RESUMEN

PIP: Studies conducted since the introduction of female condoms in the market in 1996 as a strong, soft, transparent polyurethane sheath to protect against HIV/AIDS infection was reported to gain a wide range of acceptability. Men favored its use compared to male condoms since it does not interrupt sexual activity and feels more similar to unprotected sex. Results from international studies on the efficacy of female condoms include: 1) ability to prevent unwanted pregnancies; 2) ability to prevent transmission of sexually transmitted diseases and HIV; 3) expansion of choice in increasing protection; 4) acceptability of the female condom to a wide range of men and women; 4) safety of the product; 5) easier use through constant practice; 6) provision of additional emotional comfort, sense of security and control; 7) cost-effectiveness as a prevention program; and 8) the need for a more strategic introduction in other countries. The establishment of the Female Condom Programming Guide assists with design and implementation of strategies, as well as catalyzing of new ideas and expanding of good practices in female condom programs. This article emphasizes the significance of female condom as an important technology that plays a vital role in the reproductive health programs and needs to be introduced strategically in order to provide the greatest and most cost-effective public health impact.^ieng

Asunto(s)

Condones Femeninos , Infecciones por VIH , Embarazo no Deseado , Investigación , Enfermedades de Transmisión Sexual , Anticoncepción , Demografía , Enfermedad , Servicios de Planificación Familiar , Fertilidad , Infecciones , Población , Dinámica Poblacional , Conducta Sexual , Virosis

RESUMEN

PIP: An article focuses on the influence of social marketing, particularly of condoms and efforts to fight the HIV/AIDS epidemic. Condom sales have increased, especially in Africa. These sales are a good reflection of condoms purchased and used. Concerning the prevention of HIV/AIDS, availability of condoms is the most significant achievement of condom social marketing programs; however, HIV/AIDS prevalence has not declined. The marketing of condoms has been observed to be insufficient compared to the theoretical demand for condoms. All social marketing programs should be focused on marketing and communications, expressing messages that promote safer sexual behavior. Products and services aimed at safe sexual activity are being searched as tools in the fight against AIDS. In Uganda for instance, a kit called "Clear Seven" includes a large dose of pyprofloxin, a seven-day course of doxycycline, seven condoms and partner referral cards. The Population Services International is doing voluntary counseling and testing in Zimbabwe to prevent HIV transmission and contribute to destigmatizing people living with AIDS. It is too soon to assess the effectiveness of the program, yet many countries are already planning to duplicate it.^ieng

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida , Condones , Estudios de Evaluación como Asunto , Infecciones por VIH , Servicios de Información , Comercialización de los Servicios de Salud , África , Anticoncepción , Países en Desarrollo , Enfermedad , Economía , Servicios de Planificación Familiar , Planificación en Salud , Organización y Administración , Virosis

RESUMEN

The aim of the study was to investigate if bacterial vaginosis (BV) is associated with use of specific contraceptives. Women at family planning and youth clinics (n = 956), among whom 131 had BV, were subjects for structured in-depth interviews including current and previous contraceptive use. Variables measuring sexual risk-taking were ascertained. Current users of contraceptives were compared with non-users. Both oral contraceptive (OC) and condom use showed a significant protective effect against BV, adjusted for possible confounders (odds ratios were 0.4 and 0.3, respectively). Intrauterine device use (IUD) showed no association with BV. Women with BV had less often used any contraceptives, including condom, at their sexual debut than the women in the comparison group. In this study, OC and condom use seemed to exert a protective effect against BV, whereas no effect for IUD use was found.

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PIP: To determine whether bacterial vaginosis (BV) is associated with use of specific contraceptive methods, 956 women from family planning and youth clinics at 3 Swedish hospitals were enrolled in a cohort study. 131 women had at least 3 of the 4 clinical signs of BV: a homogenous gray vaginal discharge, a vaginal pH of 4.7, a positive amine test, and the presence of "clue" cells. Age at first intercourse was 16 years among those with and without BV; however, 8.4% of women with BV, compared with only 1.7% of controls, had had more than 1 sex partner in the last 6 months. Other factors associated with BV were more than 10 lifetime sex partners, non-use of contraception at first intercourse, a history of sexual abuse, an induced abortion, smoking, and alcohol consumption. After adjustment for sexual risk-taking, there was a significant negative association between BV and oral contraceptive (OC) use (odds ratio [OR], 0.4; 95% confidence interval [CI], 0.2-0.8). There was also a significant negative association with condom use (OR, 0.3; 95% CI, 0.1-0.9). There was no association between BV and IUD use, before or after adjustment for confounding factors. Insufficient numbers of diaphragm or spermicide users were available for analysis. The finding of an apparently protective effect against BV of OCs and condoms lacks a biological explanation at present, although it is speculated that OC use increases the glycogen content of vaginal epithelial cells, in turn inhibiting the in vitro growth of certain bacteria.

