NGO participation boosts condom sales in Haiti

An estimated 10% of Haiti's urban population and 4% of the rural population is infected with HIV. As recent as a few years ago, few commercial sales outlets for condoms existed in Haiti, even in the cities. Now, however, Pante condoms are accessible to Haitians at all hours of the day even in remote areas of the country. Pante is the brand name of the condom that Population Services International (PSI) introduced in Haiti in 1990, and began packaging, promoting, and selling a year later through a condom social marketing (CSM) program funded by the AIDS Control and Prevention (AIDSCAP) Project. The CSM program allows Pante to be sold at 10% of the cost of commercial condoms. Even in the context of political instability and economic crisis which followed the overthrow of Haiti's elected government in 1991, monthly sales of Pante during 1991-95 increased from an average of 3000 to more than 400,000, and more than 16 million units were sold over the 4-year period.     

Global update: Haiti

In a country of 6 million that is the hemisphere's poorest, an American-supported Haitian campaign against AIDS has moved beyond getting people to ask questions about the risk of disease and helped make condom use commonplace. Within a year, the program has gone from selling about 40,000 condoms a month to nearly half a million. The story of condom use in Haiti, experts say, is one of careful attention to local psychology and culture. Equally important, they say, has been the subsidized price, currently about 3 cents each. In Haiti, despite infection rates that are thought to approach 10% in urban areas, there has been strong resistance to belief in the threat posed by AIDS.     

Effect of partner relationship on motivation to use condoms among adolescent mothers

PURPOSE: Adolescent mothers have high rates of repeat pregnancy and sexually transmitted infections (STIs). We sought to identify factors associated with their consistent condom use. METHODS: Data for 107 urban adolescent mothers enrolled in a longitudinal computer-assisted motivational interviewing (CAMI) intervention were analyzed. The intervention aimed to motivate and instill confidence in using condoms consistently. Data sources: 1) structured interviews during the third trimester of pregnancy (baseline), 2) CAMI responses at 9-12 months postpartum. Outcomes were dichotomized as: consistent condom users and inconsistent condom users. RESULTS: At baseline, mean age was 17 (1.1 SD) years, 96% African American, and 26% reported always using condoms. At 9-12 months postpartum, 33 (31%) used condoms consistently. Consistent condom users were less likely to report having sex with their baby's father (61% vs. 81%; p = 0.05). Adolescent mothers who used condoms consistently experienced greater self-efficacy in the prevention of STIs and recognized the importance of preventing STIs with a new boyfriend (p = 0.006). Consistent condom users held the opinion that it was more important to use condoms with a new boyfriend than with their baby's father regardless whether their main partner was the father of their baby or a new boyfriend. CONCLUSIONS: Level of motivation, belief in the importance of condom use and self-efficacy to use condoms with a new boyfriend regardless of actual sexual partner relationship were the strongest predictors of consistent condom use among adolescent mothers. Future interventions aimed at improving condom use should focus on motivation and to different views held by teens regarding their partner-specific condom use.     

Social marketing in a rural African district

21 focus group discussions were held in 5 locations of Kabarole district, Uganda, with 200 male and female participants to assess the demand for and acceptability of condoms in the region. The discussions were also held to obtain information related to the design of products and motivational materials, and included people believed to engage in high-risk sex, lower-risk members of the general population, and shop owners. Condoms and condom use are strongly desired within this population, with participants expressing interest in high-quality products of uniform size which are continuously available at convenient outlets. Moreover, shop and pharmacy owners were more than willing to display subtle messages about condoms and advertise their availability. The main barriers to use were low female acceptance, unavailability, societal attitudes, high cost, and the inability to buy condoms at night when shops are closed. Feedback led to the development of the logo of a man holding a spear and a shield and the adoption of the brand name Engabu, Rutooro terminology for a wooden shield. Comparatively stronger, yet sensitive, brown condoms were eventually packaged in dark brown wrappings in groups of 5. Vendors are offered the packets of 5 condoms for US$0.06, which they are expected t sell at US$0.08; owners expressed the preference for slot-box distribution containers. In addition, people in the sales network were all trained so they could explain proper condom use to clients. A post-study assessment found people content with the product and its presentation, so the social marketing program was officially launched in September, 1992. Condoms were sold heavily in the 1st few weeks of the program despite the lack of media and newspaper coverage per national government condom policy. Knowledge of the availability of condoms will instead be spread through counseling and health education sessions, seminars, and informal talks.     

