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Round Up Condoms
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A 2008 Reproductive Health Matters. All rights reserved. Reproductive Health Matters 2008;16(31):233–234 0968-8080/08 $ – see front matter PII: S 0 9 6 8 - 8 0 8 0 ( 0 8 ) 31 3 61 - 5
www.rhmjournal.org.uk
ROUND UP
Condoms Condom use associated with decreased urethral discharge in Malawi An audit of clinic records charted the increasing availability of condoms with a concurrent decreased incidence of patients presenting with STI-associated urethral discharge in a small Malawian community largely isolated from neighbouring towns. During a three-month period of unavailability of condoms, urethral discharge incidence increased. When availability resumed, it declined again. This statistically significant pattern challenges local belief in Malawi that condoms have a damaging effect on sexual health.1 1. Metcalfe D. A negative association between condom availability and incidence of urethral discharge in a closed Malawian community. International Journal of STD & AIDS 2007;18(8):559–62.
Simultaneous use of multiple condoms in Cambodia Simultaneous use of multiple condoms, also called double bagging, is a common practice among US men who have sex with men, and a study in Thailand in 1995 found that 51% of female sex workers reported using multiple condoms with clients. It is commonly believed that this practice leads to frequent breakage due to friction between condoms, but there is little evidence either way. Of 1,638 randomly-selected military men in one region of Cambodia, 40% reported never having had sex with a sex worker, 55% had used condoms at last sex with a sex worker and 5% had had unprotected sex at their last encounter with a sex worker. 21% of those who had sex with sex workers reported using more than one condom at their last encounter (91% of these used two condoms, 9% used three condoms). Multiple condom users were younger, more likely to be in the lowest socio-economic strata, had initiated sexual activity more recently, had visited more sex workers in the previous month,
and were more likely to have sought their HIV serostatus despite having lower knowledge of HIV transmission. This suggests that multiple condom users feel vulnerable to HIV, despite limited knowledge. As they are not avoiding high-risk sexual partnerships, they may be using multiple condoms for protection instead, although it has never been promoted by any HIV prevention programme. Research is needed on the effect of multiple condom use on condom failure rates.1 1. Morineau G, Prybylski D, Song N, et al. Simultaneous use of multiple condoms among male Cambodian military personnel visiting female sex workers. Sexually Transmitted Diseases 2007;34(10):808–12.
Catholics in five countries believe good Catholics can use condoms A five-country poll of over 4,000 randomly sampled Catholics over the age of 18 shows that Catholics support the use of condoms. When asked if condoms are pro-life because they prevent the spread of HIV, 90% of Catholics in Mexico, 86% in Ireland, 79% in the US, 77% in the Philippines and 59% in Ghana agreed. The Vatican has refused to lift its ban on condoms, and this position holds the most sway in countries least able to deal economically and medically with the disease. A considerable number of Catholics agreed that the churchTs position is wrong: 79% in Ireland, 63% in the US and 60% in Mexico, but fewer in the Philippines (47%) and Ghana (37%), illustrating the influence of the VaticanTs teachings. Most people believe the church has a responsibility to include condoms in any AIDS prevention, with results varying from 87% of Irish Catholics to 60% of Ghanaian Catholics. Interestingly, apart from the Vatican, few Catholics have heard their bishops and priests preaching against condoms.1 1. Catholic attitudes on condoms in the prevention of HIV and AIDS: Analysis of a five-nation survey. Catholics for a Free Choice. Press statement, 2007.
233
Round Up: Condoms / Reproductive Health Matters 2008;16(31):233–234
Review of impact of promotion on condom use in sub-Saharan Africa and Asia This systematic review identified 62 papers published between 1998 and 2006 presenting evaluations of interventions involving condom promotion: 44 from sub-Saharan Africa and 18 from Asia. 42 reported significant increases in condom use. There is substantial evidence of interventions targeted at sex workers and clients achieving large increases in condom use (15 out of 19 studies found significant changes). These interventions primarily utilised peer education or other health education combined with STI testing and treatment. Far less evidence exists of intervention impact on condom use in casual relationships (three out of six studies found significant changes). In primary partnerships, post-intervention condom use was low unless one partner knew they had HIV or were at high risk, or condoms were used for avoiding pregnancy (nine out of 11 studies found significant changes). Among young people, eight out of 14 studies found significant but limited changes. The magnitude of increase in condom use, and the level of use achieved, are strongly influenced by partnership type and perceptions of risk, with findings often remarkably consistent across African and Asian settings. This review supports continued promotion of condoms as part of the response to the HIV epidemic.1 1. Foss AM, Hossain M, Vickerman PT, et al. A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia. Sexually Transmitted Infection 2007;83:510–16.
