Factores asociados con el uso inconsistente del condón entre los jóvenes: revisión sistemática

Silva, Rafael de Siqueira; Bossonario, Pedro Augusto; Ferreira, Melisane Regina Lima; Andrade, Rubia Laine de Paula; Bonfim, Rafaele Oliveira; Alencar, Vitória; Monroe, Aline Aparecida

doi:10.1590/1983-1447.2024.2030207.en

Rafael de Siqueira Silva

data curation

formal analysis

investigation

writing – original draft

writing – review & editing

Universidade de São Paulo, Escola de Enfermagem de Ribeirão, Ribeirão Preto, SP, Brazil

https://orcid.org/0000-0002-0277-2667

Pedro Augusto Bossonario

data curation

formal analysis

investigation

methodology

project administration

writing – original draft

writing – review & editing

Universidade de São Paulo, Escola de Enfermagem de Ribeirão, Ribeirão Preto, SP, Brazil

https://orcid.org/0000-0001-6287-174X

Melisane Regina Lima Ferreira

formal analysis

investigation

methodology

writing – original draft

writing – review & editing

Universidade de São Paulo, Escola de Enfermagem de Ribeirão, Ribeirão Preto, SP, Brazil

https://orcid.org/0000-0003-1694-5124

Rubia Laine de Paula Andrade

data curation

formal analysis

funding acquisition

investigation

methodology

project administration

writing – original draft

writing – review & editing

Universidade de São Paulo, Escola de Enfermagem de Ribeirão, Ribeirão Preto, SP, Brazil

https://orcid.org/0000-0001-5843-1733

Rafaele Oliveira Bonfim

formal analysis

investigation

methodology

writing – original draft

writing – review & editing

Universidade de São Paulo, Escola de Enfermagem de Ribeirão, Ribeirão Preto, SP, Brazil

https://orcid.org/0000-0001-8157-2323

Vitória Alencar

formal analysis

investigation

methodology

writing – original draft

writing – review & editing

Universidade de São Paulo, Escola de Enfermagem de Ribeirão, Ribeirão Preto, SP, Brazil

https://orcid.org/0009-0009-2182-095X

Aline Aparecida Monroe

funding acquisition

investigation

methodology

project administration

writing – original draft

writing – review & editing

Universidade de São Paulo, Escola de Enfermagem de Ribeirão, Ribeirão Preto, SP, Brazil

https://orcid.org/0000-0003-4073-2735

Corresponding author: Rubia Laine de Paula Andrade rubia@eerp.usp.br

The authors declare that there is no conflict of interest

Associate editor:

Fernanda Ludmilla Rossi Rocha

Editor-in-chief:

