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Concept: Condom

191

Because lubricants may decrease trauma during coitus, it is hypothesized that they could aid in the prevention of HIV acquisition. Therefore, safety and anti-HIV-1 activity of over-the-counter (OTC) aqueous- (n = 10), lipid- (n = 2), and silicone-based (n = 2) products were tested. The rheological properties of the lipid-based lubricants precluded testing with the exception of explant safety testing. Six aqueous-based gels were hyperosmolar, two were nearly iso-osmolar, and two were hypo-osmolar. Evaluation of the panel of products showed Gynol II (a spermicidal gel containing 2% nonoxynol-9), KY Jelly, and Replens were toxic to Lactobacillus. Two nearly iso-osmolar aqueous- and both silicone-based gels were not toxic toward epithelial cell lines or ectocervical or colorectal explant tissues. Hyperosmolar lubricants demonstrated reduction of tissue viability and epithelial fracture/sloughing while the nearly iso-osmolar and silicon-based lubricants showed no significant changes in tissue viability or epithelial modifications. While most of the lubricants had no measurable anti-HIV-1 activity, three lubricants which retained cell viability did demonstrate modest anti-HIV-1 activity in vitro. To determine if this would result in protection of mucosal tissue or conversely determine if the epithelial damage associated with the hyperosmolar lubricants increased HIV-1 infection ex vivo, ectocervical tissue was exposed to selected lubricants and then challenged with HIV-1. None of the lubricants that had a moderate to high therapeutic index protected the mucosal tissue. These results show hyperosmolar lubricant gels were associated with cellular toxicity and epithelial damage while showing no anti-viral activity. The two iso-osmolar lubricants, Good Clean Love and PRÉ, and both silicone-based lubricants, Female Condom 2 lubricant and Wet Platinum, were the safest in our testing algorithm.

Concepts: HIV, In vivo, Tissues, In vitro, Condom, Lubricant, Personal lubricant, Spermicide

68

The last decade has seen a dramatic increase in the availability of sexually explicit media (SEM) on the Internet. Men who have sex with men (MSM) report near universal use of SEM. However, this widespread use of SEM among MSM may contribute to more condomless anal sex. To examine the association of viewing SEM on the Internet and the number of condomless anal sex encounters among MSM, in 2012, an online survey was conducted of 265 MSM from New York, Philadelphia, Baltimore, or Washington D.C. who reported viewing SEM online in the past 3 months. Analyses were performed using negative binomial regression. Nearly all men reported viewing SEM featuring anal sex with (91%) or without (92%) condoms in the past 3 months. Neither viewing more hours of SEM per week or compulsively viewing SEM were associated with more condomless anal sex encounters. Rather, viewing a greater proportion of SEM containing condomless anal sex was associated with engaging in more condomless anal encounters (IRR = 1.25), while viewing a greater proportion of SEM containing anal sex where condoms were used was associated with fewer condomless anal sex encounters (IRR = 0.62). MSM reported that viewing SEM caused changes in their sexual fantasies, desires, and behaviors. These findings provide important insights for health policy and the design of interventions addressing SEM and condomless sex among MSM. The findings suggest that condom use by SEM performers may benefit not only actor health, but also have health implications for SEM viewers.

Concepts: Sexual intercourse, Human sexual behavior, Chlamydia infection, Condom, Internet, Homosexuality, Sodomy, Sexology

43

People in open and other consensually nonmonogamous partnerships have been historically underserved by researchers and providers. Many studies group such partnerships together with nonconsensual nonmonogamy (NCNM) under the banner of “concurrent sexual partnerships.” Discrimination from service providers poses a substantial barrier to care. Responding to such concerns, this investigation explored sociodemographic correlates with open relationships and associations between relationship structure and sexual risk, HIV/STI testing, and relationship satisfaction in a nationally representative probability sample. Data were drawn from the 2012 National Survey of Sexual Health and Behavior (n = 2270). We used multinomial logistic regression to identify correlates with relationship structure, and linear and logistic regression to investigate associations between relationship structure and testing, condom use, and relationship satisfaction. Eighty-nine percent of participants reported monogamy, 4% reported open relationships, and 8% reported NCNM. Males, gay/lesbian individuals, bisexual individuals, and those who identified as “Other, Non-Hispanic” were more likely to report open relationships. Bisexual individuals and Black, Non-Hispanic participants were more likely to report NCNM; older participants were less likely to do so. Participants in open relationships reported more frequent condom use for anal intercourse and lower relationship satisfaction than monogamous participants. NCNM participants reported more HIV testing and lower satisfaction. Identities, experiences, and behaviors within open and other consensually nonmonogamous populations should be regarded as unique and diverse, rather than conflated with those common to other relationship structures. There is a need for greater awareness of diverse relationship structures among researchers and providers, and incorporation of related content into educational programming.

