Abstract
We conducted a structural intervention to promote the female condom (FC), comparing 44 agencies randomized to a Minimal Intervention (MI) [developing action plans for promotion and free access] or an Enhanced Intervention (EI) [with the addition of counselor training]. Intervention effects were evaluated via surveys with agency directors, counselors and clients at baseline and 12 months. Agency-level outcomes of the FC did not differ between the two interventions at follow-up. Counselors in the EI showed significantly greater gains in FC knowledge and positive attitudes, although there was no difference in the proportion of clients counseled on the FC, which significantly increased in both conditions. There was a greater increase in intention to use the FC among clients in EI agencies. Intervention effects were stronger in medical agencies. Findings suggest that making subsidized FCs available and assisting agencies to formulate action plans led to increased FC promotion. Limitations and implications for future research and intervention efforts are discussed.
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References
Farr G, Gabelnick H, Sturgen K, Dorflinger L. Contraceptive efficacy and acceptability of the female condom. Am J Public Health. 1994;84(12):1960–4.
Trussell J. Contraceptive efficacy of the Reality™ female condom. Contraception. 1998;58(3):147–8.
Lytle CD, Routson LB, Seaborn GB, Dixon LG, Bushar HF, Cyr WH. An in vitro evaluation of condoms as barriers to a small virus. Sex Transm Dis. 1997;24(3):161–4.
Drew WL, Blair M, Miner RC, Conant M. Evaluation of the virus permeability of a new condom for women. Sex Transm Dis. 1990;17(2):110–2.
Minnis AM, Padian NS. Effectiveness of female controlled barrier methods in preventing sexually transmitted infection and HIV: current evidence and future research directions. Sex Transm Infec. 2005;81(3):193–200.
Voeller B, Coulter S, Mayhan K. Gas, dye, and viral transport through polyurethane condoms (Letter to the Editor). JAMA. 1991;266(21):2986–7.
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.
Fontanet AL, Saba J, Chandelying V, et al. Protection against sexually transmitted diseases by granting sex workers in Thailand the choice of using the male or female condom: results from a randomized controlled trial. AIDS. 1998;12(14):1851–9.
French PP, Latka M, Gollub EL, Rogers C, Hoover DR, Stein ZA. Use-effectiveness of the female versus male condom in preventing sexually transmitted disease in women. Sex Transm Dis. 2003;30(5):433–9.
Artz L, Maculuso MM, Brill I, et al. Effectiveness of an intervention promoting the female condom to patients at sexually transmitted disease clinics. Am J Public Health. 2000;90(2):237–44.
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.
Choi KH, Hoff C, Gregorich SE, Grinstead O, Gomez C, Hussey W. The efficacy of female condom skills training in HIV risk reduction among women: a randomized controlled trial. Am J Public Health. 2008;98(10):1841–8.
Hoke TH, Feldblum PJ, Van Damme K, et al. Temporal trends in sexually transmitted infection prevalence and condom use following introduction of the female condom to Madagascar sex workers. Int J STD AIDS. 2007;18(17):461–6.
Latka M, Gollub EL, French P, Stein Z. Male-condom and female-condom use among women after counseling in a risk-reduction hierarchy for STD prevention. Sex Transm Dis. 2001;27(8):431–7.
Musaba E, Morrison CS, Sunkutu MR, Wong EL. Long-term use of the female condom among couples at high risk of human immunodeficiency virus infection in Zambia. Sex Transm Dis. 1998;25(5):260–4.
Cecil H, Perry MJ, Seal DW, et al. The female condom: what we have learned thus far. AIDS Behav. 1998;2(3):241–56.
WHO. (1997). The Female Condom: A review. Geneva: World Health Organization. WHO/UNAIDS.
Female Health Company (2011). The Female Health Company. 2010 annual report. Available at: http://www.femalehealth.com/images/FHC_AR_2010.pdf (Accessed 27 December 2011).
Rubin R. (March 2, 2011). Female condoms are gaining ground. USA Today. Available at: http://yourlife.usatoday.com/health/medical/womenshealth/story/2011/03/Female-condoms-are-gaining-ground/44422408/1.
Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention (2011, August). HIV among women. Available at: http://www.cdc.gov/hiv/topics/women/pdf/women.pdf.
Hoffman S, Mantell J, Exner T, et al. The future of the female condom. Perspect Sex Reprod Health. 2004;36(3):120–6.
Jones DL, Weiss SM, Chitalu N, 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.
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.
Simmons R, Hall P, Diaz J, Diaz M, Fajans P, Satia J. The strategic approach to contraceptive introduction. Stud Fam Plann. 1997;28(2):79–94.
Mantell J, Hoffman S, Exner T, Stein ZA, Atkins K. Family planning providers’ perspectives on dual protection. Perspect Sex Reprod Health. 2003;35(2):71–8.
Mantell JE, West BS, Sue K, et al. Health care providers: a missing link in understanding acceptability of the female condom. AIDS Educ Prev. 2011;23(1):65–78.
Abdool Karim Q, Preston-Whyte E, Abdool Karim SS. Accessibility of condoms to teenagers at family planning clinics in Durban. Part II: a provider’s perspective. S Afr Med J. 1992;82(5):360–2.
