1
|
Gallo MF, Warner L, Bell AJ, Wiener J, Eschenbach DA, Bukusi EA, Sharma A, Njoroge B, Ngugi E, Jamieson DJ. Assessment of changes in condom use among female sex workers in a prospective cohort study introducing diaphragm use for disease prevention. Am J Epidemiol 2010; 172:606-12. [PMID: 20660519 DOI: 10.1093/aje/kwq158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Changes in the rates of condom use and number of sexual partners were evaluated among 140 female sex workers in Kibera, Kenya, participating in a 6-month study of diaphragm safety and acceptability for prevention of sexually transmitted infections conducted in 2004-2005. Analyses were stratified by partner type. Multivariable Tobit regression modeling was used to assess the association between study visit and proportion of acts protected. Participants completed 140 baseline visits and 390 bimonthly follow-up visits. The mean percentage of coital acts reported as protected by a condom increased from 56% at baseline to 68% at the 6-month visit (P < 0.01). Similar increases were observed for condom use by all partner types. Additionally, the mean number of sexual partners decreased over the study. Furthermore, consistent (i.e., 100%) diaphragm use during follow-up was associated with a higher proportion of coital acts protected by a condom in analyses adjusted for study visit and coital frequency. These findings suggest that, despite concerns that introduction of the diaphragm would result in more risky sexual behaviors, reported condom use increased and number of partners decreased.
Collapse
Affiliation(s)
- Maria F Gallo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Huber LRB, Hogue CJ, Stein AD, Drews C, Zieman M, King J, Schayes S. Contraceptive use and discontinuation: findings from the contraceptive history, initiation, and choice study. Am J Obstet Gynecol 2006; 194:1290-5. [PMID: 16647912 DOI: 10.1016/j.ajog.2005.11.039] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Revised: 11/16/2005] [Accepted: 11/28/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study is to provide insight on the continuing high rate of unintended pregnancy among adult women. STUDY DESIGN Contracepting women were recruited while they waited for primary care appointments. A total of 369 completed the baseline questionnaire, and 145 oral contraceptive (OC) users were enrolled in a 5-week, diary-based study of adherence and sexual activity. RESULTS Most women who reported having discontinued OCs did so because of medical side effects, and most had switched to less effective methods. Among OC users, 26.4% had sexual intercourse on days they missed pills just before or after their placebo week. Nonadherence did not differ by socioeconomic factors or obesity. CONCLUSION Clinicians may need to encourage their patients to discuss their reasons for wanting to discontinue the use of an effective contraceptive method and assist them with their concerns or to switch to other effective methods to protect themselves from unintended pregnancy.
Collapse
|
3
|
Mansergh G, Marks G, Rader M, Colfax GN, Buchbinder S. Rectal use of nonoxynol-9 among men who have sex with men. AIDS 2003; 17:905-9. [PMID: 12660538 DOI: 10.1097/00002030-200304110-00016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess recent rectal use of nonoxynol-9 (N-9), intent to use the product, and factors associated with N-9 use among men who have sex with men (MSM). DESIGN Cross-sectional survey of a diverse sample of MSM in the San Francisco Bay Area. METHODS Recruitment conducted at multiple street locations on various days/times or through referral during the Fall of 2001. RESULTS Sixty-one percent (349/573) had heard of N-9, of which 55% (192/349) reported hearing in the prior year that N-9 may not be protective against HIV. Of men aware of N-9, 83% (289/349) knowingly used it in their lifetime, of which 67% (193/289) used it during anal intercourse in the previous year. Forty-one percent (79/193) of those who used N-9 during anal intercourse in the past year did so without a condom because they thought it may protect against HIV. Older men were more likely than younger men to have used N-9 for protection. Men who heard that N-9 may not protect were less likely, and African-Americans (versus Caucasians) were more likely, to say they would definitely use N-9 during anal intercourse in the future. Latinos (versus Caucasians), those with unknown HIV serostatus (versus HIV-negative), and those with lower education were less likely to know about N-9 at all, and thus were at risk for unknowingly using N-9. CONCLUSIONS Many MSM used N-9 during or following public health warnings about the product. Actions (e.g., information campaigns, warning labels specific to rectal use) should be considered by communities to reduce rectal use of N-9.
