Female Condom Use in South African College Students

描述（由申请人提供）：女性在性谈判中的不平等地位突出了她们可以主动使用的方法的必要性，例如女用避孕套。在南非，女用避孕套被认为是一种预防怀孕和疾病的方法，而且，自从政府发起了一项引入战略以来，需求一直在增长。女用避孕套有可能提高女性在两性关系中的议价能力，但它的成功使用也取决于男性伴侣的合作。为妇女学习女用避孕套谈判技巧而制定和评估的干预措施很少，特别是在南非这样的环境中，不平等的性别关系构成了特殊的挑战。这项拟议的研究将在南非的一所大学校园里开发和测试一种两次会议、特定文化的、基于群体的女性避孕套谈判和插入技巧干预。具体的研究目的是：(1)制定、实施和测试一项随机对照试验的有效性，对南非女大学生中短期和长期使用女用避孕套、男用和女用避孕套未保护场合的总数以及女用避孕套的态度进行简短的认知行为干预和标准的仅信息干预；(2)确定女性避孕套开始使用、维持和停止使用的个体、环境和方法相关决定因素；(3)采用定性方法探讨女性及其男性伴侣介绍和使用女用安全套的背景；(4)探讨男性对女用安全套的态度以及男性在使用女用安全套中的角色。在准备研究阶段，将进行形成性定性工作（校园人种学测绘和20个焦点小组，N = 200）和全校范围内1000名学生的代表性横断调查，以了解社会背景和目标人群的特征，制定适当的干预信息，并作为第二阶段试验的招募来源。试验阶段将在280名妇女中测试认知行为技能干预对短期和长期使用女用避孕套和停止使用女用避孕套的有效性。参与者将在干预前、干预后立即、干预后3个月和6个月分别接受评估。对70名女性试验参与者及其70名男性伴侣的深入访谈将增加女性参与者提供的数据，以增进对影响最初采用、长期使用和停止使用女用避孕套的背景因素的了解。如果成功的话，这种短暂的干预应该可以在其他类似的环境中广泛复制。

DESCRIPTION (provided by applicant): Women's unequal position in sexual negotiations highlights the need for methods, such as the female condom, that they can initiate. In South Africa, the female condom has been endorsed as a pregnancy and disease prevention method, and, since the launch of a government-sponsored introductory strategy, demand has been growing. The female condom has the potential to enhance women's bargaining power within their relationships, but its successful use also depends on male partner cooperation. Few interventions for women to learn female condom negotiation skills have been developed and evaluated, especially in settings such as South Africa, where unequal gender relations pose a special challenge. The proposed study will develop and test a two-session, culture-specific, group-based female condom negotiation and insertion skills intervention on a South African university campus. Specific study aims areto (1) develop, implement, and test the effectiveness in a randomized controlled trial of a brief cognitive-behavioral intervention versus a standard information-only intervention on short- and long-term use of the female condom, total number of male and female condom-unprotected occasions, and female condom attitudes among South African female university students; (2) identify the individual, contextual, and method-related determinants of female condom initiation, maintenance, and discontinuation; (3) explore the context of the introduction and use of the female condom for both women and their male partners using qualitative methods, and (4) explore men's attitudes about the female condom and men's role in female condom use. In the Preparatory Research Phase, formative qualitative work (ethnographic mapping on campus and 20 focus groups, N = 200) and a campus-wide representative cross-sectional survey of 1,000 students will be conducted to understand the social context and characterize the target population, formulate appropriate intervention messages, and serve as a recruitment source for the Phase II trial. The Trial Phase will test the effectiveness of a cognitive-behavioral skills intervention against an information-only control condition on short- and long-term use and discontinuation of the female condom among 280 women. Participants will be assessed prior to and immediately post-intervention, and at three and six months thereafter. In-depth interviews with 70 female trial participants and 70 of their male partners will augment data provided by women participants to increase understanding of the contextual factors that influence initial adoption, long-term use and discontinuation of the female condom. If successful, this brief intervention should be widely replicable in other similar settings.