Asunto(s)

Anticoncepción/métodos , Vaginosis Bacteriana/epidemiología , Adulto , Distribución de Chi-Cuadrado , Estudios de Cohortes , Condones/estadística & datos numéricos , Anticoncepción/efectos adversos , Anticoncepción/estadística & datos numéricos , Anticonceptivos Orales/normas , Femenino , Conductas Relacionadas con la Salud , Humanos , Dispositivos Intrauterinos/efectos adversos , Dispositivos Intrauterinos/estadística & datos numéricos , Modelos Logísticos , Conducta Sexual , Suecia/epidemiología , Vaginosis Bacteriana/etiología , Vaginosis Bacteriana/prevención & control

RESUMEN

We aimed to measure the effectiveness of latex condoms and of nonoxynol-9 [N-9] spermicides, in preventing HIV transmission in heterosexual serodiscordant couples in Lusaka. Each couple was examined at clinic visits scheduled at 3-month intervals for one year or more per couple, or until seroconversion or discontinuation. Couples were given condoms and their choice of 3 N-9 products and advised to use both at every intercourse. Sexual exposure was ascertained from coital logs that recorded coitus and barrier method use. HIV serological testing was done at each clinic visit (ELISA and Western blot if positive). One hundred and ten discordant couples were followed for a mean of 17.6 months. Seventy-eight per cent of coital episodes were protected by condoms, 85% by spermicides and 6.4% were unprotected. Fourteen seroconversions occurred (8.7 infections per 100 couple-years [c-y]). The rate was higher among seronegative men than seronegative women. Among couples who reported using condoms at every intercourse the infection rate was 2.3/100 c-y, compared with 10.7/100 c-y among couples using condoms less consistently (rate ratio [RR] 0.2; 95% confidence interval [CI] 0-1.6). Among couples who reported using N-9 at every intercourse, the seroconversion rate was 6.9/100 c-y; among couples who reported less than full-time N-9 use, the rate was 8.9/100 c-y (RR 0.8; 95% CI 0.2-2.8). Among the subset of female seronegatives, the N-9 RR was 0.5 (95% CI 0.1-3.8). But when we calculated HIV rates according to N-9 consistency in coital acts when condoms were not used, there was no evidence of protection with higher N-9 use. Consistent use of latex condoms reduces the incidence of HIV infection, but the association between N-9 spermicides and HIV is less clear. The current study could not provide compelling data on the impact of N-9 spermicide use on risk of HIV infection. The study's small size, as well as the consistency of concurrent condom use, limited our inferences. Available spermicide products must be studied further.

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PIP: The protective effect of consistent condom use against HIV transmission in HIV-serodiscordant couples has been documented. Unknown, however, is the anti-HIV effect of nonoxynol-9 use. This issue was addressed in a survey of 110 HIV-discordant couples from Lusaka, Zambia, who were willing to use condoms/spermicide, maintain a coital log, and return for follow-up visits every 3 months for at least 1 year. 80 of these couples (73%) had a seropositive man and 30 (27%) had a seropositive woman. The mean duration of follow-up was 17.6 months. Of the total of 15,148 recorded coital episodes, 10% were protected by condoms only, 17% by nonoxynol-9 only, 66% by both condoms and nonoxynol (according to the study protocol), and 6% were unprotected by any barrier method. Consistent barrier method use declined with duration of follow-up. There were 14 seroconversions (8.9 infections/100 couple-years), including 8 initially seronegative men and 6 initially seronegative women. Among couples who used condoms 0-50%, 51-75%, 76-99%, and 100% of the time, the seroconversion rates were 20.8, 10.1, 7.3, and 2.3/100 couple-years, respectively. Seroconversion rates were 6.9 and 8.9/100 couple-years among those reporting consistent and inconsistent use, respectively, of nonoxynol-9. Although this study failed to provide evidence that nonoxynol-9 use confers significant protection against HIV infection, its small size and the consistency of concurrent male condom use limited inferences.

Asunto(s)

Condones/estadística & datos numéricos , Infecciones por VIH/prevención & control , Nonoxinol/uso terapéutico , Espermicidas/uso terapéutico , Adolescente , Adulto , Anciano , Western Blotting , Coito , Ensayo de Inmunoadsorción Enzimática , Femenino , VIH/inmunología , Anticuerpos Anti-VIH/análisis , Infecciones por VIH/epidemiología , Seronegatividad para VIH , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Conducta Sexual , Parejas Sexuales , Zambia/epidemiología

RESUMEN

We conducted a case-control study to evaluate the association between contraceptive methods and HIV infection among Thai female commercial sex workers in Khon Kaen and Lumpang provinces, Thailand; 118 cases of HIV-1 infected sex workers were eligible for inclusion and 258 HIV-1 negative women were recruited as controls during the period of October 1, 1993 to December 31, 1994. Cases and controls were matched by age, education, parity, age at first exposure to commercial sex, number of clients per night, duration of work and sexual practice during menstruation. The ratio of case per control was 1:2. Both cases and controls were interviewed and underwent blood testing by a team of investigators. The study revealed no significant association between oral pill, injection, other contraceptives and HIV-1 infection. However, condom usage showed a significant protective effect. It is suggested that these contraceptives in this high-risk group of women do not increase the risk of HIV infection. In contrast, the use of condoms could reduce the risk of HIV infection.

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PIP: The authors conducted a case-control study to evaluate the association between contraceptive methods and HIV infection among Thai female commercial sex workers in Khon Kaen and Lumpang provinces, Thailand; 118 cases of HIV-1-infected sex workers were eligible for inclusion and 258 HIV-1-negative women were recruited as controls during the period of October 1, 1993, to December 31, 1994. Cases and controls were matched by age, education, parity, age at first exposure to commercial sex, number of clients per night, duration of work, and sexual practice during menstruation. The case/control ratio was 1:2. Both cases and controls were interviewed and underwent blood testing by a team of investigators. The study revealed no significant association between oral pills, injections, other contraceptives and HIV-1 infection. However, condom usage showed a significant protective effect. It is suggested that these contraceptives in this high-risk group of women do not increase the risk of HIV infection. In contrast, the use of condoms could reduce the risk of HIV infection.