João Lucas Campos de Oliveira

Authors, year of publication/ Journal/ Country of study	Study design	Objective	Total adolescents and young people aged 15 to 24 (N) Sex	Main results
CHEMNASIRI et al., 201019/ AIDS Education and Prevention/ Thailand	Cross-sectional	To analyze the factors associated with UIP in the population of young men who have sex with men.	827 young men: 274 MSM, of whom 128 reported UIP; 312 MSW, of whom 109 reported UIP; and 126 TGM, of whom 126 reported UIP	Factors associated with UIP in MSM: - Being receptive during anal intercourse (OR 2.68; 95%CI 1.51-4.76), and not carrying a condom at the time of the interview (OR 1.84; 95%CI 1.11-3.06). Factors associated with UIP in MSW: - Living far from family (OR 1.85; 95%CI 1.02-3.36), being receptive (OR 2.23; 95%CI 1.23-4.02) or receptive and insertive (OR 2.42; 95%CI 1.32-4.44) during anal sex, having been sexually coerced (OR 2.96; 95%CI 1.48-5.95). Factors associated with UIP in TGM: - Having completed technical or higher education (OR 1.82; 95%CI 1.07-3.15), history of STIs (OR 2.31; 95%CI 1.28-4.19), being worried about contracting HIV infection (OR 1.79; 95%CI 1.03-3.11) and not carrying a condom at the time of the interview (OR 1.93; 95%CI 1.12-3.30).
DAVIDOFF-GORE; LUKE, WAWIRE, 201120/Aids Care/Quênia	Cross-sectional	To analyze how the various dimensions of socioeconomic status are associated with UIP and how these associations vary according to gender.	959 person-months among 261 young men and women	Factors associated with UIP: - Belonging to the fourth household health quintile compared to the fifth (healthiest) quintile (OR 2.95; 95%CI 1.21-7.18); incomplete primary education or illiteracy (OR 3.09; 95%CI 1.02-9.35); food insufficiency in women (OR 5.24; 95%CI 1.05-26.22). Factors associated with not using condoms: - Belonging to the fourth household health quintile compared to the fifth (healthiest) quintile (OR 3.04; 95%CI 1.06-8.74); Not attending school (OR 2.81; 95%CI 1.11-7.09).
KATIKIRO; NJAU, 201221/ International Scholarly Research Notices/ Tanzania	Cross-sectional	To identify the factors that motivate or hinder condom use among young people out of school in an urban environment.	348 people, 186 men and 162 young women	Factors associated with non-use of condoms among men: - Feeling embarrassed to buy condoms (AOR 1.16; 95% CI 1.12-1.34), believing that condoms reduce sexual pleasure (AOR 8.19; 95% CI 3.98-17.01). Factors associated with non-use of condoms among women: - Having forced sex (AOR 1.16; 95% CI 1.10-2.78), believing that condom use reduces sexual pleasure (AOR 8.29; 95% CI 3.39-20.73), inability to convince a partner to use a condom (AOR 1.14; 95% CI 1.04-1.28). In both sexes, it was associated with not using condoms: - Having a religion that forbids condom use (OR 5.08; 95% CI 2.22-11.86) and believing that condoms don't protect against anything (OR 7.83; 95% CI 3.32-18.95).
ZEMBE et al., 201222/Plos one/ South Africa	Cross-sectional	To assess the prevalence of sexual risk behavior and HIV and the predictors of UIP among young women with multiple sexual partners.	259 young women with multiple sexual partners	Factor associated with UIP with casual partners: - Having 5 or more casual sexual partners (OR 2.43; 95% CI 1.39-4.25) Factor associated with UIP with main partners: - Having 5 or more casual sexual partners (OR 2.22; 95% CI 1.07-4.60) Factor associated with no UIP with most recent partner: - Age 20-24 (OR 4.37; 95% CI 1.67-11.81)
ZHANG et al., 201323/ Sexually transmitted infections/ China	Cross-sectional	To evaluate social and behavioral predictors of risky sexual behavior and STIs, including HIV, among adolescent sex workers.	201 young women sex workers	Factors associated with UIP or non-use of condoms in the last month: - Elementary school or illiteracy (OR 3.07; 95% CI 1.09-8.62), working less than 6 months as a sex worker (OR 2.90; 95% CI 1.02-8.19); illicit drug use (OR 8.54; 95% CI 1.04-70.41); not receiving an HIV test (OR 2.35; 95% CI 1.08-5.13). Factor associated with not using a condom during the last sexual activity with the client: - Not receiving an HIV test (OR 2.88; 95% CI 1.11-7.50).
CHIALEPEH; SUSUMAN, 201724/ Journal of Asian and African Studies/2017/ Malawi	Cross-sectional	To examine the risk factors associated with UIP and their implication in HIV/STI transmission among sexually active young people.	1,186, 511 men and 675 young women	Factors associated with UIP in men: - 15-19 age group (OR 1.60; 95% CI 1.01-2.52), married (OR 8.76; 95% CI 4.52-16.96) and with more than one partner (OR 1.78; 95% CI 1.02-3.08). Factors associated with inconsistent condom use in women: - Age group 15-19 (OR 1.47; 95% CI 1.17-1.84), married (OR 6.19; 95% CI 4.73-8.11), with more than one sexual partner (OR 4.72; 95% CI 3.43-5.31) and high school or higher education (OR 1.46; 95% CI 1.16-1.85).
HURLEY et al., 201725/Journal of Adolescent Health/ Democratic Republic of Congo	Cross-sectional	To explore the role of individual alcohol expectancies in risk behaviors among young people in the Democratic Republic of Congo.	286 men and 246 women who used alcoholic beverages	Factors associated with UIP: - Alcohol use is a factor associated with unprotected sex in men (AOR 3.41; 95% CI 2.39-4.89) and women (AOR 2.05; 95% CI 1.47-2.88); Factors associated with unprotected sex in men who use alcohol: - Age 20-24 (AOR 1.84; 95% CI 1.10-3.10); alcohol abuse (AOR 2.66; 95% CI 1.55-4.58); high (AOR 1.82; 95% CI 1.00-3.32) and moderate (AOR 1.99; 95% CI 1.02-3.87) expectations that alcohol increases the likelihood of sex or positive sexual experiences. Factors associated with unprotected sex in women who use alcohol: - Age 20-24 (AOR 2.54; 95% CI 1.46-4.42); alcohol abuse (AOR 2.66; 95% CI 1.55-4.58); moderate expectations (AOR 2.03; 95% CI 1.02-4.05) that alcohol increases the likelihood of sex or positive sexual experiences; expectation that alcohol decreases the ability to resist unwanted sex (AOR 3.54; 95% CI 1.41-8.86); expectation that alcohol decreases the ability to negotiate condom use (AOR 4.98; 95% CI 1.70-14.71).
OIDTMAN et al., 201726/ Archives of sexual behavior/ United States of America	Cross-sectional	We sought to understand whether satisfaction, anal sex without a condom and contextual factors during first intercourse are associated with sexual risk and recent condom use in young black men attracted to the same sex.	201 black men attracted to the same sex	Factors associated with recent sexual intercourse without a condom: - Emotional satisfaction at first intercourse (AOR 2.25 95% CI 1.06-4.77); time since first intercourse (AOR 1.21 95% CI 1.09-1.33 in the first hypothesis and AOR 1.14 95% CI 1.03-1.26 in the second hypothesis); First intercourse without a condom (AOR 4.95; 95% CI 2.60-9.44 in the second hypothesis and AOR 4.28; 95% CI 2.18-8.40 in the third hypothesis).
PINYAPHONG et al., 201827/ Asia Pacific Journal of Public Health/ Thailand	Cross-sectional	To assess the association of sociodemographic, individual, dyadic and social factors with UIP among male university students.	1,091 male university students	Factors associated with UIP: - Not using a condom at first intercourse (AOR 6.1; 95% CI 3.7-10.1), history of STIs (AOR 2.1; 95% CI 1.0-4.2), low self-efficacy in condom use (AOR 2.4; 95% CI 1.3-4.7), high perception that condom use reduces pleasure (AOR 1.4; 95% CI 1.0-2.1), high subjective perception of the norm that significant others tolerate unprotected sex (AOR 1.9; 95% CI 1.3-2.8).

