摘要：Objectives . We evaluated the efficacy of skills training designed to increase female condom use among women. Methods . We conducted a randomized controlled trial of 409 women, recruited from family planning clinics in northern California, who were randomly assigned to the experimental 4-session female condom skills training intervention or the comparison 4-session women's general health promotion intervention. Participants received condom use instructions at baseline and male and female condoms during the study. They completed audio computer-assisted self-interviews at baseline and at 3 and 6 months. Results . At 3 and 6 months, women in the experimental group were more likely than those in the comparison group to have used the female condom at least once in the prior 3 months. The increase in the percentage of sexual acts protected by female condoms from baseline to the 6-month follow-up was greater for the experimental group. The percentage of sexual acts during which any condom was employed was higher in the experimental group at 6 months. There were no group differences in male condom use. Conclusions . Outcomes suggest that skills training can increase female condom use and protected sexual acts without reducing male condom use among women. Women account for almost half of the 40 million estimated human immunodeficiency virus (HIV) infections worldwide. 1 Effective female condom promotion programs that could help facilitate more-widespread use of the device could have a significant impact on reducing the incidence of HIV among women and their sexual partners. The female condom, a polyurethane sheath worn inside the vagina, is the only female-initiated barrier method currently available to protect against HIV and other sexually transmitted infections (STIs). 2 Early acceptability studies have shown that the female condom is a promising disease prevention option for diverse subpopulations of women in developing and developed countries. 3 – 7 Among US women attending family planning clinics, 82% of respondents who were introduced to the female condom at their baseline visit reported having used the device at least once during the 3-month study period. 7 However, women's initial interest in the product has not moved beyond the “novelty” phase, 2 , 5 , 8 and its uptake has been limited because it has not been promoted actively by the private or public sectors in this country. 2 , 5 US studies have found low levels of lifetime use, ranging between 3% and 6%. 9 – 11 Few clinical trials have demonstrated efficacy in any intervention designed to increase female condom use. Five published US studies evaluated female condom interventions with a randomized controlled design, 9 – 13 and only 2 of these 9 , 12 demonstrated effects on ever-use or first-time use over a short term (i.e., 6 weeks and 1 month). Three studies found an increase in use of female condoms during sexual acts, but included a follow-up of only 3 months. 10 , 11 , 13 Moreover, 1 of these studies had a small sample size (n = 81), 13 whereas the other 2 did not match treatment dosage and compared a multisession experimental intervention with a single-session control intervention. 10 , 11 We conducted a randomized trial with a sample of 409 US women to test the hypothesis that female condom skills training would be efficacious in increasing sustained use of female condoms and protected sex. We matched the length and delivery mode of the intervention for experimental and comparison groups and assessed both short- and longer-term effects (i.e., 3 and 6 months).