Asunto(s)

Condones , Infecciones por VIH/epidemiología , VIH-1 , Trabajo Sexual , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Factores Socioeconómicos , Tailandia/epidemiología

RESUMEN

OBJECTIVE: To investigate trends in sexually transmitted diseases (STDs) among female commercial sex workers and in their condom use patterns during the period from 1990 to 1993 in Fukuoka, Japan. METHODS: The study group consisted of a total of 824 commercial sex workers who attended an STD clinic to undergo screening for STDs including chlamydia, gonorrhoea, syphilis, hepatitis B and HIV-1 infection during the period from 1990 to 1993. For detection of Chlamydia trachomatis and Neisseria gonorrhoeae, endocervical smear specimens were taken from the women. Blood samples were obtained for serological diagnosis of syphilis, hepatitis B and HIV-1. Commercial sex workers who visited the clinic during the period from November to December of 1993 were interviewed concerning past (1990 and 1991) and recent (1992 and 1993) condom use patterns. RESULTS: The annual detection rates of C trachomatis and N gonorrhoeae declined significantly from 16.3% in 1990 to 12.2% in 1993 (P < 0.0001) and from 1.5% in 1990 to 0.8% in 1993 (P = 0.0096), respectively. There was a remarkable reduction in the annual syphilis infection rate, from 7.5% in 1990 to 0.5% in 1993 (P = 0.0011). The positive rate for the hepatitis B surface antigen in the women ranged from only 0.6% to 1.9% and none were found to be positive for HIV-1 during the 4-year period. During the same period, there was a significant increase in the proportion of commercial sex workers always using condoms from 6.3% in 1990-91 to 25.3% in 1992-93 (P = 0.0023). CONCLUSION: The prevalences of chlamydia, gonorrhoea, and syphilis infections decreased significantly among commercial sex workers in Fukuoka from 1990 through 1993, and no commercial sex workers were HIV-1 seropositive. The reductions in the prevalence of major STDs may be related to the increased use of condoms.

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PIP: A survey of commercial sex workers in Fukuoka City, Japan, during 1990-93 revealed significant declines in the prevalence of chlamydia, gonorrhea, and syphilis during the study period, presumably as a result of increased condom use. The study group consisted of 824 commercial sex workers who attended a sexually transmitted disease (STD) clinic in Fukuoka from 1990 to 1993 for voluntary STD check-ups. The annual Chlamydia trachomatis detection rate declined from 16.3% in 1990 to 12.2% in 1993; the annual detection rate for Neisseria gonorrhoeae fell from 1.5% to 0.8%, while that for syphilis dropped from 7.5% to 0.5%. None of the 791 women screened for human immunodeficiency virus was seropositive. In addition, a subsample of 79 commercial sex workers were interviewed about their condom use. The proportion of sex workers always using condoms rose from 6.3% in 1990 to 25.3% in 1993; in this period, never use of condoms decreased from 45.6% to 5.1%.

Asunto(s)

Condones/estadística & datos numéricos , Trabajo Sexual , Enfermedades de Transmisión Sexual/epidemiología , Adolescente , Adulto , Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis , Condones/tendencias , Femenino , Gonorrea/epidemiología , Infecciones por VIH/epidemiología , VIH-1 , Hepatitis B/epidemiología , Humanos , Japón/epidemiología , Estudios Longitudinales , Persona de Mediana Edad , Prevalencia , Sífilis/epidemiología

RESUMEN

PIP: Heightened awareness of the effectiveness of condoms in preventing the sexual transmission of human immunodeficiency virus (HIV) has led to a 42% increase in worldwide production of male condoms over the last 4 years. However, women still face difficulties in convincing their partners to use this form of protection. The potential role of the female condom in acquired immunodeficiency syndrome (AIDS) prevention was addressed at a meeting co-sponsored by USAID and AIDSCAP and attended by 45 experts. The Reality female condom offers women the possibility of controlling their own protection from both pregnancy and sexually transmitted diseases (STDs) such as HIV. When used correctly, the female condom reduces the STD risk by 97%. The 6-month pregnancy rate during typical use has been estimated at 12% in the US and 22% in Latin America. Acceptability studies have found that 50-95% of participants liked using the female condom; 60% of women believed it would be easier to use the female condom than to suggest use of a male condom. A major obstacle to global distribution of the female condom is its high price: the best public sector price exceeds US$0.88. On the other hand, demand has the potential to lower the price.^ieng

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida , Condones Femeninos , Congresos como Asunto , Anticoncepción , Infecciones por VIH , Enfermedades de Transmisión Sexual , Enfermedad , Servicios de Planificación Familiar , Infecciones , Virosis

RESUMEN

Sexually transmitted diseases (STDs) are a major cause of ill health in women and their sexual partners and children. Contraceptive methods alter in various ways the risk of acquiring STD but assessment of the odds ratio is difficult due to the many confounding factors. Spermicides have been reported to kill a wide range of bacteria and viruses including HIV in vitro and to protect in vivo from infection by gonorrhoea, chlamydia and pelvic inflammatory disease (organisms unspecified). Spermicides will not cure pre-existing infections. Condoms and diaphragms will give some protection from bacterial and viral infections in all parts of the genital tract. Hormonal contraception and tubal ligation give protection to the upper genital tract but not the cervix. Carcinoma of the cervix follows the same pattern as STDs. The risk of pelvic infection in intrauterine device users is discussed in the chapter by Bromham (pp 100-123, this issue).

