Area of Interest

Introduction & Background

The condom is a sheath like object made of varying material of which the most popular is latex. The first design of condoms used lamb intestine, as it’s main constituent. However, this was not much better than not wearing one at all because of its porosity. The first condom was said to be available in 3000 B.C. It is very unclear why they were used at that time, but today they are used to prevent unwanted pregnancies and transmission of sexually transmitted diseases and infections. Although they had been around for a long time, it was not until the post 1880’s when Italian anatomist Gabriello Fallopio`s (1523-62) published work on syphilis stipulated that a linen sheath could be used to prevent the transmission of the disease. Nevertheless, it’s use never caught on and condoms were next brought into the spotlight in the 1930’s when Margaret Sanger founder of Planned Parenthood, thought to have condoms available to women in order to prevent unwanted pregnancies. However condom use then fell dramatically in the sexually free sixties at which time diseases such as gonorrhoea and syphilis increased dramatically. Although these diseases were easily treated there were no cures.

When HIV/AIDS was “discovered” in the 1980’s, with the condom already proven itself against other STD’s in became clear that it could be of extreme importance in preventing the spread of the deadly disease. With this in mind health officials began a safer sex campaign, which-among other things-promoted the consistent use of condoms. This program continues to date and is in high gear in most parts of the world.

An estimated 500,000 people in the Caribbean are living with HIV and 83% of all people living with AIDS are between the ages of 25 and 49 (CAREC, 2002). Considering that it takes the disease approximately 10 years to show any signs of infection therefore means that the majority of persons contracted the disease between the ages of 15 and 39.

Despite these alarming statistics and the visible and aggressive campaign promotion of safer sex, studies show that many persons, even among the educated habitually have unprotected sex, thereby continually putting themselves and others at risks of contracting STD’s.

The study will therefore try to elucidate the factors affecting condom use during sexual activity and examine reasons why persons refuse to use condoms despite the broad spectrum of knowledge provided on this matter. Factors to be elaborated on in the study are age, gender, religiosity, relationship status and educational level. The various relationships between these independent variables and the dependent variable, condom use will be examined.

Rationale

As there is no cure for HIV/AIDS/STDs, the only way to combat the spread of these diseases is through behaviour change. One such method is consistent condom use during sexual intercourse. Yet, much of the sexually active public approaches the practice with an attitude of non-chalance, even with the efforts by health professionals to educate the wider society. This study will thereby serve to elucidate the various sociodemographic causes of condom use or lack thereof.

Objectives

Major Objective:

To determine whether there is a relationship between socio-demographic factors and level condom use during sexual activity.

Specific Objectives:

To identify how age impacts on condom use

To understand the effects education has on condom use

To learn how religiosity manifest in condom use.

To pinpoint the influence union status has on condom use

Literature Review

Condom Use As It Relates to Sexually Transmitted Disease

People use approximately 6 billion to 9 billion condoms per year. However according to population reports, to protect adequately against sexually transmitted diseases at least 15 billion more needs to be used. The need for condoms is becoming increasingly urgent due to the rapid spread of H.I.V.- human immune deficiency virus, which is among the top ten causes of death in the world. According to the joint United Nations programme on HIV aids (UNAIDS) in 1998 alone, approximately 2.5 million people died of AIDS related causes and 16,000 per day became infected with HIV. There is supposedly no cure for aids and so the best way to treat it is by abstinence or the use of a condom. All persons once sexually active should use condoms, there are however many factors which will affect if condoms will be used in any kind of relationship to begin with.

In order to be more popular condoms need to be more accessible, needs to be promoted more and people need to overcome social and personal obstacles. However, despite the fact that many people know that they can get aids without the use of a condom they still refuse to use them as a means of protection. Certain obstacles to condom use such as powerful social norms such as visiting commercial sex workers, traditional gender roles which keep women from talking about sex and the use of condoms, adultery or abuse and rejection by spouse because of perceived lack of trust further discourages the masses to use condoms.