Changes in HIV-related preventive behavior in the US population: data from national surveys, 1987-2002

This study estimated 1987-2002 trends in preventive behaviors closely linked to HIV from several large health surveys providing the most recently available data. These behaviors include condom use, dual use of condoms with other contraceptive methods, and HIV testing. Condom use increased throughout the period for adolescents, but there is no evidence of overall increased condom use for adults after the mid-1990s. After 2000, adult condom use with primary partners was low even among those at highest risk. Dual use of condoms with other contraceptive methods was reported by a small and increasing percentage of adolescents and adults. By 2001 a high percentage of US adults reported having been tested at least once, and reproductive-age and pregnant women were tested at a greater rate than others. However, 1 in 4 pregnant women had never been tested for HIV. This review indicates that even after considerable increase in preventive behaviors, it is still possible to identify a relatively large segment of the population that is at risk for transmitting or acquiring HIV. Prevention programs serving high-risk populations need to work toward increasing safe sex practices with main partners and HIV testing among the never-tested, particularly reproductive-age women.     

Students' awareness of and attitudes to AIDS

Students' attitudes to and knowledge and awareness of the acquired immune deficiency syndrome (AIDS) was assessed by questionnaire. The recent information campaign reached a high proportion of the sample of 1063 students and television was the most memorable medium. Students were generally aware that AIDS was not associated with social contact but there was confusion about the risk of infection from donating or receiving blood, with 17.9% of blood donors now less willing to donate blood. Most of the students were aware that the condom reduces the risk of spread of AIDS sexually but there was no indication of widespread condom usage among the 399 students who admitted they were sexually active; 39.1% of this group used condoms alone or with other protection. Almost half the sample (47.6%) would like to have the opportunity to have their blood tested for the AIDS virus; 96 students would prefer this to be at a clinic and 59 of them would not wish their family doctor to know the result. A high proportion of the sample considered that AIDS victims should be cared for at home or in a special hospice.     

Assessing prevention achievements and failures: the importance of monitoring and evaluation

Aids prevention evaluations are necessary for determining whether the program is effective or moving in the expected direction and to satisfy donor requirements. The important issues are the methods of evaluation, when to conduct an evaluation, and how much money should be devoted to evaluation. Research is necessary in the beginning stage of program planning for program strategies, identification of the target audience, determination of the context of behavior, and cost effectiveness in reaching the target audience. Methods and materials for research need to be pretested in order to prevent failure and wasting money on full implementation. Quantitative as well as qualitative data may be extracted. During the early implementation stage, research is needed to monitor progress; appropriate methods might be participant observation, interviews, and/or focus groups. The aim is to measure the extent to which planned activities are actually being implemented and the extent to which the audience is being reached. The results might indicate whether efforts need to be enhanced or whether there are obstacles. Program effectiveness is also determined by an assessment of outcome after a period of time of operation. The program objectives determine what outcome measures are appropriate. It could be that there is measurement of whether risk practices decreased or knowledge and attitudes have changed. When knowledge, attitudes, and behavior changes are measured, self-reports are necessary, but biased. WHO's Global Program on AIDS has suggested using the following indicators: number of sexual partners, condom use, and reported incidence of sexually transmitted diseases. Observation is one method of measuring behavior change, which is not possible with sex behavior. One project measured condom use in sex worker locations by counting the number of discarded condoms in rooms, once the number of condoms distributed was known. Condom use may also be indirectly measured by condom sales or by counting the reduction in sexual partners. Feedback is also necessary as programs mature. The important question to ask is how pretesting, monitoring, feedback, and evaluation will contribute to program success.     