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PIP: Spermicides kill a wide range of bacteria and viruses causing sexually transmitted diseases (STDs), including the human immunodeficiency virus (HIV) in vitro, and protect in vivo from infection by gonorrhoea, chlamydia, and pelvic inflammatory disease (PID). In the UK and the US, the most commonly used compound in spermicidal agents is the neutral surfactant nonoxynol-9. Although spermicides reduce the incidence of reinfection by some STDs, an in vivo virucidal action is not supported by convincing data. Among barrier methods, latex condoms provide an impervious barrier in vitro to most STD pathogens, including HIV. Natural condoms made of sheep intestinal membrane can allow passage of hepatitis B viral particles but not HIV in vitro. Several studies have shown protection against cervical gonorrhoea and PID among diaphragm users; however, diaphragm use has been associated with an increased rate of urinary infection and also bacterial vaginosis. It is conceivable that women using oral contraceptives (OCs) do not develop as much tubal damage as women not using OCs because of a modified immunological reaction. A study carried out in Europe showed a statistically significant protective effect against PID of the levonorgestrel-containing IUD as compared with the copper-containing Nova-T. A case/control study of 1028 women in Chicago in 1970 noted admission for PID during the following 7 years of only 1 woman who had been sterilized compared to 9 controls. A case/control study examining risk factors for cervical intraepithelial neoplasia (CIN) in 103 women with biopsy-confirmed CIN II or III did not find an increased risk with either OC or IUD use after adjusting for other known risk factors. After adjustment for age and education, the odds ratio for diaphragm use was .3 and the odds ratio for condom use was .5. Thus, hormonal contraception and tubal ligation give protection to the upper genital tract but not to the cervix.

Asunto(s)

Anticoncepción , Enfermedades de Transmisión Sexual/prevención & control , Adulto , Factores de Confusión Epidemiológicos , Anticoncepción/métodos , Femenino , Humanos , Masculino

RESUMEN

Condoms for men are currently the most effective of the nonprescription contraceptive methods. They are readily available, simple to use, and relatively inexpensive, and they are not associated with major adverse effects. If used both properly and consistently, condoms can significantly reduce the risk of transmission of HIV and other STDs. The protection offered by the latex condom may be increased by the concurrent use of a vaginal foam or cream containing nonoxynol 9. The practicing pharmacist should know about the variety of condoms available, be able to explain their correct use to maximize effectiveness, and compare condom use with other types of contraceptives. The practitioner should be available to answer patrons' questions and provide counseling on contraceptives and "safe sex" practices.

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PIP: In the US. condoms for males are made of either lamb cecum or latex. Lamb cecum condoms are less elastic than latex condoms. Thus, they can come off the penis making them less effective form of protection from sexually transmitted diseases (STDs). They are also more expensive. Condoms come in several varieties (reservoir end and lubricated with a spermicide, nonoxynol 9) and in several sizes (standard and large). Their contraceptive effectiveness ranges from 64% to 97%. Study design, patient characteristics, and socioeconomic status may explain this broad range. Breaking, improper use, and inconsistent use account for contraceptive failures. Use with vaginal foam reduces the failure rate to 1 to 3%. Some advantages identified by consumers and health workers were peace of mind, ease of use, convenience, preventing, STDs, arousing to put on, easily obtained, safe and effective, no side effects or toxicity, inexpensive, medical supervision not required, and can be used as a backup contraceptive. Some disadvantages include reduced sensation, breakage or slippage and improper use. Men and women sometimes suffer allergic reactions from the lubricants, spermicides, or chemicals used in manufacturing. Pharmacists could advise consumers to switch to another condom brand. If this does not stop the irritation, the consumer should see a physician because an STD may be causing the irritation. In vitro studies indicate that nonoxynol 9 kills or inactivates many STD pathogens including herpes simplex virus and HIV. A female condom should be available by the end of 1992. Trials show it to protect effectively against pregnancy and STDs. Even though neither the female condom nor diaphragm cause vaginal trauma, the condom does not change the vaginal flora significantly. Pharmacists should familiarize themselves with the different types of male and female condoms and be able to adequately counsel customers about their correct use and safe sex practices.

Asunto(s)

Conducta de Elección , Condones , Farmacéuticos , Anticoncepción , Femenino , Humanos , Masculino , Educación del Paciente como Asunto , Embarazo , Enfermedades de Transmisión Sexual/prevención & control