AIDS has been called a disease of behaviour (AISCAP 1997). If more people avoided risky sexual behaviour by using condoms and abstinence they could avoid contracting STD’S. Social and cultural norms, especially gender norms discourage people from using condoms even when they know they are at risk. The ‘fact’ that wives have less power than men prevents many women from asserting themselves and express that they want to use a condom (Reid, 1996). They are more dependent on men and it is difficult for them to protect their own reproductive health (Drennan, 1998). Thus even though some wives know that their husbands are in extra marital affairs, chances are, nothing will be said, maybe because of a fear of reprisal. Some wives may also feel that their husbands would accuse them of infidelity and as a study done in Nepal shows, women’s concerns about having good character is given more importance than their sexual health. On the other hand, men, who have more power to use condoms, may not use them because of peer pressure even when they are well aware of the dangers (Kirby, 1995). A study done in Uganda however showed that men were more likely to use condoms when they thought it was the norm (McCombie, ) whereby many working men were three times more likely to have used condoms two months prior to when the study was conducted than men who did not think it was the norm.

Societal pressures are supplemented by the traditional negative image of condoms, because of false rumours and myths. People often associate condoms with uncleanliness, illicit sex, infidelity, and immoral behaviour (AIDSCAP, 1997). This statement may be illustrated by the following responses in various interviews; In Brazil and Guatemala women said “condoms are for women in the street and not the home”, in Jamaica “the condom is for outside, not inside the relationship”, in South Africa “the condom is used only for back pocket partners” (Gordon, 1996). Improving the image of condoms and making its use the norm are two ways of thereby increasing its use. Yet, for those naïve one’s, the perceived risk of contracting HIV or STD’S is extremely low. For some, the risk of AIDS appears vague and distant and is therefore not worth worrying about and risk loosing the immense pleasure they can gain otherwise without using condoms (Pinkerton & Abramson, 1992).

People need to realize that condoms are a very effective way of preventing the transmission of disease, the sooner the better. Laboratory tests have shown that no STD including HIV can penetrate the latex condom (Conant, et al, 1986). In a 1987-91 study of couples in which one partner had HIV, all 123 couples who used condoms every time for four years prevented transmission of HIV. In 122 couples that did not use condoms every time, 12 partners became infected. A similar study showed that using condoms every time prevented HIV transmission for all but 2 of 171 women who had male partners with HIV. However 8 out of 10 women whose partners didn’t use condoms every time became infected. Other studies have showed that condoms offer a great deal of protection against chlamydeous, gonorrhoea and trichomoniasis by about 60%, 80% and 30% respectively. Condoms were however found to offer less protection against genital herpes, the genital wart virus (HPV) and others that can be transmitted through skin-to-skin contact (Cates et al1992).

Age and Condom Use

Survey data collected by the Centre for Disease Control and Prevention in the United States indicates (C.D.C.) that there has been a significant increase in condom use by adolescents in the last two decades. Among sexually active adolescent males 17 to 19 years of age reported condom use increased form 21% in 1979 to 58% in 1988. For males 15 to 19 years of age there was an increase from 57% in 1988 to 67% in 1995. For females aged 15 to 19 there was an increase from 23% to 47% in 1982 and 1988 respectively.

Despite this noted increase in condom use unprotected sex among adolescents is still an issue of great concern as condom use by a half to two-thirds of adolescents is not sufficient to stem the spread of sexually diseases and unintended pregnancies. Studies carried out by the C.D.C. showed that only 45% of adolescent males report using a condom for every act of intercourse and that condom use actually decreases with age when comparing males 15 to 17 with those 18 to 19.Females between 15 and 19 years report less frequent use of condoms during intercourse than males. This is presumably because these females are engaging in sexual relationships with older partners. General findings however indicate that for adolescents the odds of using a condom drops 21% one partner is two or more years older (Department of Health UK, 1999).

A study conducted in Rwanda in 2000 with a sample of 3013 students from 15 to 24 years of age found that 46% and 71% of sexually active males and females respectively used condoms on their last encounter. For the same age group condom use was found to be high for casual partners. Where regular partners were concerned condom use was higher for female than males.

