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

618 Abstracts 33132-33136

12th World AIDS Conference

FC and a willingness to comply, (2) positive attitudes toward the FC, and (3) belief
that FC sustains partner's erection (R2 =.53, F (3.51) = 18.89, p <.0001).
Conclusion: Factors of the Theory of Reasoned Action were more important
predictors for African-American women; Health Belief Model and Self-effiacy factors were more important predictors for Hispanic women. Interventions intended
for African-American women should emphasize positive attributes of the FC and
strengthen normative influences supporting FC use. For Hispanic women, interventions should emphasize the contraceptive efficacy of the FC and include
self-efficacy skills training.
S33132 A prospective study of couples who use the female
condom: Exposure to semen during use
Louise Lawson1, M. Macaluso1, A. Duerr2, A. Bloom3, G. Hortin4,
K. Hammond', R. Blackwell'. 1University of Alabama at Birmingham, MJH 108,
Birmingham, Alabama 35294-2010; 2CDC, Atlanta GA; 3USAID, Washington
DC; 4National Cancer Institute, Bethesda MD, USA
Objective: To evaluate the female condom using post-coital testing for semen
exposure among 210 well-trained mutually monogamous couples at low risk of
STD.
Methods: Used condoms were evaluated for breakage using a water leak test;
11 of 2232 (0.5%) broke. Pre-and post-coital vaginal swabs were collected by
the women and tested for prostate specific antigen (PSA), a marker of semen.
Analysis of semen exposure was restricted to condoms used after at least 24
hours of abstinence (N = 1464). To assess semen exposure, we used a criterion
based on a cutoff (PSA < 1 ng/ml in the pre-coital swab and PSA > 1 ng/ml
in the post-coital swab) and a criterion based on relative difference (post-coital
minus pre-coital PSA > 30ng/ml). The number of condom uses that met both
criteria represents a lower (maximum-specificity) boundary of the frequency of
semen exposure, whereas the number that met either criterion represents an
upper (maximum-sensitivity) boundary.
Results: The lower boundary of the rate of semen exposure was 7% (106
uses), whereas the upper boundary was 21% (309 uses). Semen exposure (upper boundary) was more likely to occur if the participant reported breakage (Odds
ratio - OR = 13.69, 95% Confidence Interval - Cl = 3.28-57.21), the penis entering
outside of the condom (OR = 3.08, CI = 1.22-7.73), the outer ring moving into
the vagina (OR = 9.50, CI = 4.72-19.13), or semen leaking from the condom (OR
= 4.68, Cl = 2.29-9.59). No problem was reported during use of 1141 condoms.
The rate of semen exposure in this group was 19%. (lower boundary of the rate:
5%).
Conclusion: The rate of female condom failure as measured by semen exposure is relatively high in this study. Furthermore, semen exposure occurs often
in the absence of user-reported problems. To the extent that semen exposure is
an indicator of pregnancy and STD risk, these findings indicate that self-report
underestimates the frequency of condom failure. It is not known whether this
problem is specific to the female condom. The male latex condom and condoms
made of new materials should be evaluated using similar procedures.
33133 Experiences of 100 men who have sex with men using
the female condom for anal sex
Danial Wohlfeiler1, S. Gibson', W. McFarland2, K. Scheer2, M.H. Katz2. Stop
AIDS Project, 201 Sanchez, San Francisco CA 94114; 2San Francisco Dept
Public Health, San Francisco CA, USA
Background: To examine opinions and experiences of men who have sex with
men (MSM) using female (Reality") condoms.
Methods: Convenience sample of 100 MSM completing a self-administered
questionnaire.
Results: Eighty-six percent of respondents said they would use Reality" again;
54% would rather use Reality' than a conventional condom. Acceptability was
higher among MSM who were HIV-positive, in non-monogamous relationships, or
had sero-discordant partners. Negative experiences included: difficulty inserting
(33%), irritation (17%), bunching up (12%), unpleasant texture (10%), and noise
(9%). Breakage occurred 3 times in 334 episodes of use.
Conclusions: Reality" is a welcome, alternative HIV prevention method for
some MSM.
33134 Acceptability of vaginal microbicides in Zimbabwe is high
Martha Moon1, M. Mbizvo2, M. Mwale', P. Nyamapfeni1, J. Heiman3,
N. Padian3. 1UCSF Center for AIDS Prevention 74 New Montgomery San
Francisco, CA; 3UCSF Dept. of Ob, Gyn, and RS San Francisco, CA, USA; 2Univ
of Zimbabwe Med School, Harare, Zimbabwe
Background: The objective of this study was to assess public opinion about
vaginal microbicides in order to inform the design of upcoming efficacy trials
of these products. Study design was a cross-sectional interviewer administered
survey. The study was conducted between November 1996-October 1997 by

local Shona-speaking nurses who interviewed 303 men and 309 women in various settings throughout greater Harare including clinics (for women); taxi stands,
workplaces, street corners, and commercial farms (for men).
Methods: Signed informed consent was obtained from all participants. A brief
product demonstration (including vaginal contraceptive film, gel, foam, cream
and suppositories) was followed by a private individual interview. The survey
included questions about demographics, sexual activities, condom usage, and

willingness to use existing products as well as products with various hypothetical
characteristics.
Results: Males (n = 303) and females (n = 309) answered questions about
each product on a 4 point scale of "very willing to try" to "not at all willing to try."
The categories "very willing," "somewhat willing," and "a little willing" to try were
collapsed for analysis into the category "willing to try."

