Project Manager, College of Medicine, University of Ibadan
Anecdote evidences revealed that men who have sex with men are 19 times more at risk of HIV infection than the general population. Available data in Nigeria showed that HIV prevalence among MSM increased from 13.5% in 2007 to 22.9% in 2015 with 61% condom use among them, the lowest compared to other population categories in the key affected population. Unavailability of lubricant has been identified as one of the restraining factors in HIV programming but national surveys on HIV in Nigeria do not capture lubricant use and its effect on condom use. This study assessed lubricant use and its association with condom use among MSM in Southwestern Nigeria. Age of the participants was 27.0±7.2 years, and age of start of sexual intercourse with other men was 22.1±18.3. Majority (71.1%) were never married and 43.3% have at least one female sexual partner. Many (76.7%) use lubricants for sexual intercourse, getting them from chemist shops at expensive cost compared to condoms. Condom use was higher among respondents with higher education but not statistically significant (p=0.422). There was a significant relationship between the use of lubricant and condom use for sexual intercourse. However, this was stronger for male sexual partners (p=0.000) than for female partners (p=0.053). Condom use is associated with lubricant use. Higher association for male partners suggests that lubricant availability might explain the MSM sexual activities will improve their condom use with other men if lubricant is available.
Abstract: In Mozambique, women are the most affected by HIV/AIDS. Self-efficacy is one of the main predictors of effective use of a condom. Therefore, it is essential to identify the factors that influence condom-use negotiation self-efficacy in vulnerable women. The aim of this paper is to identify socio-demographic, marital, and psychosocial factors associated with condom-use negotiation self-efficacy among Mozambican women at risk for HIV infection.Participants were women (173) who were patients at the Gynecology Department of the Central Hospital of Beira, Mozambique, and at risk for HIV infection. Women completed measures of condom-use negotiation self-efficacy, HIV prevention knowledge, and perceived barriers against safer sex.The results showed that demographic and marital variables are associated with condom-use negotiation self-efficacy, namely, those having more than 9 years of education, who are younger and not living with a partner, and who talk about AIDS with partners report higher condom-use negotiation self-efficacy. Regarding psychosocial factors, higher HIV prevention knowledge and fewer perceived barriers to safer sex predict higher condom-use negotiation self-efficacy.These results can contribute to sexual health promotion and HIV/AIDS prevention in Mozambican women because they identify at-risk groups and marital and psychosocial malleable factors that can be targeted in AIDS prevention among at-risk Mozambican women.
Pub.: 24 Aug '17, Pinned: 28 Sep '17
Abstract: Use of more effective contraception may lead to less condom use and increased incidence of sexually transmitted infection.The objective of this study was to compare changes in condom use and incidence of sexually transmitted infection acquisition among new initiators of long-acting reversible contraceptives to those initiating non-long-acting reversible contraceptive methods.This is a secondary analysis of the Contraceptive CHOICE Project. We included 2 sample populations of 12-month continuous contraceptive users. The first included users with complete condom data (baseline, and 3, 6, and 12 months) (long-acting reversible contraceptive users: n = 2371; other methods: n = 575). The second included users with 12-month sexually transmitted infection data (long-acting reversible contraceptive users: n = 2102; other methods: n = 592). Self-reported condom use was assessed at baseline and at 3, 6, and 12 months following enrollment. Changes in condom use and incident sexually transmitted infection rates were compared using χ(2) tests. Risk factors for sexually transmitted infection acquisition were identified using multivariable logistic regression.Few participants in either group reported consistent condom use across all survey time points and with all partners (long-acting reversible contraceptive users: 5.2%; other methods: 11.3%; P < .001). There was no difference in change of condom use at 3, 6, and 12 months compared to baseline condom use regardless of method type (P = .65). A total of 94 incident sexually transmitted infections were documented, with long-acting reversible contraceptive users accounting for a higher proportion (3.9% vs 2.0%; P = .03). Initiation of a long-acting reversible contraceptive method was associated with increased sexually transmitted infection incidence (odds ratio, 2.0; 95% confidence ratio, 1.07-3.72).Long-acting reversible contraceptive initiators reported lower rates of consistent condom use, but did not demonstrate a change in condom use when compared to preinitiation behaviors. Long-acting reversible contraceptive users were more likely to acquire a sexually transmitted infection in the 12 months following initiation.
