Number of people who report the use of a condom at last sex

Background

This indicator is used by community HIV programs to track and monitor progress towards ensuring condom usage among those vulnerable to HIV. This indicator is collected by vulnerable children and key population programs to ensure that those living with HIV, or at risk of acquiring HIV, are engaging in safe sexual behaviors. Although this indicator can be collected for last high-risk sex, all sexual encounters among key and vulnerable populations can be perceived as high-risk, particularly because young people tend to engage in multiple concurrent sexual relationships and key populations often face the highest risk of HIV transmission from their non-commercial, non-exclusive partners. Although there are many barriers to condom use, community prevention interventions that engage communities in their design and implementation have been shown to have an impact on sexual behaviors, like condom use with noncommercial, nonexclusive clients and partners, and sexually transmitted infection (STI) and HIV prevalence. Community prevention interventions that involve peer education, improving advocacy, changing negative policies, and increasing community awareness, as well as an enabling environment (STI clinics, drop-in centers, condoms, lubricants, STI treatment) have been shown to be effective in reducing risky behavior and decreasing prevalence. This indicator can also be used by community programs engaging in community campaigns to determine the effectiveness of messaging.

Numerator

Number of adults and adolescents who report using a condom the last time they had sexual intercourse during the reporting period

Note: programs and researchers have examined condom use among program beneficiaries and target populations in numerous ways. Programs and studies involving key populations have worded this indicator, or related indicators, in many different ways. The following domains are examples:

• Consistent condom usage
• Refusal to have sex without a condom
• Charging higher fees for sex without a condom
• Using condoms for contraception
• Ability to identify one formal source of condoms
• Ever experience of condom sabotage
• Ever receipt of free condoms
• Knowledge that condom use prevents HIV transmission
• Power to negotiate condom use
• Receipt of condom-negotiation skills training
• Condom usage with the person with whom pregnancy was conceived
• Identify as the main condom use decision maker
• Always use a condom
• Risky sexual acts covered through condom

Key population programs and research have defined this indicator by various periods (such as, in the past week, in the past 6 months, in the past month/30 days, at last sex, during pregnancy) and by types of sexual partner (such as, one time paying, regular paying, and non-paying, clients, noncommercial partner, casual partner, regular partner, occasional partner). Although community programs may alternatively collect information on whether condoms were used consistently or always within a certain period with a certain type of partner, these questions may be subject to recall bias. A recommended alternative for this indicator is the number of adults and adolescents who report using condoms consistently or always during sexual intercourse in the past week.

Unit of measure

Number

Calculation

Sum results across reporting period

Method of measurement

Community workers can ask the beneficiary this question directly, to determine whether condom(s) were used the last time they engaged in sexual intercourse. Community workers should engage with caution, when discussing sexual behavior, especially with any adolescent below the age of 18. Children below the age of 13 should not be questioned. Before a minor below the age of 18 can be questioned, his or her caregiver must consent.

Data source

This information is often collected by programs for vulnerable children during adult and child counseling sessions and by key population programs during peer outreach.

Disaggregation

• Key population type (sex workers, men who have sex with men, people who inject drugs, transgender people)
• Partner type (one time paying, regular paying, and non-paying)
• Sex
• Age
• HIV status
• Pregnancy/lactation status

Data quality considerations

The overall number reported for this indicator should equal the sum of individuals in each disaggregation type. Only one type of age disaggregation should be used throughout, and overlap should be avoided. Community workers should use caution when discussing this information with any individual below the age of 18 and should be trained to communicate effectively with minors about sensitive topics.

Reporting frequency

Community workers should collect this information regularly, but they should monitor progress monthly with support from their supervisors. The indicator should be reported on a quarterly basis.

Data element

Condom use at last sex         

Category

HIV Prevention, Key Populations

References

The DHS Program. (n.d.). Retrieved from https://dhsprogram.com/What-We-Do/Survey-Types/AIS.cfm

Condom use at last high-risk sex. (2018, January 16). Retrieved from https://www.measureevaluation.org/prh/rh_indicators/womens-health/stis-hiv-aids/condom-use-at-last-high-risk-sex

OVC Survey Toolkit. (2017, June 13). Retrieved from https://www.measureevaluation.org/measure/our-work/ovc/ovc-program-evaluation-tool-kit

Gutierrez, J. P., McPherson, S., Fakoya, A., Matheou, A., & Bertozzi, S. M. (2010). Community-based prevention leads to an increase in condom use and a reduction in sexually transmitted infections (STIs) among men who have sex with men (MSM) and female sex workers (FSW): The Frontiers Prevention Project (FPP) evaluation results. BMC Public Health, 10(497). Retrieved from http://doi.org/10.1186/1471-2458-10-497