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Condoms
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A 2006 Reproductive Health Matters. All rights reserved. Reproductive Health Matters 2006;14(27):222–223 0968-8080/06 $ – see front matter PII: S 0 9 6 8 - 8 0 8 0 ( 0 6 ) 2 7 2 4 0 - 9
www.rhmjournal.org.uk
ROUND UP
Condoms 200 million condoms sold in Nigeria In a triumph for the acceptance of condoms, the Nigerian National Action Committee on AIDS (NACA) has announced that 200 million condoms have been used over the last four years. An estimated 83% of commercial sex workers now use or insist on the use of condoms. This acceptance of condoms for either contraceptive use or protection against sexually transmitted infection is a positive development which must be sustained in the fight against HIV/AIDS. Other promising indicators in the fight against AIDS are the seven million Nigerians who have taken part in voluntary counselling and testing for HIV, and the 100,000 mothers who have taken positive steps to prevent mother-to-child transmission.1 1. Odittah C. 200 million condoms sold in Nigeria. 4 December 2005. At: bhttp://allafrica.com/stories/ printable/200512050959.htmlN.
Nine out of ten condom users in Benin do not know the correct way to use them Some 314 female sex workers and 208 men in Benin were interviewed and asked to demonstrate on a wooden penis how they usually used male condoms. Using four criteria – tearing open the envelope at the notch, finding the correct side, holding the top of the condom to avoid air entering, and correct unrolling – only 11.0% of women and 11.2% of men showed correct condom use. Condom breakage was frequently reported by the sex workers and was significantly associated with incorrect use, especially not tearing the condom envelope at the notch and not holding the top to avoid air entering. This emphasises the need not only to make condoms available and widely used, but to educate people in their correct use.1 1. Mukenge-Tshibaka L, Alary M, Geraldo N, et al. Incorrect condom use and frequent breakage among female sex workers and their clients. International Journal of STD and AIDS 2005;16(5):345–47.
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Clients of sex workers in Cambodia fail to use condoms with their girlfriends Clients of sex workers (468) from 30 brothels in Cambodia were interviewed and had blood collected to investigate their role as possible bridges in the transmission of HIV to the general population. The prevalence of HIV among the men was high (9.2%). 64% of them were considered to have a high level of knowledge of HIV, understanding its mode of transmission and the role of condoms in prevention. 74% always used a condom with a commercial sex worker, comparable to rates among groups of men in the military (70%), police (81%) taxi drivers (70%) and general urban (73%) and rural (61%) populations, but considerably below the 90% target set by the government’s National Programme for HIV/ AIDS Prevention. Nevertheless, almost all clients (96%) had used a condom at last sex with a sex worker. However, only 34% had used a condom at last sex with their girlfriend and only 14% said they always used a condom with their girlfriend, thus providing a mechanism for clients of sex workers to act as a major bridge for HIV transmission to the general population. Cambodia has already seen an increasing proportion of HIV infections by transmission from husbands to their wives. Condom promotion programmes need to target marital intercourse as well.1 1. Hor LB, Detels R, Heng S, et al. The role of sex worker clients in transmission of HIV in Cambodia. International Journal of STD and AIDS 2005;16(2): 170–74.
Foreign clients of Singapore sex workers are less likely to use condoms than local clients A cohort of 677 migrant workers from other parts of Asia and 133 local workers, recruited from the streets and brothels of Singapore, were surveyed as to condom use with women sex workers. Foreign clients were more likely
Round Up: Condoms / Reproductive Health Matters 2006;14(27):222–223
than locals to be inconsistent condom users, with 29% of clients from China, for example, reporting inconsistent use compared with 8% of local clients. Inconsistent use among foreign clients increased significantly with the number of freelance sex workers. This indicates that condom promotion programmes aimed at migrant workers visiting Singapore’s sex workers may need to be separately designed according to their target audience.1 1. Wong ML, Chan RK, Koh D, et al. A comparative study of condom use and self-reported sexually transmitted infections between foreign Asian and local clients of sex workers in Singapore. Sexually Transmitted Diseases 2005;32(7):439–45.