Accord ing to Bankole et al studies conducted in 1988 and 1995 showed that condom use was higher among women younger than 20 than among those aged 30 and older. Information from the 1995 study indicated that women18 and younger were twice as likely to use a condom as those aged 20 to 29 and were 1.8 times more likely than those aged 40 to 44 to use a condom.

A Male Out Survey completed in 2000 by 1832 men indicated that condom use among men age 20 to 24 was 2.6 times more likely than those aged 30 and over. It also revealed that the proportion of middle-aged gay men having sex without a condom has nearly doubled between 1996 and 2000.

Overall the general trend highlighted by these studies is that condom use decreases with age for women and men. However the effect of decreased condom use with increased age is much more profound in men.

Education and Condom Use

As we are measuring condom use as affected by educational level in Jamaica then it would be wise to view what studies in other parts of the world have said about the relationship. A study done by E. Lagare (2001) and others titled ‘Smart Decision: Education and Condom Use in Africa, hypotheses that education level is associated with condom use within non-spousal partnerships in four sub-Sahara African Cities. In early 2001 one thousand men and another thousand women, between the ages of 15—49, from Cameroon, Kenya, Benin and Zambia were randomly selected for the study. Researcher interviewed the candidates asking about their extramarital sexual contact in the last 12 months. It was revealed that not only does the higher the education level the higher the condom use, but also that it was the most consistent determinant of condom use across all four cities. 

Study carried out in Nigeria used secondary date from the 1998 June and December waves of Sexual Behaviour and Condom Use survey. The surveys used a multistage cluster sampling method to obtain candidates. Combined there were 11,357 participants, with equal distribution between the genders and urban and rural inhabitants. Ages 15-17 were over sampled in order to garner particular insight in the sexual behaviour of adolescents. Analysis of the data collected indicated that condom use increase with the level of education. This was particularly true for women, as those who attained higher education levels used the contraceptive method 22.2 more than illiterate women. For men of similar educational attainment condom use was 2.8 times greater than illiterate men. (Condom Use in Nigeria).

The 1988 National Survey of Family Growth (NSFG), in The United States, interviewed a nationally representative sample of 8,450 civilian non-institutionalised women who were aged 15-44 as of March 1, 1988. In the 1995 survey, a national probability sample of 10,847 civilian non-institutionalised women who were aged 15-44 as of April 1, 1995, was interviewed. In both surveys, information was collected on a variety of issues relating to the women's background, family and fertility experiences. It was found that in both surveys women who were better educated exhibited more condom use. It showed specifically that college graduates were 1.5 times as likely as high school graduates to use the condoms. (Bankole et al., 1999).

However, research commissioned and carried out by the Global Programme on AIDS and the World Health Organisation, between 1989 and 1991, produced finding contrary to those in the abovementioned studies. Data was gathered from the general populations, aged 15—49, of 12 global points—seven from sub-Sahara Africa, four from Asia and One from South America. Researchers Jean-Claude Deheneffe, Michel Caraël, and Amadou Noumbissi analyzed the gathered data and found that that educational levels had very little effect on whether or not persons used condoms during sexual activity.

Religiosity and Condom Use

A study by Zelnik and colleagues (1981) showed that while higher religiosity predicted later initiation of and less frequent intercourse, it was not related to contraceptive use or pregnancy rates. Likewise, another study examining data from the National Longitudinal Study of Adolescent Health found no association between contraceptive use and religiosity (Bearman and Brückner, 2001).” (Whitehead et al, Reasons for hope: A Review of Research on Religiosity and Sexual Behaviour)

Finally, one study of mainly white participants indicated that religiosity was related to Risker sexual behaviours including numerous sexual partners and lack of contraceptive use. (Whitehead et al, Reasons for hope: A Review of Research on Religiosity and Sexual Behaviour)

In many studies, only one item about religion was included in the survey instrument used to collect data. Most often, the item addressed the denomination of the student (i.e. Protestant, Catholic, Buddhist, etc.), the frequency of attendance at religious services, or the importance of religion to the adolescent. (Whitehead et al, Reasons for hope: A Review of Research on Religiosity and Sexual Behaviour)

A relationship between religiosity and sexual intercourse was the only relationship that most of these studies found. Most times, there was no relationship at all between religiosity and contraceptive (including condoms) use. Findings also show that Protestant females are less likely to use contraception when they do engage in sexual activity, and for Catholics, these findings are mixed. The findings to date for male sexual behaviour are too inconclusive to make generalizations.