RESUMEN

PIP: STD prevention efforts in Latin America, particularly in the Dominican Republic, have begun to stress the need for behavioral changes. Traditionally, the professional public health community has focused on secondary prevention of STDs -- detection and treatment of the disease in order to prevent complications from developing. But in light of the AIDS epidemic, greater attention has been paid to primary prevention. Hoping to prevent the disease from occurring, primary prevention efforts target high risk groups (prostitutes and their clients and young people) with health education and promotion of behavioral change. Such changes include using condoms, seeking medical care for STDs, and decreasing the number of sex partners. An example of primary prevention programs is the Avancemos Project in the Dominican Republic. Launched in 1989 by the country's Ministry of Health and Family Health International's AIDSTECH Division, the project targets sex workers with several intervention measures. Initially, the Avancemos Project trained 16 sex workers to serve as peer educators to distribute condoms and educational materials. These 16 volunteers have in turn trained more than 300 other peer educators. Among the educational materials distributed by the peer educators are 2 comic books entitled "Martiza's Advice" and "The Triumphs of Maritza." A handsome, well dressed, and street-wise sex worker, the title character in these comic books instructs on a range of issues, including how to negotiate with clients how to use a condom. As those involved with the project attest, the comic books have become extremely popular among the target group, tapping into the women's buried feelings of self-worth.^ieng

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida , Condones , Atención a la Salud , Conductas Relacionadas con la Salud , Educación en Salud , Necesidades y Demandas de Servicios de Salud , Medios de Comunicación de Masas , Grupo Paritario , Investigación , Enfermedades de Transmisión Sexual , Enseñanza , Américas , Conducta , Región del Caribe , Comunicación , Anticoncepción , Países en Desarrollo , Enfermedad , República Dominicana , Educación , Servicios de Planificación Familiar , Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Planificación en Salud , Infecciones , América Latina , América del Norte , Organización y Administración , Conducta Sexual , Virosis

RESUMEN

PIP: The official number of abortions in Japan in 1991 was 457,000. That number is estimated to be 50% of the actual number as abortion is a lucrative business in Japan costing between US$525 and US$1125. In the mid-1950s the number of abortions was estimated at 1 million. The 2 primary forms of birth control in Japan are the rhythm method and the condom. Condom sales total 600 million per year. The low-dose pill is illegal, but the high-dose pill is allowed for the control of menstrual problems. Some 300,000 women take the high-dose pill, despite its readily acknowledged side effects. Another problem with oral contraceptives is a social stigma of promiscuity. Japan's pharmaceutical industry has devoted a lot of time and effort into marketing a low-dose pill. Drug companies started clinical studies in 1987 and in 1990 9 companies submitted formal requests to manufacture and market the low-dose pill. The Ministry of Health and Welfare's Central Pharmaceutical Affairs Council rejected all requests. The decision is not based on safety or effectiveness; but upon the belief by the government that the widespread use of the pill would defeat any measures to control the spread of the AIDS virus. The government feels that the condoms should be the only contraceptive available, because it is the only one that helps to control the spread of AIDS. There are more than 2600 people in Japan infected with AIDS. However, the Director General of the 16,000 member Japan Society of Obstetrics and Gynecology contends that the pill and AIDS are 2 separate issues. A recent 1990 survey found that only 10% of Japanese women would use the low-dose pill if it were available. 75% of women who use the rhythm method claim to ask their partners to use condoms. The deputy executive director of the Family Planning Federation of Japan claims that the government is worried that the widespread use of the pill would only further decrease Japan's population growth rate, already at .4%.^ieng

Asunto(s)

Aborto Inducido , Aborto Legal , Síndrome de Inmunodeficiencia Adquirida , Condones , Seguridad de Productos para el Consumidor , Conducta Anticonceptiva , Anticonceptivos Orales , Fertilidad , Gobierno , Accesibilidad a los Servicios de Salud , Métodos Naturales de Planificación Familiar , Personal Administrativo , Asia , Anticoncepción , Demografía , Países Desarrollados , Enfermedad , Servicios de Planificación Familiar , Asia Oriental , Infecciones por VIH , Japón , Legislación como Asunto , Organización y Administración , Población , Dinámica Poblacional , Virosis

RESUMEN

This article reviews the existing British literature on the micro-social details of young people's heterosexual encounters, emphasizing the cultural factors which impede the adoption of health education advice. Most of the findings cited come from qualitative projects that relied primarily on detailed interviews or group discussions. Six issues are highlighted: difficulties in talking about sex; the gender-role expectations brought to an encounter; the primary function of condoms as contraceptives; problems in buying, carrying and using condoms; how the stage of a particular relationship affects behaviour, and gendered power relations. Several important issues are not addressed in the existing literature. The survey data on sexual behaviour suggest that HIV has had little impact on sexual activity, apart from a reported increase in condom use. Qualitative studies reveal the moral categories, gender-role expectations, power inbalances and other cultural factors that prevent a high level of knowledge about HIV transmission from being translated into safer heterosexual behaviour. Their findings provide important insights into how realistic and practical safer sex messages are. They suggest that to promote health in respect to HIV it is necessary not only to advocate specific precautionary behaviour, such as using condoms, but also to address wider cultural issues relating to the taboos around the discussion of sex and the empowerment of women.

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PIP: The existing British literature concerning the heterosexual activity of young people, highlighting the cultural factors that impede the adoption of safer sex practices, is reviewed. From research based primarily on detailed interviews and group discussions, focus is on the following issues: the difficulties in talking about sex; the gender-role expectations brought to the sexual encounter; the primary function of condoms as contraceptives; problems in buying, carrying, and using condoms; how the evolution of a particular relationship affects the sexual behavior of the partners; and the imbalances of power between genders. Apart from a reported increase in condom use, HIV has had little impact on the sexual activity of young people. Verbal communication prior to intercourse is rare,. a silence that protects the self-esteem of the partners and precludes a discussion of their sexual histories, but which also prevents discussion of condom use. Condom use is also limited by the embarrassment of buying, carrying, or using a one. Condoms still appear to be the most widely used contraceptive during young people's first intercourse, but if a sexual relationship is perceived as long term, the woman is likely to go on the pill. All these issues are influenced by the power inequalities between men and women. Economic needs and the expectation that a man's sexual gratification is paramount constrain women's choices. These findings suggest that in order to promote safer sex practices for HIV prevention, underlying cultural issues must be addressed, in particular: 1) the taboo against serious discussion of sexual behavior and 2) the extent to which women are able to exercise their own interests in sexual encounters.