Category	Associated factors
Sociodemographic factors	- aged between 20 and 2422^,25 or men aged between 15 and 1924; - not attending school20, low schooling20^,23^-24, or high school or college education19^,24; - married people24; - recent work as a sex worker23; - people on food insufficiency20; - living away from family19.
Experiences during sexarche	- first intercourse without a condom26^-27; - time since first intercourse26; - emotional satisfaction at first intercourse26.
Options and positions assumed in sexual practices	- being receptive during anal intercourse19; - having multiple partners22.
Beliefs and taboos	- religion21; - believe in the low effectiveness of condoms21; - feeling ashamed of buying them21; - high and moderate expectations that alcohol increases the likelihood of sex or positive sexual experiences or that it decreases the ability to resist unwanted sex or negotiate condom use25; - low self-efficacy regarding condom use27; - believing that condoms reduce pleasure during sex21^;27; - worry about contracting HIV19.
Communication difficulties	- difficulty negotiating condom use or being coerced or forced19^;21
Behavioral factors	- use of illicit drugs23; - use of alcohol25; - not carrying a condom19.
Young people's health history	- have a history of STIs27; - not having been tested for HIV23.

	1. Were the criteria for inclusion in the sample clearly defined?	2. Were the study subjects and the setting described in detail?	3. Was the exposure measured in a valid and reliable way?	4. Were objective, standard criteria used for measurement of the condition?	5. Were confounding factors identified?	6. Were strategies to deal with confounding factors stated?	7. Were the outcomes measured in a valid and reliable way?	8. Was appropriate statistical analysis used?
CHEMNASIRI et al., 201019	Y	Y	Y	Y	N	N	Y	Y
DAVIDOFF-GORE; LUKE, WAWIRE, 201120	Y	Y	N	Y	Y	Y	Y	N
KATIKIRO; NJAU, 201221	Y	Y	Y	Y	N	N	Y	N
ZEMBE et al., 201222	Y	Y	Y	Y	N	N	Y	Y
ZHANG et al., 201323	Y	Y	Y	Y	N	N	Y	UN
CHIALEPEH; SUSUMAN, 201724	Y	Y	N	N	Y	Y	Y	Y
HURLEY et al., 201725	Y	Y	N	Y	Y	Y	Y	Y
OIDTMAN et al., 201726	Y	N	Y	Y	Y	Y	Y	Y
PINYAPHONG et al., 201827	Y	Y	Y	Y	N	N	Y	Y

[TFN1] AIDS = Acquired Human Immunodeficiency Syndrome; AOR = Adjusted Odds Ratio; HIV = Human Immunodeficiency Virus; MSW: Male sex worker; MSM: Man who has sex with man; TGM: Transgender man; 95% CI = Confidence Interval (all were 95%); STI: Sexually Transmitted Infection; OR = Odds Ratio; UIP = inconsistent condom use.

[TFN2] Source: prepared by the authors (2023).

Factores asociados con el uso inconsistente del condón entre los jóvenes: revisión sistemática

RESUMEN