Twenty-five studies were conducted on the relationship between attendance at religious services and sexual behaviour. Their findings included that more frequent attendance is associated with: More conservative sexual attitudes and less frequent intercourse, later initiation of intercourse for white males and for females across racial/ethnic groups, and decreased contraceptive use for females and increase use for males.

. In conclusion, while many studies indicate that religion plays a protective role regarding adolescent and sexual behaviours, with regard to condom use itself these studies, for the most part, they found no association between the religiosity and condom use.

The conclusion of these studies was that, “While many of the findings here support the hypothesis that religion plays a protective role regarding adolescents and sexual behaviour, numerous studies did NOT find such an association.” (Whitehead et al,)

After conducting extensive research they were unable to find a significant relationship between religiosity and the resulting sexual behaviour (such as condom use) of the adolescents.

Union Status and Condom Use

A study carried completed In Mexico City with an all male population found that single men are almost twice as likely to use condoms as married men. The study also cites findings in the United States which reported that men who did not live with a formal partner were more likely to use a condom (Hernandez-Giroon et al, 1999)

The 1988 National Survey of Family Growth (NSFG), in The United States, previously mentioned also had reports that support the abovemention findings. Condom use was substantially higher among women who were not in a union than among those who were. In addition, increases in condom use among sexually active women who were not in a union were much larger than increases among all sexually active women or among women who were in a union. In fact, while current use varied little by union status in 1988 (12% vs. 16%), by 1995 those not in a union were twice as likely as those in a union to have used a condom at last intercourse (15% vs. 30%) (Bankole et al, 1999).

These studies have been carried out in significant point over the world. As such this research intends to understand how condom use affect by the factors (Age, Education, Religiosity and Union Status) examined above within a Jamaican context.

Methodology

Hypotheses

General Hypothesis:

Socio-demographic factors will affect the level of condom use during sexual intercourse.

Specific Hypothesis:

Age:

H_o: There is no relationship between age and condom use.

H_a: There is an inverse relationship between age and condom use.

Education:

H_o: There is no relationship between Education and Condom Use

H_a: There is a positive relationship between Education and Condom Use

Religiosity:

H_o: There is no relationship between Religiosity and Condom Use

H_a: There is an inverse relationship between Religiosity and Condom Use

Union Status:

H_o: There is no relationship between Union Status and Condom Use

H_a: There is an inverse relationship between the stability of Union Status and

Condom Use

Explanatory Model

AGE

EDUCATION
		CONDOM USE
RELIGIOSITY
UNION STATUS

Data

The design used a stratified multi-staged sample with quota controls for gender. Only 25 of the 234 sampling regions have been selected; because of the importance of monitoring changes in behaviour in the island’s capital and also its main tourist parish, Kingston and St. Andrew and St. James are purposely selected. From each selected sampling region, two Electoral Districts have been selected with the probability proportionate to size. Same sex interviewing was used which promotes higher respondent co0mpacency and validity of information. A total of 1498 persons were surveyed (50.3% male).

Variables

Dependent Variable:

Condom Use:

By asking the participants to indicate whether or not they have ever used condoms during sexual intercourse was used as a means of measuring Condom Use. A Frequency was run on Q702. (Condom Use). It was then recoded into a new variable called Recondom. In order to restructure the variable into a clearly relevant dichotomous one, “yes” responses were assigned a value of 1 and “no” responses a value of 2, with all other values were being declared as “system missing.” A frequency was then run on the new dichotomous variable.

