Sterilized Hispanic women surveyed at a publicly funded primary care facility in Houston were only half as likely as women relying on hormonal contraceptives to say that they used condoms consistently or that they planned to use them.1 Women had elevated odds of using condoms consistently if their partner had positive attitudes toward condoms or if they considered themselves to be at high risk of acquiring HIV or other sexually transmitted diseases (STDs). Sterilization is an increasingly popular contraceptive choice among U.S. women, but little is known about sterilized women's use of condoms for disease protection. It is particularly important to understand patterns of condom use among Hispanic women who have been sterilized, because Hispanic women's risk of HIV and other STDs often is elevated by their partners' behavior.
The survey was conducted at a primary care facility that serves a low-income population; all sexually active Hispanic clients who were sterilized or used the pill or injectable were invited to participate. In all, 224 sterilized women and 104 users of hormonal methods completed self-administered questionnaires, which asked about their background characteristics; their condom use with their main partner in the past three months; their likelihood of using condoms in the next three months; their perceptions of their ability to use condoms, of their susceptibility to disease and of the benefits of condom use; and their partner's role in the decision to use condoms.
Sterilized women were significantly older than hormonal method users (36 vs. 30 years), had had more pregnancies (3.2 vs. 2.2) and births (2.8 vs. 1.8), and were more likely to say that they were satisfied with their current contraceptive method (91% vs. 75%). They rated their chances of contracting HIV and other STDs significantly lower (1.8 and 1.6, respectively, on a four-point scale) than did hormonal method users (2.5 and 2.2). The two groups were statistically indistinguishable with respect to other characteristics that may be related to STD risk (including their current number of partners, their number of partners in the last year and their STD history).
When asked how frequently they had used condoms in the last three months, sterilized women were half as likely as users of the pill or injectable to say at least 90% of the time (18% vs. 32%); the difference was statistically significant. They were no more likely than users of hormonal methods to report having used condoms some of the time, but were significantly more likely to say that they had seldom or never used them (72% vs. 52%).
Responses regarding women's plans to use condoms in the next three months followed a similar pattern. Twenty-four percent of sterilized women were sure that they would use condoms, compared with 47% of users of hormonal methods; 62% and 37%, respectively, were sure that they would not. Women in the two groups were equally likely to be undecided about their future use.
Roughly two-fifths of consistent condom users and three-quarters of inconsistent users in each contraceptive method group agreed that condom use makes sex less pleasurable. Substantial proportions (approximately 20-30% of consistent users and 50-60% of inconsistent users) agreed that getting condoms is embarrassing and that condoms have undesirable side effects. Few consistent users reported that condom use is unacceptable to their partner, but one in three inconsistent users gave this response.
In logistic regression analyses that controlled for women's marital status and level of education, two factors were significantly associated with the likelihood of consistent condom use (p<.05). Among both sterilized women and those using other methods, those whose partner had favorable attitudes toward the condom and those who considered themselves highly susceptible to disease had elevated odds of using condoms consistently. Additionally, women in a long-term relationship (whose likelihood of consistent condom use was significantly reduced at the bivariate level) appeared somewhat less likely than those who had known their partners for a short time to use condoms consistently, but the association reached only a marginal level of significance.
While the researchers acknowledge that their findings may have limited generalizability outside the population of low-income Hispanic women, they point to several important implications for STD prevention programs. First, in view of partners' influence on condom decision-making, programs geared toward increasing use in the Hispanic community may need to include men more than they have in the past. Second, "improvement of women's assertiveness and negotiation skills may be pertinent" for effective STD prevention. Finally, programs should "broaden women's awareness of how their disease-risk status can be accurately estimated and should increase their knowledge of the effectiveness of condoms as protection against disease transmission."--D. Hollander
1. Sangi-Haghpeykar H, Horth F and Poindexter AN III, Condom use among sterilized and nonsterilized Hispanic women, Sexually Transmitted Diseases, 2001, 28(9): 546-551.