Collapse
Affiliation(s)
- Gordon Mansergh
- Epidemiology Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30333, USA
| | | | | | | | | |
Collapse
|
4
|
Fitch JT, Stine C, Hager WD, Mann J, Adam MB, McIlhaney J. Condom effectiveness: factors that influence risk reduction. Sex Transm Dis 2002; 29:811-7. [PMID: 12466725 DOI: 10.1097/00007435-200212000-00013] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J Thomas Fitch
- Department of Pediatrics, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas 78209, USA
| | | | | | | | | | | |
Collapse
|
5
|
Dominik R, Zhou H, Cai J. A statistical model for the evaluation of barrier contraceptive efficacy. Stat Med 2001; 20:3279-94. [PMID: 11746318 DOI: 10.1002/sim.965] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper describes an approach for the analysis of barrier contraceptive efficacy trials that accounts for timing frequency of intercourse and compliance. We allow exposure variables to vary for each act of intercourse and we control for timing of each act through a specific parametric function of the day of the act relative to the last day of the follicular phase of the cycle. The model can be used to examine the level of protection provided by a barrier versus no contraceptive method even when no control group of non-users is studied, as long as there are acts with no barrier use during the fertile window. We present results of a simulation study which examines performance of estimators and power under a variety of scenarios, including situations where an accurate benchmark for ovulation day is not available. As compared to the survival analysis approach commonly used in this setting, simulation results show that the new approach yields considerable gains in power to detect differences between the efficacy of contraceptive methods. An application to data from the FemCap versus diaphragm trial show results consistent with previous findings suggesting superiority of the diaphragm but also provides new evidence of the per act protection provided by both methods.
Collapse
Affiliation(s)
- R Dominik
- Family Health International, P.O. Box 12950, Research Triangle Park, North Carolina 27709, USA.
| | | | | |
Collapse
|
6
|
Fitch JT. Are condoms effective in reducing the risk of sexually transmitted disease? Ann Pharmacother 2001; 35:1136-8. [PMID: 11573868 DOI: 10.1345/aph.1a272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A panel of more than two dozen experts reviewed the scientific evidence on condom effectiveness for sexually transmitted disease (STD) prevention, and a final report was released July 20, 2001, by the Department of Health and Human Services. This panel was cosponsored and convened for a two-day workshop by four government agencies (Agency for International Development, Food and Drug Administration, Centers for Disease Control and Prevention [CDC], and the National Institutes of Health [NIH]).
Collapse
Affiliation(s)
- J T Fitch
- National Institute of Allergy and Infectious Diseases, National Institute of Health, Department of Health and Human Services, Washington, DC, USA.
| |
Collapse
|
7
|
Steiner MJ, Hertz-Picciotto I, Taylor D, Schoenbach V, Wheeless A. Retrospective vs. prospective coital frequency and menstrual cycle length in a contraceptive effectiveness trial. Ann Epidemiol 2001; 11:428-33. [PMID: 11454502 DOI: 10.1016/s1047-2797(01)00248-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine how well information at enrollment would predict coital frequency and menstrual segment length during a prospective contraceptive effectiveness trial. METHODS We compared retrospective reports of monthly coital frequency and menstrual segment (cycle) length with prospective information for women participating in a contraceptive trial of the Reality((R)) female condom. RESULTS Participants reported slightly higher mean monthly coital frequency and slightly longer menstrual segments prior to the study than during the study (12.6 acts vs. 12.0 acts per month and 30.8 days vs. 28.4 days). We examined the actual distribution of differences between the retrospective and prospective measures and found considerable variability. Among the 195 participants studied, parous women were less likely to predict accurately menstrual segment length (OR 0.4; 95% CI 0.3--0.9), while older women were more likely to predict accurately coital frequency (OR 1.9; 95% CI 0.9--3.3). CONCLUSIONS Coital frequency and menstrual segment length vary considerably over time. Hence, prospective data collection is essential to accurately characterize these variations and to properly interpret results from contraceptive trials and other studies concerned with fecundability and hazards of reproduction.