Condom distribution in Bali: assuring supply meets demand

Hundreds of thousands of tourists visit Bali each year, many of whom pay to have sex with local residents. Kuta, one of Bali's major tourist resort towns, has manifested an higher demand for condoms than other studied areas in Indonesia. Such demand is laudable in the context of a growing HIV/AIDS epidemic, but demand must encounter supply to be worthwhile. The Citra Usadha Indonesia Foundation (YCUI) has been conducting outreach education in Kuta and other areas of Bali since February 1992. Over that time, outreach workers have found that street youths' and prostitutes' main sources for condoms, pharmacies, supermarkets, and YCUI outreach workers, are either closed or potentially unavailable at night, when most sexual transactions occur. Pharmacies and supermarkets close at 10 pm. YCUI therefore initiated a six-month condom distribution program in 1994 to encourage the approximately 150 street vendors working in Kuta to sell condoms. Street vendors who enrolled in the program were provided with a monthly supply of 30 free condoms for the period of six months and invited to sell them to the public at whatever price the market set. Concurrently, YCUI promoted condom sales and increased awareness of the new condom source through social marketing techniques and their network of outreach workers. After six months, 122 vendors had participated in the program selling 10,255 condoms. Vendors were able to sell more and more condoms as the program progressed. A final evaluation will be conducted October 1994 to determine how many vendors still sell condoms now that the free supplies have been discontinued.     

Musical and clothing invitations to protection

The Chaussez Capote Project interviewed 48 youths in Abidjan and Dabou aged 14-25 years on how to best get individuals in their age group to use condoms. 251 individuals aged 15-25 were also surveyed in Abidjan on the same subject. While more than 80% of this latter group had already discussed AIDS, sexually transmitted disease (STD), and prevention with others, 90% still wanted advice on these themes from medical staff and the media. 40% who had already used condoms did so incorrectly, while approximately 33% had experienced condom breakage during use. Respondents felt that condom promotion should be associated with information on AIDS, STDs, and contraception or information on general health. In response to this feedback, the project commissioned the creation of a promotional music cassette with French and African songs of different musical styles. Lyrics imparted technical information and correct misconceptions related to condom use. Free distribution of the cassette commenced August 1992, and approximately 800 were given to organizations and businesses. The cassette also aired on radio and Ivorian television, but met with only limited success. It is thought that its impact was limited due to the small number of copies duplicated and inefficient distribution. A new version was therefore created with different songs and short messages by popular African singers for local duplication and sale at a subsidized price starting December 1993. As a 2nd intervention, clothing metaphors applied to condoms and condom use were applied to the development of a clothing promotion loincloth designed Spring 1993. The cloth was pretested and revised to ultimately consist of panels depicting 2 young couples, a condom, a panther, and the words Entre nous. The cloth has been ordered for use by the National AIDS Committee, a condom social marketing project, and the French agency for development cooperation.     

避孕套性能测试

目的对目前避孕套的质量现状进行分析,对存在的问题和可能的解决方法进行探讨.方法对45批次避孕套进行尺寸、爆破强度、老化、针孔、包装标志等多项物理性能的测试.结果测试样品中,12批次不合格,合格率为73.3%.结论避孕套的质量关系到很多人的身体健康,因此对避孕套进行质控参数、性能要求的进一步研究是非常必要的.     

Looking for change in response to the AIDS epidemic: trends in AIDS knowledge and sexual behavior in Zambia, 1990 through 1998

This study investigates trends in AIDS knowledge and sexual behavior among men and women in urban Lusaka 1990 to 1998, and in all of Zambia, 1992 to 1998. Using data from representative surveys of urban Lusaka and of the country as a whole, population proportions were estimated to examine trends in knowledge and sexual risk behaviors. Differences in the estimated proportions between 1990 and 1998 were tested in Lusaka. In all Zambia, tests of difference were conducted between the earliest and latest years for which data were available for each indicator. A decline in premarital sexual activity was observed in urban Lusaka. In 1990, 50% of never married women reported no sexual experience, compared with 60% in 1998 (p =. 003); among men, the figures were 38% and 53%, respectively (p <. 001). Fewer women (1990, 8%; 1998, 2%; p <.001) and men (1990, 31%; 1998, 19%; p =.07) had extramarital partners. The bulk of change observed in urban Lusaka took place from 1990 to 1996; the changes in men's behavior observed between 1996 and 1998 were also observed in the national estimates for those years. National figures for other indicators from 1992 to 1998 were less encouraging. Apart from an increase in having ever used condoms, no change in women's sexual behavior was observed. Fewer men had premarital sex from 1996 to 1998 (1996, 64%; 1998, 46%; p <.001), but condom use with nonregular partners decreased among men (1996, 38%; 1998, 29%; p =.02). Prevention campaigns focused on education about AIDS and promoting safer sexual behavior appear to have made a difference in the early 1990s in Zambia. Findings from more recent years indicate that further change has stagnated. Renewed efforts are needed, particularly targeting condom use with nonregular partners.     

