AIDS and Behavior

, Volume 17, Issue 3, pp 1195–1204 | Cite as

Awareness and Acceptability of Female Condoms Among Monogamous Hong Kong Chinese Female Sexually Transmitted Infection Patients

  • Hua You
  • Joseph T. F. Lau
  • Jing Gu
  • Hi Yi Tsui
  • Zixin Wang
  • Jean H. Kim
Original Paper


Female condom is an effective means of HIV prevention. Monogamous female sexually transmitted infection (STI) patients are exposed indirectly to high risk of contracting HIV/STI via their sole male sex partners. There are few interventions to protect such women whilst female condom use is a potential means of self-protection. With informed consent, this cross-sectional study investigated the prevalence of awareness and acceptability of female condoms among 335 Chinese monogamous female STI patients attending a government STI clinic in Hong Kong. Among those who were aware of female condoms (66.9 % of the sample), 68.3 % were willing to use free female condoms. Awareness was associated with having the sex partner being a boyfriend (OR = 3.76, P < 0.001), knowledge about asymptomatic property of HIV (OR = 2.14, P = 0.006) and no immunity for STI (OR = 2.14, P = 0.011), experience of HIV antibody testing (OR = 2.21, P = 0.004) and unemployment (OR = 0.50, P = 0.011). Among those who had heard of female condoms, acceptability was associated with knowledge about possibility to contracting two STI concomitantly (OR = 2.26, P = 0.03) and perceived chance of contracting STI from the sex partner in the coming 6 months (OR = 2.27, P = 0.04). Awareness is relatively low but the prevalence of acceptability is encouraging. Female condoms have been underused and should be promoted among monogamous female STI patients as a means of empowerment as an option for sex protection.


Female condom Awareness Acceptability Monogamous STI females HIV/STI prevention 



The authors gratefully acknowledge Hong Kong Council for the AIDS Trust Fund, Department of Health, Hong Kong Special Administrative Region, C.H.O.I.C.E and Hong Kong Federation of Women’s Centers for their support. We also wish to acknowledge the following people for their support of this study: the women who kindly agreed to the study, the doctors and nurses from the Social Hygiene Clinic in Yau Ma Tei (YMT) in Hong Kong who distributed part of field surveys and qualitative research, and thank all others who supported the project with data processing and data analysis.