Collapse
Affiliation(s)
- M J Steiner
- Family Health International, Research Triangle Park, NC 27707, USA
| | | | | | | | | |
Collapse
|
8
|
Piret J, Gagné N, Perron S, Désormeaux A, Tremblay MJ, Gourde P, Omar RF, Bergeron AM. Thermoreversible gel as a candidate barrier to prevent the transmission of HIV-1 and herpes simplex virus type 2. Sex Transm Dis 2001; 28:484-91. [PMID: 11473223 DOI: 10.1097/00007435-200108000-00012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sexually transmitted diseases (STDs) caused by HIV, herpes simplex virus (HSV), and other pathogens are spreading dramatically. The need to develop active products and vehicles to reduce this epidemic is urgent. GOAL The efficacy of a thermoreversible gel formulation as a possible barrier to prevent the transmission of pathogens causing STDs was evaluated. STUDY DESIGN This evaluation investigated the ability of the gel formulation to prevent infection of susceptible cells by HIV-1 and HSV-2 in vitro, the diffusion of radiolabeled herpes virus and micelles of polymer through an insertion membrane, and the electron microscopic appearance of herpes virus and gel alone or mixed together. RESULTS The gel formulation prevents infection of susceptible cells by HIV-1 and HSV-2. It acts as an effective artificial physical barrier against the herpes virus within the first 4 hours of incubation. Herpes virus is coated by the gel or entrapped within micelles of the gel, which could hinder its attachment to target cells and inhibit its infectivity. CONCLUSION This thermoreversible gel formulation represents an attractive matrix for the incorporation of microbicides to prevent the spread of STDs.
Collapse
Affiliation(s)
- J Piret
- Centre de Recherche en Infectiologie, Université Laval, Québec, Québec, Canada
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Wolitski RJ, Halkitis PN, Parsons JT, Gómez CA. Awareness and use of untested barrier methods by HIV-seropositive gay and bisexual men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2001; 13:291-301. [PMID: 11565589 DOI: 10.1521/aeap.13.4.291.21430] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Little is known about HIV-seropositive men's awareness and use of untested barrier methods during anal intercourse. A sample of 240 HIV-seropositive men (69.2% men of color) completed a self-administered survey that included items on nonoxynol-9 (N-9), female condoms, and the simultaneous use of two male condoms (double bagging). Most participants (79.6%) had heard of N-9 being used to prevent HIV transmission during anal intercourse. Of these, 20.0% rated N-9 as more effective than condoms, and 14.6% had used N-9 instead of condoms. Fewer men (35.4%) were aware of female condoms being used during anal intercourse. Overall, few respondents (5.4%) had used female condoms; 53.8% of whom rated the device as more pleasurable than male condoms. Most men (69.6%) had heard of double bagging, and 35.2% had engaged in this practice. Of these, 45.1% rated the practice as less pleasurable than using a single condom. Few associations were observed between participant characteristics and the awareness or use of these barrier methods. The widespread use of these untested methods emphasizes the urgent need to further educate HIV-seropositive men about the potential risks of N-9 use and to test the effectiveness of other strategies that may serve as alternatives to male condom use.
Collapse
Affiliation(s)
- R J Wolitski
- Behavioral Intervention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | |
Collapse
|
10
|
Hays MA, Irsula B, McMullen SL, Feldblum PJ. A comparison of three daily coital diary designs and a phone-in regimen. Contraception 2001; 63:159-66. [PMID: 11368990 DOI: 10.1016/s0010-7824(01)00183-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Barrier contraceptive trials and disease intervention studies often utilize coital diaries to measure sexual exposures: dates and frequency of intercourse, product use, additional or alternative contraceptive use, and menstrual bleeding. The validity of these self-reported data is a matter of debate, but if used, better diary designs are sought. We studied 3 different coital diaries, plus a phone-in regimen (none or weekly) in a 3 x 2 factorial design to compare participant ratings and promptness of recording. Our underlying presumption was that ease of and satisfaction with use, and promptness of data collection, are associated with greater accuracy. A self-completed questionnaire at the end of the study collected comparative retrospective data. Diary 1 captured information about a single day on one page and had three columns, for up to three possible acts of intercourse. Diary 2 had the same question format as the first diary, but contained 7 days per page. Diary 3 had 7 days on a page, but instead of a column for each act, participants enumerated the number of acts, the types of contraception used, and condom use details. Half of the women in each diary group phoned in their data weekly. Phone-in improved participants' satisfaction with the diary design as reflected by higher ratings of diary features. Phone-in did not improve recall of data at the end of the study for any of the diaries. There were no differences in the promptness of diary completion. Diaries 1 and 2 showed good concordance with recalled data, and participants expressed a preference for the layout of Diary 2. Women assigned to Diary 3 expressed dissatisfaction with the design and were worse at recalling data at the end of the study, probably due to the complexity of that diary design.
