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Round Up Condoms
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A 2007 Reproductive Health Matters. All rights reserved. Reproductive Health Matters 2007;15(29):204–207 0968-8080/06 $ – see front matter PII: S 0 9 6 8 - 8 0 8 0 ( 07 ) 2 9 2 91 - 2
www.rhmjournal.org.uk
ROUND UP
Condoms A condom named ‘‘NYC’’
‘‘No glove, no love’’ in Kenya
With the government’s imprimatur and a condom wrapper inspired by New York’s subways, city workers and volunteers in New York City handed out more than 150,000 condoms at numerous subway stations across the city on 14 February, Valentine’s Day. In June 2005, the city started an internet-based Free Condom Initiative to provide community and social service organisations with condoms. Since then, the number of condoms distributed has soared to 1.5 million a month from about 300,000. On Valentine’s Day last year, the health department announced that it was developing the first New York City-branded condom. The black plastic wrapper simply says bNYC condomQ on the front, with each letter in a coloured circle, like the letters used by the transport authority to denote subway lines. The condoms are available at more than 100 night spots and retail outlets and in bulk orders to clinics and community groups.1
Kenya has a national HIV prevalence of 5.9%. Prevalence in young women is 7.7%, almost twice as high as in young men of the same age. However, recent research shows that HIV prevention messages disseminated in schools and via the media and celebrity campaigns are getting through to young women. More than 70% of young Kenyan women use condoms to prevent pregnancy, HIV and other STIs, according to a study conducted by research group Infotrak Research & Consulting, in conjunction with a young women’s magazine, Eve Girl. 2,400 young women aged 18–25 in Kenya’s eight provinces were interviewed as part of the Sex Track study. Only 24% did not use condoms during intercourse, while 54% used them bpersistentlyQ. The same survey also found that many young women fail to continue using condoms consistently after initial sexual encounters. A government programme sponsored by the World Bank buys and distributes hundreds of millions of condoms each year in Kenya, with an additional 150 million privately purchased.1
1. Chan S with Zeller Jr T. A new condom in town named bNYCQ. New York City distributed 150,000 of its own brand of condoms Wednesday. New York Times, 15 February 2007.
204
1. No Glove, No Love: young women take charge of condom use. IRIN News. 28 February 2007.
Round Up: Condoms / Reproductive Health Matters 2007;15(29):204–207
Campaign for men to protect their wives from HIV in India A national campaign launched by the human rights organisation Breakthrough in India asks men to wear condoms to protect their wives from HIV. Two million women in India are estimated to have HIV, most of whom got it from their husbands. The campaign bWhat kind of man are you?Q promotes gender equality and calls for male accountability and responsibility for reducing the spread of HIV. A promotional campaign in bookshops, a regional and national broadcast and print media campaign in seven languages, web-based events, and advertising on hoardings all aim to reach a wide and varied audience. Breakthrough’s SMS helpline on HIV/ AIDS has already answered over 4,000 questions, from methods of preventing HIV transmission to negotiating relationships. It is the first time SMS technology has been used as an HIV/AIDS helpline in India.1 1. At: bwww.breakthrough.tv/campaignN. 16 October 2006.
Review of sexual behaviour data from 59 countries This paper presents analyses of sexual behaviour data for the 59 countries where it was available. Gaps in data from the Middle East and Asia were found. Trends towards earlier sexual experience were less pronounced and widespread than is sometimes supposed, and in many developing countries the trend is towards later onset of sexual activity for women. However, a trend towards later marriage has led to an increase in the prevalence of premarital sex. Most people are married and married people have the most sex. Sex among young people tends to be sporadic and is greater in industrialised than developing countries. Monogamy is the dominant pattern; men more than women have more than one partner, but patterns of age mixing and the age structures of populations, especially in Africa, help explain the difference. Marriage is not protective of sexual health. Very early sexual experience within marriage, as well as outside it, can be coercive and traumatic. Condom use is increasing in most countries. Shifts in poverty, education and employment, mobility, public
promotion of sexual health and other factors affect sexual behaviour and must be taken into account in public health strategies, not just individual behaviour. School-based sex education supports knowledge of risk and risk reduction and safer sex, and delays onset of sexual activity. This article is also rich with information about specific countries.1 1. Wellings K, Collumbien M, Slaymaker E, et al. Sexual behaviour in context: a global perspective. Lancet 2006;368(9548):1706–28.