  1. 1.
    Brown T, Peerapatanapokin W. The Asian Epidemic Model: a process model for exploring HIV policy and programme alternatives in Asia. Sex Transm Infect. 2004;80(Suppl 1):i19–24.PubMedCrossRefGoogle Scholar
  2. 2.
    Nguyen NT, Nguyen HT, Trinh HQ, Mills SJ, Detels R. Clients of female sex workers as a bridging population in Vietnam. AIDS Behav. 2009;13(5):881–91.PubMedCrossRefGoogle Scholar
  3. 3.
    Fajans P, Ford K, Wirawan DN. AIDS knowledge and risk behaviors among domestic clients of female sex workers in Bali, Indonesia. Soc Sci Med. 1995;41(3):409–17.PubMedCrossRefGoogle Scholar
  4. 4.
    Alary M, Lowndes CM. The central role of clients of female sex workers in the dynamics of heterosexual HIV transmission in sub-Saharan Africa. AIDS. 2004;18(6):945–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Couture MC, Soto JC, Akom E, Labbe AC, Joseph G, Zunzunegui MV. Clients of female sex workers in Gonaives and St-Marc, Haiti characteristics, sexually transmitted infection prevalence and risk factors. Sex Transm Dis. 2008;35(10):849–55.PubMedCrossRefGoogle Scholar
  6. 6.
    Manopaiboon C, Kilmarx PH, Supawitkul S, et al. HIV communication between husbands and wives: effects on husband HIV testing in northern Thailand. Southeast Asian J Trop Med Public Health. 2007;38(2):313–24.PubMedGoogle Scholar
  7. 7.
    Yang H, Li X, Stanton B, et al. Heterosexual transmission of HIV in China: a systematic review of behavioral studies in the past two decades. Sex Transm Dis. 2005;32(5):270–80.PubMedCrossRefGoogle Scholar
  8. 8.
    Beattie T, Bhattacharjee P, Ramesh B, et al. Violence against female sex workers in Karnataka state, south India: impact on health, and reductions in violence following an intervention program. BMC Public Health. 2011;10:476.CrossRefGoogle Scholar
  9. 9.
    Lau JT, Tsui HY, Ho SP, Wong E, Yang X. Prevalence of psychological problems and relationships with condom use and HIV prevention behaviors among Chinese female sex workers in Hong Kong. AIDS Care. 2010;22(6):659–68.PubMedCrossRefGoogle Scholar
  10. 10.
    Yang C, Latkin CA, Liu P, Nelson KE, Wang C, Luan R. A qualitative study on commercial sex behaviors among male clients in Sichuan Province, China. AIDS Care. 2010;22(2):246–52.PubMedCrossRefGoogle Scholar
  11. 11.
    Lau JT, Siah PC, Tsui HY. Behavioral surveillance and factors associated with condom use and STD incidences among the male commercial sex client population in Hong Kong–results of two surveys. AIDS Educ Prev. 2002;14(4):306–17.PubMedCrossRefGoogle Scholar
  12. 12.
    Lau JT, Tsui HY. Behavioral surveillance surveys of the male clients of female sex workers in Hong Kong: results of three population-based surveys. Sex Transm Dis. 2003;30(8):620–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Wingood GM, DiClemente RJ. Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Educ Behav. 2000;27(5):539–65.PubMedCrossRefGoogle Scholar
  14. 14.
    Liu H, Detels R, Li X, Stanton B, Hu Z, Yang H. Risk of HIV transmission within marriage in rural China: implications for HIV prevention at the family level. Sex Transm Dis. 2005;32(7):418–24.PubMedCrossRefGoogle Scholar
  15. 15.
    Tapia-Aguirre V, Arillo-Santillan E, Allen B, Angeles-Llerenas A, Cruz-Valdez A, Lazcano-Ponce E. Associations among condom use, sexual behavior, and knowledge about HIV/AIDS. A study of 13,293 public school students. Arch Med Res. 2004;35(4):334–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Callegari L, Harper CC, van der Straten A, Kamba M, Chipato T, Padian NS. Consistent condom use in married Zimbabwean women after a condom intervention. Sex Transm Dis. 2008;35(6):624–30.PubMedCrossRefGoogle Scholar
  17. 17.
    Lescano CM, Vazquez EA, Brown LK, Litvin EB, Pugatch D. Condom use with “casual” and “main” partners: what’s in a name? J Adolesc Health. 2006;39(3):443 e1-7.Google Scholar
  18. 18.
    Haque MR, Soonthorndhada A. Risk perception and condom-use among Thai youths: findings from Kanchanaburi demographic surveillance system site in Thailand. J Health Popul Nutr. 2009;27(6):772–83.PubMedGoogle Scholar