Collapse
Affiliation(s)
- M A Hays
- Biostatistics Division and Clinical Research Department, Family Health International, Research Triangle Park, NC 27709, USA.
| | | | | | | |
Collapse
|
11
|
Cates W. Microbicides 2000 conference. Panel discussion: streamlining the process and regulatory issues. Microbicide research-streamlining the process. AIDS 2001; 15 Suppl 1:S64-5. [PMID: 11403010 DOI: 10.1097/00002030-200102001-00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- W Cates
- Family Health International, Research Triangle Park, North Carolina, USA
| |
Collapse
|
12
|
Abstract
BACKGROUND AND OBJECTIVES Young blacks and Hispanics are an emerging risk group for contracting HIV. The goal of this study was to assess the most salient correlates of condom use for young Hispanics and blacks in Los Angeles county sexually transmitted diseases (STD) clinics as a first step toward designing a short clinic-based intervention. STUDY DESIGN Face-to-face interviews were conducted with 376 patients younger than the age of 27 years at six STD clinics operated by the Los Angeles County Department of Health Services. Assessment included several attitudinal variables and AIDS risk behaviors. RESULTS Condom use at last intercourse ranged from 40% among Hispanic females to 48% among black males. Among females, condom users were more likely to report high self-efficacy regarding condom use, peer norms supporting condom use, and more sexual communication than respondents who did not use a condom at last intercourse. Among males, no relationship was found between condom use at last intercourse and these attitudinal variables, except for sexual communication. The most important correlate of condom use among males and females was the frequency of carrying condoms. CONCLUSIONS Our findings suggest that offering educational group sessions and attractive means for carrying condoms to patients in STD clinics may have the potential to increase condom use. The efficacy of these intervention strategies should be explored in future studies.
Collapse
Affiliation(s)
- A E Maxwell
- University of California Los Angeles School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, USA
| | | | | |
Collapse
|
13
|
Wittkowski K, Susser E, Dietz K. Wittkowski and Colleagues Respond. Am J Public Health 1999. [DOI: 10.2105/ajph.89.1.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
14
|
Feldblum PJ, Weir SS, Cates W. The protective effect of condoms and nonoxynol-9 against HIV infection: a response to Wittkowski and colleagues. Am J Public Health 1999; 89:108-10. [PMID: 9987480 PMCID: PMC1508499 DOI: 10.2105/ajph.89.1.108-a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
15
|
Nelson DB, Ness RB, Peipert JF, Soper DE, Amortegui AJ, Gluck J, Wiesenfeld H, Rice PA. Factors predicting upper genital tract inflammation among women with lower genital tract infection. J Womens Health (Larchmt) 1998; 7:1033-40. [PMID: 9812300 DOI: 10.1089/jwh.1998.7.1033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We sought to identify factors that discriminate between women with a lower genital tract infection and women with a lower genital tract infection and endometritis. This study enrolled women at risk for or having a lower genital tract infection with Chlamydia trachomatis or Neisseria gonorrhoeae and measured behavioral and clinical factors. Women were identified through contact tracing of male partners, presentation with cervicitis, or presentation with symptoms of pelvic inflammatory disease and classified as (1) having a lower genital tract infection without endometritis, (2) having a lower genital tract infection with endometritis, (3) having no lower genital tract infection with endometritis, and (4) having neither a lower genital tract infection nor endometritis. The primary comparison was between women having a lower genital tract infection without endometritis to women having a lower genital tract infection and endometritis. Women with a lower genital tract infection and endometritis were older and reported a history of more sexually transmitted diseases (70.0% vs. 56.7%), abdominal pain (82.2% vs. 60.0%), and use of barrier methods of contraception (28.9% vs. 8.6%) than women with a lower genital tract infection alone. The regression model found that women with a lower genital tract infection and endometritis were 7.1 times (95% CI = 2.2-23.0) more likely to report abdominal pain and 4.6 times (95% CI = 1.5-14.9) more likely to use barrier methods of contraception than women with a lower genital tract infection alone. These results suggest that behavioral factors, in addition to symptoms, can be used to identify women with and without upper genital tract involvement.
