al., 2018). Worldwide, youths are more sexually active than any other population group. This in return predisposes them to risks like unwanted pregnancies, unsafe abortions, and sexually Transmitted Infections including HIV/AIDS (Access, 2017). Despite the efficacy of the female condom, relatively low utilization rates are still reported, even in developing countries. Knowledge of female condom use, perception, and attitude among women can influence the utilization of this product. This study aimed to assess the individual factors that influence the utilization of female condoms in Kisauni Sub-County, Mombasa-Kenya. A descriptive cross-sectional study design was employed. A total of 148 women between the ages of 18 and 24 years was sampled. A multi-stage cluster sampling method was used. Structured questionnaires and Focused Group Discussions were used to collect data. Descriptive analysis, chi-square model, and multivariate analysis were used to analyze the qualitative data. The level of significance was fixed at a P value of 0.05 (P=0.05). Qualitative data from FGDs were analyzed thematically. Chi-square test of independence showed no significant relationship between the age of the participant and female condom use (p > 0.05, χ 2 = 0.249, df = 1). The prevalence of female condom use among women aged 18 to 24 years sampled in this study was 12.8%. The association between marital status and the use of female condoms was insignificant (p>0.05, df=2, likelihood ratio=1.377). A chi-square test for independence between the level of education and the use of female condoms showed no significant relationship (p > 0.05, χ 2 = 0.530, df = 2). There was no significant association between the employment status and female condom utilization (p > 0.05, df = 2, Likelihood ratio=2.461), among the participants. There was no significant association between the participants' religion and female condom utilization (p > 0.05, χ 2 = 1.434, df = 2) as observed from the results.
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Intimate partners of people living with HIV are at risk of HIV infection. We assessed the acceptability of female condom use among 89 married, heterosexual, HIV-serodiscordant couples from Sichuan and Hunan provinces in China for this prospective observational cohort study. Participants used female condoms for 3 months, reporting use and attitudes in written logs and questionnaires. At the end of the study, 58.4% of couples expressed willingness to continue using female condoms. Factors associated with willingness to use female condoms were (a) the female partner reporting having experienced forced sex by the male partner, (b) applying a lubricant to the penis, (c) understanding the correct application method, (d) being married more than 20 years, and (e) experiencing no difficulty during the first use. Most HIV-serodiscordant couples found female condoms to be acceptable. Increasing access to female condoms could be an acceptable alternative barrier method to male condoms for preventing HIV transmission.
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The objective of this study was to analyze knowledge, experiences and beliefs in the sexual reproductive field of prevention of Sexually Transmitted Diseases (STDs) in students enrolled in the 1st and 2nd years of high school from different socioeconomic backgrounds. This was a descriptive and analytical cross-sectional investigation of a convenience sample of 258 students in Belo Horizonte - MG, in schools classified as A, B2 and C1, according to economic status criterion. Results showed that socioeconomic position was relevant to differences between students enrolled at the three schools as to initiation of sexual intercourse and knowledge. This difference was not significant as to parent-adolescent sexual orientation. Students enrolled at school A demonstrated greater mastery of contents, although some unknowns that are essential to a practice less vulnerable have also proved to be independent of parental socioeconomic and educational level. The limitations of knowledge associated to beliefs and life experiences of sexuality contributed to a greater vulnerability of STI, teenage pregnancy and the consequences related to gender and sexual violence. The results indicate the urgency for seeking investigative and interventional alternatives that give breadth to sexuality discussions with teenagers including approaches such as gender, generation, violence in intimate relationships, sexual and reproductive rights and access to health care so that teenagers see themselves as protagonists in their way of being and self-expression of sexuality.
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Background: Proper use of condom prevents Sexually Transmitted Infections (STIs) and unwanted pregnancies. Efforts have been made in Rwanda to raise the population awareness on the use of the Female Condom but little is known about the current status of its use among college students. Objectives: To assess the knowledge, attitudes and use of the female condom among undergraduates of Kigali Health Institute. Methods: A descriptive study was carried out between May and June 2010. The sample was randomly selected from the students of Kigali Health Institute. A questionnaire based study was conducted involving 429 students. It captured the sample characteristics, their knowledge, attitudes and use of the female condom. The data were entered and analysed in SPSS 16.0. Results: About 79% of the students were aware of the female condom, but only 24% knew how to use it. Most respondents believed that the female condom can prevent the unwanted pregnancies (78%), the STIs and HIV/AIDS (81%). About 8% had ever tried it and less than three percent cited it as their contraception method. Conclusion: Awareness of the female condom was high but few students knew how to use it. Overall, favourable attitudes were recorded though neutral ones were higher and use of female condom was very low. Key words: Knowledge, attitude, use, female condom
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A cross-sectional study of female condom awareness, usage and concerns among the female undergraduates of the University of Ibadan was conducted in September 2004. The results of 850 out of the 879 female students interviewed were used for analysis (96.6%). Over 80% had knowledge of the female condom as a form of modern contraception and the majority of them learnt about it through the mass media (39.9%) and health workers (34.4%). However, only 11.3% had ever used the female condom, with most (40%) using it to prevent both unwanted pregnancy and sexually transmitted infections including HIV (STI/HIV). The sexual partners' approval was appreciable, accounting for about 42.7% among those that had experience of the female condom usage. Major concerns mentioned such as difficulty of inserting it into the vagina and lack of sexual satisfaction, were not different from those in earlier studies. The result of this study looks promising judging from a high awareness level of the female condom, even though its usage is low. The female condom may be an alternative strategy to combat unsafe sexual practises and its sequelae in a country like Nigeria that is male dominated.
