Feasibility study of the Home-based Exercises for Responsible Sex (HERS) intervention to promote correct and consistent condom use among young women

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What is the problem? Rates of sexually transmitted infections (STIs) in England have increased by around 50% over the last 10 years, with about half a million new cases occurring every year. STIs can have serious consequences beyond the immediate impact of the infection itself and the health, social, and economic costs of STIs are huge; the current estimated cost of treatment to the NHS is £620 million per year. The Department of Health has identified the need to reduce STI rates as a priority for improving sexual health and have recognised young heterosexuals as target 'at-risk' groups. Public Health England have launched a campaign to promote condom use.Why do we need to do something? Male condoms can be protective against STIs when used correctly and consistently; however, there are many issues which stop people using them or using them properly, such as negative attitudes, reduced sexual pleasure, and problems with 'fit and feel'. The protection condoms provide against STIs is also reduced when they are not used from the start to the finish of sex, which is more commonly reported by couples who experience problems whilst using condoms or who express a dislike of them. Many health promotion programmes have tried to increase condom use by focusing on improving men's knowledge and condom use skills, and more recently on promoting pleasure and fun when using condoms and lubricants. However, women also report problems and dissatisfaction with condoms, such as discomfort, vaginal friction, and reduced sensation. Women also often apply condoms to their male partners and report errors and problems when putting them on which can result in erection loss. Educating women as well as men about ways to enhance their pleasurable condom use experience is likely to be an important public health strategy, yet very few interventions to date have focused on this approach.What are we going to do? We want to develop and test a condom promotion programme for use among young women aged 16-25 in the UK. The programme starts with a training session to build women's confidence and skills related to pleasurable condom and lubricant use. We will then give out "condom kits" (containing different condoms and lubricants) and ask women to try out the contents of the kit at home by themselves and with their sexual partners by completing various homework exercises. As they try out each condom and lubricant they are asked to think about their own pleasure and which they like best. Women then rate the condoms and lubricants they use. The aim of the programme is for women to improve their experiences with condoms and lubricants and their ability to use them as part of pleasurable and safe sexual activity.To ensure that we develop a programme which is acceptable to young women and which will work we will be interviewing young women and health promotion professionals to find out their views and assist us in developing the components of the new programme. We will then invite local authority commissioned genito-urinary medicine (GUM) and outreach services in Hampshire to take part and help recruit 50 young women aged 16-25, who are at risk of STIs through the non-use of condoms with new and casual partners, to test out the programme.What we will measure: We want to know if young women like the different components of the programme and if it is possible to recruit for our study from GUM and outreach settings. We are also testing whether it is possible to do a larger trial to see if the programme can change women's attitudes and use of condoms and lubricants, and to estimate the costs, time, resources, sample sizes, outcome measures etc. needed to carry this out. At the end of the programme we will ask women for their views about the study and what we asked them to do.This work will increase the likelihood of developing an effective condom promotion programme for young women, and will assess whether a larger trial is justified and appropriate.