Evaluating the Home-based Intervention Strategy (HIS-UK) to reduce new chlamydia infection among young men aged 16-25 years by promoting correct and consistent condom use: What is the cost effectiveness of two different delivery models (face-to-face and digital delivery)? Protocol for a randomised controlled trial. (Preprint)

BACKGROUND The health, social, and economic costs of sexually transmitted infections (STIs) represent a major public health concern. Young people are considered one of the groups most at risk for acquiring and transmitting STIs. Correct and consistent condom use has been shown to be the most effective method for reducing STIs; however, condoms are often not used properly. Evidence has shown that brief behavioural change interventions that focus on skills, communication, and motivation to acquire safe sex practices, should be adopted into routine care to reduce STIs. Funding for sexual health services (SHS) in England has declined dramatically, so novel ways of reducing clinic attendance are being sought. The Home-based Intervention Strategy (HIS-UK) to promote condom use among young men has shown promise in feasibility and pilot studies by demonstrating high acceptability of the intervention in participant and health professional feedback, including aiding men to find condoms that they like and to feel more confident when using condoms. OBJECTIVE To determine the effectiveness and cost-effectiveness of HIS-UK when compared to usual condom distribution care in young men. The three trial arms consisting of ‘eHIS’ (HIS-UK delivered digitally), ‘proHIS’ (HIS-UK delivered face-to-face) and control condition (usual NHS care) will be compared against three primary outcomes: the extent to which they increase correct and consistent condom use, improve condom use experiences (pleasure, fit-and-feel), and reduce chlamydia test positivity. METHODS The study aims to address skills acquisition and motivation to use condoms. Eligibility criteria include men aged 16-25 years at risk of STIs through reporting of condom use errors (i.e. breakage/slippage) or condomless penile-vaginal or penile-anal intercourse with casual/non-regular or new sexual partners during the previous three months. Prospective participants will be recruited through targeted advertisements and an opportunistic direct approach at selected sexual health and genitourinary medicine services and University-associated health centres and GP practices. Community and educational establishments will be used to further advertise the study and signpost men to recruitment sites. Participants will be randomly allocated to one of three trial arms. A repeated measures design will assess the three parallel arms with baseline and 12 monthly follow-up questionnaires post intervention and three chlamydia screening points (baseline, 6 and 12 months). RESULTS Recruitment commenced in March 2020. Due to the COVID-19 pandemic the study was halted and has since reopened for recruitment in Summer 2021. CONCLUSIONS If effective and cost-effective, HIS-UK can be scaled up into routine NHS usual care to reduce both STI transmission in young people and pressure on NHS resources. This intervention may further encourage SHSs to adopt further digital technologies, allowing for such services to become more widely available to young people whilst also decreasing health inequalities and fear of stigmatisation. CLINICALTRIAL ISRCTN: 11400820, October 2019

Diversities of Sexual Activities and Correlates of Safe Sex Practices Among Adolescents in Plateau State, Nigeria

Background: Unsafe sex, particularly, condomless sex exposes adolescents to sexual and reproductive health risks. This study aimed to assess the sexual experiences and to determine the most important covariates of sexual activity and consistent condom use among adolescents in Plateau State, Nigeria.Methods: A cross sectional survey was conducted among 428 adolescents selected from 6 LGAs through a multistage sampling technique. The data was analyzed using the IBM Statistical package for Social Sciences (SPSS) version 23, multiple logistic regression was conducted to determine the covariates of sexual activity and condom use.Results: About one third (38%) of the adolescents were sexually active, 5.7% had same sex partners, 70% had more than one sexual partner and majority (72.4%) were not consistently using condom during sex. Logistic regression results showed that older adolescents (OR = 5.73; CI = 3.72–8.12; p = 0.001) and out of school adolescents (OR = 2.68; CI = 1.79–4.00; p = 0.001) were more likely to be sexually active, while multivariable logistic regression analysis showed age (AOR = 0.33; CI = 0.12–0.90; p = 0.031) and gender as important covariates of being sexually active, (AOR = 6.29; CI = 3.18–12.44; p = 0.001). Inconsistent condom use was more likely among adolescents; with lower education, (OR = 2.14; CI = 1.19–3.85; p = 0.011), having sex with older partners (OR = 0.61; CI = 0.42–0.90; P = 0.013) and with low awareness of SRH issues (OR = 2.08; CI = 1.02–4.22; p = 0.044). The multivariable logistic regression however, showed gender, being male (AOR = 0.43; CI = 0.006–3.09; p = 0.023) as covariate of consistent condom use.Conclusion: Most sexually active adolescents had multiple sexual partners, some had same sex partners and majority were not consistently using condom. Older adolescents and those out of school were more likely to be sexually active. Awareness of SRH issues significantly influenced condom use while gender, specifically being male, was the independent covariate for being sexually active and for consistent condom use. We recommend sexual health intervention targeted at adolescents. In addition, gender should be mainstreamed into adolescent sexual and reproductive health programmes.