  19. 19.
    Montgomery CM, Lees S, Stadler J, et al. The role of partnership dynamics in determining the acceptability of condoms and microbicides. AIDS Care. 2008;20(6):733–40.PubMedCrossRefGoogle Scholar
  20. 20.
    Fourn L, Yacoubou M, Zohoun T. Evaluation survey of the acceptability of the condom in Benin. Afr Med. 1990;29(288):443–6.PubMedGoogle Scholar
  21. 21.
    Lau JT, Yang X, Wang Q, et al. Gender power and marital relationship as predictors of sexual dysfunction and sexual satisfaction among young married couples in rural China: a population-based study. Urology. 2006;67(3):579–85.PubMedCrossRefGoogle Scholar
  22. 22.
    Hong H, Qin QR, Li LH, Ji GP, Ye DQ. Condom use among married women at risk for sexually transmitted infections and HIV in rural China. Int J Gynaecol Obstet. 2009;106(3):262–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Qin Q, Ji G, Ye D. Condom use and knowledge among married women in rural areas of China. Int J Gynaecol Obstet. 2009;105(2):175–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Hong H, Ji GP, Ye DQ. Long-term follow-up of a peer-led HIV/AIDS prevention program for married women in rural China. Int J Gynaecol Obstet. 2009;106(1):69–70.PubMedCrossRefGoogle Scholar
  25. 25.
    Bisika T. Female controlled methods of contraception and sexually transmitted infections including HIV in Malawi: examining the role of the female condom and microbicides. East Afr J Public Health. 2009;6(2):223–5.PubMedGoogle Scholar
  26. 26.
    Napierala S, Kang MS, Chipato T, Padian N, van der Straten A. Female condom uptake and acceptability in Zimbabwe. AIDS Educ Prev. 2008;20(2):121–34.PubMedCrossRefGoogle Scholar
  27. 27.
    Center for Health and Gender Equity. Female condoms and U.S. foreign assistance: an unfinished imperative for women’s health. Retrieved from: 2011.
  28. 28.
    Spizzichino L, Pedone G, Gattari P, et al. The female condom: knowledge, attitude, and willingness to use. The first Italian study. Ann Ist Super Sanita. 2007;43(4):419–24.PubMedGoogle Scholar
  29. 29.
    Feldblum PJ, Kuyoh MA, Bwayo JJ, et al. Female condom introduction and sexually transmitted infection prevalence: results of a community intervention trial in Kenya. AIDS. 2001;15(8):1037–44.PubMedCrossRefGoogle Scholar
  30. 30.
    Hoffman S, Smit JA, Adams-Skinner J, Exner T, Mantell J, Stein Z. Female condom promotion needed. Lancet Infect Dis. 2008;8(6):348.PubMedCrossRefGoogle Scholar
  31. 31.
    Yimin C, Zhaohui L, Xianmi W, et al. Use of the female condom among sex workers in China. Int J Gynaecol Obstet. 2003;81(2):233–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Yimin C, Zhaohui L, Xianmi W, et al. Introductory study on female condom use among sex workers in China. Contraception. 2002;66(3):179–85.PubMedCrossRefGoogle Scholar
  33. 33.
    Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Schilling RF, el-Bassel N, Leeper MA, Freeman L. Acceptance of the female condom by Latin- and African-American women. Am J Public Health. 1991;81(10):1345–6.PubMedCrossRefGoogle Scholar
  35. 35.
    National Cancer Institute. Theory at a glance. Available at:
  36. 36.
    Lau JT, Tsui HY, Zhang Y, et al. Comparing HIV-related syringe-sharing behaviors among female IDU engaging versus not engaging in commercial sex. Drug Alcohol Depend. 2008;97(1–2):54–63.PubMedCrossRefGoogle Scholar
  37. 37.
    Guo H, Wei JF, Yang H, Huan X, Tsui SK, Zhang C. Rapidly increasing prevalence of HIV and syphilis and HIV-1 subtype characterization among men who have sex with men in Jiangsu, China. Sex Transm Dis. 2009;36(2):120–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Lau JT, Kim JH, Tsui HY. Prevalence and factors of sexual problems in Chinese males and females having sex with same-sex partner in Hong Kong: a population-based study. Int J Impot Res. 2006;18(2):130–40.PubMedCrossRefGoogle Scholar
  39. 39.
    Ruan Y, Jia Y, Zhang X, et al. Incidence of HIV-1, syphilis, hepatitis B, and hepatitis C virus infections and predictors associated with retention in a 12-month follow-up study among men who have sex with men in Beijing, China. J Acquir Immune Defic Syndr. 2009;52(5):604–10.PubMedCrossRefGoogle Scholar