Asunto(s)

Actitud Frente a la Salud , Infecciones por VIH/prevención & control , VIH-1 , Educación en Salud/normas , Psicología del Adolescente , Conducta Sexual , Adolescente , Comunicación , Dispositivos Anticonceptivos Masculinos/estadística & datos numéricos , Femenino , Identidad de Género , Humanos , Masculino , Poder Psicológico , Investigación

RESUMEN

PIP: Blacks in South Africa see the government campaign promoting condom use to prevent AIDS as a political ruse to control population growth among Blacks. The City Health Department of Johannesburg does not use a government created poster targeted to Blacks because it implies that only Blacks have AIDS. Even though the number of AIDS cases in South Africa is lower (700 reported cases) than that of its neighbors, the number of HIV infected individuals is growing. So nongovernmental organizations are trying to overcome the division between the government and Blacks by finding alternative ways to stem the AIDS epidemic. The African Research and Educational Puppetry Programme uses Puppets Against AIDS to bridge racial, cultural, language, and educational barriers to thus educate Blacks about AIDS. It not only hopes to create and perform educational and socially valuable theater, but also to rediscover performing arts traditions in southern and central Africa. Since about 76% of the black population in rural South Africa is illiterate, the gray skinned puppets constitute an interactive and inoffensive way to communicate a serious message. Someone demonstrates how to put on a condom using a life size model which induces controversy among physicians and educated whites. Blacks in Johannesburg and surrounding townships are not offended, however. In fact, many have never seen condoms before the demonstration. The puppets emphasize that safe sex and having sex with only 1 partner can stop the spread of AIDS. Each performance also includes live African percussion and music. A narrator distributes free condoms and AIDS information brochures to the audience. Videotapes of each performance are used to evaluate audience reactions. Independent evaluation teams evaluate the impact of the performance. 1-4 day workshops on AIDS, puppet making, story development, and performing skills follow each performance.^ieng

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida , Publicidad , Negro o Afroamericano , Condones , Curriculum , Estudios de Evaluación como Asunto , Educación en Salud , Medios de Comunicación de Masas , Política , Evaluación de Programas y Proyectos de Salud , Población Blanca , África , África del Sur del Sahara , África Austral , Población Negra , Comunicación , Anticoncepción , Cultura , Demografía , Países en Desarrollo , Enfermedad , Economía , Educación , Escolaridad , Etnicidad , Servicios de Planificación Familiar , Infecciones por VIH , Comercialización de los Servicios de Salud , Organización y Administración , Población , Características de la Población , Clase Social , Factores Socioeconómicos , Sudáfrica , Virosis

RESUMEN

PIP: An innovative AIDS control program targeting sex workers and clients in Ethiopia has shown that hard work and government support are essential for the success of a program. Serosurveys conducted in 1988 and 1989 had shown that certain groups were particularly vulnerable to HIV infection: women who engage in formal or informal prostitution and their clients -- often migrant workers or truck drivers. So in mid-1990, Ethiopia's Department of AIDS Control (DAC) launched an intervention effort targeting these high-risk groups, a program entitled the Multiple Partner Sexual Contact (MPSC) Female and Male Mobilization and Condom Promotion Project. The program had a 3-layer strategy: 1) establishing a "trickle down" training process, which would create a network of MPSC peer educators and organizers; 2) identifying MPSC men to serve as educators for other men; and 3) ensuring the widespread availability of condoms for both men and women. As site for its pilot project, DAC selected Nazareth, a trading city of more than 30% among MPSC females. After 6 months of operation, the program's effectiveness convinced DAC to expand the project to 9 additional sites. An evaluation of the project has revealed several important findings: 1) retraining and motivation sessions must be constantly maintained; 2) men's resistance to condom use may be diminished by targeting them with education at the same time as the women; 3) interventions that take into account the socioeconomic issues faced by MPSC women make the program more effective; 4) it is important to develop new educational materials periodically; and 5) involving the owners and managers of sex-related businesses makes the program more effective.^ieng

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida , Condones , Atención a la Salud , Educación , Proyectos Piloto , Investigación , Factores de Riesgo , Parejas Sexuales , Voluntarios , África , África del Sur del Sahara , África Oriental , Conducta , Biología , Anticoncepción , Países en Desarrollo , Enfermedad , Etiopía , Servicios de Planificación Familiar , Infecciones por VIH , Planificación en Salud , Organización y Administración , Conducta Sexual , Virosis

