For condoms to prevent disease and pregnancy, they must be used correctly and
consistently. Consistent use requires sustained behavior patterns.
In a project with International Planned Parenthood Federation affiliates in Brazil,
Honduras and Jamaica, counseling of women has shifted from an emphasis on contraceptive
methods, side effects and correct use to the broader context of their sexuality and risk
of STD infection, as a means of promoting behavior change.
Providers discuss contraceptives in what they call a "sexuality-based"
approach, talking with a woman about her current sexual partner, past partners, whether
her partner travels in his work, whether she thinks he might have other sexual partners,
and how these factors relate to her risk of STD infection. The project has also been more
aggressive in educating men about STDs and condom use, including involving men in
counseling.
Achieving a behavior pattern that results in consistent condom use can be difficult.
One study identified which groups of women need more intensive counseling for consistent
condom use. It found that people who choose condoms as a contraceptive method require more
counseling than people who use condoms as a backup method. This is because those choosing
it as their primary contraceptive may have underestimated how hard it is to use condoms
every time.1
Counseling appears to increase condom use when it involves both men and women in a
monogamous situation, and when it focuses on skill building. In a project that counseled
144 heterosexual HIV-discordant couples every six months over six years, condom use
increased, and there were no HIV seroconversions.2 Another
study compared women who received several 90-minute group counseling sessions and a
one-month follow-up session in skill training about condom use to women who received a
general health message. Three months later, condom use had more than doubled among the
first group, but had only increased marginally among those receiving the general message.3
- William R. Finger
References
- Oakley D, Bogue E-L. Quality of condom use as reported
by female clients of a family planning clinic. Am J Public Health 1995;85(11):1526-30.
- Padian NS, O'Brien TR, Chang Y, et al. Prevention of
heterosexual transmission of human immunodeficiency virus through couple counseling. J
Acq Immune Defic Syndr 1993;6(9):1043-48.
- Kelly JA, Murphy DA, Washington CD, et al. The effects
of HIV/AIDS intervention groups for high-risk women in urban clinics. Am J Public
Health 1994;84(12):1918-22.
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