Study on Influencing Factors to HIV Health Services Among Men Who Have Sex with Men (MSM) from 2013 to 2021

Background We assessed the utilization of HIV health services and its influencing factors on consistent condom use, HIV testing and HIV counseling among men who have sex with men (MSM) based on Andersen Behavioral Model, so as to provide a theoretical basis for future infectious disease prevention and control strategies and health services policy formulation.method This is a cross-sectional study from 2013 to 2021. A sample survey was conducted in southwest China including Chongqing, Sichuan, Xinjiang and Guangxi, and an anonymous self-administered questionnaire survey was conducted among MSM who met the requirements and were recruited. Based on Anderson Behavioral Model, the questionnaire divided the influencing factors into predisposing factor, enabling factor and need factor. There were 2908 valid questionnaires. Multivariate logistic regression analysis was used to explore the factors influencing the utilization of health services.Results In the survey of HIV health services, 36.49% of respondents consistently used condoms, 82.81% had HIV testing, and 65.61% had HIV counseling. It can be obtained that among the predisposing factor, older age is a factor that promotes HIV testing but is a hindrance to consistent condom use. Condom use was higher among MSM who were Ethnic Han and had an education level of "junior high or below". Among the enabling factor, not finding a sexual partner through the Internet, not having commercial sex were associated with consistent condom use. Urban and high income were enablers of HIV testing and HIV counseling. Among the need factor, improved HIV knowledge could promote HIV testing and HIV counseling among MSM.Conclusions For these groups, MSM with high-risk characteristics should be identified as a priority in the future public health services. HIV knowledge should be promoted in health education, and mental health diagnosis and treatment also should be strengthened.

HIV Knowledge Among Cisgender Female Sex Workers of Haitian Descent Working at the Border of Haiti and Dominican Republic

In this brief report, we aim to assess levels of HIV mis-information among cisgender Haitian female sex workers engaged in sex work at the Haiti and Dominican Republic border. We conducted bivariate analyses on the 2014 Border Study on Sex Workers comparing responses from female sex workers on the Haiti side of the border to those from their peers on the Dominican Republic side (N = 212). Prevention of HIV acquisition by correct and consistent condom use with each sex act was correctly endorsed by 90.5% of female sex workers in Haiti but only 57.0% of their peers in Dominican Republic (χ2 = 32.28, p < 0.001); 84.1% of respondents in Haiti correctly identified that HIV can be transmitted through a single unprotected sexual act, compared to 52.3% in Dominican Republic (χ2 = 25.2, p < 0.001). Significantly higher percentages of female sex workers in Dominican Republic correctly responded that HIV can be transmitted in pregnancy, compared to respondents in Haiti (96.5 vs. 71.4%; χ2 = 21.42, p < 0.001). Higher percentages of respondents in Dominican Republic correctly answered that HIV can be transmitted through needle sharing, relative to respondents in Haiti (100.0 vs. 89.7%; χ2 = 9.45, p < 0.01). Respondents in Dominican Republic more accurately rejected the possibility of transmission through food or through mosquito bites, compared to respondents in Haiti (95.4 vs. 81.8%, χ2 = 8.51, p < 0.01; 97.7 vs. 86.5%, χ2 = 7.81, p < 0.01, respectively). Findings indicate that if HIV knowledge is examined aggregating responses to individual questions, then elements of misinformation may remain unaddressed. For example, we found significant differences in correct answers ranging from 16.7 to 100.0%.

Prevalence of Consistent Condom Use and Associated Factors among Serodiscordant Couples in Ethiopia, 2020: A Mixed-Method Study