Independent Variables:

Age:

Age was measured by having the respondent indicate how old they were at their last birthday. A frequency was run on the interval/ratio variable age (Q102b). It was subsequently recoded into four ordinal categories: 15 to 23 years, 24 to 32 years, 33 to 40 years and 41- 49 years, and assigned values of 1,2,3 and 4 respectively. It was recoded into four categories to reflect some semblance of maturity: relative adolescents, young adults, settled young adults and the middle age. A frequency was run on this new variable Age group, and renamed ‘Respondents Age Group.’

Education

The Last Educational Institution attended was used to measure the participants’ educational level. A frequency was run on nominal variable Q103, labelled ‘Last School Attended.’ It was recoded into the ordinal variable RQ103 and labelled ‘Levels of Education’. Basic and primary were assigned a value of 1, All Age and Secondary a value of 2, Skills Training and Other were grouped and assigned a value of 3 and Tertiary a value of 4. No formal was declared “system missing.” During conceptualisation we considered skills training as a higher educational level than High School yet lower than tertiary thus they were placed in the same category. Other and Skills Training were grouped both for simplicity and in order to increase frequency.

Religiosity:

A Frequency was done on nominal Variable Q111, labelled ‘Church Attended.’ A recode was performed to increase simplicity, making the new variable dichotomous. It was named RQ111 and labelled ‘Church Groups’. Religiosity was measured in terms of whether or not the participants attended church. A value of 1 was assigned to those who had no religious affiliation; a value of 2 was assigned to those who did.

Union Status:

A frequency was run on nominal Q201 called ‘Relationship Status.’ A recode was done in order to eliminate those respondents who failed to answer. This new variable was named RQ201 and labelled ‘Type of Relationship.’ The variable was operationalised in terms of the stability of the relationship. From this criterion four categories were formed and then assigned values. These categories were: ‘Married or living with partner (1), Partner who visits or who you visit (2), Girlfriend or Boyfriend (3) and Single being number 4. “System missing” accounted for all the other values.

Analysis Plan

As condom use, the dependent variable, is dichotomous and the independent variables are either ordinal or nominal, making Chi Square the most appropriate statistical test. All Chi Squares will be Interpreted with an alpha value of 0.05.

Data Analysis and Interpretation

Table 1. Frequency and Percent Distributions of Explanatory Model Variables, Male and Female Jamaicans, N=1498
Variable	Number and Percent
Age 15 – 23 years 24 – 32 years 33—40 years 41—49 years	879 (58.7) 402 (26.8) 135 (9.0) 82 (5.5)
Education Basic School / Primary All Age/ Secondary Skills Training Tertiary	143 (9.6) 1119 (74.9) 120 (8.0) 112 (7.5)
Union Status Married / Living With Partner Visiting Partner Girlfriend / Boyfriend Single	305 (20.4) 429 (28.7) 280 (18.7) 483 (32.3)
Religiosity No Religious Affiliation Religious Affiliation	447 (30.0) 1043 (70.0)

The 15 –23 age group represented more than half the sample, 58.7 %. Approximately three-quarters of persons in the sample had up to a secondary level education. The majority (32.3%) of the participants were single, with visiting partners following closely with 28.7 %. However, there was not much difference between number of persons married or living with partners and those who had boyfriends or girlfriends, with the former category accounting for 20.4 % and the later a close

18.7%. It was also noticed that the vast majority of the participants (70.0%) has some sort of religious

affiliation.

Table 2. Frequency and Percent Distributions of Condom Use by Age and Chi-Square Results (N=1498)

	Number And Percentage Ages 15--23	Number And Percentage Ages 24—32	Number And Percentage Ages 33--40	Number And Percentage Ages 41--49	χ^2
Condom Use	162 (67.5%)	142 (75.5%)	57 (80.3%)	44 (72.1%)	6.004
No Condom Use	78 (32.5%)	46 (24.5%)	14 (19.7%)	17 (27.9%)
	*p>.05.

The results indicate that there is no statistical relationship between age and the use of condoms (x2 (3)= 6.00374, p>. 05). Although the amount of condom use decreased as people got older, this was not enough to establish a relationship.