Positive reinforcement to promote safer sex among clients

The AIDS Research Foundation of India (ARFI) began an intervention program with sex workers in Madras where the women reported that they were willing to use condoms, whereas the customers were not. Accordingly, ARFI is focusing on clients using a positive reinforcement approach: repetition of the desirability of condom use by communication. First, truck drivers and dock workers have been targeted. Drivers interviewed by ARFI were familiar with the condom as a contraceptive method rather than a disease-preventing method, and used it with their wives. The ARFI program has convinced tobacco shopkeepers to stock condoms for drivers. Truckers receive key chains with a holder for a condom. At transit site tea shops songs are aired about road and roadside safety sponsored by a tire manufacturer with a message about rubber (tires and condoms). Women selling sex at transit sites are also educated about the human immunodeficiency virus (HIV) infection and sexually transmitted diseases (STDs) while attempting to increase their level of hygiene. The typical Friday night sex-seeking behavior among dock workers consists of drinking in a wine shop and soliciting sex workers. Port management and unions have also been recruited for promoting AIDS-related education after participating in health education sessions with flip charts and flash cards. Rest rooms display posters on condom use, some men have been recruited as condom holders for distribution on Friday nights, and barber shops also feature posters with messages about safer sex. AIDS/STD prevention programs have to deal with prevailing practices, values, and beliefs. Results indicate increased condom use among clients as shown by increased sales at transit site tobacco shops and shops around the port. In the future the program will pay more attention to improving the negotiation skills of sex workers.     

Why do heterosexual young adults who use reliable contraception also use condoms? Results from a diary‐based prospective longitudinal study

Objectives. To identify characteristics of individuals and characteristics of sexual encounters that predict whether people using contraception will also use condoms (dual use), and to determine whether dual use is prompted by concerns about unplanned pregnancy and/or sexually transmitted infections (STIs). Design. A longitudinal prospective design was used to identify characteristics of individuals and characteristics of specific sexual encounters that predict condom use. Methods. A sample of 349 sexually active heterosexual young adults was recruited at universities and trade colleges in Melbourne, Australia. Participants completed a self‐administered questionnaire, and a representative subsample (N = 103) completed a structured condom use diary in which they reported on up to 10 instances of vaginal intercourse. Respondents reported use of condoms and other forms of contraception during 919 instances of vaginal intercourse. Results. In multivariate analyses, dual use of condoms in addition to other contraception was predicted by attitudes toward condoms, intentions to use condoms, partner type and discussion of condom use with sexual partners. Dual use was not related to greater concern about HIV/STIs or unplanned pregnancy. Conclusion. Encouraging heterosexual young adults to discuss condom use, and developing their skills for negotiation of condom use will increase rates of condom use, thereby reducing current high rates of unplanned pregnancy and STIs.     

Attitudes toward condom use and AIDS among patients from an urban family practice center

As part of an effort to better educate patients about using condoms, a survey was done to assess the sexual practices, attitudes toward acquired immunodeficiency syndrome (AIDS) and condom use by patients who visit an urban family practice center. A self-administered questionnaire was given to 126 patients of whom the majority were black and single. Seventeen percent indicated they had sex with more than one person in the 3 months before the survey. Within the last 5 years, 10% had sex with an intravenous drug abuser, and 6% with someone of the same sex. Fifty percent believed that condoms decrease sexual pleasure for men and 31% thought condoms made sex inconvenient. Twenty-seven percent of those surveyed believed that a man's penis may be too large for a condom and 18% believed that uncircumcised men could not use condoms. Forty-five percent believed they should be screened for human immune deficiency virus exposure. The results highlight attitudes and beliefs that may function as barriers to condom use and should be addressed when encouraging condom use with this population.     