Pub.: 19 Sep '17, Pinned: 28 Sep '17
Abstract: Sexual health is an important area of study-particularly for minority youth and youth living in disadvantaged neighborhoods.The purpose of the research was to examine the sources of sexual health information associated with youth adopting sexual risk reduction behaviors.Data collection took place in a small city in the Northeastern United States using cross-sectional behavioral surveys and modified venue-based sampling. Participants included 249 African American and Latino youth aged 13-24. Participants reported their sources of information about contraception and human immunodeficiency virus/sexually transmitted disease, such as TV/movies, parents, social media; their intentions to have sex; and condom and contraception use during their last sexual activity. Social media use, past pregnancy experience, past sexual history, age, and gender were also measured. Standard tests of bivariate association (chi-square and F tests) were used to examine initial associations between sexual risk reduction behavior and exposure to sexual risk reduction information on social media. Logistic regression models were used to test multivariate relationships between information sources and sexual risk reduction behavior.Youth who were exposed to sexual health messages on social media were 2.69 times (p < .05) and 2.49 times (p < .08) more likely to have used contraception or a condom at last intercourse, respectively. Parents, schools, or traditional media as information sources were not significantly associated with contractive use or condom use at last intercourse.Youth sexual behavior is increasingly informed by social media messages. Health practitioners should utilize social media as an important health promotion tool.
Pub.: 01 Sep '17, Pinned: 28 Sep '17
Abstract: This paper explores barriers to consistent condom use among female sex workers in Jamaica in a qualitative study using grounded theory. Multiple perspectives were sought through 44 in-depth interviews conducted with female sex workers, clients, the partners of sex workers and facilitators of sex work. Poverty and lack of education or skills, severely limited support systems as well as childhood abuse served to push the majority of participants into sex work and created vulnerability to HIV and other STIs. Despite these constraints, women found ways to exercise agency, ensure condom use, adopt protective measures and gain economic advantage in various aspects of the Jamaican sex trade. Perceived relationship intimacy between sex workers and their clients and/or their main partners emerged as the main factor contributing to reduced risk perception and inconsistent condom use. Relationship intimacy, with associated trust and affirmation of self, is the most important factor influencing sexual decision-making with respect to lapse in condom use among female sex workers in Jamaica. Study findings provide important insights that can enhance individual psychosocial, interpersonal and community-based interventions as well as inform environmental, structural and policy interventions to reduce risk and vulnerability among female sex workers.
Pub.: 02 Sep '17, Pinned: 28 Sep '17
Abstract: The development of antiretroviral (ARV)-based prevention products has the potential to substantially change the HIV prevention landscape; yet, little is known about how appealing these products will be outside of clinical trials, as compared with the existing options.We conducted a discrete choice experiment (DCE) to measure preferences for 5 new products among 4 important populations in the HIV response: adult men and women in the general population (aged 18 to 49 y), adolescent girls (aged 16 to 17 y), and self-identifying female sex workers (aged 18 to 49 y). We interviewed 661 self-reported HIV-negative participants in peri-urban South Africa, who were asked to choose between 3 unique, hypothetical products over 10 choice sets. Data were analyzed using multinomial, latent class and mixed multinomial logit models.HIV protection was the most important attribute to respondents; however, results indicate significant demand among all groups for multipurpose prevention products that offer protection from HIV infection, other STIs, and unwanted pregnancy. All groups demonstrated a strong preference for long-lasting injectable products. There was substantial heterogeneity in preferences within and across population groups.Hypothetical DCE data may not mirror real-world choices, and products will have more attributes in reality than represented in choice tasks. Background data on participants, including sensitive areas of HIV status and condom use, was self-reported.These results suggest that stimulating demand for new HIV prevention products may require a more a nuanced approach than simply developing highly effective products. No single product is likely to be equally attractive or acceptable across different groups. This study strengthens the call for effective and attractive multipurpose prevention products to be deployed as part of a comprehensive combination prevention strategy.
Pub.: 03 Sep '17, Pinned: 28 Sep '17
Abstract: HIV prevalence among Thai men who have sex with men (MSM) and transgender women (TG) are 9.15% and 11.8% respectively, compared to 1.1% in the general population. To better understand early adopters of Pre-Exposure Prophylaxis (PrEP) in Thailand, we analyzed bio-behavioral and socio-demographic characteristics of PrEP-eligible MSM and TG.Four Thai urban community clinics between October 2015 and February 2016 METHODS:: Socio-demographics, HIV risk characteristics, and PrEP knowledge and attitudes, were analyzed in association with PrEP initiation among eligible Thai MSM and TG. Adjusted analysis explored factors associated with PrEP acceptance. We then analyzed HIV risk perception, which was strongly associated with PrEP initiation.Of 297 participants, 55% accepted PrEP (48% of MSM, 54% of TG). Perceived HIV risk levels were associated with PrEP acceptance (OR 4.3; 95%CI:1.5-12.2. OR 6.3; 95%CI:2.1-19.0. OR 14.7; 95%CI:3.9-55.1; for minimal, moderate, and high perceived risks, respectively). HIV risk perception was associated with prior HIV testing (OR 2.2; 95%CI:1.4-3.5); inconsistent condom use (OR:1.8; 95%CI:1.1-2.9); amphetamine use in the past 6 months (OR:3.1; 95%CI:1.1-8.6); and uncertainty in STI history (OR:2.3; 95%CI:1.4-3.7). Approximately half of those who reported either inconsistent condom use (46%), multiple partners (50%), group sex (48%), or had baseline bacterial STI (48%) perceived themselves as having no or mild HIV risk.HIV risk perception plays an important role in PrEP acceptance. Perception does not consistently reflect actual risk. It is therefor critical to assess a client's risk perception, and provide education about HIV risk factors that will improve the accuracy of perceived HIV risk.