Japan uses the most condoms Japan uses 1.624 billion condoms a year, 58% of all condoms produced worldwide.1 1. Factfile. Metro (UK). 1 November 2006.
Consistent condom use decreases HPV risk in women A study of 82 women students aged 18–22 who were newly sexually active or sexually inexperienced found that the more consistently their male partners used condoms, the less likely they were to get human papillomavirus (HPV) infection. The students had gynaecological examinations every four months and recorded information about their sexual behaviour every two weeks via a web-based diary. Information recorded included frequency of vaginal intercourse and condom use, number of partners and number of their previous partners, and partners’ circumcision status. Women whose partners used condoms 100% of the time were at 70% lower risk of acquiring HPV infection. Frequency of vaginal intercourse and partner circumcision status did not significantly affect the risk of infection, but the number of new sexual partners and their previous number of partners greatly increased the risk. The pattern was similar in the case of HPV types associated with both a high and low risk of cervical cancer. Frequency of condom use did not significantly influence the risk of developing cervical lesions, but having one or more new partners did. Consistent condom use can offer protection against HPV, including strains not protected against by the HPV vaccine.1 205
Round Up: Condoms / Reproductive Health Matters 2007;15(29):204–207
1. Winer RL, et al. Condom use and the risk of genital papillomavirus infection in young women. New England Journal of Medicine 2006;354(25):2645–54. Summarised in: London S. Frequent male condom use decreases women’s risk of HPV infection. International Family Planning Perspectives 2006;32(3):155.
Condom merchandising to increase consistent use in US Despite high HIV incidence in the US and general awareness of the protection from condom use, many sexually active adults use condoms inconsistently. Condom availability is strongly related to condom use, but most research into condom purchasing has focused on the issue of embarrassment, not on how the physical positioning of condoms within shops helps or hinders their purchase. This research began by assessing the placement of condoms in 59 retail outlets in six towns in the state of Connecticut and found that condoms were typically placed next to feminine hygiene products, in full view of customers and staff. In order to assess the effect of placing condoms in different contexts within a store, researchers created a simulated drug store with four aisles, one containing neutral products such as toothpaste and soap, one containing positive health products such as vitamins and fitness magazines, one containing sensual products such as massage oils, candles and sexually suggestive magazines and a final aisle containing potentially embarrassing health products such as haemorrhoid cream, tampons and laxatives. 120 heterosexual undergraduate students were randomly assigned to one of four groups and invited to browse the shelves of the store and then to evaluate five different branded products, including the condoms which were positioned on one the four aisles, a different one for each group. Participants were asked to rate the ease of finding the product, price, attitudes towards the product and recent use of the product. On handing in the evaluation, free samples of three products, including condoms, were available for the students to take unobserved. Men who saw condoms in the sensual products aisle were more likely to be positive about condoms and take more free condoms. Women were more embarrassed when they saw condoms in the sensual aisle and more positive when they were in the neutral aisle. Thus, the placing of condoms might inhibit condom purchase and gender206
specific preferences must be recognised by placing condoms in several locations to increase positive attitudes and condom purchases.1 1. Scott-Sheldon LAJ, Glasford DE, Marsh KL, et al. Barriers to condom purchasing: effects of product positioning on reactions to condoms. Social Science and Medicine 2006;63:2755–69.
Erection loss, condom use and risk behaviour in the US 278 men attending an STI clinic who had used a condom during penile–vaginal sex at least three times in the past three months were asked to complete an anonymous questionnaire. The men were asked to report on how they used condoms, how consistently they used them, how many different sexual partners they had had in the past three months, and whether they had experienced erection loss associated with condom use. There was an association between frequent unprotected vaginal sex and condom-associated erection loss. Men with erection loss were also more likely to remove condoms before sex was over. Thus, condom-associated erection loss may be common amongst those at risk for STIs and the problem could result in incomplete or inconsistent condom use. Lack of confidence to use condoms correctly, problems with the fit and feel of condoms and having sex with multiple partners are identified as possible causes of condom-associated erection loss.1 1. Graham CA, Crosby R, Yarber WL, et al. Erection loss in association with condom use among young men attending a public STI clinic: potential correlates and implications for risk behaviour [Abstract]. Sexual Health 2006;3(4):255–60.