Female condoms improve public health in Madagascar Increasing the availability of female condoms can reduce STI risk. In Madagascar, 1,000 sex workers were followed for 18 months. Status for three STIs was assessed every six months, and condom use every two months. Male condoms were promoted for the entire period and female condoms were introduced during the final 12 months, during which the use of protection with paying partners increased (78% protection at six months, 83% at 12 months, 88% at 18 months). Use of protection with nonpaying partners remained low, fewer that 30% of sex acts. With the female condom added as an option, STI prevalence dropped: 52% at baseline, 50% at six months, 41% at 12 months and 40% at 18 months.1 234
1. Hoke TH, Feldblum PJ, Van Damme K, et al. Temporal trends in sexually transmitted infection prevalence and condom use following introduction of the female condom to Madagascar sex workers. International Journal of STD and AIDS 2007;18(7):461–66.
No condoms for Anambra State, Nigeria It is now illegal to encourage the use of condoms in southeast Nigeria’s Anambra State. The state government has also banned the advocacy and distribution of other forms of contraception, including intra-uterine devices and other ‘‘un-natural’’ birth control. The state commissioner for health claims that instead of teaching children how to use condoms they should be taught total abstinence. More than 3 million people are living with HIV and AIDS in Nigeria, and the rate is rising. Condoms are openly available partly because the federal government, in partnership with family health organisations, has programmes to advocate, distribute and sell them. Many religious groups around the country also back condom use, having recognised that messages urging abstinence have failed. The ban may have been designed to appeal to local evangelical groups and ‘‘uphold morals’’. The state government has also spoken against abortion, and say that medical practitioners will face stiff penalties if they are caught carrying out abortions.1 1. Nigeria: No condoms for Anambra State. IRIN News. 7 April 2008.
Female condom fails to take off in Kenya An estimated 740,000 women have HIV in Kenya. While 200,000 female condoms were supplied in 2007, consumption was only 10,000. The failure of the female condom to take off deprives women and men of one of the most effective ways to protect themselves against HIV infection. This failure is due to the high cost compared to male condoms, cultural barriers discouraging women from getting female condoms from government facilities, a shortage of accurate information on their use, and insufficient effort by the government to popularise them. Better marketing and more information is needed to ensure that women use the female condom.1 1. Kenya: what about the female condom? IRIN PlusNews. 14 September 2007.
A 2008 Reproductive Health Matters. All rights reserved. Reproductive Health Matters 2008;16(31):233–234 0968-8080/08 $ – see front matter PII: S 0 9 6 8 - 8 0 8 0 ( 0 8 ) 31 3 61 - 5
www.rhmjournal.org.uk
ROUND UP
Condoms Condom use associated with decreased urethral discharge in Malawi An audit of clinic records charted the increasing availability of condoms with a concurrent decreased incidence of patients presenting with STI-associated urethral discharge in a small Malawian community largely isolated from neighbouring towns. During a three-month period of unavailability of condoms, urethral discharge incidence increased. When availability resumed, it declined again. This statistically significant pattern challenges local belief in Malawi that condoms have a damaging effect on sexual health.1 1. Metcalfe D. A negative association between condom availability and incidence of urethral discharge in a closed Malawian community. International Journal of STD & AIDS 2007;18(8):559–62.
Simultaneous use of multiple condoms in Cambodia Simultaneous use of multiple condoms, also called double bagging, is a common practice among US men who have sex with men, and a study in Thailand in 1995 found that 51% of female sex workers reported using multiple condoms with clients. It is commonly believed that this practice leads to frequent breakage due to friction between condoms, but there is little evidence either way. Of 1,638 randomly-selected military men in one region of Cambodia, 40% reported never having had sex with a sex worker, 55% had used condoms at last sex with a sex worker and 5% had had unprotected sex at their last encounter with a sex worker. 21% of those who had sex with sex workers reported using more than one condom at their last encounter (91% of these used two condoms, 9% used three condoms). Multiple condom users were younger, more likely to be in the lowest socio-economic strata, had initiated sexual activity more recently, had visited more sex workers in the previous month,
and were more likely to have sought their HIV serostatus despite having lower knowledge of HIV transmission. This suggests that multiple condom users feel vulnerable to HIV, despite limited knowledge. As they are not avoiding high-risk sexual partnerships, they may be using multiple condoms for protection instead, although it has never been promoted by any HIV prevention programme. Research is needed on the effect of multiple condom use on condom failure rates.1 1. Morineau G, Prybylski D, Song N, et al. Simultaneous use of multiple condoms among male Cambodian military personnel visiting female sex workers. Sexually Transmitted Diseases 2007;34(10):808–12.
