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Behavioral interventions for improving condom use for dual protection.

Laureen M Lopez1, Conrad Otterness, Mario Chen

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Area of Science:

  • Public Health
  • Epidemiology
  • Behavioral Science

Background:

  • Unprotected sex is a significant global health risk, contributing to disease, disability, and mortality, primarily due to sexually transmitted infections (STIs) like HIV.
  • Male condoms offer dual protection against pregnancy and HIV/STIs when used consistently and correctly.

Purpose of the Study:

  • To review comparative studies on behavioral interventions aimed at improving condom use.
  • To identify interventions associated with effective condom use, verified by biological assessments for objective evidence of protection.

Main Methods:

  • Searched multiple databases (MEDLINE, POPLINE, CENTRAL, EMBASE, LILACS, OpenGrey, COPAC, ClinicalTrials.gov, ICTRP) for comparative studies up to September 2013.
  • Included randomized or non-randomized studies of behavioral interventions for condom use, comparing them against usual care or no intervention.
  • Focused on studies with biological outcomes (pregnancy, HIV/STI, semen presence) measured at least three months post-intervention, excluding self-reported data.

Main Results:

  • Seven randomized controlled trials (RCTs) met eligibility criteria, with most being cluster-RCTs conducted in Africa, the USA, and England.
  • Interventions showed no significant difference in pregnancy or HIV outcomes but had favorable effects on some STIs, including reduced incidence of HSV-2, syphilis, and gonorrhea in specific trials.
  • One study reported an increased incidence of gonorrhea among young women in the intervention group.

Conclusions:

  • Few studies exist with limited evidence for the effectiveness of behavioral interventions promoting dual protection via condom use.
  • Favorable results were not observed for pregnancy or HIV prevention, with only some positive findings for other STIs.
  • There is a need for effective, feasible interventions in resource-limited settings, rigorously tested with valid outcome measures, to prevent pregnancy and HIV/STI transmission.