Long-term use of the female condom among couples at high risk of human immunodeficiency virus infection in Zambia

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.

PIP: A study conducted in Lusaka, Zambia, sought to determine whether couples at high risk of HIV infection would use the female condom over a 1-year period and if such use would lead to a reduction in unprotected coital acts. A total of 99 couples in which at least one partner had a sexually transmitted disease were enrolled. At baseline, 73% of men were HIV-positive and 8% had gonorrhea, while 47% of the women were HIV-positive and 10% had gonorrhea. The couples were given female condoms, male condoms, and spermicides and counseled to use either condom and spermicide for each coital act. 51, 38, and 30 couples were available for follow up at 3, 6, and 12 months, respectively. A total of 3426 coital acts were recorded during the study period. 45%, 46%, and 57% of coital acts were protected by the male condom at 3, 6, and 12 months, respectively. Female condoms were used in 24%, 27%, and 23% of coital acts and by 86%, 79%, and 67% of the returning couples during each time interval. Less than 15% of sex acts during any time period were unprotected by a barrier method. Male condom use was higher when only the female was HIV-infected, while female condom and spermicide use were higher when the male was infected. Higher levels of use of the female condom at 12 months were correlated with high self-efficacy and low perceived barriers to method use. Although male condoms were used more often than the female condom, these findings suggest that the addition of female condoms to the barrier method mix may reduce unprotected sex among couples at high risk of HIV infection.