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Several case-control studies suggest that the male condom protects women against some sexually transmitted diseases. The female condom is the first barrier device under the woman's control that may be effective in the prevention of sexually transmitted diseases. To determine if appropriate use of the female condom decreased the rate of recurrent vaginal trichomoniasis in previously diagnosed and treated women. One hundred and four sexually active women with vaginal trichomoniasis were treated with metronidazole and assigned to a group using the female condom or a control group during a 45-day period of continued sexual activity. Fifty women served as controls, and 54 women were assigned to use the female condom. Only 20 women used the female condom each time they had sexual intercourse. Reinfection with trichomonas occurred in 7/50 (14%) controls, in 5/34 (14.7%) noncompliant users, and in 0/20 compliant users of the female condom. The compliant use of the female condom is effective in preventing recurrent vaginal trichomoniasis.
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Unlabelled: THE NEED FOR PREVENTION: Women throughout the world face a growing risk of infection with HIV. Consistent condom use, one cornerstone of primary prevention strategy, is not always feasible for many women. Consequently, women urgently need infection prevention technology that is within their personal control. Methods: This session will review current efforts to develop and test female-controlled methods for preventing sexual transmission of HIV and other sexually transmitted pathogens. Both physical and chemical methods will be summarized, including recent findings concerning the efficacy and acceptability of the vaginal pouch (female condom), as well as an overview of research on vaginal microbicides. Data from studies of existing over-the-counter spermicides will be reviewed. The wide range of novel microbicidal products currently being evaluated in the laboratory and early clinical trials demonstrate the breadth of possibilities presented by chemical barrier methods. However, formidible challenges face public and private sector research and development efforts. This session will conclude by highlighting several issues related to the clinical evaluation and introduction of female-controlled prevention technology.
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The male condom is the most effective barrier method available for protection against sexually transmitted diseases (STDs), including HIV infection. There is an urgent need to develop and evaluate other prevention methods, such as the female condom. This study estimated the additional protection against STDs offered to sex workers by giving them the option of using the female condom when clients refused to use a male condom. Sex establishments in four cities in Thailand were randomized into two study groups: one in which sex workers were instructed to use male condoms consistently (male condom group); and one in which sex workers had the option of using the female condom if clients refused or were not able to use male condoms (male/female condom group). Randomization was done by sex establishments, and not by individuals, to minimize sharing of female condoms across study groups. The proportion of unprotected sexual acts (defined as sexual acts in which condoms were not used, tore, or slipped in or out) and incidence rate of STDs (gonorrhoea, chlamydial infection, trichomoniasis and genital ulcer disease) were measured over a 24-week period and compared between the two study groups. Results are available from 34 sex establishments (249 women) in the male/female condom group, and 37 sex establishments (255 women) in the male condom group. Condom use was very high in both groups (97.9 and 97.3 % of all sexual acts, respectively, P > 0.05). Male condom use was lower in the male/female condom group when compared with the male condom group (88.2 and 97.5%, respectively, P < 0.001). However, this reduction in male condom use was counterbalanced by the use of female condoms in 12.0% of all sexual acts in the male/female condom group, contributing to a 17% reduction in the proportion of unprotected sexual acts in this group when compared to the male condom group (5.9 versus 7.1%, respectively, P = 0.16). Female condom use was sustained over the entire study period. There was also a 24% reduction in the weighted geometric mean incidence rate of STDs in the sex establishments of the male/female condom group compared to the male condom group (2.81 versus 3.69 per 100 person-weeks, P = 0.18).