Using condoms protects from criminal prosecution in New Zealand A New Zealand judge has ruled that an HIVpositive man cannot be prosecuted under New Zealand law for ‘‘criminal nuisance’’ after nondisclosure of his HIV status because he used a condom for vaginal sex, and because unprotected oral sex without ejaculation results in a negligible risk of HIV transmission. Although this was a case about HIV exposure, rather than transmission, lawyers in Britain see this as a groundbreaking decision, which may help to clarify their own prosecutions for ‘‘recklessly inflicting grievous bodily harm’’ by transmitting HIV to a sexual partner, as there is currently considerable uncertainty over whether English and Welsh law requires disclosure of HIV regardless of condom use.1 1. Bernard EJ. Groundbreaking New Zealand ruling finds condom use eliminates HIV disclosure requirement. October 2005. At: bhttp://www. aidsmap.com/en/news/99FCF282-21EF-4ED5-99FCB3A9E2E1A110.aspN.
Barriers to condom use in Mongolia Although there have been very few reported cases of HIV in Mongolia, it is probable that HIV infection will become more prevalent, as half of the population is under 20 and there is an increasing rate of sexually transmitted infections in young people. This is therefore an appropriate and key time to promote safer sex practices. Focus group discussions with teachers, health professionals and 17–19 year old female and, separately, male students suggest that condom use has promiscuous connotations despite endorsement by the Ministry of Health and NGOs. Male students were knowledgeable about condoms, citing them as the best method of protection from sexually transmitted infections, and some knew to check the expiry date and package integrity before use. About half the students agreed that negotiating condom use was a joint responsibility whereas the remainder followed the cultural norm that contraception was a woman’s responsibility. Barriers to condom use quoted by the girls included unplanned sex, monogamous pairings, the refusal of their partner to wear a condom and lack of funds to buy condoms. The male students agreed and said negotiating condom use could be very embarrassing as it implied promiscuity in either themselves or the girl concerned. Interestingly, the male students did not see the need to use condoms to protect themselves, assuming the girls they slept with were virgins, and were more concerned with social than health implications of infection. The suggestion that condoms should be distributed in schools as a health promotion intervention was strongly rejected by teachers and health professionals, being seen as too embarrassing and as an encouragement to have sex.1 1. Roberts AB, Oyun C, Batnasan E, et al. Exploring the social and cultural context of sexual health for young people in Mongolia: implications for health promotion. Social Science and Medicine 2005;60(7):1487–98.
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A 2006 Reproductive Health Matters. All rights reserved. Reproductive Health Matters 2006;14(27):222–223 0968-8080/06 $ – see front matter PII: S 0 9 6 8 - 8 0 8 0 ( 0 6 ) 2 7 2 4 0 - 9
www.rhmjournal.org.uk
ROUND UP
Condoms 200 million condoms sold in Nigeria In a triumph for the acceptance of condoms, the Nigerian National Action Committee on AIDS (NACA) has announced that 200 million condoms have been used over the last four years. An estimated 83% of commercial sex workers now use or insist on the use of condoms. This acceptance of condoms for either contraceptive use or protection against sexually transmitted infection is a positive development which must be sustained in the fight against HIV/AIDS. Other promising indicators in the fight against AIDS are the seven million Nigerians who have taken part in voluntary counselling and testing for HIV, and the 100,000 mothers who have taken positive steps to prevent mother-to-child transmission.1 1. Odittah C. 200 million condoms sold in Nigeria. 4 December 2005. At: bhttp://allafrica.com/stories/ printable/200512050959.htmlN.
Nine out of ten condom users in Benin do not know the correct way to use them Some 314 female sex workers and 208 men in Benin were interviewed and asked to demonstrate on a wooden penis how they usually used male condoms. Using four criteria – tearing open the envelope at the notch, finding the correct side, holding the top of the condom to avoid air entering, and correct unrolling – only 11.0% of women and 11.2% of men showed correct condom use. Condom breakage was frequently reported by the sex workers and was significantly associated with incorrect use, especially not tearing the condom envelope at the notch and not holding the top to avoid air entering. This emphasises the need not only to make condoms available and widely used, but to educate people in their correct use.1 1. Mukenge-Tshibaka L, Alary M, Geraldo N, et al. Incorrect condom use and frequent breakage among female sex workers and their clients. International Journal of STD and AIDS 2005;16(5):345–47.