Background. Heterosexual transmission within serodiscordant relationships is the core source of new HIV infections. Although consistent condom use can significantly reduce HIV transmission risk among serodiscordant couples, it has not been extensively studied in Ethiopia. Consequently, the current study looked at the proportion of serodiscordant couples in Ethiopia who used condoms consistently and the factors associated with that. Methods. A cross-sectional was conducted from October 2019 to June 2020. For the quantitative findings to be more robust and reliable, a qualitative design was incorporated. An interviewer-administered questionnaire was used to collect the data. Qualitative data were collected using gender-matched four focus group discussions. Multivariable logistic regression was conducted to identify factors associated with consistent condom use. The statistical significance of the variables was declared at a P value of less than 0.05. Results. This study confirmed that the proportion of consistent condom use was 58.4% [95% CI: 53.1-63.1%]. After controlling for all other variables, unmarried partners, adjusted odds ratio AOR = 0.44 [95% CI: 0.229-0.877] and students and employees, AOR = 0.33 [95% CI: 0.130-0.846] and AOR = 0.39 [95% CI: 0.165-0.939], respectively, were less likely consistently use condoms, whereas couples living together, AOR = 1.86 [95% CI: 1.197-2.195], receiving counseling about condom use, AOR = 1.90 [95% CI: 1.182-3.076], and having more knowledge about HIV, AOR = 1.61 [95% CI: 1.031-2.525] were more likely to use condoms consistently. Conclusion. Despite its importance, the proportion of consistent condom use among serodiscordant couples was significantly low. To improve condom use consistently, planners, policymakers, and health care practitioners should consider the factors listed above when making decisions. There should be an increased focus on student and employee intervention as well.

Sexual-risk behaviours and HIV and syphilis prevalence among in- and out-of-school adolescent girls and young women in Uganda: A cross-sectional study

Background Adolescent girls and young women (AGYW) are at increased risk of sexually transmitted infections (STIs). We assessed sexual-risk behaviours and HIV and syphilis prevalence among AGYW in Uganda to inform the design of target-specific risk-reduction interventions. Methods This analysis utilizes data from 8,236 AGYW aged 10–24 years, collected in 20 districts, between July and August 2018. AGYW engaged in sexual-risk behaviour if they: a) reported a history of STIs; or b) had their sexual debut before age 15; or c) engaged in sex with 2+ partners in the past 12 months; or c) did not use or used condoms inconsistently with their most recent partners. We diagnosed HIV using DetermineTM HIV-1/2, Stat-PakTM HIV-1/2 and SD Bioline. We used SD Bioline Syphilis test kits to diagnose syphilis and Treponema Pallidum Hemagglutination Assay for confirmatory syphilis testing. Comparison of proportions was done using Chi-square (χ2) tests. Data were analysed using STATA (version 14.1). Results Of 4,488 AGYW (54.5%) that had ever had sex, 12.9% (n = 581) had their sexual debut before age 15; 19.1% (n = 858) reported a history of STIs. Of those that had ever had sex, 79.6% (n = 3,573) had sex in the 12 months preceding the survey; 75.6% (n = 2,707) with one (1) and 24.2% (n = 866) with 2+ partners. Condom use with the most recent sexual partner was low, with only 20.4% (n = 728) reporting consistent condom use while 79.6% (n = 2,842) reported inconsistent or no condom use. In-school AGYW were significantly less likely to have ever had sex (35.6% vs. 73.6%, P<0.001), to have had sexual debut before age 15 (7.7% vs. 15.5%, P<0.001) or to engage in sex with 2+ partners (5.3% vs. 15.8%, P<0.001). Consistent condom use was significantly higher among in-school than out-of-school AGYW (40.1% vs. 12.7%, P<0.001). Overall, 1.7% (n = 143) had HIV while 1.3% (n = 104) had syphilis. HIV and syphilis prevalence was higher among out-of-school than in-school AGYW (HIV: 2.6% vs. 0.9%; syphilis: 2.1% vs. 0.5%, respectively). Conclusion In-school AGYW engaged in more protective sexual behaviors and had less HIV and syphilis than their out-of-school counterparts. These findings suggest a need for target-specific risk-reduction interventions stratified by schooling status.

Determinants of Consistent Condom Use Among Filipino Women: Results From the 2017 Philippine National Demographic and Health Survey

Background: Consistent condom use had been perennially low in the Philippines, despite being a tested and proven public health intervention to prevent unwanted pregnancy and sexually transmitted infections. Considering the high fertility rate, teenage pregnancy rate, and the rapidly increasing incidence of HIV in the country, we identify the determinants of consistent condom use in the country. Methods: We used data from the individual recode of the 2017 Philippine National Demographic and Health Survey. We used logistic regression for survey data to identify factors associated with consistent condom use. Results: Out of 25,074 respondents, only 261 (1.13%) have used condoms consistently with their most recent partner. Reach of information and education campaigns on contraceptive use via different media ranged from 62% via television to 7% via SMS. After adjusting for confounders, those who were able to ask their partners to use condoms during sexual intercourse has 6.10 times (adjusted odds ratio: 6.10; 95% Confidence Interval (95% CI): 2.00. 18.61) odds of consistent condom use than those who were unable to ask their partners to use condoms during sexual intercourse. Meanwhile, HIV knowledge (aOR: 1.17; 95% CI: 0.99, 1.39), hearing about contraception in television (aOR: 1.54; 95% CI: 0.99, 2.39), age (aOR: 0.98; 95% CI: 0.95, 1.00), and number of children (aOR: 1.09; 95% CI: 0.98, 1.20) have borderline significant associations with consistent condom use. Conclusions: The low percentage of those who use condoms consistently, together with the low reach of information and education campaigns highlight the need to further intensify information and education campaigns to promote consistent condom use. Interventions to improve sexual agency and promote HIV knowledge should be implemented to address the burden of unwanted pregnancies and HIV in the Philippines.