Collapse
Affiliation(s)
- D B Nelson
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
BACKGROUND Studies of condom efficacy rely on self-reported behavior. Objective markers of exposure to semen may provide a more valid assessment of condom failure and failure to use condoms. GOALS OF THIS STUDY To compare three semen biomarkers: acid phosphatase (AP) activity, prostate specific antigen (PSA), and the human seminal plasma antigen (MHS-5). STUDY DESIGN Twenty women were intravaginally inoculated with six measured, increasingly larger amounts of their partners' semen. Vaginal fluid was collected by the participant using swabs and tested. RESULTS Background levels of PSA were low (0.00-1.25 ng/ml), background levels of AP were variable (0-350 U/l), and all preinoculation samples were negative for MHS-5. All postinoculation samples were positive for PSA, 64 of 117 (55%) for AP, and 14 of 120 (12%) for MHS-5. CONCLUSION The PSA immunoassay was the best semen biomarker under these sampling and testing conditions.
Collapse
Affiliation(s)
- M L Lawson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham 35294-2170, USA
| | | | | | | | | | | |
Collapse
|
17
|
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; 25:260-4. [PMID: 9587178 DOI: 10.1097/00007435-199805000-00008] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Few studies have measured female condom use for more than a 6-month period or among persons at high risk of STD. OBJECTIVE To measure long-term use of the female condom among couples at high risk of HIV infection and to evaluate the effect of female condom use on unprotected coital acts. STUDY DESIGN Ninety-nine Zambian couples with symptomatic sexually transmitted diseases (STD) received female condoms, male condoms, and spermicides and were counseled to use either condom plus spermicide for each coital act. Couples were followed up at 3-, 6-, and 12-month visits. Barrier contraceptive use was measured prospectively by coital log. RESULTS Among the 99 couples enrolled, 51, 38, and 30 couples were successfully followed up for 3, 6, and 12 months, respectively. Female condoms were reportedly used in 24%, 27%, and 23% of coital acts and by 86%, 79%, and 67% of the returning couples during each time interval. Higher-level female condom users used male condoms less often but had fewer unprotected coital acts (5% vs. 14%; p < 0.05) than lower-level female condom users. CONCLUSION A majority of couples at high risk of HIV infection used the female condom in conjunction with other barrier methods over a 1-year period. The addition of female condoms accompanied by appropriate counseling to the barrier method mix may reduce unprotected sex among couples at high-risk of HIV infection.
Collapse
Affiliation(s)
- E Musaba
- University Teaching Hospital, Lusaka, Zambia
| | | | | | | |
Collapse
|
18
|
Cook RL, Rosenberg MJ. Do spermicides containing nonoxynol-9 prevent sexually transmitted infections? A meta-analysis. Sex Transm Dis 1998; 25:144-50. [PMID: 9524992 DOI: 10.1097/00007435-199803000-00007] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES There are conflicting opinions on whether to recommend spermicides containing nonoxynol-9 for prevention of sexually transmitted diseases, including human immunodeficiency virus (HIV). GOAL To systematically review and summarize the medical literature on the effect of spermicides containing nonoxynol-9 on prevention of gonorrhea, chlamydial infection, and HIV. STUDY DESIGN Meta-analysis. Potential articles were identified through computerized literature searches. Articles were included if the design was clinical trial, cohort, case-control, or cross-sectional; original outcome data were presented for gonorrhea, chlamydial infection, or HIV; and spermicides containing nonoxynol-9 were used separately from other barrier methods. Study characteristics including design, population, spermicide dose, and delivery method were abstracted. Relative risks (RR) and 95% confidence intervals (CI) were determined from information published in the study or from study authors. Summary risk estimates were computed for clinical trials. RESULTS Twelve eligible articles were identified, including six clinical trials and six observational studies. Eleven articles evaluated gonorrhea; each found a reduced risk of infection with spermicide use. Among six clinical trials, the summary RR was 0.62 (95% CI, 0.49-0.78). The five articles evaluating chlamydial infection also found significant reduction among spermicide users, with the four clinical trials having a summary RR of 0.75 (95% CI, 0.62-0.91). The degree of spermicidal protection against gonorrhea and chlamydial infection did not differ materially among studies with different study designs or spermicidal preparations (i.e., sponge, gel, suppository, or film). Three studies evaluated degree of protection according to consistency of use and found stronger protection with more consistent use. The two studies on spermicidal prevention of HIV had contrasting results: An observational study found a significant protective effect (RR = 0.1), whereas a clinical trial found a nonsignificantly increased risk (RR = 1.7). CONCLUSIONS Nonoxynol-9-containing spermicides have an appreciable protective effect against both gonorrhea and chlamydial infection, and wider use of spermicides might substantially reduce the incidence of these diseases. However, insufficient data exist to judge their effect on HIV transmission, and more research on the effect of nonoxynol-9 on HIV transmission is urgently needed to make evidence-based clinical decisions and public health recommendations in the future.
