Advancing Sexual and Reproductive Health and Rights
 
International Family Planning Perspectives
Volume 29, Number 4, December 2003
DIGEST

Misconceptions About Condom Efficacy Linked to High Risk of Unprotected Sex Among Chinese STD Patients

In southern China, 71% of males and 28% of females with a newly diagnosed sexually transmitted disease (STD) had had sex with a nonregular partner in the previous six months, according to a survey conducted in public clinics.1 Most respondents with new STDs did not consistently use condoms, either with nonregular partners or with regular partners. In addition, two-thirds stated that it was likely that they would have unprotected sex with nonregular partners before their STD was cured. Misconceptions about HIV, STDs and condoms were common among respondents overall but were more common among those with less education. The odds that respondents had had or anticipated having unprotected sex before their STD was cured was elevated among those who had more misconceptions, those who believed that condoms were not effective for prevention and those who perceived themselves to be very likely to contract HIV or STDs in the future.

The study was conducted in four public hospitals in Guangzhou, a metropolitan city in southern China, during 2001. Adolescents and adults visiting the hospitals' dermatology and venereal disease clinics because of symptoms of a previously undiagnosed STD were eligible for the study if an infection was confirmed. Study participants completed anonymous questionnaires.

Analyses were based on 619 respondents (440 male and 179 female respondents). Male respondents were nearly equally distributed across age-groups, whereas about 70% of female respondents were aged 20-29. Larger proportions of female respondents had a lower educational level and were unemployed, and larger proportions of male respondents were professionals. About half of both male and female respondents were married and came from rural areas. A significantly larger proportion of male respondents had previously had an STD (21% vs. 10%).

In the six months before the study, the proportion of respondents who had had a regular sex partner was lower among males than among females (62% vs. 71%), whereas the proportion with a nonregular partner was higher among males than among females (71% vs. 28%). During the same period, significantly larger proportions of male than female respondents had had sex with a commercial sex worker (30% vs. 3%), with someone they did not know (18% vs. 3%) or with a friend or colleague (31% vs. 22%).

Although the proportion of respondents who reported consistently (always) using condoms with nonregular sex partners before the current STD episode was three times as high among males as among females, the proportion for each gender was low (17% vs. 6%). The respective proportions were even lower for consistent use of condoms with regular sex partners (5% vs. 3%).

Among respondents who had had a nonregular sex partner in the previous six months, 68% stated that it was likely that they would have unprotected sex with a nonregular partner before their STD was cured, whereas only 23% stated that it was unlikely. The rest believed that they had already done so. The proportion of respondents stating that unprotected sex was unlikely was significantly greater among those aged 35 or older, but did not differ by gender or education level.

In contrast, among respondents who had had a regular sex partner in the previous six months, 90% stated that it was unlikely that they would have unprotected sex with a regular partner before their STD was cured. About 6% believed that they had already done so, and 5% believed that they were likely to do so.

At least 85% of respondents knew that HIV could be transmitted by unprotected vaginal or anal sex, sharing of needles and blood transfusion, and from mother to child. However, 69% of respondents did not know about the lag between HIV infection and its detection, 81% did not know that an infected person may have no symptoms for years and 37% believed that AIDS is curable.

Misconceptions about STDs and condoms were also common. Large proportions of respondents mistakenly believed that gonorrhea is not an STD (49%), that people infected with an STD once are immune to infections thereafter (32%), that a person cannot have two STDs simultaneously (59%) and that an asymptomatic person cannot transmit an STD (51%).

Similarly, substantial proportions of respondents did not know that condoms have an expiration date (39%) or that they should not be reused (25%), or believed that it is appropriate to put on a condom just before ejaculation (25%). Significantly larger proportions of female than male respondents believed that condom use is not effective for preventing STD infection (21% vs. 11%) and HIV infection (24% vs. 14%). In general, the proportion of respondents holding misconceptions about HIV, STDs and condoms declined with rising levels of education.

Larger proportions of male than female respondents believed that it was likely or very likely that they would become infected with an STD in the future (31% vs. 18%). Among respondents overall, 10% believed that it was likely or very likely that they would become infected with HIV in the future, 60% believed that it was unlikely and the rest were unsure.

In a multivariate analysis of characteristics that influenced whether respondents had had or anticipated having unprotected sex with a nonregular partner before cure of their STD, the odds for males were significantly elevated for those who had previously had an STD (odds ratio, 2.0); those who were less knowledgeable about HIV (2.2), STDs (2.7) and condoms (3.7); those who believed they were very likely to become infected with HIV (7.0) or an STD (3.2) in the future; and those who believed that condoms are not effective for preventing HIV infection (2.4). Among female respondents, the odds were significantly elevated only for those who believed that condoms are not effective for preventing STDs (3.5).

A second multivariate analysis examined factors that influenced whether respondents had had or anticipated having unprotected sex with a regular partner before cure of their STD. The odds were significantly elevated for males who were less knowledgeable about condoms (odds ratio, 2.4), those who believed that they were very likely to become infected with HIV (8.6) or an STD (5.6) in the future and those who believed that condoms are not effective for preventing HIV infection (2.3). Among female respondents, the odds were significantly elevated only for those who believed that condoms are not effective for preventing infection with HIV (3.1) or STDs (3.5).

The investigators comment that people with STDs who have unprotected sex before their disease is cured can serve as a bridge for infection of others. Misconceptions about HIV, STDs and condoms are likely contributing to this practice and to the sharply rising rates of infection in China, they observe. They contend that interventions promoting education and condom use are urgently needed to "break the cycle of STD infection."--S. London

REFERENCE

1. Lau JTF et al., Needs assessment for STD/HIV prevention among patients with sexually transmitted diseases in southern China, Sexually Transmitted Diseases, 2003, 30(8):600-608.