Article
To measure the impact on sexually transmitted infection (STI) prevalence of a female condom introduction and risk-reduction program at Kenyan agricultural sites. We conducted a cluster-randomized trial to determine whether a replicable, community-level intervention would reduce STI prevalence. Six matched pairs of tea, coffee and flower plantations were identified. The six intervention sites received an information/motivation program with free distribution of female and male condoms, and six control sites received only male condoms and related information. Participants were tested for cervical gonorrhea and chlamydia by ligase chain reaction on urine specimens, and vaginal trichomoniasis by culture, at baseline, 6 and 12 months. Participants at intervention (n = 969) and control sites (n = 960) were similar; baseline STI prevalence was 23.9%. Consistent male condom use was more than 20% at 12 months. Consistent female condom use was reported by 11 and 7% of intervention site women at 6 and 12 months. Unadjusted STI prevalence was 16.5 and 17.4% at 6 months, and 18.3 and 18.5% at 12 months, at the intervention and control sites, respectively. Logistic regression models confirmed the null effect of the female condom intervention. Female condom introduction did not enhance STI prevention at these sites. It is unclear which aspects of the intervention -- STI education, condom promotion, case management -- were associated with decreased STI prevalence from baseline to follow-up.
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Comparison of male condom (MC) vs. female condom (FC) with respect to self-reported mechanical and acceptability problems and semen exposure using prostate-specific antigen (PSA) as an objective biological marker and evaluation of the effect of an educational intervention on self-reported problems and semen exposure, by condom type. Randomized crossover trial. Four hundred women attending a family planning clinic in Brazil were randomized and either received in-clinic instruction or were encouraged to read the condom package insert; all used two FCs and two MCs. We measured the rates of self-reported user problems with MC and FC use and the rates of semen exposure during use (assessed by testing vaginal fluid for PSA). The educational intervention group reported fewer problems with either condom as compared with the control group (p = .0004, stratified by condom type). In both groups, self-reported problems were more frequent with FC use than with MC use (p < .0001, stratified by intervention). The educational intervention did not significantly reduce semen exposure. Overall, semen exposure occurred more frequently with FC use (postcoital PSA, > 1 ng/mL; 22%) than with MC use (15%); the difference, however, was small and nonsignificant for high PSA levels (> or = 150 ng/mL; 5.1% for FC vs. 3.6% for MC). In this study, the FC was less effective than the MC in preventing semen exposure during use and led more frequently to self-reported user problems. Both devices were highly protective against "high-level" semen exposure, as measured by postcoital PSA levels in vaginal fluid. In-clinic education may reduce user problems and increase acceptability and use of both devices.
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We carried out an evaluative study on factors associated with long-term use of female condoms for STI/HIV prevention. A total of 255 women and 29 men who were using female condoms for at least 4 months participated in qualitative/quantitative interviews. The study was conducted in six Brazilian cities. Four primary themes were identified as influencing acceptability and adoption of the female condom: (1) personal "assistance" (counseling) during the early adoption phase; (2) safety; (3) pleasure; and (4) increased sense of power for safer sex negotiation. Alternate use of male and female condoms was the norm among participants, but for approximately one third of the sample, the female condom was the preferred option for safer sex. The study findings suggest that providing clients with explicit and sustained intervention strategies may have a decisive influence on long-term adoption of female condoms.
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The female condom remains the only female-initiated method for preventing pregnancy and STDs, including HIV. Innovative methods for promoting its use, and for involving male partners in its use, are needed. A sample of 217 women and their main male sexual partners were randomly assigned to one of three study conditions: a six-session relationship-based STD prevention intervention provided to the couple together, the same intervention provided to the woman only or a single-session education control provided to the woman only. Assessments were conducted at baseline and three months postintervention. Contrast coding was used to examine whether the effects of the two active interventions differed from those of the control intervention, and whether the effects of the two active interventions differed from each other. Regression analyses were used to estimate treatment effects. During follow-up, participants in either active intervention were more likely to use a female condom with their study partner and with all partners, and used female condoms at a higher rate with all partners, than individuals assigned to the control intervention; at the end of three months, they were more likely to intend to use the condom in the next 90 days. No significant differences in outcomes were found between the active intervention groups. Focusing on both a woman and her main male sexual partner is efficacious in increasing female condom use and intention to use among heterosexual couples at risk for HIV and other STDs.
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We conducted a systematic review of 137 articles and abstracts related to various aspects of the female condom, as well as a closer analysis of five randomized controlled trials on effectiveness. These five studies indicated strongly the benefits of female-condom use in increasing protected sex acts, and two studies found promising decreases in sexually transmitted infection (STI) incidence with the introduction of the female condom. Ten studies provided detailed information on patterns of long-term use, many suggesting that the female condom reaches women less likely to use other dual protection methods. There exists limited but convincing evidence that the female condom is effective in increasing protected sex and decreasing STI incidence among women. Future research on the female condom must move away from assessing acceptability and focus on assessing effectiveness and improving impact in diverse settings.