Male-Condom and Female-Condom Use Among Women After... : Sexually Transmitted Diseases (original) (raw)

Original Articles

Male-Condom and Female-Condom Use Among Women After Counseling in a Risk-Reduction Hierarchy for STD Prevention

Latka, Mary PhD*; Gollub, Erica DrPH†; French, Pamela MD, MPH†‡; Stein, Zena MB, BCh*

*From the Columbia University School of Public Health, New York, New York; the †City of Philadelphia Department of Public Health, Philadelphia, Pennsylvania; and the ‡Medical College of Pennsylvania, Philadelphia, Pennsylvania

The authors thank the Philadelphia Women's Health Sister Studies team, Lisa M. Blum, Abby Chen, and Lori Johns, for conducting the hundreds of health education sessions required for this experiment and for data collection, Pat Ragone for providing the clinical care, Carol Rogers for her health counseling expertise, Barbara Sturgis for administrative support, and Eileen Kelley for database support. The authors thank Jacquie Astemborski and Don Hoover for analytic support and Megan Saynisch for manuscript preparation. Most importantly, the authors thank the staff and patients at Philadelphia's Health Center Number One. This article is dedicated to the memory of Lisa M. Blum.

Supported by grant no. H25/CCH304327-046 from the Centers for Disease Control and Prevention (Atlanta, GA) and the Female Health Company, Chicago, IL. This study was reviewed and approved by the Institutional Review Boards of the Columbia Presbyterian Medical Center and the City of Philadelphia.

Dr. Latka is currently affiliated with the Center for Urban Epidemiologic Studies, New York Academy of Medicine (New York, NY). Dr. Gollub is currently affiliated with the Center for Addiction Studies, University of Pennsylvania (Philadelphia, PA). Dr. French is currently affiliated with SmithKline-Beecham Pharmaceuticals (Philadelphia, PA).

Reprint requests: Mary Latka, PhD, New York Academy of Medicine, 1216 Fifth Ave Room 556, New York, NY 10029. E-mail: [email protected]

Received October 7, 1999, revised February 4, 2000, and accepted February 16, 2000.

Abstract

Background:

A concern with hierarchy messages, which promote male condoms and female-controlled barrier methods along a prevention continuum, is that they may discourage condom use.

Goal:

To measure male-condom and female-condom use among women who received hierarchy counseling and compare this with women counseled about condoms only.

Study Design:

Three observational cohorts that correspond to prevention message received were assembled, and consisted of female sexually transmitted disease clinic patients who were counseled about male condoms, female condoms, or a hierarchy message. The hierarchy message promoted male and female condoms, the diaphragm and cervical cap, spermicides, and withdrawal, in descending order of effectiveness against sexually transmitted diseases. After counseling, women were interviewed and returned for follow-up visits at 2 weeks, 4 months, and 6 months. The outcome was the mean proportion of male condom- or female condom-protected coital acts at each follow-up visit in the hierarchy cohort. The outcome was dichotomized as high (≥ 70% of coital acts protected) or low (< 70%), and generalized estimating equations were used to compare observed follow-up condom use with baseline within the hierarchy cohort and observed follow-up condom use between cohorts. It was assumed that condom use in persons not present at 6 months was equal to baseline levels, and condom use estimates were calculated for each full cohort that was initially enrolled.

Results:

The mean proportion of condom-protected coital acts in the hierarchy cohort was significantly increased from baseline at each follow-up visit. There were no differences in observed condom use during follow up between the hierarchy cohort and either the male-condom or the female-condom cohort. However, when the full cohort initially enrolled was considered, 6-month condom use was significantly higher in the hierarchy cohort than in the male-condom cohort.

Conclusion:

Hierarchy counseling was associated with a significant increase in condom use. Our findings suggest that offering a choice of male and female condoms results in increased protection over counseling in male condoms alone.