AIDS and Behavior

, Volume 19, Issue 9, pp 1642–1654 | Cite as

Female Condom Use and Adoption Among Men and Women in a General Low-Income Urban U.S. Population

  • Margaret R. WeeksEmail author
  • Weihai Zhan
  • Jianghong Li
  • Helena Hilario
  • Maryann Abbott
  • Zahíra Medina
Original Paper


HIV prevention is increasingly focused on antiretroviral treatment of infected or uninfected persons. However, barrier methods like male condoms (MC) and female condoms (FC) remain necessary to achieve broad reductions in HIV and other sexually transmitted infections (STI). Evidence grows suggesting that removal of basic obstacles could result in greater FC use and reduced unprotected sex in the general population. We conducted four annual cross-sectional surveys (2009–2012) of urban residents (N = 1614) in low-income neighborhoods of a northeastern U.S. city where prevalence of HIV and other STIs is high. Findings indicate slow FC uptake but also heterosexual men’s willingness to use them. Factors associated with men’s and women’s FC use included positive FC attitudes, network exposure, and peer influences and norms. These results suggest that men can be supporters of FC, and reinforce the need for targeted efforts to increase FC use in both men and women for HIV/STI prevention.


Female condom HIV prevention STI prevention Women Men Gender differences 


Crecientemente la prevención del VIH se ha enfocado en tratamientos antivirales, tanto para personas afectadas o no con el VIH. Sin embargo, métodos de prevención como los condones masculinos (CM) y los condones femeninos (CF) permanecen necesarios para alcanzar una amplia reducción en el VIH y otras enfermedades de transmisión sexual (ETS). Una creciente evidencia sugiere que eliminando unos obstáculos básicos puede resultar en un aumento en el uso del CF y en la población en general, en una disminución en sexo sin protección. Nosotros llevamos a cabo cuatro (4) estudios comparativos (2009-2012) con una muestra de residentes de área urbana (N = 1614), en vecindarios de bajo ingreso, y de una ciudad en el Noroéste de EU, donde la incidencia del VIH y otras ETS es alta. Los resultados indican una aceptación lenta del CF, pero también la diponibilidad del hombre heterosexual a usarlos. Factores en común asociados, tanto en mujeres como en hombres en el uso del CF, incluyen una actitud positiva hacia el CF, exposición en cadena e influencias de individuos y normas afines. Estos resultados sugieren que los hombres pueden ser partidiarios del CF y reafirma la necesidad de un mayor esfuerzo dirigido al aumento en el uso del CF (tanto en hombres como en mujeres) para la prevención del VIH/ETS.



The authors are deeply indebted to the project Steering Committee, including Paul Botticello, Clair Kaplan, Shawn Lang, Lucy Rohena, and Danielle Warren-Diaz, and other members of the project research team, including Emil Coman, Paige Nuzzolillo, Joella Morris, Mary Prince, Zulma Rios and Ellen Cromley. This study was supported by the National Institute of Mental Health (Grant Number 1R01MH084724), and was an affiliated study of the Center for Interdisciplinary Research on AIDS (P30MH062294). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.


