Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 33128-33131 617

Duration of the study was 15 days in year 1997. Each participant used 3 FC and
answered an interview schedule after each use for a small incentive. Some men,
partners (P) of a few women, also participated.
Results: Some responses of the 58 women respondents interviewed are given
below:

Response-"YES"= Y
Ever used Male Condom (MC) - Y
Preference to FC - Y
FC protects if P unfaithful - Y
Use FC regularly in future - Y
Willing to pay for FC - Y
Own initiative on
Protection method
When to have sex
Use FC without P knowing - Y
Using FC if P doesn't use MC - Y
Never want to use FC

A
15%
94%
78%
50%
17%
A
36%
Nil
6%
Nil
6%

B
33%
38%
25%
13%
13%
B
47%
20%
Nil
13%
38%

C
53%
47%
87%
67%
87%
C
33%
20%
Nil
53%
7%

Conclusion: There seems a 'felt need' for a protective device, be it male or
female condom. Many women felt that they could use FC for their own protection
with better control over their sexual relationships. Most of the SWs interviewed
were willing to pay for FC if it was subsidised. The number of women empowered
to choose protective device of their choice went up by four times (7% to 28%)
during DESH's programs. In-depth studies on FC are needed.
33128 1Use of Reality" condoms for anal sex by
HIV-seronegative US gay/bisexual men at increased risk
of HIV infection
Michael Gross', S.P. Buchbinder2, S. Holte3, C. Celum4, B.A. Koblin5. 1ABT
Associates, Inc 4800 Montgomery Lane, Bethesda, MD; 2AIDS Office- S.F Dept.
Of Public Health San Francisco Ca; 3Fred Hutchinson Cancer Research Ctr,
Seattle, WA; 4 University Of Washington, Seattle, WA; 5Koblin BA New York
Blood Center New York NY USA
Background: Assess use of the Reality" "female condom" during anal sex by
gay/bisexual men at increased risk, user characteristics, and extent and types of
reported problems.
Methods: Self-administered questionnaire completed by 2,272 study participants who reported anal sex at the Month 18 follow-up visit for a prospective
cohort in 6 US cities (Boston, Chicago, Denver, New York, San Francisco, Seattle)
analyzed by descriptive statistics, chi-square tests, multiple logistic regression.
Results: A total of 148 (7% of the cohort) reported using the device in the prior
6 months for receptive (97.4%) or insertive (97.4%) anal sex, including 46 (2%)
who tried it for both. San Francisco and Seattle cohorts had the highest rates of
use (respectively 16% and 7%, compared with 1% to 4% in the 4 other cities).
Most men who tried the device used it more than once in the prior 6 months; 19%,
2X; 39%, -3X. Among 47 receptive users who cited problems, main concerns
were pain or discomfort (n = 18), inserting the device (n = 11) and keeping it in
place if the inner ring is removed before insertion (n = 6); a few reported bleeding.
Among 35 insertive users who cited problems, main complaints were that the
device was not pleasurable (n = 12), difficult to keep in place (n = 8), or insert
(n = 4). Nevertheless, 72% of those who used the device for receptive anal sex
and 85% of men who used it for insertive anal sex said they were very/somewhat
likely to use it in the future. Men who had more frequent anal sex (>1X/month)
were far more likely to have used the device than men having anal sex less often
(O.R. = 3.74, 95% C.I. 2.27, 6.15, controlling for factors significant on crude, but
not adjusted, analysis [city, partner number, drug use]).
Conclusions: Willingness to consider future use of Reality"' among the more
sexually active men who have tried it, despite reported problems, suggests that
this device may offer a feasible alternative barrier method, but problems inherent
in the design developed for vaginal use (discomfort associated with the inner ring,
difficulty inserting and retaining without the inner ring) suggest that a redesigned
product would be preferable for anal sex. Reports of possible rectal trauma
(bleeding) particularly warrant further study.
33129 US women at risk of HIV/STD: Who wants and who uses
female condoms
Rebecca Cabral1, L. Pulley2, L. Artz2, C. Johnson3, R. Stephens3,
L. Jeannotte3, M. Macaluso2. 14770 Buford Hwy, NE: Mailstop K-34 Atlanta,
Georgia 30341-3717; 2University of Alabama at Birmingham, Birmingham AL;
3Centers for Disease Control and Prevention, Atlanta GA, USA
Objective: The female condom (FC) has been promoted as a woman-controlled
alternative to the male condom (MC). We assessed predictors of initial receptiveness to and subsequent use of the FC, focusing on method features and
relationship variables, among women from two US urban STD clinics.
Method: Data are from women enrolled (7/95 - 7/97) in a cohort study of the
effectiveness of MCs and FCs for prevention of STDs (n = 824). Participants were
given a baseline structured interview, an intervention promoting the FC (with MC
as backup), free barrier supplies of choice, and training on keeping a sexual diary.
Diaries were reviewed and supplies replenished at six, monthly follow-up visits.
Results: Participant were 85% African American, median age 23, 52% employed, 65% had STD history, median lifetime number 6 sex partners. Using

