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.