Speizer IS, Hotchkiss DR, Magnani RJ, Hubbard B, Nelson K. Do service providers in Tanzania unnecessarily restrict clients’ access to contraceptive methods? Int Fam Plan Perspect. 2000;26(1):13–20.
Barbosa RM, Kalckmann S, Berquo E, Stein Z. Notes on the female condom: experiences in Brazil. Int J STD AIDS. 2007;18(4):261–6.
Mantell JE, Scheepers E, Abdool Karim Q. Introducing the female condom through the public health sector: experiences from South Africa. AIDS Care. 2000;12(5):589–601.
Mqhayi M, Beksinska M, Smit J, et al. Introduction of the female condom in South Africa: Programme activities and performance 1998–2001. Johannesburg (South Africa): Reproductive Health Research Unit, Draft Report, 2003.
Weeks MR, Hilario H, Li J, Coman E, Abbott AM, Sylla L, Corbett M, Dickson-Gomez J. Multilevel social influences on female condom use and adoption among women in the urban United States. AIDS Patient Care STDs. 2010;24(5):297–309.
UNAIDS, STI/HIV/AIDS Prevention Center, & WHO. (2000). Need and acceptability of female condom among women in Thanh Xuan Commune and Dong Da District, Hanoi. Hanoi: UNAIDS, STI/HIV/AIDS, Prevention Center, World Health Organization, 2000.
Blankenship KM, Bray SJ, Merson MH. Structural interventions in public health. AIDS. 2000;14(suppl 1):S11–S21.
Bauermeister JA, Tross S, Ehrhardt AA. A review of HIV/AIDS system-level interventions. AIDS Behav. 2009;13(3):430–48.
Mantell JE, Hoffman S, Weiss E, et al. The acceptability of the female condom: perspectives of family planning providers in New York City, South Africa, and Nigeria. J Urban Health. 2001;78(4):658–68.
Penman-Aguilar A, Hall J, Artz L, et al. Presenting the female condom to men: a dyadic analysis of effect of the woman’s approach. Women’s Health. 2002;35(1):37–51.
Rivers K, Aggleton P, Elizondo J, et al. Gender relations, sexual communication and the female condom. Critical Public Health. 1998;8(4):273–89.
Artz L, Demand M, Pulley L, Posner SF, Macaluso M. Predictors of difficulty inserting the female condom. Contraception. 2002;65(2):151–7.
Bandura A, editor. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice-Hall; 1986.
Bandura A, editor. A social cognitive approach to the exercise of control over AIDS infection. Beverly Hills: Sage; 1992.
Bruce J. Fundamental elements of quality of care: a simple framework. Stud Fam Plann. 1990;21(2):61–91.
Green LW, Kreuter MW, editors. Health promotion planning: an educational and environmental approach. 3rd ed. Mayfield: Mountain View; 1999.
Neilands TB, Choi K-H. A validation and reduced form of the female condom attitudes scale. AIDS Educ Prev. 2002;14(2):158–71.
Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrik. 1986;73(1):13–22.
Philpott A, Knerr W, Boydell V. Pleasure and prevention: when good sex is safer sex. Reprod Health Matters. 2006;14(28):23–31.
Choi KH, Roberts KJ, Gomez C, Grinstead O. Facilitators and barriers to use of the female condom: qualitative interviews with women of diverse ethnicities. Women’s Health. 1999;30(1):53–70.
Rogers EM. Diffusion of innovations (4th ed). New York: The Free Press; 1995.
Fixsen DL, Blase KA. Creating new realities: program development and dissemination. J Appl Behav Anal. 1993;26(4):597–615.
Cronbach LJ. Test validation. In: Thorndike RL, editor. Educational measurement. Washington: American Council on Education; 1971.
Cronbach LJ, Meehl PE. Construct validation in psychological tests. Psych Bull. 1955;52:281–302.
Kaler A. The female condom in North America: selling the technology of ‘empowerment’. J Gender Studies. 2004;13(2):139–52.
Latka M. Female-initiated barrier methods for the prevention of STI/HIV: where are we now? Where should we go? J Urban Health. 2001;78(4):571–80.
Acknowledgments
This research was supported by a grant from NIMH (NIMH; R01-MH078770; Theresa M. Exner, PhD, Principal Investigator). The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University is supported by a center grant from the National Institute of Mental Health (P30-MH43520; Principal Investigator: Anke A. Ehrhardt, PhD). We thank the women and men who participated in this study. We also acknowledge the contributions of our collaborators, particularly Alma R. Candelas and Nkechi Oguaghe of the AIDS Institute, who assisted with agency matching and recruitment; Zena Stein, who facilitated buy-in and contributed conceptually to the study; and the Professional Development Program, Rockefeller College, University at Albany, State University of New York, who were central to intervention development and training, particularly Lisa Skill and Linnaea Scavone. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NationaI Institute of Mental Health, the New York State Department of Health, the New York State Psychiatric Institute, or Columbia University.
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Exner, T.M., Tesoriero, J.M., Battles, H.B. et al. A Randomized Controlled Trial to Evaluate a Structural Intervention to Promote the Female Condom in New York State. AIDS Behav 16, 1121–1132 (2012). https://doi.org/10.1007/s10461-012-0176-3
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DOI: https://doi.org/10.1007/s10461-012-0176-3
Keywords
- Female condom
- HIV prevention
- Structural intervention
- United States