TP 163 Condom Use Self-Efficacy and Exposure to Semen Among Female STI Clinic Patients in Kingston, Jamaica

Tuesday, June 10, 2014
Exhibit Hall
Maria Gallo, PhD1, Jennifer Legardy-Williams, MPH2, Markus Steiner, PhD3, Maurizio Macaluso, MD, PhD4, Marcia Hobbs, PhD5, Tina Hylton-Kong, MD, MPH6, Clive Anderson, MD7, Marion Carter, PhD8, Elizabeth Costenbader, PhD3 and Lee Warner, PhD, MPH9, 1Division of Epidemiology, College of Public Health,, Ohio State University, Columbus, OH, 2Division of Reproductive Health, Centers for Disease Control and Prevention, 3Clinical Sciences Division, FHI 360, 4Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 5School of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, 6Comprehensive Health Centre (CHC)/Epidemiology Research and Training Unit (ERTU), 7Office of the Vice Chancellor, University of the West Indies, 8Health Services Research and Evaluation Branch, CDC, Atlanta, GA, 9Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA

Background: Research on correlates of condom use, including condom use self-efficacy (CUSE), generally has relied on self-reported behavior.

Methods: We evaluated correlates of testing positive for prostate-specific antigen (PSA), a marker of recent semen exposure, among adult female participants in the Assessing Counseling Message Effectiveness (ACME) Study. Participants attended an STI clinic in Kingston, Jamaica and received syndromic treatment. At enrollment and 6-day follow-up visits, women were administered a questionnaire on sexual behavior, which included a validated instrument on CUSE. Vaginal swabs were collected for testing for on-site, rapid PSA testing (ABAcard p30). We conducted principal component analyses (PCA) on the 23 items in the CUSE instrument, which yielded a single component. We used multivariable logistic regression (with generalized estimating equations) to assess predictors of PSA detection.

Results:  Of the 300 women in ACME, 285 and 286 had PSA data at the enrollment and follow-up visits, respectively. PSA was detected in 9.3% of visits. PSA detection was more common among single women than those in a relationship (adjusted odds ratio [aOR], 3.7; 95% CI, 1.2-11.1) and among those reporting no contraception use at enrollment compared to condom use only (aOR, 2.9; 95% CI, 1.2-7.2). PSA also was detected more often in women reporting recent sex or recent transactional sex. Finally, women with a lab-confirmed STI diagnosis at enrollment were more likely to have PSA detected than those not diagnosed (aOR, 2.2; 95% CI, 1.1-4.2). The PCA factor (OR, 1.2; 95% CI, 0.9-1.6) and the items from the CUSE instrument that were assessed individually were not associated with PSA.  

Conclusions: Although prior research suggests that CUSE is a strong predictor of condom use, we found no evidence of an inverse association between CUSE and semen exposure. Reliance on self-reported condom use in earlier studies could have introduced bias.