Understanding sexual behaviour change in rural southwest Uganda: A multi-method study
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Abstract:
Studies report substantial sexual behaviour change in Africa in response to HIV/AIDS. Generally there seems to be an increase in condom use and a reduction in partners, with men reporting more change than women. However, it is not only important to know whether people are changing their sexual behaviour but also their reasons for changing and the consistency and extent of change. Between 1996 and 2000 a study involving 196 respondents was carried out in rural southwest Uganda to investigate the exact nature of behaviour change and the reasons for change or lack of change since people became aware of HIV/AIDS. Data were collected from three rounds of questionnaire surveys, four rounds of open in-depth interviews, six rounds of semi-structured interviews and from informal conversations and participant observation. In order to obtain a comprehensive assessment of behaviour change the data for each participant from all sources were compared and discrepancies were then followed up by re-interviewing participants. After triangulation between all sources of data, 48% of respondents had ever used a condom. Condom use in 76% of all cases was at least partly AIDS related, while 19% was exclusively for protection against HIV. Condom use tended to be sporadic: only 13% of condom users currently used a condom regularly and most of this use was for family planning. After triangulation, 45% had reduced the number of sexual partners. Of all partner reductions, 93% was at least partly AIDS related; 29% was exclusively to avoid HIV. Half of those who had reduced the number of partners either stuck to one partner or abstained. Men reported more change than women. Of those who reported no partner reduction, 89% could not reduce the number of partners because they already had only few or a single partner or abstained; most of these were women. Most of those who could change their sexual behaviour had already changed, though the degree of change (particularly condom use) was often minimal. Not only behaviour change, but also the maintenance of safe behaviour is important. Also, understanding reasons for change and extent and consistency of change are important when planning and evaluating interventions.Keywords:
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The female condom may provide women with the first female-controlled barrier method that is effective against sexually transmitted diseases, including HIV infection.This study evaluated the acceptability of the female condom among sex workers in Thailand.Data on use and acceptability of the female condom were collected using a structured questionnaire during an 8-week follow-up.Analyses included 148 women who were still in follow-up at week 8. Sex workers used, on average, 2.8 female condoms per week. The overall satisfaction rate with the female condom was 68%, although, among users, 31% had difficulties in device insertion, 37% had pain from the inner ring, and 22% reported itching sensations. The main reason for using the female condom in the future was its perceived safety, and the main reason for not using it would be the client's refusal.Two-thirds of the sex workers were satisfied with the female condom. Difficulties at insertion, discomfort during use, and clients' attitude were potential obstacles to the use of the female condom in the future.
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The female condom, which took 7 years and more than $26 million to develop, has been approved as a barrier protection method by the Food and Drug Administration. It is marketed by its developer, The Female Health Co. in Chicago. The female condom is a transparent sheath that lines the vagina and creates a barrier against sperm and sexually transmitted diseases. Positive and negative attributes are listed, and commonly asked questions about the female condom are answered. The condoms are sold in pharmacies for $2 to $3 each, but are available free of charge from various family planning clinics. Contact information is provided.
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In 1996, over 9 million women have been estimated to have HIV, about 80% through unprotected sex with an infected male partner. This article presents the female condom as an alternative barrier method that gives women more control over their bodies and couples more options in protecting themselves and their partners. In contrast to the male condom, which can be damaged by heat, light, and humidity, the female condom is both strong and durable. It has no special storage arrangements because it is made of polyurethane. The female condoms' greater coverage of the female genitals also offers extra protection for both partners. In addition, it gives protection in situations where it can be inserted hours before intercourse, unlike the male condom, which reduces the chances that it will be used. In terms of attitudes toward the method, a study in South Africa showed that, of almost 600 women included, 84% said they would use the female condom in the future, 47% of whom said their partners either liked it or had no problems with it. Although the commercial price of female condoms in developing countries is much too high for the populations who are most likely to benefit from them, a program with the producer of the female condom has been negotiated to potentially lower its price.
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This article briefly discusses the female condom and presents step-by-step instructions on how to use it. Although the female condom costs much more than the male condom, many women who have learned how to use it properly like it. The female condom is made of a durable material called polythene and can be inserted anytime, from several hours before sex to immediately before the penis comes into contact with the vagina. It can also be used during anal sex. While it is recommended that a new female condom be used each time a couple has sex, some women report that they have successfully re-used the female condom after washing and relubricating it.
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Frequently asked questions about the female condom include questions about its effectiveness as a contraceptive, which is as high as the other barrier methods and can approach 95% with perfect use. Its effectiveness in preventing transmission of sexually transmitted diseases and HIV infection is speculative but promising because the condom material is impermeable to the causative agents. The female condom is safe to use except by people who are sensitive to polyurethane or silicone. The condom is made in one size and has a closed inner ring and an open outer ring (which remains outside of the vagina during use). The condoms are prelubricated, and additional water-based lubrication can be used. The accepted shelf life of the female condom in the US is two years, but this may be extended. The female condom is impervious to normal changes in temperature, altitude, and humidity; however, it can be ripped by a sharp object such as a fingernail or jewelry. The female condom can be used with other nonbarrier methods but should not be used in conjunction with a male condom or in the presence of a tampon. Pregnant or menstruating women and women of any age can safely use the device, and it can be inserted several hours prior to use. Studies have shown that many women like the device and would recommend it to others.
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