A 2005 Reproductive Health Matters. All rights reserved. Reproductive Health Matters 2005;13(25):184–186 0968-8080/05 $ – see front matter PII: S 0 9 6 8 - 8 0 8 0 ( 0 5 ) 2 51 7 6 - 5
Condoms Contraceptive effectiveness of male condoms high Data from two randomised, controlled contraceptive efficacy trials were combined, involving 800 couples who used three latex condom brands exclusively for up to six menstrual cycles. Detailed reports (3,715) on slippage and breakage were collected from the first five study condom uses. Vaginal samples (243) were collected from the first study condom use and tested for the presence of prostate-specific antigen (PSA) and spermatazoa. The combined clinical breakage rate for the first five condom uses was 0.4% and the slippage rate 1.1%. The combined, six-cycle, typical-use pregnancy rate was 7% (95% CI 5.0–9.0). The combined, six-cycle, consistent-use pregnancy rate was 1.0% (95% CI 0.0–2.1). PSA was detected in only 1.2% of post-coital vaginal samples. There were no differences in performance or efficacy among the three brands. The study concludes that the condoms rarely broke or slipped off during intercourse, and risk of semen leakage from intact condoms was very low. The condoms provided high contraceptive efficacy, especially when used consistently.1 1. Walsh TL, Frezieres RG, Peacock K, et al. Effectiveness of the male latex condom: combined results for three popular condom brands used as controls in randomized clinical trials. Contraception 2004;70: 407–13.
Better instruction in the use of condoms could reduce breakage and slippage A questionnaire given to 428 single men and women examined incidents of condom breakage and slippage over the previous three months. Breakage and slippage were found to be associated with never receiving instruction on correct condom use, more than one sex partner, more 184
frequent use of condoms and partner(s) being less than highly motivated to use condoms. Breakage occurred three times more often among those who reported that condoms had contacted a sharp object, whereas those using condoms without proper lubrication and those experiencing loss of erection during sex were more likely to report slippage. Improved instructions addressing these factors may reduce the incidence of condom breakage and slippage and thus enhance condom effectiveness.1 1. Yarber WL, Graham CA, Sanders SA, et al. Correlates of condom breakage and slippage among university undergraduates. International Journal of STD and AIDS 2004;15(7):467–72.
Branded mass media condom campaigns positively affect risk perception For mass media health campaigns to work they need to change perceptions before they can affect behaviour. Questionnaires given to over 2000 15–39 year olds in Kenya asked them about their exposure to generic and branded mass media messages about HIV/AIDS and condom use, and about their personal risk perception, condom effectiveness, condom availability and embarrassment in obtaining condoms. Those exposed to branded advertising messages were significantly more likely to consider themselves at higher risk of acquiring HIV and to believe in the severity of AIDS. Exposure to branded messages was also associated with a higher level of belief in the individual’s ability to control their risk of infection, a greater belief in the efficacy of condoms, a lower level of perceived difficulty in obtaining condoms and reduced embarrassment in purchasing condoms. Moreover, there was a dose-response relationship: a higher intensity of exposure to advertising was associated with more
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positive outcomes. Exposure to generic advertising messages was less frequently associated with positive health beliefs. Branded mass media campaigns that promote condom use as an attractive lifestyle choice are likely to contribute to the development of perceptions that are conducive to the adoption of condom use.1 1. Agha S. The impact of a mass media campaign on personal risk perception, perceived self-efficacy and on other behavioural predictors. AIDS Care 2003;15(6):749–62.
Le Visa – Niger’s own brand of condom A project to increase condom use in Niger has launched its own brand of condoms designed to appeal specifically to the local market. The product goes under the brand name ‘‘Le Visa’’ chosen for its cross-cultural appeal and the puns associated with its name, such as the concept of ‘‘ticket to ride’’, ‘‘approval to enter’’ and ‘‘single use only’’. The package image is of the capote (a local type of hat) which is also a slang name for a condom in French. It is hoped that this will make condoms more acceptable and accessible to those who need them and is being introduced as part of a larger programme to increase knowledge and awareness, targeting the most vulnerable sections of the population.1
More training in condom use needed in the UK This study of 300 men and 300 women attending a genito-urinary (STI) clinic in the UK shows that less than a quarter of all the respondents always used condoms, and 55% of the homosexual and bisexual men. About half the condom users reported problems with condoms such as tearing or the condom coming off, though many who reported problems did not specify their nature. This suggests that many participants may continue to be at risk through inconsistent use and condom accidents. More women (50%) than men (38%) remembered being given training in the use of condoms, particularly at school, but there was no correlation between lack of training and condom accidents. The authors suggest there should be more education on the use of condoms by health care professionals, particularly in facilities where condoms are supplied.1 1. Handy P. Condom use amongst men and women attending a genitourinary medicine clinic. Journal of Family Planning and Reproductive Health Care 2004;30(3):159–62.
Delayed application of condoms is common in Australia
In an effort to slow the increase of HIV in Korea, the Korean Centre for Disease Control has launched a campaign to improve the image of condoms. Condom use in the country is only about 12% and the KCDC and the Korea AntiAIDS Federation are broadcasting public service commercials twice a day nationwide on MBCTV in an attempt to increase this figure and thus reduce the number of new infections.1
Seven focus group discussions with heterosexual men and women aged 18–25 in Australia revealed that both withdrawal and delayed application of condoms are widespread. Delayed application divided into two categories – after limited unprotected penetration and for ejaculation only. Withdrawal and ‘‘ejaculation only’’ condom use both occurred more often in regular rather than casual relationships, were more likely to be negotiated and were more likely to be used when there was no perceived risk of STI. In contrast, condom use ‘‘after limited unprotected penetration’’ was more likely in casual encounters, and more often unplanned and not negotiated. Both practices highlight a need to ensure that condoms are used correctly and that young adults are encouraged to negotiate sexual activity and condom use.1
1. Sun-Young L. 455 more test positive for HIV/AIDS in Korea. Korea Herald. 21 October 2004. At: bwww. procaare.org/archive/procaare/200410/ msg00036.php N.
1. De Visser R. Delayed application of condoms, withdrawal and negotiation of safer sex among heterosexual young adults. AIDS Care 2004;16(3):315–22.
1. Brown JM. Le Visa – a ticket to ride in Niger. Futures Group Europe. June 2004. At: bwww.futuresgroup. comN.
Advertising condoms in Korea
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Condom use can speed up regression of HPV-associated lesions
1. Bleeker MC, Hogewoning CJ, Voorhorst FJ, et al. Condom use promotes regression of human papillomavirus-associated penile lesions in male sexual partners of women with cervical intraepithelial neoplasia. International Journal of Cancer 2003;107(5):804–10. 2. Hogewoning CJ, Bleeker MC, van den Brule AJ, et al. Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: a randomised clinical trial. International Journal of Cancer 2003;107(5): 811–16.
A study of over 100 women with cervical intraepithelial neoplasia (CIN, a precursor of cervical cancer) and their male sexual partners indicates that consistent condom use can speed up regression of HPV-associated lesions and infection. The CIN regression rate at two-year follow-up was 53% for the 64 women in the condom-use group compared with 35% for the 61 women in the non-condom group. The rates of HPV clearance were 23% and 4% respectively. Of two types of penile lesions in the partners, flat ones regressed faster in the condom-use group, with median regression time shortening from 13.9 months to 7.4 months, whereas there was no difference found for papular lesions. Thus it
appears that condom use promotes regression of CIN lesions, clearance of HPV in women, and regression of flat penile lesions in men, presumably by blocking repeated transmission and re-infection between partners.1,2
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