Condom acceptability in Mexico, South Africa and Thailand Researchers evaluated the PATH women’s condom which was created after six years of research and development. 60 couples in three sites in Mexico, South Africa and Thailand were recruited. All were in good general and genital health, monogamous, at low risk of STIs and protected from pregnancy by a non-barrier contraceptive. Most of the women were parous and over half had prior experience of using PATH’s female condom prototypes. Women visited the clinic to practice condom insertion and removal
Round Up: Condoms / Reproductive Health Matters 2007;15(29):204–207
and at a third visit each couple received three PATH condoms, lubricant, instructions and questionnaires to be completed after each condom use. Questionnaires were collected and participants interviewed two weeks later. The condom was easy to use, stable during use, comfortable and satisfactory during sex for users in all three sites. Levels of satisfaction did not differ significantly with increased use or between men and women, leading the researchers to conclude that the PATH’s women’s condom is acceptable and easy to use for new and experienced users and could facilitate a high level of partner cooperation.1 1. Coffey PS, Kilbourne-Brook M, Austin G, et al. Shortterm acceptability of the PATH Woman’s Condom among couples at three sites. Contraception 2006;73:588–93.
protection methods, and are effective in increasing protected sex acts and in decreasing STI incidence among women. They may increase the ability of women to negotiate safer sex, which is vital in areas such as sub-Saharan Africa where HIV transmission occurs in the context of deep-rooted gender inequality. Female condoms complement, not replace, male condoms, as increasing the range of options is likely to lead to more protected sex acts. Future studies need to stop assessing acceptability and start looking at effective implementation of programmes which reach a large number number of women and men, looking at cost of different condoms, distribution models and female condom re-use. The authors call for further community-based studies that measure protected sex acts and STI incidence rather than STI prevalence and include measurement of breakage and slippage.1
Female condom use: a literature review 1. Vijayakumar G, Mabude Z, Smit J, et al. A review of female condom effectiveness: patterns of use and impact on protected sex acts and STI incidence. International Journal of STD and AIDS 2006;17: 652–59.
ABBAS / MAGNUM PHOTOS
This systematic literature review of 137 articles on female condom use covered acceptability, use, re-use, negotiation, facilitators and barriers to use, efficacy and effectiveness, and promotion. Female condoms reach those unlikely to use other dual
Demonstration, Tours, France, 1996 207
A 2007 Reproductive Health Matters. All rights reserved. Reproductive Health Matters 2007;15(29):204–207 0968-8080/06 $ – see front matter PII: S 0 9 6 8 - 8 0 8 0 ( 07 ) 2 9 2 91 - 2
www.rhmjournal.org.uk
ROUND UP
Condoms A condom named ‘‘NYC’’
‘‘No glove, no love’’ in Kenya
With the government’s imprimatur and a condom wrapper inspired by New York’s subways, city workers and volunteers in New York City handed out more than 150,000 condoms at numerous subway stations across the city on 14 February, Valentine’s Day. In June 2005, the city started an internet-based Free Condom Initiative to provide community and social service organisations with condoms. Since then, the number of condoms distributed has soared to 1.5 million a month from about 300,000. On Valentine’s Day last year, the health department announced that it was developing the first New York City-branded condom. The black plastic wrapper simply says bNYC condomQ on the front, with each letter in a coloured circle, like the letters used by the transport authority to denote subway lines. The condoms are available at more than 100 night spots and retail outlets and in bulk orders to clinics and community groups.1
Kenya has a national HIV prevalence of 5.9%. Prevalence in young women is 7.7%, almost twice as high as in young men of the same age. However, recent research shows that HIV prevention messages disseminated in schools and via the media and celebrity campaigns are getting through to young women. More than 70% of young Kenyan women use condoms to prevent pregnancy, HIV and other STIs, according to a study conducted by research group Infotrak Research & Consulting, in conjunction with a young women’s magazine, Eve Girl. 2,400 young women aged 18–25 in Kenya’s eight provinces were interviewed as part of the Sex Track study. Only 24% did not use condoms during intercourse, while 54% used them bpersistentlyQ. The same survey also found that many young women fail to continue using condoms consistently after initial sexual encounters. A government programme sponsored by the World Bank buys and distributes hundreds of millions of condoms each year in Kenya, with an additional 150 million privately purchased.1
1. Chan S with Zeller Jr T. A new condom in town named bNYCQ. New York City distributed 150,000 of its own brand of condoms Wednesday. New York Times, 15 February 2007.