Concepts: Regression analysis, Logistic regression, Polyamory, Monogamy, Condom, Multinomial logit, Psychology of sexual monogamy, Non-monogamy

33

BACKGROUND: Data for trends in contraceptive use and need are necessary to guide programme and policy decisions and to monitor progress towards Millennium Development Goal 5, which calls for universal access to contraceptive services. We therefore aimed to estimate trends in contraceptive use and unmet need in developing countries in 2003, 2008, and 2012 . METHODS: We obtained data from national surveys for married and unmarried women aged 15-49 years in regions and subregions of developing countries. We estimated trends in the numbers and proportions of women wanting to avoid pregnancy, according to whether they were using modern contraceptives, or had unmet need for modern methods (ie, using no methods or a traditional method). We used comparable data sources and methods for three reference years (2003, 2008, and 2012). National survey data were available for 81-98% of married women using and with unmet need for modern methods. FINDINGS: The number of women wanting to avoid pregnancy and therefore needing effective contraception increased substantially, from 716 million (54%) of 1321 million in 2003, to 827 million (57%) of 1448 million in 2008, to 867 million (57%) of 1520 million in 2012. Most of this increase (108 million) was attributable to population growth. Use of modern contraceptive methods also increased, and the overall proportion of women with unmet need for modern methods among those wanting to avoid pregnancy decreased from 29% (210 million) in 2003, to 26% (222 million) in 2012. However, unmet need for modern contraceptives was still very high in 2012, especially in sub-Saharan Africa (53 million [60%] of 89 million), south Asia (83 million [34%] of 246 million), and western Asia (14 million [50%] of 27 million). Moreover, a shift in the past decade away from sterilisation, the most effective method, towards injectable drugs and barrier methods, might have led to increases in unintended pregnancies in women using modern methods. INTERPRETATION: Achievement of the desired number and healthy timing of births has important benefits for women, families, and societies. To meet the unmet need for modern contraception, countries need to increase resources, improve access to contraceptive services and supplies, and provide high-quality services and large-scale public education interventions to reduce social barriers. Our findings confirm a substantial and unfinished agenda towards meeting of couples' reproductive needs. FUNDING: UK Department for International Development, the Bill & Melinda Gates Foundation, and the UN Population Fund (UNFPA).

Concepts: Pregnancy, Birth control, Emergency contraception, Marriage, Abortion, Condom, Need, Bill & Melinda Gates Foundation

32

Pre-exposure prophylaxis (PrEP) safely and effectively prevents HIV in populations at high risk, including men who have sex with men (MSM). PrEP scale-up depends upon primary care providers and community-based organizations (CBOs) sharing PrEP information. This study aimed to determine whether healthcare provider or CBO contact was associated with PrEP awareness among Baltimore MSM.

Concepts: HIV, AIDS, Health care, Sexual intercourse, Human sexual behavior, Condom, Vaginal lubrication, Post-exposure prophylaxis

32

Condom-associated erection problems (CAEP) are an underestimated factor related to inconsistent or incomplete male condom use. The underlying mechanisms of CAEP are not understood, and whether men who report these difficulties are also likely to experience erectile problems in situations when condoms are not used has not been studied.

Concepts: Sexual intercourse, Condom, Penis

32

In the USA, men who have sex with men (MSM) in primary partnerships are at elevated risk for human immunodeficiency virus (HIV) infection. Pre-exposure prophylaxis (PrEP), a new biomedical prevention strategy, has potential to reduce HIV transmission. This study examined predictors of PrEP adoption intentions among HIV-negative MSM in primary partnerships.

Concepts: HIV, AIDS, Immune system, Sexual intercourse, Human sexual behavior, Condom, Vaginal lubrication, Post-exposure prophylaxis

29

The purpose of this study is to use mixed (qualitative/quantitative) methods to determine (1) the feasibility and acceptability of using online social networking to facilitate HIV-related discussions and (2) the relationship between HIV-related online discussions and requests for a home-based HIV testing kit among men who have sex with men.

Concepts: HIV, AIDS, Sexual intercourse, Oral sex, Human sexual behavior, Condom, Social network service, Vaginal lubrication

28

Recently, mainstream English-language news organisations have been reporting that a ‘male pill’ will soon be available. A common theme running through many published articles is that women will not trust men to use these new male contraceptives, though rarely is evidence provided to support this claim. In order to understand this disconnect between women’s distrust for men as a group and their trust in their male partners, this paper examines three dominant ideologies of masculinity that inhibit men’s contraceptive trustworthiness as a group. First, there is a cultural belief that men have an uncontrollable sex drive, which interferes with their ability to contracept. Second, there is a commonly held idea that men are incompetent in domestic tasks, which impairs their ability to correctly use contraception. Third, there is a social perception that men are not committed to pregnancy prevention, or at least not to the degree that women are.

Concepts: Pregnancy, Birth control, Sexual intercourse, Hormonal contraception, Combined oral contraceptive pill, Sociology, Abortion, Condom

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BACKGROUND: There is considerable interest in developing new multipurpose prevention technologies to address women’s reproductive health needs. This study describes an innovative barrier contraceptive device - based on the SILCS diaphragm - that also provides long-term controlled release of the lead candidate anti-HIV microbicide dapivirine. STUDY DESIGN: Diaphragm devices comprising various dapivirine-loaded polymer spring cores overmolded with a nonmedicated silicone elastomer sheath were fabricated by injection molding processes. In vitro release testing, thermal analysis and mechanical characterization were performed on the devices. RESULTS: A diaphragm device containing a polyoxymethylene spring core loaded with 10% w/w dapivirine provided continuous and controlled release of dapivirine over a 6-month period, with a mean in vitro daily release rate of 174 mcg/day. The mechanical properties of the new diaphragm were closely matched to the SILCS diaphragm. CONCLUSIONS: The study demonstrates proof of concept for a dapivirine-releasing diaphragm with daily release quantities potentially capable of preventing HIV transmission. In discontinuous clinical use, release of dapivirine may be readily extended over 1 or more years.

Concepts: Birth control, Diaphragm, Injection molding, Condom, SILCS diaphragm, Barrier contraception, Cervical cap, Program for Appropriate Technology in Health