Understanding the association between exposure to family planning messages and consistent condom use among never married men in Ghana

Background Despite considerable efforts to promote condom use, sexually active people in sub-Sahara Africa still engage in risky sexual behaviours, with condom use relatively low. With this high vulnerability of these persons to HIV and sexually transmitted infections, research related to exposure to family planning messages to help curb this trend remains sparse. This study examined how exposure to family planning messages in the midst of some socio-demographic factors is associated with consistent condom use among sexually active never married men in Ghana. Methods Data were obtained from the 2014 Demographic and Health Survey (DHS) of Ghana. Only never married men (15–64 years) who have had sexual experience in the last 12 months were included in the analysis (N = 971). Frequencies, percentages, chi-square tests and binary logistic regression analyses were carried out. Results of the binary logistic regression analysis were presented using crude odds ratios (cOR) and adjusted odds ratios (aOR). Results The results showed that only 26.15% of sexually active never married men in Ghana consistently used condom during sex. Men who were exposed to family planning messages were 51% more likely use condom consistently compared to those who are not exposed [aOR = 1.51, CI = 1.04–2.18]. In terms of the covariates, the likelihood of consistent condom use among men in Ghana was lower among those aged 35 years and above compared to those aged 15–24 [aOR = 0.46 CI = 0.21–0.99]. The odds of consistent condom use among men increased with level of education, with men with higher level of education having the highest odds of consistent condom use compared to those with no formal education [aOR = 9.98, CI = 2.05–48.46]. Men of the richest wealth quintile were more likely to use condom consistently compared to those of the poorest wealth quintile [aOR = 2.62, CI = 1.30–5.27]. Higher odds of consistent condom use was found among men who dwelled in the Central, Northern, and Upper East regions compared to those of the Western region. Conclusion Our findings have established a strong association between exposure to family planning messages alongside age, educational level, wealth, and region of residence and consistent condom use. Men exposed to family planning messages were more likely to use condoms consistently. Designed programs should use intervention strategies that focus on interactive and participatory educational activities to improve sexually active men’s interpersonal communication on family planning messages, especially on consistent condom use with their sexual partners.

Correlations Between Community-Level HIV Preexposure Prophylaxis Coverage and Individual-Level Sexual Behaviors among US Men Who Have Sex with Men

Background HIV preexposure prophylaxis (PrEP) has been associated with changes in sexual behavior after PrEP initiation. However, behavioral differences may also emerge among PrEP non-users in communities with high PrEP coverage. Methods We used demographic, behavioral, and sexual network data from ARTnet, a cross-sectional study of US men who have sex with men conducted during 2017-2019. Multivariable regression models with a Bayesian modeling framework in which individuals were nested within their residential geographic areas were used to estimate associations between area-level PrEP coverage and five sexual behavior outcomes (number of total, main, and casual male partners [network degree]; count of one-time partnerships; and consistent condom use in one-time partnerships), controlling for individual PrEP use. Findings PrEP coverage ranged from 10.3% (Philadelphia) to 38.9% (San Francisco). Total degree was highest in Miami (1.35) and lowest in Denver (0.78), while the count of one-time partners was highest in San Francisco (11.7/year) and lowest in Detroit (1.5/year). Adjusting for individual PrEP use and demographics, community PrEP coverage was associated with higher total degree (adjusted incidence rate ratio [aIRR]=1.73; 95% CrI, 0.92-3.44), casual degree (aIRR=2.05; 95% CrI, 0.90-5.07), and count of one-time partnerships (aIRR=1.90; 95% CrI, 0.46-8.54). Without adjustment for individual PrEP use, these associations were amplified. There were weaker associations with main degree (aIRR=1.21; 95% CrI, 0.48-3.20) and consistent condom use in one-time partnerships (aIRR=1.68; 95% CrI, 0.86-3.35). Interpretation Most of the associations between community PrEP coverage and sexual behavior were explained by individual PrEP use. However, there were residual associations after controlling for individual PrEP use, suggesting that PrEP coverage may partially drive community-level changes in sexual behavior.