Table 3 Frequency and Percent Distributions of Condom Use by Educational Level and Chi-

Square

	Number And Percentage Basic / Primary	Number And Percentage All Age / Secondary	Number And Percentage Skills Training	Number And Percentage Tertiary	χ^2
Condom Use	58 (77.3%)	275 (70.3%)	37 (74.0%)	35 (81.4%)	3.559
No Condom Use	17 (22.7%)	116 (29.7%)	13 (26.0%)	8 (18.6%)
	*p>.05.

Condom use across the different categories of educational levels were relatively similar with the highest percentage being in the tertiary category with 81.4% and the lowest percentage being in the all-age and secondary category with 70.3%. Though they do vary somewhat, it is not sufficient enough to establish a relationship, (x2 (3)=3.56, p>.05).

Table 4 Frequency and Percent Distributions of Condom Use by Religious Affiliation and Chi-

Square Results (N=1498)

	Number And Percentage No Religious Affiliation	Number And Percentage Religious Affiliation	χ^2
Condom Use	129 (71.7%)	274 (72.5%)	.0409
No Condom Use	51 (28.3%)	104 (27.5)
	*p>.05.

Condom use in both categories is more or less equal and as such there is not a statistically significant relationship between religious affiliation and condom use (x2 (1)=. 04088, p>05).

Table 5. Frequency and Percent Distributions of Condom Use by Union Status and Chi-Square Results (N=1498)

	Number And Percentage Married or Living with Partner	Number And Percentage Partner Who Visits	Number And Percentage Girlfriend or Boyfriend	Number And Percentage Single	χ^2
Condom Use	138 (74.2%)	104 (72.7%)	54 (73.0%)	108 (69.2%)	1.0957
No Condom Use	48 (25.8%)	39 (27.3%)	20 (27.0%)	48 (30.8%)
	*p>.05.

The results indicate that a statistically significant relationship does not exist between frequency of condom use and Union status χ² (3) =1.09565, p>.05. Condom use varied six percent between the highest, (74.2%) in the married or living with partner category, and the lowest (69.2%) in the single category. This variation was far too insignificant to denote a relationship.

Discussion and Conclusion

Discussion

Based on the data analysis of the independent variables against the dependent one, it was revealed that the socio-demographic factors do not have a significant impact on condom use. All variables exhibited a variation but not enough to constitute a significant relationship. These findings were surprising as previous researches done indicated that there was a relationship between these variables and the frequency of condom use.

The major limitation posed to this study was the fact that an analysis was being done from secondary data hence there was no control over the information gathering process and variables were not measured, as we would have preferred. We were not able to gain familiarity with the data due to a lack of firsthand knowledge hence depriving us the opportunity of grasping the data’s nuances.

The frequency of the use of cross-sectional designs does not allow for a complete understanding of the relationship between variables—particular age, religiosity and union status. We believe that considering the dynamic nature of the variables in question longitudinal studies may be best suited to determine whether or not they are associated with condom use.

Conclusion

Having analysed this study, we have learnt that, in Jamaica, the most obvious socio-demographic factors do not have a considerable impact on the level of condom use during sexual intercourse. Therefore, this indicates that more extensive studies need to be done to highlight the actual factors that impact condom use. Moreover, there should be focus on a wider array of variables instead of the most obvious ones. With more significant findings, researchers will be able to channel these data into the relevant areas to promote wider condom use in the society. Promoting condoms can improve the image portraying them as fun, reliable and important. Counselling and mass media can foster safe sexual behaviour and tech condom negotiation skills.

Reference

Aids Control and Prevention Project (AIDSCAP). Making prevention work: Global

lessons learned from the AIDS Control and Prevention (AIDSCAP) Project 1991-1997. Research Triangle Park, North Carolina, Family Health International, 1997. 113 p.

___________. (AIDSCAP). The female condom: From research to the marketplace. Arlington,

Virginia, Family Health International, Aug. 1997. 44 p.