  1. 1.
    Granich R, Crowley S, Vitoria M, Smyth C, Kahn JG, Bennett R, et al. Highly active antiretroviral treatment as prevention of HIV transmission: review of scientific evidence and update. Curr Opin HIV AIDS. 2010;5(4):298–304.PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Holtgrave DR, Maulsby C, Wehrmeyer L, Hall HI. Behavioral factors in assessing impact of HIV treatment as prevention. AIDS Behav. 2012;16(5):1085–91.CrossRefPubMedGoogle Scholar
  3. 3.
    Golub SA, Operario D, Gorbach PM. Pre-exposure prophylaxis state of the science: empirical analogies for research and implementation. Curr HIV/AIDS Rep. 2010;7(4):201–9.PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Young I, McDaid L. How acceptable are antiretrovirals for the prevention of sexually transmitted HIV?: a review of research on the acceptability of oral pre-exposure prophylaxis and treatment as prevention. AIDS Behav. 2014;18(2):195–216.PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Hoffman S. The female condom in the age of antiretroviral-based HIV prevention. J Womens Health. 2013;22(1):7–8.CrossRefGoogle Scholar
  7. 7.
    Vermund SH, Hayes RJ. Combination prevention: new hope for stopping the epidemic. Curr HIV/AIDS Rep. 2013;10(2):169–86.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Minnis AM, Padian NS. Effectiveness of female controlled barrier methods in preventing sexually transmitted infections and HIV: current evidence and future research directions. Sex Transm Infect. 2005;81(3):193–200.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Warren M, Philpott A. Expanding safer sex options: introducing the female condom into national programmes. Reprod Health Matters. 2003;11(21):130–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Mantell JE, West BS, Sue K, Hoffman S, Exner TM, Kelvin E, et al. Health care providers: a missing link in understanding acceptability of the female condom. AIDS Educ Prev. 2011;23(1):65–77.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Mantell JE, Hoffman JA, Weiss E, Adeokun L, Delano G, Jagha T, et al. The acceptability of the female condom: perspective of family planning providers in New York City, South Africa, and Nigeria. J Urban Health. 2001;78(4):658–68.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Weeks MR, Abbott M, Hilario H, Radda K, Medina Z, Prince M, et al. Structural issues affecting creation of a community action and advocacy board. Health Educ Res. 2013;28(3):375–91.PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Weeks MR, Coman E, Hilario H, Li J, Abbott M. Initial and sustained female condom use among low-income urban U.S. women. J Womens Health. 2013;22(1):26–36.CrossRefGoogle Scholar
  14. 14.
    Weeks MR, Hilario H, Li J, Coman E, Abbott M, Sylla LN, et al. Multi-level social influences on female condom use and adoption among urban United States women. AIDS Patient Care STDS. 2010;24(5):297–309.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Campbell AN, Tross S, Hu MC, Pavlicova M, Kenney J, Nunes EV. Female condom skill and attitude: results from a NIDA clinical trials network gender-specific HIV risk reduction study. AIDS Educ Prev. 2011;23(4):329–40.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Beksinska M, Smit J, Joanis C, Hart C. Practice makes perfect: reduction in female condom failures and user problems with short-term experience in a randomized trial. Contraception. 2012;86(2):127–31.CrossRefPubMedGoogle Scholar
  17. 17.
    Gallo MF, Kilbourne-Brook M, Coffey PS. A review of the effectiveness and acceptability of the female condom for dual protection. Sex Health. 2012;9(1):18–26.CrossRefPubMedGoogle Scholar
  18. 18.
    Coman EN, Weeks MR, Yanovitzky I, Iordache E, Barbour R, Coman MA, et al. The impact of information about the female condom on female condom use among males and females from a U.S. urban community. AIDS Behav. 2013;17(6):2194–201.PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Jones D, Kashy D, Villar-Loubet O, Weiss S. Enhancing acceptability and use of sexual barrier products among HIV concordant and discordant couples. AIDS Behav. 2013;17(6):2185–93.PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Witte SS, El-Bassel N, Gilbert L, Wu E, Chang M, Hill J. Promoting female condom use to heterosexual couples: findings from a randomized clinical trial. Perspect Sex Reprod Health. 2006;38(3):148–54.CrossRefPubMedGoogle Scholar
  21. 21.
    Corbett M, Dickson-Gomez J, Hilario H, Weeks MR. A little thing called love: condom use among high-risk primary heterosexual couples. Perspect Sex Reprod Health. 2009;41(4):218–24.PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Schensul JJ, LeCompte MD. Essential ethnographic methods: a mixed methods approach. 2nd ed. Lanham: Rowman Altamira; 2012.Google Scholar
  23. 23.
    Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44(2):174–99.CrossRefGoogle Scholar
  24. 24.
    Gallagher KM, Sullivan PS, Lansky A, Onorato IM. Behavioral surveillance among people at risk for HIV infection in the US: the National HIV Behavioral Surveillance System. Public Health Rep. 2007;122(Suppl 1):32.PubMedCentralPubMedGoogle Scholar