Knowledge,attitudes & barriers to condom use among female sex workers and truck drivers in Uganda: a mixed-methods study

Background

There is limited documentation on knowledge, attitudes and barriers to condom use among female sex workers (FSWs) and truck drivers (truckers).

Objective

To explore knowledge, attitudes and barriers to condom use among FSWs and truckers operating along major transport corridors in Uganda

Methods

Structured questionnaires were administered to explore FSWs'' and truckers'' knowledge of and attitudes towards condom use among 259 FSWs and 261 truckers. Qualitative data were collected on barriers to condom use using focus group discussions. Quantitative data were analyzed using SPSS while qualitative data were audio-recorded, transcribed and thematically analyzed.

Results

Condom knowledge was high with 97% of FSWs and 95% of truckers agreeing with the statement, “using condoms properly and consistently reduces risk of HIV infection”. Attitudes towards condom use were generally favorable with 91% of FSWs and 82% of truckers agreeing with the statement, “condom use is the best method of HIV prevention”. Qualitative findings show that poverty, refusal to use condoms by male partners, alcohol use before sex and beliefs that condoms ‘kill the mood for sex’ remain key barriers to consistent condom use.

Conclusions

Consistent condom use among FSWs and truckers is still hampered by economic and relationship factors.     

Country watch. Uganda

In 1991, Medecins sans Frontieres initiated an HIV/AIDS prevention program in Moyo District, Uganda, with the goal of gradually transferring responsibility for it to local people through the training of AIDS control advisors (ACA). Informational pamphlets were developed along with an action plan for a village-based information campaign, followed by the insertion of 8 women and 22 men into a two-week training course in Moyo Town on prevention measures and communication. The ACAs were evaluated monthly both qualitatively and quantitatively with an overall evaluation conducted in January 1992. All villages had been visited several times in the first five months, with the ACAs meeting 50,000 people and distributing 45,000 pamphlets and 40,000 condoms. Community collaboration was excellent, although condoms were distributed to only adults and older teenagers in response to local cries that condom distribution encouraged immorality. Some language difficulties were also encountered. ACAs continued to distribute condoms upon request over the period February-August 1992, but concentrated upon drivers, beer brewers and their customers, traders, musicians, soldiers, barmaids, fishermen, teachers and school children, traditional healers and birth attendants, and religious leaders. Subsequent to this period, the advisors received a week of training on conducting KAP surveys. Refinements were made later in the program with the Ugandan assistant manager ultimately taking over field responsibility in May 1993. Although the ACA team was reduced from 30 to 10 people, it continues to work closely with all district authorities.     

Development of a scale for attitude toward condom use for migrant workers in India

Background : The propaganda for the use of condoms remains one of the mainstay for prevention of human immunodeficiency virus (HIV) transmission. In spite of the proven efficacy of condom, some moral, social and psychological obstacles are still prevalent, hindering the use of condoms. Aims : The study tried to construct a short condom-attitude scale for use among the migrant workers, a major bridge population in India. Settings and Design : The study was conducted among the male migrant workers who were 18-49 years old, sexually active and had heard about condoms and were engaged in nonformal jobs. We recruited 234 and 280 candidates for Phase 1 and Phase 2 respectively. Materials and Methods : Ten items from the original 40-item Brown's ATC (attitude towards condom) scale were selected in Phase 1. After analysis of Phase 1 results, using principal component analysis six items were found appropriate for measuring attitude towards condom use. These six items were then administered in another group in Phase 2. Utilizing Pearson's correlations, scale items were examined in terms of their mean response scores and the correlation matrix between items. Cornbach's alpha and construct validity were also assessed for the entire sample. Results : Study subjects were categorized as condom users and nonusers. The scale structure was explored by analyzing response scores with respect to the items, using principal component analysis followed by varimax rotation analysis. Principal component analysis revealed that the first factor accounted for 71% of the variance, with eigenvalue greater than one. Eigenvalues of the second factor was less than one. Application of screen test suggests only one factor was dominant. Mean score of six items among condom users was 20.45 and that among nonusers was 16.67, which was statistically significant ( P Conclusion : This tailor-made attitude-toward-condom-use scale, targeted for most vulnerable people in India, can be included in any rapid survey for assessing the existing beliefs and attitudes toward condoms and also for evaluating efficacy of an intervention program.     