Bankole, A., Darroch. J., & Singh, S. (1999, November /December). Determinants of Trends in

Condom Use in the United States, 1988—1995. Family Planning Perspectives, 31 (6), 264—271. Retrieved November 25, 2002 from the World Wide Web: http://www.agi-usa.org/pubs/journals/3126499.html

Cates, W. & STONE, K. (1992). Family planning, sexually transmitted diseases and contraceptive

choice: A literature update, part I. Family Planning Perspectives 24(3): 75-84.

Conant, M., Hardy, D., Sernatinger, J., Spicer, R., & Levy, J. (1986). Condoms prevent transmission

of AIDS-associated retrovirus. Journal of the American Medical Association 255(13): 1706..

Condom use in Nigeria. (2000). Wangonet. [Website] http://www.wangonet.org/Aids/ 
Pubs/Condom%20use%20in%20Nigeria.htm (25 Nov. 2002)

Deheneffe, J., Caraël, Michel. & Noumbissi, A. [Website] http://europa.eu.int/comm/development/

aids/limelette/pdfs/confront_aids_chapter_08.pdf

Drennan, M. (1998) Reproductive health: New perspectives on men's participation. Population

Reports, Series J, No. 46. Baltimore, Johns Hopkins School of Public Health, Population Information Program, 35.

Emmanuel Lagarde, (2001, September 19). Smart decisions: education and condom use in 
Africa. ID21 Health.  [Online Serial]. http://www.id21.org/health/h5jg1g1.html (last week Wednesday).

 Gordon, G. (1996) Sexual reality: The gap between family planning services and clients' needs. In:

Zeidenstein, S. and Moore, K., eds. Learning About Sexuality: A Practical Beginning. New York, Population Council and International Women's Health Coalition. p. 363-379.

Joint United Nations Programme On HIV/AIDS (UNAIDS). (1998, December) AIDS epidemic

update: Geneva, UNAIDS, Dec. 1998. 18 p.

 Kibiridge, D. 50m condoms used in Uganda. The Monitor (Kampala, Uganda). Africa Online wire

service. Dec. 1, 1998.

 Kim, N., Stanton, B., LI, X., Dickersin, K., & Galbraith, J. (1997) Effectiveness of the 40 adolescent

AIDS-risk reduction interventions: A quantitative review. Journal of Adolescent Health 20(3):

204-215. .

 Kirby, D. (1995.) A review of educational programs designed to reduce sexual risk-taking

behaviours among school-aged youth in the United States. Santa Cruz, California, ETR Associates, 4 .

Marc, Adam. (2002). Condom Slip-ups Common Among College-Age Men: A study finds they could

use a how-to course in using the birth-control devices. A Health Me. [Website]. Retrieved November 18 from the World Wide Web http://www.ahealthyme.com/article/hscoutn/102766494

Mason, K. (1994). HIV transmission and the balance of power between women and men: A global

view. Health Transition Review 4(Suppl.): 217-240.

McCombie, S. Predictors of condom use among urban men in Uganda: The importance of perceived

norms and condom availability (draft). Washington, D.C., Academy for Educational Development, n.d. (AIDSCOM Research Note) 3 p.

New Study Examines Adolescents' Partners and Condom Use. (2001) Shop Talk: School Health

Opportunities and Progress Bulletin.6(12). Retrieved November 15 from the World Wide Web: http://www.siecus.org/pubs/shop/volume6/shpv60030.html

Pinkerton, S. and Abramson, P.(1992). Is risky sex rational? Journal of Sex Research 29(4): 561-568.
Reid, E. (1996) HIV and development: Learning from others. In: Sherr, L., Hankins, C., and Benett,

L. AIDS as a Gender Issue: Psychosocial Perspectives, 235—253. Taylor and Francis.

Whitehead, B, Wilcox, B., Rostosky, S., Randall, B., and Wright, M. (2001). Reasons for Hope: A

Review of Research on Adolescent Religiosity and Sexual Behavior. In Keeping the Faith: The Role of Religion and Faith Communities in Preventing Teen Pregnancy. Washington, DC: The National Campaign to Prevent Teen Pregnancy