Collapse
Affiliation(s)
- R L Cook
- Robert Wood Johnson Clinical Scholars Program, University of North Carolina at Chapel Hill, USA
| | | |
Collapse
|
19
|
Cates W, Raymond EG. Emergency contraception--parsimony and prevention in the medicine cabinet. Am J Public Health 1997; 87:909-10. [PMID: 9254551 PMCID: PMC1380918 DOI: 10.2105/ajph.87.6.909] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- W Cates
- Family Health International, Research Triangle Park, N.C., USA
| | | |
Collapse
|
20
|
Affiliation(s)
- R A Royce
- Department of Epidemiology, University of North Carolina, Chapel Hill 27599, USA
| | | | | | | |
Collapse
|
21
|
Prevention of HIV/STI transmission: clarifying the research questions. REPRODUCTIVE HEALTH MATTERS 1997. [DOI: 10.1016/s0968-8080(97)90097-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
22
|
Farr G, Acosta Castro LA, DiSantostefano R, Claassen E, Olguin F. Use of spermicide and impact of prophylactic condom use among sex workers in Santa Fe de Bogota, Colombia. Sex Transm Dis 1996; 23:206-12. [PMID: 8724510 DOI: 10.1097/00007435-199605000-00008] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Condom use is one of the most important preventive measures sex workers can take to reduce the risk of becoming infected with a sexually transmitted disease. However, a client may refuse to use a condom when requested. Some sexually transmitted disease prevention programs are recommending that sex workers use spermicide as an alternative prophylaxis when a condom is refused, yet little is known about the effect of this recommendation on prophylactic condom use. GOAL To determine if using spermicide, either in conjunction with condoms or as a backup, influenced overall condom use among a group of sex workers at high risk of sexually transmitted diseases in Santa Fe de Bogota, Colombia. STUDY DESIGN Participants were assigned randomly to one of three condom use groups: use of condoms only (Condoms Only), use of condoms and spermicides concurrently (Condom and Spermicide), or use of spermicide when condoms were refused (Spermicide as a Backup). A total of 199 sex workers entered the study and were asked to return for follow-up every 2 weeks for a period of 12 weeks. RESULTS Women assigned to the Spermicide as a Backup group used a condom for an average of 78.1% of their reported acts of intercourse, compared with an average of 94.5% in the Condom Only and 92.3% in the Condom and Spermicide groups. However, women in the Spermicide as a Backup group used a condom or spermicide for an average of 96.9% of their acts of intercourse. Condoms were used for every intercourse act by less than 5% of the women in the Spermicide as a Backup groups, compared with 50.7% in the Condom Only group and 41.2% in the Condom and Spermicide group (P 0.001). When condoms were not used, client refusal was the primary reason reported. The incidence of sexually transmitted diseases and other urogenital inflammations in all groups was lower than expected. CONCLUSIONS Among Colombian sex workers, condom use declined substantially when women were instructed to use spermicides if they were unable to persuade their partner to use a condom. However, these same women usually used the study spermicide as an alternate prophylaxis.
Collapse
Affiliation(s)
- G Farr
- Family Health International, Research triangle Park, North Carolina 27709, USA
| | | | | | | | | |
Collapse
|