RESUMEN

PIP: This article contains a the script for a slide-tape presentation entitled Working Against AIDS, a presentation developed by the Brazil Family Planning Association (BEMFAM) which is designed to debunk common misconceptions about the disease. This audio-visual, which targets Brazilian workers, can be used during talks, seminars, and meetings. A discussion of the issues involved usually follows the presentation of Working Against AIDS. The presentation contains 30 illustrated slides (these are included in the article). The presentation begins by explaining that much of the information concerning AIDS is prejudicial and misleading. The next few slides point out some of the common misconceptions about AIDS, such as claims denying the existence of the disease, or suggestions that only homosexuals and prostitutes are at risk. The presentation then goes on to explain the ways in which the virus can and cannot be transmitted. Then it discusses how the virus destroys the body's natural defenses and explains the ensuing symptoms. Slides 14 and 15 point out that no cure yet exists for AIDS, making prevention essential. Slides 16-23 explain what actions are considered to be high risk and which ones do not entail risk. Noting that AIDS can be prevented, slide 24 says that the disease should not present an obstacle to spontaneous manifestations of human relations. The next slide explains that condoms should always be used when having sex with someone who could be infected with AIDS. Finally slides 26-30 demonstrate the proper way to use and dispose of a condom.^ieng

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida , Recursos Audiovisuales , Comunicación , Condones , Educación en Salud , Factores de Riesgo , Signos y Síntomas , Materiales de Enseñanza , Américas , Biología , Brasil , Anticoncepción , Países en Desarrollo , Enfermedad , Educación , Servicios de Planificación Familiar , Infecciones por VIH , América Latina , América del Sur , Enseñanza , Virosis

RESUMEN

PIP: Noting the difficulty in changing sexually promiscuous behavior, the author examines the available treatments and preventive agents for AIDS. AIDS poses a serious health and economic threat to the world, considering that by the turn of the century, some 40-50 million people will be infected. Infection through sexual contact continues to increase at an alarming rate. 30% of all prostitutes in India are infected with the virus, and in Bombay, some 6000 men get infected through sexual contact with prostitutes every month. In some ways, the AIDS epidemic parallels the outbreak of syphilis in the later part of the 19th century. Despite the lack of cure for syphilis at this time, sexual behavior went unchanged. AIDS differs, however, in that the carriers of the disease can remain symptom free for up to 2-15 years or more. During this period, the HIV virus integrates itself into the host's genetic constitution, targeting the cells of the lymphoid cell system and cells situated in the mouth and genital linings, eventually destroying the immune system. The fields of immunology, virology, chemotherapy, and genetic engineering have made great strides in AIDS research. And despite of a high cost, the drug aziodothymidine (AZT) has succeeded in extending the lives of many patients. But a cure does not appear to be in the near future. Fortunately, condoms and spermicidal agents have been shown to protect against infection. The spermicidal agents Nonoxynol-9 and cycloheximide possess anti-HIV properties. Furthermore, another spermicide, cholorhexidine, can be used as a mouth wash to protect from infection after oral sex. Since history has shown the difficulty of changing sexual behavior, efforts should focus on preventing viral spread.^ieng

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida , Condones , Estudios de Evaluación como Asunto , Nonoxinol , Preparaciones Farmacéuticas , Conducta Sexual , Estadística como Asunto , Sífilis , Terapéutica , Asia , Conducta , Anticoncepción , Anticonceptivos , Países en Desarrollo , Enfermedad , Servicios de Planificación Familiar , Infecciones por VIH , India , Infecciones , Investigación , Enfermedades de Transmisión Sexual , Espermicidas , Virosis

RESUMEN

Since 1985, a population of over 1,000 predominantly HIV-positive female prostitutes residing in a low-income area of Nairobi, has been enrolled in a sexually transmitted disease (STD)/HIV control programme. The major elements of the programme include the diagnosis and treatment of conventional STD, and the promotion of condom use to prevent the transmission of HIV and other sexually transmitted infections. Using estimates of numbers of HIV-seropositive prostitutes, numbers of sexual contacts, susceptibility of clients to HIV, HIV transmission efficiency, rates of condom use and the basic reproductive rate of HIV infection in Kenya, we estimate that the programme is responsible for preventing between 6,000 and 10,000 new cases of HIV infection per year among clients and contacts of clients. The total annual operating cost of the programme is approximately US$77,000 or between US$8.00 and US$12.00 for each case of HIV infection prevented. Programmes to reduce the transmission of HIV and other sexually transmitted infections which are targeted at high-frequency STD transmitters, such as prostitutes, can be effective and relatively inexpensive to undertake. More such programmes should be developed and evaluated in different settings.

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida/prevención & control , Infecciones por VIH/prevención & control , Educación en Salud/economía , Enfermedades Virales de Transmisión Sexual/prevención & control , Síndrome de Inmunodeficiencia Adquirida/economía , Síndrome de Inmunodeficiencia Adquirida/transmisión , Estudios de Cohortes , Dispositivos Anticonceptivos Masculinos/economía , Dispositivos Anticonceptivos Masculinos/estadística & datos numéricos , Análisis Costo-Beneficio , Femenino , Infecciones por VIH/economía , Infecciones por VIH/transmisión , Seropositividad para VIH/diagnóstico , Humanos , Kenia/epidemiología , Masculino , Evaluación de Programas y Proyectos de Salud , Trabajo Sexual , Enfermedades Virales de Transmisión Sexual/economía , Enfermedades Virales de Transmisión Sexual/transmisión

