Fast track — ArticlesPromotion of condom use in a high-risk setting in Nicaragua: a randomised controlled trial
Introduction
More than 30 million people are estimated to have HIV-1 infection worldwide, and 16 000 new infections, mostly acquired heterosexually, are estimated to occur each day.1 Most HIV-1-infected people live in less-developed countries, mainly in sub-Saharan Africa and southeast Asia. In the absence of an effective vaccine, behavioural change is at the centre of HIV/AIDS prevention, including the promotion of condom use.1, 2, 3, 4 Little, however, is known about the effectiveness of different strategies intended to encourage and facilitate protective behaviours among people at risk of infection.
Randomised trials are recommended as the primary strategy for assessment of programme effectiveness,5 but are rare. Among 1184 abstracts submitted with the keywords “behavioural interventions” to the 12th World AIDS Conference in Geneva in 1998, only 30 (2·5%) described randomised controlled trials. There are practical and political difficulties with such trials, and studies frequently require substantial investment of time, expertise, and funding. These factors have probably contributed to the generally low quality of evaluation research in the field of HIV and AIDS prevention.6, 7, 8 Another factor is the “urge to do something”, coupled with strong beliefs that interventions will work, which is understandably widespread among public-health advocates, AIDS activists, and their allies.9 The production and distribution of leaflets and posters, and the distribution of condoms to people perceived to be at high risk of acquiring HIV-1 infection, has been a regular component of prevention activities.
Nicaragua is a country with rapidly rising HIV-1-infection rates1, 10 and the prevalence of sexually transmitted infections is high.10, 11 In Nicaragua and elsewhere in Latin America, motels, boarding houses and hotels rent rooms for short times for discreet commercial and non-commercial sex. These establishments are called moteles in Nicaragua (motels in this paper). We did a randomised controlled trial with a factorial design of condom promotion by use of health-education leaflets and posters and different strategies of condom provision in motels in Nicaragua's capital, Managua, to find out whether these factors could increase condom use.
Section snippets
Study area and selection of motels
We did this study, preceded by a pilot study in 1990,12 in Managua's district IV. This district is in central Managua and has about 200 000 residents who are mainly from lower socioeconomic strata. The district includes Managua's largest street market (Mercado Oriental), from where many sex workers operate. We made a list of all the motels in the study area based on registers of motels from the police, the municipality, and the health centre that serves the area. We also did a street-to-street
Results
Seven (19·4%) motel owners refused to be interviewed and nine (25·0%) were interviewed but declined to participate in the study. 20 motels were therefore included; 12 were used mainly for commercial sex and eight for non-commercial sex. Condom use for 6507 couples was recorded on 473 motel-days between July 31 and October 4, 1997. One motel closed down during the study period and the 44 (0·68% of total) couples recorded on 17 (3·6% of total) days at this motel were excluded from further
Discussion
Evaluation research should provide information on the development of programmes aiming to increase condom use. The choice of an adequate outcome is central to the design. New HIV-1 infection is clearly the most informative outcome in assessment of any prevention programme for HIV and AIDS. Although studies have been done with incidence of HIV-1 or other sexually transmitted infections as the outcome,15, 16 sample-size constraints in low-risk populations and ethical issues in high-risk groups
References (26)
- et al.
Condom promotion, sexually transmitted diseases treatment, and declining incidence of HIV-1 infection in female Zairian sex workers
Lancet
(1994) - et al.
How many people actually use condoms? An investigation of motel clients in Managua
Soc Sci Med
(1993) - et al.
Impact of improved treatment of sexually transmitted disease on HIV infection in rual Tanzania: randomised controlled trial
Lancet
(1995) - et al.
Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial
Lancet
(1999) Report on the global HIV/AIDS epidemic
(1998)Human immunodeficiency virus (HIV) transmission from HIV infected persons to their stable heterosexual partners: follow-up of a European cohort of 304 couples
N Engl J Med
(1994)Condoms: now more than ever–population reports Series H
(1990)- et al.
Evaluating AIDS prevention programs
(1991) - et al.
Sexual health education interventions for young people: a methodological review
BMJ
(1995) - et al.
Behavioural interventions for HIV/AIDS prevention
AIDS
(1995)
Do we know the effectiveness of behavioural interventions?
Lancet
The evaluation of behavioural interventions for gay men: obstacles to evidence-based prevention
Int J STD AIDS
AIDS in Nicaragua: epidemiological, political and sociocultural perspectives
Int J Health Serv
Cited by (58)
Assessing knowledge, attitudes, and behaviors related to HIV and AIDS in Nicaragua: A community-level perspective
2013, Sexual and Reproductive HealthcareCitation Excerpt :Rather, negotiation skills about condom use, high levels of sexual and HIV communication, partner age, and non-violent intimate relationships are better predictors of consistent condom use [26]. By contrast, it has been reported that condom use has become more frequent in casual sexual intercourse, especially in commercial sex [28,29]. In our study, men were less aware of becoming infected by HIV.
Effectiveness of a theory-based postpartum sexual health education program on women's contraceptive use: A randomized controlled trial
2011, ContraceptionCitation Excerpt :Moreover, CSE has been posited to predict contraceptive behaviors and might influence how knowledge is translated into behavior because individuals who feel they can and should use contraceptives may be more receptive to information [30]. Indeed, the relationship between CSE and contraceptive behavior (or effective use) has been confirmed [30,31]. Our study findings are consistent with the work of the National Institutes of Mental Health Multisite HIV Prevention Trial [32], which used social-cognitive theory as a framework to influence condom use, knowledge, and self-efficacy to execute safer sexual behaviors.
The 100% Condom Use Program: A demonstration in Wuhan, China
2008, Evaluation and Program PlanningCorrelation without a cause: An epidemiological odyssey
2020, International Journal of EpidemiologyStructural Interventions in HIV Prevention: A Taxonomy and Descriptive Systematic Review
2017, AIDS and Behavior