  40. 40.
    Rugpao S. Women’s reports of condom use in Thai couples under intensive and regular STI/HIV risk reduction counseling. AIDS Behav. 2008;12(3):419–30.PubMedCrossRefGoogle Scholar
  41. 41.
    Mehta SH, Gupta A, Sahay S, et al. High HIV prevalence among a high-risk subgroup of women attending sexually transmitted infection clinics in Pune, India. J Acquir Immune Defic Syndr. 2006;41(1):75–80.PubMedCrossRefGoogle Scholar
  42. 42.
    Leeper MA. Preliminary evaluation of reality, a condom for women. AIDS Care. 1990;2(3):287–90.PubMedCrossRefGoogle Scholar
  43. 43.
    Hounton SH, Carabin H, Henderson NJ. Towards an understanding of barriers to condom use in rural Benin using the Health Belief Model: a cross sectional survey. BMC Public Health. 2005;5:8.PubMedCrossRefGoogle Scholar
  44. 44.
    Gielen AC, Faden RR, O’Campo P, Kass N, Anderson J. Women’s protective sexual behaviors: a test of the health belief model. AIDS Educ Prev. 1994;6(1):1–11.PubMedGoogle Scholar
  45. 45.
    Lau JT, Tang AS, Siah PC, Tsui HY. Assessment of HIV-related sexual risk behaviors among the general female population in Hong Kong. Arch Sex Behav. 2002;31(6):535–42.PubMedCrossRefGoogle Scholar
  46. 46.
    Sheeran P. Intention–behavior relations: a conceptual and empirical review. Eur Rev Soc Psychol. 2002;12(1):1–36.CrossRefGoogle Scholar
  47. 47.
    Sarkin JA, Johnson SS, Prochaska JO, Prochaska JM. Applying the transtheoretical model to regular moderate exercise in an overweight population: validation of a stages of change measure. Prev Med. 2001;33(5):462–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Bull SS, Posner SF, Ortiz C, et al. POWER for reproductive health: results from a social marketing campaign promoting female and male condoms. J Adolesc Health. 2008;43(1):71–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Brown S, Wimberly Y. Reducing HIV/AIDS transmission among African-American females: is the female condom a solution? J Natl Med Assoc. 2005;97(10):1421–3.PubMedGoogle Scholar
  50. 50.
    Newman PA, Lee SJ, Duan N, et al. Preventive HIV vaccine acceptability and behavioral risk compensation among a random sample of high-risk adults in Los Angeles (LA VOICES). Health Serv Res. 2009;44(6):2167–79.PubMedCrossRefGoogle Scholar
  51. 51.
    Janz NK, Becker MH. The health belief model: a decade later. Health Educ Q. 1984;11(1):1–47.PubMedCrossRefGoogle Scholar
  52. 52.
    Tang CS, Wong CY, Lee AM. Gender-related psychosocial and cultural factors associated with condom use among Chinese married women. AIDS Educ Prev. 2001;13(4):329–42.PubMedCrossRefGoogle Scholar
  53. 53.
    Zhao R, Wang B, Fang X, Li X, Stanton B. Condom use and self-efficacy among female sex workers with steady partners in China. AIDS Care. 2008;20(7):782–90.PubMedCrossRefGoogle Scholar
  54. 54.
    Kumar S, Quinn SC, Kim KH, Musa D, Hilyard KM, Freimuth VS. The social ecological model as a framework for determinants of 2009 H1N1 influenza vaccine uptake in the United States. Health Educ Behav. 2012;39(2):229–43.PubMedCrossRefGoogle Scholar
  55. 55.
    Wang Z, Lau JT, Gu J. Acceptability of circumcision among clients of female sex worker in Hong Kong. AIDS Behav. 2012;16(7):1836–45.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Hua You
    • 1
  • Joseph T. F. Lau
    • 2
    • 3
  • Jing Gu
    • 4
  • Hi Yi Tsui
    • 2
  • Zixin Wang
    • 2
  • Jean H. Kim
    • 2
  1. 1.Department of Social Medicine and Health Education, School of Public HealthNanjing Medical UniversityNanjingChina
  2. 2.Faculty of Medicine, Centre for Health Behaviours Research, The School of Public Health and Primary CareThe Chinese University of Hong KongShatinHong Kong
  3. 3.Centre for Medical Anthropology and Behavioral HealthSun Yat-sen UniversityGuangzhouChina
  4. 4.Department of Medical Statistics and Epidemiology, School of Public HealthSun Yat-sen UniversityGuangzhouChina

Personalised recommendations