222
Clients of sex workers in Cambodia fail to use condoms with their girlfriends Clients of sex workers (468) from 30 brothels in Cambodia were interviewed and had blood collected to investigate their role as possible bridges in the transmission of HIV to the general population. The prevalence of HIV among the men was high (9.2%). 64% of them were considered to have a high level of knowledge of HIV, understanding its mode of transmission and the role of condoms in prevention. 74% always used a condom with a commercial sex worker, comparable to rates among groups of men in the military (70%), police (81%) taxi drivers (70%) and general urban (73%) and rural (61%) populations, but considerably below the 90% target set by the government’s National Programme for HIV/ AIDS Prevention. Nevertheless, almost all clients (96%) had used a condom at last sex with a sex worker. However, only 34% had used a condom at last sex with their girlfriend and only 14% said they always used a condom with their girlfriend, thus providing a mechanism for clients of sex workers to act as a major bridge for HIV transmission to the general population. Cambodia has already seen an increasing proportion of HIV infections by transmission from husbands to their wives. Condom promotion programmes need to target marital intercourse as well.1 1. Hor LB, Detels R, Heng S, et al. The role of sex worker clients in transmission of HIV in Cambodia. International Journal of STD and AIDS 2005;16(2): 170–74.
Foreign clients of Singapore sex workers are less likely to use condoms than local clients A cohort of 677 migrant workers from other parts of Asia and 133 local workers, recruited from the streets and brothels of Singapore, were surveyed as to condom use with women sex workers. Foreign clients were more likely
Round Up: Condoms / Reproductive Health Matters 2006;14(27):222–223
than locals to be inconsistent condom users, with 29% of clients from China, for example, reporting inconsistent use compared with 8% of local clients. Inconsistent use among foreign clients increased significantly with the number of freelance sex workers. This indicates that condom promotion programmes aimed at migrant workers visiting Singapore’s sex workers may need to be separately designed according to their target audience.1 1. Wong ML, Chan RK, Koh D, et al. A comparative study of condom use and self-reported sexually transmitted infections between foreign Asian and local clients of sex workers in Singapore. Sexually Transmitted Diseases 2005;32(7):439–45.
Using condoms protects from criminal prosecution in New Zealand A New Zealand judge has ruled that an HIVpositive man cannot be prosecuted under New Zealand law for ‘‘criminal nuisance’’ after nondisclosure of his HIV status because he used a condom for vaginal sex, and because unprotected oral sex without ejaculation results in a negligible risk of HIV transmission. Although this was a case about HIV exposure, rather than transmission, lawyers in Britain see this as a groundbreaking decision, which may help to clarify their own prosecutions for ‘‘recklessly inflicting grievous bodily harm’’ by transmitting HIV to a sexual partner, as there is currently considerable uncertainty over whether English and Welsh law requires disclosure of HIV regardless of condom use.1 1. Bernard EJ. Groundbreaking New Zealand ruling finds condom use eliminates HIV disclosure requirement. October 2005. At: bhttp://www. aidsmap.com/en/news/99FCF282-21EF-4ED5-99FCB3A9E2E1A110.aspN.
Barriers to condom use in Mongolia Although there have been very few reported cases of HIV in Mongolia, it is probable that HIV infection will become more prevalent, as half of the population is under 20 and there is an increasing rate of sexually transmitted infections in young people. This is therefore an appropriate and key time to promote safer sex practices. Focus group discussions with teachers, health professionals and 17–19 year old female and, separately, male students suggest that condom use has promiscuous connotations despite endorsement by the Ministry of Health and NGOs. Male students were knowledgeable about condoms, citing them as the best method of protection from sexually transmitted infections, and some knew to check the expiry date and package integrity before use. About half the students agreed that negotiating condom use was a joint responsibility whereas the remainder followed the cultural norm that contraception was a woman’s responsibility. Barriers to condom use quoted by the girls included unplanned sex, monogamous pairings, the refusal of their partner to wear a condom and lack of funds to buy condoms. The male students agreed and said negotiating condom use could be very embarrassing as it implied promiscuity in either themselves or the girl concerned. Interestingly, the male students did not see the need to use condoms to protect themselves, assuming the girls they slept with were virgins, and were more concerned with social than health implications of infection. The suggestion that condoms should be distributed in schools as a health promotion intervention was strongly rejected by teachers and health professionals, being seen as too embarrassing and as an encouragement to have sex.1 1. Roberts AB, Oyun C, Batnasan E, et al. Exploring the social and cultural context of sexual health for young people in Mongolia: implications for health promotion. Social Science and Medicine 2005;60(7):1487–98.
223