Condom services to prevent HIV transmission: are they workable?

This editorial argues that in order to increase the use of condoms in the fight against AIDS, WHO's Global Program on AIDS (GPA) must address the problems of weak condom distribution and promotion systems. The available data indicates that condom use can protect against HIV transmission. Studies in Zaire, Denmark, Germany, and Australia reveal that seropositivity among prostitutes who use condoms is much lower than among prostitutes who do not use condoms. However, the use of condoms largely depends on whether services are available to the people who practice risk behavior, and whether such people can be motivated to adopt safe sex practices -- including proper and consistent condom use. In order to bring about this desired behavior change, it is essential to have a strongly managed integrated program that combines condom services and health promotion, as well as specific plans and budgets to distribute and promote condoms. In supporting national AIDS programs, GPA's current strategy for condom services includes the following: 1) the provision of high-quality, low-cost condoms; 2) assistance in developing comprehensive program management and technical support plans and budgets for incorporation into subsequent funding cycles; and 3) support for research and development of new methods for preventing the sexual transmission of HIV -- including barrier methods that can be controlled by women.     

Knowledge, attitudes, and behavior of homeless African-American adolescents: implications for HIV/AIDS prevention

The purpose of this pilot study was to describe the knowledge of HIV/AIDS, attitudes about condom use, and the sexual behavior of African-American adolescents who reside in a children's emergency homeless shelter. The Attitudes Toward Condom Usage Questionnaire, the AIDS Knowledge and Attitude Survey, and a Perceived Risk of HIV/AIDS Scale were modified and administered to 37 African-American male and female adolescents who reside in an emergency shelter. HIV/AIDS knowledge and attitudes about condoms among these respondents were comparable to those of other adolescents described in the literature in that there was a strong knowledge of HIV/AIDS, although sexual behavior and attitudes toward condoms were not consistent with this knowledge. Significant differences between male and female respondents were only found on three items of the Attitudes Toward Condom Usage Questionnaire and on the Perceived Risk of HIV/AIDS Scale at the 0.05 level. The knowledge, attitudes, and sexual behavior of homeless, African-American adolescents should be examined to develop and implement appropriate programs to address the specific needs of this population. Further research should focus on this population and expand on this preliminary data.     

Country watch: Dominican Republic

In the Dominican Republic, 93% of female sex workers did not use condoms because of client refusal according to a survey. The organizations PROCETS and COIN carried out a project to learn why clients refused and to develop educational materials to assist sex workers. The project held 8 focus group discussions with 65 women and identified clients' most common arguments against condom use, compiled a list of successful strategies, and developed 5 profiles of clients: the executive, the smooth talker, the macho, the stubborn one, and the indomitable one. These typical clients were featured in a comic book with 5 stories in which Maritza, a clever sex worker, counters the men's refusal to use condoms and convinces 4 of them to do so. In the 5th story, she tells a young sex worker that she should refuse clients who do not want safer sex. The women participated in all stages of the comic book's development. The project then trained other sex workers to use the comic book in peer education and discussion to enhance the sex workers' sense of self-efficacy. In the first 2 months, peer educators distributed 2895 copies of the comic book to sex workers in 2 major cities. A follow-up survey is evaluating the comic's impact by comparing the women who read the comic with those who did not to determine correlations between self-efficacy and safer sex negotiation and condom use. In a 3rd stage, male clients will be approached so that appropriate interventions can be developed with them. The Maritza comic book has been used for a flipchart series to train on sexually transmitted diseases (STD) prevention. Some of the issues addressed include the uselessness of vaginal douches against STDs, the need to talk frankly with physicians about symptoms, the importance of using all medicines prescribed for treatments, and the incubation periods of diseases.