Failure to Use and Sustain Male Condom Usage: Lessons Learned from a Prospective Study among Men Attending STI Clinic in Pune, India.
Failure to Use and Sustain Male Condom Usage: Lessons Learned from a Prospective Study among Men Attending STI Clinic in Pune, India.
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DOI：
10.1371/journal.pone.0135071
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Mehendale SM
中科院分区：
文献类型：
--
作者：
Sahay S;Deshpande S;Bembalkar S;Kharat M;Parkhe A;Brahme RG;Paranjape R;Bollinger RC;Mehendale SM
男子持续或一贯使用避孕套仍然是一个挑战。在印度浦那进行了一项研究，以确定与在性病诊所就诊的男子未能坚持使用避孕套有关的因素。在14137性病门诊就诊者中，8360名HIV血清阴性男性参加了队列研究。在1284名男性中研究了安全套使用行为的变化，这些男性在第一次计划的季度随访中返回，309名男性在入组队列时报告了安全套使用的一致性。采用Logistic回归模型分析异性恋男性高危行为的相关数据，以确定与安全套使用行为变化相关的因素。将观察到的与安全套使用相关的人口统计学、行为学和生物学因素拟合到5个考克斯比例风险模型中，计算风险比及其95%置信区间，以确定无法维持安全套使用行为的独立预测因素。单变量分析显示，30岁或以上的男性（p = 0.002）和那些没有接触女性性工作者（FSW）的人更有可能无法持续使用安全套。然而，在多变量分析中，这两个因素均未显示出显着相关性。婚姻状况和一生中与Hijra（太监）的接触与其避孕套使用行为的改变失败相关[AOR 0.33（CI 0.13-0.82; p = 0.017）]。在2年的随访中，尽管进行了咨询，但仍记录了61起“安全套使用失败”事件（15.5/100人年，95%CI 12.3-19.5年）。年龄较大、与非CSW性伴接触、生殖器溃疡/分泌物综合征是不能持续使用安全套的重要预测因素。已婚的一夫一妻制老年男子，报告与性工作者接触并患有生殖器溃疡疾病，在第一次接触自愿艾滋病毒咨询和检测后，有不使用避孕套的风险。这是一个初级预防方案。需要通过对这一人群的后续咨询来加强避孕套的宣传和咨询。
Sustained or consistent use of condoms by men remains a challenge. A study was carried out to identify factors associated with failure to use condoms consistently by men attending STD clinics in Pune, India. Among 14137 STI clinic attendees, 8360 HIV sero-negative men were enrolled in a cohort study. The changes in condom usage behavior were studied among 1284 men who returned for first scheduled quarterly follow up, 309 reported consistent condom use at the time of enrollment in the cohort. Data pertaining to heterosexual men practicing high risk behavior were analyzed to identify factors associated with change in condom use behavior using logistic regression model. Demographic, behavioral and biological factors observed to be associated with condom use were fitted in five Cox proportional hazards models to calculate hazard ratios and their 95% confidence intervals to identify independent predictors of failure to sustain condom use behavior. The univariate analysis showed that men who were 30 years or older in age (p = 0.002) and those who did not have contact female sex worker (FSW) were more likely to fail to sustain consistent condom use. However both these factors did not show significant association in multivariable analysis. Marital status and contact with Hijra (eunuch) in lifetime were associated with failure to change in their condom use behavior [AOR 0.33 (CI 0.13–0.82; p = 0.017)]. During the follow up of 2 years, 61 events (15.5 per 100 person years, 95% CI 12.3–19.5 years) of ‘failure of condom use’ were recorded despite counseling. Older age, contact with non CSW partner and presence of genital ulcer disease / discharge syndrome were significant predictors of failure to sustain condom use. Married monogamous older men, who report contact with sex worker and present with genital ulcer disease are at risk of failure to use condom after first exposure to voluntary HIV counseling and testing. This is a scenario of primary prevention program. Condom promotion and counseling needs to be reinforced through follow up counseling among this population.