  25. 25.
    Salganik MJ, Heckathorn DD. Sampling and estimation in hidden populations using respondent-driven sampling. Sociol Methodol. 2004;34(1):193–240.CrossRefGoogle Scholar
  26. 26.
    Borgatti SP. NetDraw: graph visualization software. Boston: Analytic Technologies; 2002.Google Scholar
  27. 27.
    Pulerwitz J, Amaro H, DeJong W, Gortmaker SL, Rudd R. Relationship power, condom use and HIV risk among women in the USA. AIDS Care. 2002;14(6):789–800.CrossRefPubMedGoogle Scholar
  28. 28.
    Neilands TB, Choi K. A validation and reduced form of the female condom attitudes scale. AIDS Educ Prev. 2002;14(2):158–71.CrossRefPubMedGoogle Scholar
  29. 29.
    Gile KJ. Improved inference for respondent-driven sampling data with application to HIV prevalence estimation. J Am Stat Assoc. 2011;106(493):135–46.CrossRefGoogle Scholar
  30. 30.
    Winship C, Radbill L. Sampling weights and regression analysis. Sociol Methods Res. 1994;23(2):230–57.CrossRefGoogle Scholar
  31. 31.
    Choi KH, Gregorich SE, Anderson K, Grinstead O, Gomez CA. Patterns and predictors of female condom use among ethnically diverse women attending family planning clinics. Sex Transm Dis. 2003;30(1):91–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Holmes L Jr, Ogungbade GO, Ward DD, Garrison O, Peters RJ, Kalichman SC, et al. Potential markers of female condom use among inner city African–American women. AIDS Care. 2008;20(4):470–7.PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    Witte SS, Wada T, El-Bassel N, Gilbert L, Wallace J. Predictors of female condom use among women exchanging street sex in New York City. Sex Transm Dis. 2000;27(2):93–100.CrossRefPubMedGoogle Scholar
  34. 34.
    Mantell JE, Smit JA, Beksinska M, Scorgie F, Milford C, Balch E, et al. Everywhere you go, everyone is saying condom, condom. But are they being used consistently? Reflections of South African male students about male and female condom use. Health Educ Res. 2011;26(5):859–71.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Beksinska M, Smit J, Mabude Z, Vijayakumar G, Linda J. Male partner involvement and assistance in female condom use. Eur J Contracep Reprod Health Care. 2008;13(4):400–3.CrossRefGoogle Scholar
  36. 36.
    Harvey SM, Bird ST, Galavotti C, Duncan EAW, Greenberg D. Relationship power, sexual decision making and condom use among women at risk for HIV/STDs. Women Health. 2002;36(4):69–84.CrossRefPubMedGoogle Scholar
  37. 37.
    Paranjape A, Bernstein L, George DM, Doyle J, Henderson S, Corbie-Smith G. Effect of relationship factors on safer sex decisions in older inner-city women. J Womens Health. 2006;15(1):90–7.CrossRefGoogle Scholar
  38. 38.
    Jones DL, Weiss SM, Chitalu N, Mumbi M, Shine A, Vamos S, et al. Acceptability and use of sexual barrier products and lubricants among HIV-seropositive Zambian men. AIDS Patient Care STDS. 2008;22(12):1015–20.PubMedCentralCrossRefPubMedGoogle Scholar
  39. 39.
    Hoffman S, Exner TM, Leu CS, Ehrhardt AA, Stein Z. Female-condom use in a gender-specific family planning clinic trial. Am J Public Health. 2003;93(11):1897–903.PubMedCentralCrossRefPubMedGoogle Scholar
  40. 40.
    Vijayakumar G, Mabude Z, Smit J, Beksinska M, Lurie M. A review of female-condom effectiveness: patterns of use and impact on protected sex acts and STI incidence. Int J STD AIDS. 2006;17(10):652–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Beksinska M, Smit J, Joanis C, Potter W. New female condoms in the pipeline. Reprod Health Matters. 2012;20(40):188–96.CrossRefPubMedGoogle Scholar
  42. 42.
    Heckathorn DD. Respondent-driven sampling II: deriving valid population estimates from chain-referral samples of hidden populations. Soc Probl. 2002;49(1):11–34.CrossRefGoogle Scholar
  43. 43.
    Volz E, Heckathorn DD. Probability based estimation theory for respondent driven sampling. J Off Stat. 2008;24(1):79–97.Google Scholar
  44. 44.
    Hirky AE, Kirshenbaum SB, Melendez RM, Rollet C, Perkins SL, Smith RA. The female condom: attitudes and experiences among HIV-positive heterosexual women and men. Women Health. 2003;37(1):71–89.CrossRefPubMedGoogle Scholar
  45. 45.
    Penman-Aguilar A, Hall J, Artz L, Crawford MA, Peacock N, van Olphen J, et al. Presenting the female condom to men: a dyadic analysis of effect of the woman’s approach. Women Health. 2002;35(1):37–51.CrossRefPubMedGoogle Scholar
  46. 46.
    Seal DW, Ehrhardt AA. Heterosexual men’s attitudes toward the female condom. AIDS Educ Prev. 1999;11(2):93–106.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Margaret R. Weeks
    • 1
    Email author
  • Weihai Zhan
    • 2
  • Jianghong Li
    • 1
  • Helena Hilario
    • 3
  • Maryann Abbott
    • 1
  • Zahíra Medina
    • 1
  1. 1.Institute for Community ResearchHartfordUSA
  2. 2.Connecticut Department of Children and FamiliesHartfordUSA
  3. 3.University of Connecticut Health CenterFarmingtonUSA

Personalised recommendations