204
1. No Glove, No Love: young women take charge of condom use. IRIN News. 28 February 2007.
Round Up: Condoms / Reproductive Health Matters 2007;15(29):204–207
Campaign for men to protect their wives from HIV in India A national campaign launched by the human rights organisation Breakthrough in India asks men to wear condoms to protect their wives from HIV. Two million women in India are estimated to have HIV, most of whom got it from their husbands. The campaign bWhat kind of man are you?Q promotes gender equality and calls for male accountability and responsibility for reducing the spread of HIV. A promotional campaign in bookshops, a regional and national broadcast and print media campaign in seven languages, web-based events, and advertising on hoardings all aim to reach a wide and varied audience. Breakthrough’s SMS helpline on HIV/ AIDS has already answered over 4,000 questions, from methods of preventing HIV transmission to negotiating relationships. It is the first time SMS technology has been used as an HIV/AIDS helpline in India.1 1. At: bwww.breakthrough.tv/campaignN. 16 October 2006.
Review of sexual behaviour data from 59 countries This paper presents analyses of sexual behaviour data for the 59 countries where it was available. Gaps in data from the Middle East and Asia were found. Trends towards earlier sexual experience were less pronounced and widespread than is sometimes supposed, and in many developing countries the trend is towards later onset of sexual activity for women. However, a trend towards later marriage has led to an increase in the prevalence of premarital sex. Most people are married and married people have the most sex. Sex among young people tends to be sporadic and is greater in industrialised than developing countries. Monogamy is the dominant pattern; men more than women have more than one partner, but patterns of age mixing and the age structures of populations, especially in Africa, help explain the difference. Marriage is not protective of sexual health. Very early sexual experience within marriage, as well as outside it, can be coercive and traumatic. Condom use is increasing in most countries. Shifts in poverty, education and employment, mobility, public
promotion of sexual health and other factors affect sexual behaviour and must be taken into account in public health strategies, not just individual behaviour. School-based sex education supports knowledge of risk and risk reduction and safer sex, and delays onset of sexual activity. This article is also rich with information about specific countries.1 1. Wellings K, Collumbien M, Slaymaker E, et al. Sexual behaviour in context: a global perspective. Lancet 2006;368(9548):1706–28.
Japan uses the most condoms Japan uses 1.624 billion condoms a year, 58% of all condoms produced worldwide.1 1. Factfile. Metro (UK). 1 November 2006.
Consistent condom use decreases HPV risk in women A study of 82 women students aged 18–22 who were newly sexually active or sexually inexperienced found that the more consistently their male partners used condoms, the less likely they were to get human papillomavirus (HPV) infection. The students had gynaecological examinations every four months and recorded information about their sexual behaviour every two weeks via a web-based diary. Information recorded included frequency of vaginal intercourse and condom use, number of partners and number of their previous partners, and partners’ circumcision status. Women whose partners used condoms 100% of the time were at 70% lower risk of acquiring HPV infection. Frequency of vaginal intercourse and partner circumcision status did not significantly affect the risk of infection, but the number of new sexual partners and their previous number of partners greatly increased the risk. The pattern was similar in the case of HPV types associated with both a high and low risk of cervical cancer. Frequency of condom use did not significantly influence the risk of developing cervical lesions, but having one or more new partners did. Consistent condom use can offer protection against HPV, including strains not protected against by the HPV vaccine.1 205
Round Up: Condoms / Reproductive Health Matters 2007;15(29):204–207
1. Winer RL, et al. Condom use and the risk of genital papillomavirus infection in young women. New England Journal of Medicine 2006;354(25):2645–54. Summarised in: London S. Frequent male condom use decreases women’s risk of HPV infection. International Family Planning Perspectives 2006;32(3):155.