logistic regression analysis, controlling for five demographic variables, the major
factors associated with being very interested in trying the FC, at baseline, were:
strongly valuing features of female-control (OR = 2.1), having four or more lifetime
sex partners (OR = 2.1), rejecting the belief that condoms are unnecessary in stable relationships (OR = 1.7), inability to talk with partner about need for MCs (OR
= 2.2), having low MC self-efficacy (OR = 2.8), and gender-polarized rather than
shared decision power in the relationship (OR = 2.3); a negative association with
strongly disliking internal insertion features (OR = 0.14) was found. The factors
associated with using the FC more than once during follow up were: reporting high
future likelihood of using an intravaginal barrier method (OR = 3.0), relationship
with main partner > six months (OR = 2.0), absence of social norms supporting
MC use (OR = 1.7); a negative association with male-dominated decision making
structure (OR = 0.5) was found.
Conclusions: Women who reported difficulty negotiating MC use and valued
woman-control features were initially receptive to the FC. Actually using the FC
was most likely among women in long-term relationships and less likely among
women reporting little decision making power. In both models, partner violence
and MC reactions (coercion, abandonment) were insignificant. The HIV prevention potential of the FC may be mediated by complex relationship factors such as
the balance of decision making.
33130 An acceptability study of female controlled methods of
protection against HIV and STDs in southwestern Uganda
Robert Pool', G. Green2, G. Hart1, J. Wilkinson3, S. Harrison', AK. Mbonye4,
J.A.G. Whitwortht. 'Medical Research Council PO. Box 49 Entebre; 4Ministry Of
Health Entebre, Uganda; 2University Of Essex Colchester; 'Medical Research
Council Glasgow; 3London School Of Hygiene & Tropical Medicine London, UK
Objective: To assess the acceptability of female controlled methods of protection
against HIV and STDs among men and women in south western Uganda.
Methods: Focus group discussions (FGDs) were held with 138 women and 42
men to investigate attitudes to the male condom and female controlled methods
of protection. The female condom, foaming tablets, sponge, foam, gel and film
were demonstrated. 146 women selected 2 products and were given the product
of their first choice to try for 5 weeks and interviewed after 1 and 5 weeks. This
was repeated for their second choice product. They then used their favourite
product for a further 3 months, with follow-up interviews every month. 22 male
partners were also interviewed. At the end experiences with the products were
evaluated during FGDs.
Results: 66 women (45%) completed the trial. The main reason for non-completion was social mobility. Only 2 women dropped out because they did not like
the products. Product preference after the initial demonstration but before actual
use was the same as at the end of the trial. The most popular formulations were
the sponge (25% of the women), foaming tablets (23%), and the female condom
(19%). The foam was of medium popularity (16%). The gel (9%) and film (7%)
were least popular. "Dry sex" is not popular and increased lubrication was an
important determinant of acceptability. Age, level of education and location did
have some effect on preference. Secrecy was a dominant theme in the FGDs
and although the issue was overcome with use, female control remained an
important issue: the women valued the control which the products gave them; the
men remained anxious about female control, but generally accepted the products
once their partners started using them.
Conclusions: The products were generally well received. The sponge, foaming tablets and female condom were most popular. Acceptability and specific
preferences were socially and culturally determined. Female control remained an
important issue for both sexes. These factors will need to be studied in different
cultural contexts before products are marketed.
33131 Evaluation of the female condom by African-American
and Hispanic women
Heather Cecil, L.M. Bogart, S.D. Pinkerton. Cair Med College, 1201 N Prospect
Ave, Milwaukee, WI, USA
Background: Condoms have been shown to provide an effective barrier against
transmission of HIV and other STDs. However, because women encounter barriers to enacting condom use, female-controlled alternatives are needed. The
female condom (FC) is the only female-controlled barrier method currently available to protect women from STDs. In order to promote use of the FC, an in-depth
understanding of women's attitudes and beliefs is required. Such information can
facilitate the development of interventions promoting FC use.
Objectives: To assess attitudes towards the FC, and to identify facilitators and
barriers associated with willingness to use the FC among women at-risk for STDs.
This study was guided by the Health Belief Model, Theory of Reasoned Action,
and Self-efficacy theory.
Methods: 60 African-American and 60 Hispanic women (18-35 years), recruited from community-based organizations, completed a self-report survey.
Univariate (t-tests) and regression analyses were conducted.
Results: Compared to Hispanic women, African-American women had higher

normative belief scores, had more positive attitudes, and perceived fewer barriers to using the FC (all p's <.055). Intentions to use the FC among Hispanic
women were predicted by: (1) positive attitudes towards the FC, (2) belief in its
contraceptive effectiveness, (3) belief that sex partners 2 would not be angry, (4)
self-efficacy to refuse sexual intercourse, and (5) self-efficacy to use the FC (R2
=.58, F (7.39) = 7.57, p <.0001). Among African-American women, intentions
were predicted by: (1) beliefs that significant others want respondent to use the