Catholics in five countries believe good Catholics can use condoms A five-country poll of over 4,000 randomly sampled Catholics over the age of 18 shows that Catholics support the use of condoms. When asked if condoms are pro-life because they prevent the spread of HIV, 90% of Catholics in Mexico, 86% in Ireland, 79% in the US, 77% in the Philippines and 59% in Ghana agreed. The Vatican has refused to lift its ban on condoms, and this position holds the most sway in countries least able to deal economically and medically with the disease. A considerable number of Catholics agreed that the churchTs position is wrong: 79% in Ireland, 63% in the US and 60% in Mexico, but fewer in the Philippines (47%) and Ghana (37%), illustrating the influence of the VaticanTs teachings. Most people believe the church has a responsibility to include condoms in any AIDS prevention, with results varying from 87% of Irish Catholics to 60% of Ghanaian Catholics. Interestingly, apart from the Vatican, few Catholics have heard their bishops and priests preaching against condoms.1 1. Catholic attitudes on condoms in the prevention of HIV and AIDS: Analysis of a five-nation survey. Catholics for a Free Choice. Press statement, 2007.
233
Round Up: Condoms / Reproductive Health Matters 2008;16(31):233–234
Review of impact of promotion on condom use in sub-Saharan Africa and Asia This systematic review identified 62 papers published between 1998 and 2006 presenting evaluations of interventions involving condom promotion: 44 from sub-Saharan Africa and 18 from Asia. 42 reported significant increases in condom use. There is substantial evidence of interventions targeted at sex workers and clients achieving large increases in condom use (15 out of 19 studies found significant changes). These interventions primarily utilised peer education or other health education combined with STI testing and treatment. Far less evidence exists of intervention impact on condom use in casual relationships (three out of six studies found significant changes). In primary partnerships, post-intervention condom use was low unless one partner knew they had HIV or were at high risk, or condoms were used for avoiding pregnancy (nine out of 11 studies found significant changes). Among young people, eight out of 14 studies found significant but limited changes. The magnitude of increase in condom use, and the level of use achieved, are strongly influenced by partnership type and perceptions of risk, with findings often remarkably consistent across African and Asian settings. This review supports continued promotion of condoms as part of the response to the HIV epidemic.1 1. Foss AM, Hossain M, Vickerman PT, et al. A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia. Sexually Transmitted Infection 2007;83:510–16.
Female condoms improve public health in Madagascar Increasing the availability of female condoms can reduce STI risk. In Madagascar, 1,000 sex workers were followed for 18 months. Status for three STIs was assessed every six months, and condom use every two months. Male condoms were promoted for the entire period and female condoms were introduced during the final 12 months, during which the use of protection with paying partners increased (78% protection at six months, 83% at 12 months, 88% at 18 months). Use of protection with nonpaying partners remained low, fewer that 30% of sex acts. With the female condom added as an option, STI prevalence dropped: 52% at baseline, 50% at six months, 41% at 12 months and 40% at 18 months.1 234
1. Hoke TH, Feldblum PJ, Van Damme K, et al. Temporal trends in sexually transmitted infection prevalence and condom use following introduction of the female condom to Madagascar sex workers. International Journal of STD and AIDS 2007;18(7):461–66.
No condoms for Anambra State, Nigeria It is now illegal to encourage the use of condoms in southeast Nigeria’s Anambra State. The state government has also banned the advocacy and distribution of other forms of contraception, including intra-uterine devices and other ‘‘un-natural’’ birth control. The state commissioner for health claims that instead of teaching children how to use condoms they should be taught total abstinence. More than 3 million people are living with HIV and AIDS in Nigeria, and the rate is rising. Condoms are openly available partly because the federal government, in partnership with family health organisations, has programmes to advocate, distribute and sell them. Many religious groups around the country also back condom use, having recognised that messages urging abstinence have failed. The ban may have been designed to appeal to local evangelical groups and ‘‘uphold morals’’. The state government has also spoken against abortion, and say that medical practitioners will face stiff penalties if they are caught carrying out abortions.1 1. Nigeria: No condoms for Anambra State. IRIN News. 7 April 2008.
Female condom fails to take off in Kenya An estimated 740,000 women have HIV in Kenya. While 200,000 female condoms were supplied in 2007, consumption was only 10,000. The failure of the female condom to take off deprives women and men of one of the most effective ways to protect themselves against HIV infection. This failure is due to the high cost compared to male condoms, cultural barriers discouraging women from getting female condoms from government facilities, a shortage of accurate information on their use, and insufficient effort by the government to popularise them. Better marketing and more information is needed to ensure that women use the female condom.1 1. Kenya: what about the female condom? IRIN PlusNews. 14 September 2007.