Condom merchandising to increase consistent use in US Despite high HIV incidence in the US and general awareness of the protection from condom use, many sexually active adults use condoms inconsistently. Condom availability is strongly related to condom use, but most research into condom purchasing has focused on the issue of embarrassment, not on how the physical positioning of condoms within shops helps or hinders their purchase. This research began by assessing the placement of condoms in 59 retail outlets in six towns in the state of Connecticut and found that condoms were typically placed next to feminine hygiene products, in full view of customers and staff. In order to assess the effect of placing condoms in different contexts within a store, researchers created a simulated drug store with four aisles, one containing neutral products such as toothpaste and soap, one containing positive health products such as vitamins and fitness magazines, one containing sensual products such as massage oils, candles and sexually suggestive magazines and a final aisle containing potentially embarrassing health products such as haemorrhoid cream, tampons and laxatives. 120 heterosexual undergraduate students were randomly assigned to one of four groups and invited to browse the shelves of the store and then to evaluate five different branded products, including the condoms which were positioned on one the four aisles, a different one for each group. Participants were asked to rate the ease of finding the product, price, attitudes towards the product and recent use of the product. On handing in the evaluation, free samples of three products, including condoms, were available for the students to take unobserved. Men who saw condoms in the sensual products aisle were more likely to be positive about condoms and take more free condoms. Women were more embarrassed when they saw condoms in the sensual aisle and more positive when they were in the neutral aisle. Thus, the placing of condoms might inhibit condom purchase and gender206
specific preferences must be recognised by placing condoms in several locations to increase positive attitudes and condom purchases.1 1. Scott-Sheldon LAJ, Glasford DE, Marsh KL, et al. Barriers to condom purchasing: effects of product positioning on reactions to condoms. Social Science and Medicine 2006;63:2755–69.
Erection loss, condom use and risk behaviour in the US 278 men attending an STI clinic who had used a condom during penile–vaginal sex at least three times in the past three months were asked to complete an anonymous questionnaire. The men were asked to report on how they used condoms, how consistently they used them, how many different sexual partners they had had in the past three months, and whether they had experienced erection loss associated with condom use. There was an association between frequent unprotected vaginal sex and condom-associated erection loss. Men with erection loss were also more likely to remove condoms before sex was over. Thus, condom-associated erection loss may be common amongst those at risk for STIs and the problem could result in incomplete or inconsistent condom use. Lack of confidence to use condoms correctly, problems with the fit and feel of condoms and having sex with multiple partners are identified as possible causes of condom-associated erection loss.1 1. Graham CA, Crosby R, Yarber WL, et al. Erection loss in association with condom use among young men attending a public STI clinic: potential correlates and implications for risk behaviour [Abstract]. Sexual Health 2006;3(4):255–60.
Condom acceptability in Mexico, South Africa and Thailand Researchers evaluated the PATH women’s condom which was created after six years of research and development. 60 couples in three sites in Mexico, South Africa and Thailand were recruited. All were in good general and genital health, monogamous, at low risk of STIs and protected from pregnancy by a non-barrier contraceptive. Most of the women were parous and over half had prior experience of using PATH’s female condom prototypes. Women visited the clinic to practice condom insertion and removal
Round Up: Condoms / Reproductive Health Matters 2007;15(29):204–207
and at a third visit each couple received three PATH condoms, lubricant, instructions and questionnaires to be completed after each condom use. Questionnaires were collected and participants interviewed two weeks later. The condom was easy to use, stable during use, comfortable and satisfactory during sex for users in all three sites. Levels of satisfaction did not differ significantly with increased use or between men and women, leading the researchers to conclude that the PATH’s women’s condom is acceptable and easy to use for new and experienced users and could facilitate a high level of partner cooperation.1 1. Coffey PS, Kilbourne-Brook M, Austin G, et al. Shortterm acceptability of the PATH Woman’s Condom among couples at three sites. Contraception 2006;73:588–93.
protection methods, and are effective in increasing protected sex acts and in decreasing STI incidence among women. They may increase the ability of women to negotiate safer sex, which is vital in areas such as sub-Saharan Africa where HIV transmission occurs in the context of deep-rooted gender inequality. Female condoms complement, not replace, male condoms, as increasing the range of options is likely to lead to more protected sex acts. Future studies need to stop assessing acceptability and start looking at effective implementation of programmes which reach a large number number of women and men, looking at cost of different condoms, distribution models and female condom re-use. The authors call for further community-based studies that measure protected sex acts and STI incidence rather than STI prevalence and include measurement of breakage and slippage.1
Female condom use: a literature review 1. Vijayakumar G, Mabude Z, Smit J, et al. A review of female condom effectiveness: patterns of use and impact on protected sex acts and STI incidence. International Journal of STD and AIDS 2006;17: 652–59.
ABBAS / MAGNUM PHOTOS
This systematic literature review of 137 articles on female condom use covered acceptability, use, re-use, negotiation, facilitators and barriers to use, efficacy and effectiveness, and promotion. Female condoms reach those unlikely to use other dual
Demonstration, Tours, France, 1996 207