An intervention study examining the effects of condom wrapper graphics and scent on condom use in the Botswana Defence Force

Abstract

Free condoms provided by the government are often not used by Botswana Defence Force (BDF) personnel due to a perceived unpleasant scent and unattractive wrapper. Formative work with the BDF found that scented condoms and military-inspired (camouflage) wrapper graphics were appealing to personnel. A non-randomized intervention study was implemented to determine whether condom wrapper graphics and scent improved condom use in the BDF. Four military sites were selected for participation. Two sites in the south received the intervention condom wrapped in a generic wrapper and two sites in the north received the intervention condom wrapped in a military-inspired wrapper; intervention condoms were either scented or unscented. Two hundred and eleven male soldiers who ever had sex, aged 18–30 years, and stationed at one of the selected sites consented to participate. Sexual activity and condom use were measured pre- and post-intervention using sexual behavior diaries. A condom use rate (CUR; frequency of protected sex divided by the total frequency of sex) was computed for each participant. Mean CURs significantly increased over time (85.7% baseline vs. 94.5% post-intervention). Adjusted odds of condom use over time were higher among participants who received the intervention condom packaged in the military wrapper compared with the generic wrapper. Adjusted odds of condom use were also higher for participants who reported using scented vs. unscented condoms. Providing scented condoms and condoms packaged in a miltiary-inspired wrapper may help increase condom use and reduce HIV infection among military personnel.

Keywords:

• HIV
• sexual behaviors
• condom use
• military
• HIV prevention intervention

Acknowledgments

The authors wish to thank members of the Botswana Defence Force (BDF) who participated in this study, BDF study personnel who helped facilitate data collection, and Population Services International for designing the condom wrappers. In addition, we would like to thank the US Department of Defense HIV/AIDS Prevention Program epidemiology team for their logistical support, including Dr Judy Harberston, Dr Marni Jacobs, Dr Jenny McAnany, Audrey Djibo, and Stan Ito. We also thank Dr Braden Hale, Dr Carol Macera, and Anthony Davis for their thoughtful suggestions on this paper. Lastly, we would like to acknowledge funding from the President's Emergency Plan for AIDS Relief, which made this study possible.

This research is supported by the Department of Defense HIV/AIDS Prevention Program, under work unit 60546. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, the Department of Defense, or the US Government. Approved for public release; distribution is unlimited. Human subjects participated in this study after giving their free and informed consent. This research has been conducted in compliance with all applicable federal regulations governing the protection of human subjects in research (Protocol NHRC.2010.0025).