Characteristics of products
Prevents pregnancy as well as HIV
Prevents other STI as well as HIV
Has no side effects
Leaks a little
Causes itching, burning or pain

"Willing to try" Existing products "Willing to try"
Males Females Males Females

94.7% 99.7%
96.8% 99.7%
94.4% 97.1%
30.9% 35.3%
9.9% 20.6%

Foam
Gel
Suppository
Film
Cream

70.9% 60.9%
81.4% 73.1%
79.5% 80.2%
73.4% 84.1%
77.8% 70.1%

Conclusions: Men and women had definite opinions about which product
characteristics they would and would not like in a vaginal microbicide, but were
enthusiastic and expressed willingness to try different products that will be tested
in future efficacy trials.
33135 Women substance abusers' concerns about and
experiences with the female condom
Hugh Klein, D.A. Welka, H.L. Crosby, M.R. Eber, J.A. Hoffman. Friends
Research Institute DC, 401 Schuler Road Silver Sping, MD, USA
Purpose: To study initial reactions to, concerns about, and experiences with the
female condom among women who use drugs, to ascertain the viability of this
device as an HIV prevention tool in this high-risk population
Methodology: 131 women who injected a drug and/or used crack cocaine
at least once during the previous 30 days were recruited via street outreach
by indigenous outreach workers in Washington, DC. Eligibility criteria included:
being age 18 or older, no drug treatment during the previous 30 days, and having
had oral, anal, and/or vaginal sex during the previous 30 days. Women were
interviewed about their HIV risk behavior involvement and were exposed to a
risk reduction intervention that included specific, detailed information about the
female condom. They were given free oral mucosa HIV tests and a starter pack
of female condoms, and were asked to use at least one female condom by the
time they returned for their HIV test results. One week and again three months
later, they were asked about their experiences and their partners' reactions to
using the female condoms.
Results: Initial concerns about the female condom included whether the device
would fit inside the vagina, how the device would stay in place during sex, and
whether it was long enough to cover the full length of the partner's penis. Of
the 85% who returned for the one-week post-interview, approximately 75% of
the women used at least one female condom, with half of the remainder having
wanted to try the device but lacking an opportunity to do so. The majority of
women who used the device reported positive experiences with it; this was especially true for women who already were users of male condoms. People who liked
the device reported liking the extra warmth and enhanced sensations compared
to the use of male condoms, the ability to insert the device several hours prior
to sexual intercourse, having a device that is woman-controlled, and the sheer
novelty of using a new type of condom.
Conclusions: Among women who use drugs, the female condom appears
to be a viable method of avoiding the transmission of HIV. Initial concerns and
questions about the device need to be addressed in a forthright manner when
introducing the device into this population, and instructions about the "dos and
don'ts" of using the device must be clear if it is to be used correctly. Once
these conditions are met, though, it appears that the female condom provides an
acceptable option for protection against HIV infection.
33136 Acceptability of the female condom among women drug
users in Brazil
Hilary Surratt12, J. Inciardi2, P. Telles3, D. McBride4, B. Pok2. 1305 Madison
Ave., Suite 2023, New York, New York 10017; 2Univ. of Miami, Miami FL;
4Andrews Univ. Berrien Springs MI, USA; 3State Univ. of Rio de Janeiro, Rio de
Janeiro RJ, Brasil
Issue: There is evidence to suggest that traditional approaches to HIV risk reduction have not been effective among women at high risk. Few educational programs
have been tailored specifically for women's special needs, and most have promoted methods requiring the full participation and cooperation of male partners.
Project: This study sought to introduce drug-involved women to the female
condom - a female-controlled method of protection from HIV and other sexually
transmitted diseases. The primary aim of this initiative was to assess the level
of acceptability of this new device among women at high-risk for HIV infection in Rio de Janeiro, Brazil. As part of a larger study funded by the National
Institute on Drug Abuse's Cooperative Agreement for AIDS Community-Based
Research, low-income, adult, cocaine-using women were recruited and interviewed about their drug use and sexual behaviors. In conjunction with individual
pre-test HIV prevention counseling, all respondents participated in a detailed
education/demonstration session with the female condom. Women were asked
to try the female condom with their partners and to report their experiences at two
points of contact.
Results: Outcome data have indicated that a sizable proportion of the women
followed up in Rio de Janeiro used the female condom during vaginal sex on one