Academic journal article International Journal of Men's Health

How Safe Is Sex with Condoms?: An In-Depth Investigation of the Condom Use Pattern during the Last Sex Act in an Urban Area of Bangladesh

Academic journal article International Journal of Men's Health

How Safe Is Sex with Condoms?: An In-Depth Investigation of the Condom Use Pattern during the Last Sex Act in an Urban Area of Bangladesh

Article excerpt

The policy of condom intervention is based on achieving ejaculation inside a condom, a "mechanical" goal of sexual interaction, a social act. However, most research on condom use has focused upon a simplistic reliance on survey results of condom use during the last sex act. Interviews with 20 hotel-based, female sex workers and 15 (male) clients were conducted to explore patterns of claimed condom use during the last sex act. The Health Belief Model guided this study and was found deficient in providing an understanding of condom use. The clients' perceptions of dominating sexuality and "the male's right" to enjoy sexual intercourse in commercial settings increased partial condom use. The invisibility of AIDS reduced participants' perceived susceptibility to and severity of suffering from the disease, while using condoms at any time during intercourse was perceived as being beneficial. Condom interventions need to be based on deeper understanding of the complexity of people's lives.

Key Words: condom use, female sex workers, male clients, sexual intercourse, Bangladesh

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Condom use during sexual intercourse, whether vaginal or anal, is a prime prevetion tion tool against sexually transmitted infections (STIs). Correct and consistent condom use can also decrease the spread of the human immunodeficiency virus (HIV) (Pinkerton & Abramson, 1997). Many organisms, including HIV, cannot be transmitted through an intact condom worn during sexual intercourse (Fiumara, 1972; Roper, Peterson, & Curran, 1993). Findings from 10 cohort studies conducted in Western countries, which evaluated the efficacy of condom use among heterosexual couples, showed that consistent condom use could protect people against HIV infection (Feldblum, Morrison, Roddy, & Cates, 1995). The most convincing evidence of condom effectiveness comes from studies of HIV-discordant couples, in which one partner is infected with HIV and the other not (Centers for Disease Control [CDC], 1998; Feldblum et al., 1995). Studies of such couples have found significantly lower risks of HIV infections among consistent condom users (Allen et al., 1992; Laurian, Peynet, & Verroust, 1989; Ngugi et al., 1988; Plummer et al., 1991; CDC, 1998). A multi-European country study of 256 HIV-discordant couples followed for an average of 20 months did not find a single new infection occurring among couples using condoms during every sex act (De Vincenzi, 1994). Condoms may help prevent AIDS over the long term not only by blocking transmission of HIV but also protecting against other STIs. For instance, people with genital ulcerative STIs such as chancroid, genital human papillomavirus, herpes simplex, and syphilis are two to seven times more likely to become infected with HIV than people who do not have STIs (Diallo et al., 1992; Laga, Nzila, & Goeman, 1991). If a condom is not worn before penetration, the pre-ejaculatory fluid that contains HIV and sperm may be secreted inside the vagina. This pre-ejaculatory fluid increases the risk of HIV as well as pregnancy (Ilaria et al., 1992; Pudney, Oneta, Mayer, Seage, & Anderson, 1992; Trussell, 1998). In addition, the contact of the infected mucosal surface with an uninfected surface also facilitates transmission of a number of STIs (Sparling, 1990). Therefore, condoms can only be highly effective if they are used correctly and continuously throughout intercourse (De Visser & Smith, 2000).

Baseline, cross-sectional sexual behavioral surveys or post-intervention evaluation surveys are conducted using quantitative instruments. Calculation is made by measuring the percentage of men who reported condom use at the last episode of sex with a sex worker and those who reported sexual intercourse with a sex worker in the last 12 months preceding the survey. Researchers and program managers use this indicator as evidence of risk behaviors and the success or failure of condom promotion interventions as well. …

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