Academic journal article Journal of Health Population and Nutrition

Condom-Use Skills Checklist: A Proxy for Assessing Condom-Use Knowledge and Skills When Direct Observation Is Not Possible

Academic journal article Journal of Health Population and Nutrition

Condom-Use Skills Checklist: A Proxy for Assessing Condom-Use Knowledge and Skills When Direct Observation Is Not Possible

Article excerpt

INTRODUCTION

Other than abstinence, protected sex remains the most effective prevention against acquisition of HIV and other sexually transmitted diseases (STDs) (1,2). Since incorrect condom-use significantly reduces the effectiveness of condoms, protected sex includes not only the use of condoms but also their correct use (3). It is estimated that condom-breakage/ leakage or unintentional removal during penetrative sex occurs at least once in a lifetime among 1-33% of persons ever using a condom, with higher rates of failure among adolescents than among older users (4-8). Strict control over manufacturing eliminates most structural flaws (9), leaving incorrect use as the major contributor to condom failure. Identified mistakes include completely unrolling the condom before application and using an oil-based lubricant (10,11). Moreover, there is evidence that youths with no or less knowledge, including that of correct condom-use, are less likely to use condoms than youths who have accurate knowledge (12). Therefore, both to reduce failure in condom-use and to augment condom-use, knowledge of correct condom-use is an important component of protected sex.

Despite our recognition of the importance of correct condom-use in prevention of the transmission of HIV and other STDs, few studies have assessed accuracy of condom-use skills in this context of disease-transmission studies. In one recent review of 45 studies assessing the effectiveness of condom-use against transmission of gonorrhoea and/or chlamydia published during 1966-2004, only two studies actually assessed the correctness of use, and these assessments were not comprehensive (2). In the first study conducted in California among 122 male patients returning to an STD clinic for follow-up and who had had sexual intercourse since the last visit, 75% had not used a condom, 17% had used a condom at least once, and 8% had used a condom at each sexual exposure. Users and non-users did not differ in rates of STDs at the follow-up visit but some condom-users who presented with re-infection with gonorrhoea reported that the condom was not put on until the man had already been exposed to vaginal fluids, suggesting that improper condom-use may have played a role in the failure of the condom to prevent infection (13). The second study, conducted among 1,122 female patients seen at a clinic for STDs in Alabama, during 1992-1995, involved two sub-studies: a cohort analysis among 919 women and a case-crossover analysis among 183 women. In the cohort analysis which only assessed condom-use, no protective effect was found for condom-use. By contrast, the case-crossover analysis of assessed self-reported condom-use and condom-breakage and slippage among the sample revealed protective effects of correct condom-use. Visits at which they were infected with gonorrhoea and/or chlamydia (n=228 visits) compared to visits in which they were not infected (n=743 visits) revealed a highly-protective effect of consistent condom-use without breakage or slippage. Sub-analysis also revealed that rates of STDs were lower in the intervals in which they reported consistent condom-use without breakage or slippage compared to those intervals in which they reported consistent condom-use but with breakage and slippage (14).

Since the promotion of both use and correct use of condoms are typically core components of HIV/STD-prevention interventions (15-17), some researchers conducting evaluations of these interventions have also attempted to assess the correctness of use as an intervention outcome (16). Examination of this aspect of intervention effect has generally relied on two approaches: self-reports of behaviour and direct observation. In the former, subjects are asked to describe their experience with condom-use during a defined period of time and to describe practices which might contribute to ineffectiveness of condom-use (e.g. using sharp instruments to open condom packages) or practices implying incorrect use (e. …

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