RESUMEN

PIP: The origin of the term condom is not known, but it may have been derived from the Latin word condus meaning receptacle. Or it may have been names for an English physician named Condom, although there is no proof of this. Potential users should not be put off by a misperception of the word condom as vulgar. The 1st condoms were made of animal intestines and were designed to prevent spread of sexually transmitted diseases. They decreased sensitivity and could not be mass produced. The 1839 discovery of a process for vulcanizing rubber permitted widescale production of condoms for the 'st time in the later 1800s. Although condoms are not completely safe wither as a contraceptive or a preventive measure, they offer more advantages than disadvantages. They reduce sensitivity and interrupt lovemaking, but their use can be converted into an element of erotic play. The condom should be placed on the erect penis and carefully unrolled to the base. The condom should be carefully removed after ejaculation to ensure that no liquid escapes. Condoms offer protection against the life threatening AIDS virus and against unwanted pregnancy. They have the further advantage of requiring male participation and thus of fostering greater egalitarianism in family planning and contraception. Condom use is slowly gaining ground. 10 years ago a person seeking condoms in a Mexican pharmacy had to request them, but today they are sold in supermarkets and on pharmacy display racks. Channels for free distribution of condoms should be increased to remove the financial constraint on their acceptance.^ieng

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida , Condones , Américas , Anticoncepción , Países en Desarrollo , Enfermedad , Servicios de Planificación Familiar , Infecciones por VIH , América Latina , México , América del Norte , Virosis

RESUMEN

The need for behavioral change of risky sexual practices has been of the highest priority since the onset of the AIDS epidemic. The major focus of education for safe sex has been emphasis on condom use. We surveyed 124 individuals applying to treatment for various chemical dependencies and 60 individuals applying for non-chemical-dependency medical treatment on various aspects of condom knowledge, history of use, and attitudes. Respondents reported that AIDS has motivated them to increase their use of condoms, however, only 13.9% always use them. Education is needed in the areas of increasing protection. Along with the use of a condom, the need for a reservoir tip and the risks associated with multiple sex partners should be stressed.

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PIP: This report contains the findings of a survey designed to investigate the knowledge of condoms, history of use, and attitudes among chemically attitudes among chemically addicted populations. The study took place in the Division of Alcohol and Drug Dependence of the SUNY Health Science Center at Brooklyn, Department of Psychiatry, Kings Country Addictive Disease Hospitals. Researchers interviewed 124 individuals seeking treatment for chemical dependency, as well as 60 individuals applying for non-chemical dependency treatment to serve as controls. 25% of those interviewed reported intravenous injection as their primary route of drug administration, 25% reported smoking crack of sniffing cocaine, 17.4% cited alcohol abuse. The remaining 32.6% made up the control group. In a few instances, drug users scored better than the controls on condom knowledge, but overall, the survey found no significant differences in the level of knowledge about AIDS and condoms use among the drug, alcohol, and control groups. As expected, the survey found that those individuals who have a history of condom use scored higher on the knowledge quiz than those with less experience. Very few individuals in any of the groups mentioned monogamy as a strategy for risk reduction, or mentioned multiple sex partners as high-risk activity. While sensitivity and embarrassment did not play a significant role in condom use frequency, 26.1% of those interviewed agreed with the statement "If my partner doesn't mention using a condom neither will I." 32% of males and 57.1% of females reported having has a sex partner refuse to use a condom. These findings, the report explains, suggest the need to address sexually risky behavior within the chemically addicted populations.

Asunto(s)

Dispositivos Anticonceptivos Masculinos , Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Abuso de Sustancias por Vía Intravenosa/psicología , Adulto , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Ciudad de Nueva York , Factores de Riesgo , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/rehabilitación

RESUMEN

PIP: This article reports on a study of HIV seroprevalence and sexual lifestyles among Italian intravenous drug users (IVDUs). Unlike the situation in the US and most of Europe, where HIV infection is found primarily among homosexual and bisexual men, intravenous drug users account for 66% of the hiv cases in Italy. This study, which ran from January through March of 1990, involved interviews with 124 IV heroin users having methadone treatment in a Public Assistance Center in Rome. The goals of the study included conducting a demographic survey and investigation of the serological condition of IVDUs, investigating the sexual behavior of both HIV positive and negative subjects, and investigating any changes in the sexual habits of the subjects following awareness of their serological condition. 34 of those interviewed were women and 90 were men. Ages ranged from 18-41 years. Of the 124 subjects, 120 were heterosexual, 2 homosexual, and 2 bisexual. 39 heterosexuals, as well as the 2 homosexuals and the 2 bisexuals, tested HIV positive. 96% of the IVDUs interviewed reported being sexually active, and 67% indicated having at least 1 sexual intercourse a week (28% reported 10 or less sexual intercourses in a year). Although all those interviewed acknowledged being aware of the risk of sexually transmitted AIDS, 60% of the HIV positive and 88% of the HIV negative subjects did not use condoms regularly (56% of the HIV negative subjects never used condoms). The article lists some of the reasons given for irregular use of condoms. Concerning changes in sexual habits, 46% of the HIV negative and 63% of the HIV positive subjects indicated reducing the number of sexual partners and/or using condoms.^ieng

Asunto(s)

Coito , Condones , Infecciones por VIH , Homosexualidad , Entrevistas como Asunto , Prevalencia , Investigación , Conducta Sexual , Parejas Sexuales , Trastornos Relacionados con Sustancias , Conducta , Anticoncepción , Recolección de Datos , Países Desarrollados , Enfermedad , Europa (Continente) , Servicios de Planificación Familiar , Italia , Proyectos de Investigación , Problemas Sociales , Virosis