Pub.: 14 Sep '17, Pinned: 28 Sep '17
Abstract: One of the challenges facing researchers in the domain of human immunodeficiency virus prevention is the assessment of condom use in an unbiased self-reported manner. The current study presents the development and preliminary validation of an indirect condom use test (I-CUTE), designed to assess condom use tendencies and to overcome self-report biases. Two samples were included using correlational designs. In sample 1, 88 students from European university completed the I-CUTE with questionnaires of condom use barriers, social desirability, and condom use negotiation self-efficacy. In sample 2, 212 students from sub-Saharan universities completed the I-CUTE with questionnaires of condom use barriers and knowledge. The I-CUTE included 17 pictures of human figures in relation to condom use, where participants had to choose one of the four a-priori given sentences reflecting the figures' thoughts. This represented a semi-projective, yet standardized test. In sample 1, I-CUTE scores were inversely related to barriers, positively correlated with condom use negotiation self-efficacy and unrelated to social desirability. In sample 2, I-CUTE scores were inversely related to barriers and unrelated to knowledge scores. In a multiple regression, condom use barriers had a unique contribution to explaining variance in I-CUTE scores, beyond the contribution of background variables and knowledge. These results support the preliminary reliability and validity of the I-CUTE tool in a variety of cultures, and reveal its lack of bias by social desirability and the importance of condom use barriers in condom use tendencies.
Pub.: 15 Sep '17, Pinned: 28 Sep '17
Abstract: College students commonly engage in risky sexual behaviors, such as casual sexual encounters and inconsistent condom use. Discounting paradigms that examine how individuals devalue rewards due to their delay or uncertainty have been used to improve our understanding of behavioral problems, including sexual risk. The current study assessed relations between college women's sexual partners discounting and risky sexual behavior. In this study, college women (N = 42) completed two sexual partners delay discounting tasks that assessed how choices among hypothetical sexual partners changed across a parametric range of delays in two conditions: condom availability and condom unavailability. Participants also completed two sexual partners probability discounting tasks that assessed partner choices across a parametric range of probabilities in condom availability and unavailability conditions. Additionally, participants reported risky sexual behavior on the Sexual Risk Survey (SRS). Participants discounted delayed partners more steeply in the condom availability condition, but those differences were significant only for those women with three or fewer lifetime sexual partners. There were no consistent differences in discounting rate across condom availability conditions for probability discounting. Sexual partners discounting measures correlated with risky sexual behaviors as measured by the SRS, but a greater number of significant relations were observed with the condoms-unavailable delay discounting task. These findings suggest the importance of examining the interaction of inconsistent condom use and multiple partners in examinations of sexual decision-making.
Pub.: 16 Sep '17, Pinned: 28 Sep '17
Abstract: Despite prevention efforts, the incidence of sexually transmitted infection among HIV-positive men who have sex with men remains high, which is indicative of unchanged sexual risk behaviour. Discussing sexual risk behaviour has been shown to help prevent sexually transmitted infections among HIV-positive men who have sex with men.The aim of this study was to identify factors that influence whether - and how - specialised HIV nurses discuss sexual risk behaviour with HIV-positive men who have sex with men. Identifying these factors could indicate how best to improve the frequency and quality of discussions about sexual risk behaviour, thereby reducing sexual risk behaviour and sexually transmitted infections.Qualitative study, focus groups among HIV nurses.Dutch HIV treatment centres.A purposive sample was taken of 25 out of 87 HIV nurses working in one of the 26 specialised HIV treatment centres in the Netherlands. Of the 25 HIV nurses we approached, 22 participate in our study.Three semi-structured focus group interviews were held with 22 HIV nurses from 17 hospitals. Interviews were transcribed verbatim, and thematic analysis was performed.HIV nurses agreed that discussing sexual risk behaviour is important, but barriers were experienced in relation to doing so. In accordance with the theory of planned behaviour, attitudes, perceived norms and perceived behavioural control were all found to be relevant variables. Barriers to discussing sexual risk behaviour were identified as: dealing with embarrassment, the changing professional role of an HIV nurse, time constraints, and the structure of the consultation.To improve the frequency and quality of discussions about sexual risk behaviour with HIV-positive men who have sex with men, our data suggests it would be beneficial to support HIV nurses by developing tools and guidelines addressing what to discuss and how. Using a related topic as a conversational 'bridge' may help nurses to broach this subject with their patients. This would allow HIV nurses to discuss possible risk reduction strategies, such as pre-exposure prophylaxis for HIV-negative partners, condom use, strategic positioning, or sero-sorting.
Pub.: 25 Sep '17, Pinned: 28 Sep '17