Female condom skill and attitude: results from a NIDA Clinical Trials Network gender-specific HIV risk reduction study.

The female condom is effective in reducing unprotected sexual acts; however, it remains underutilized in the United States. This study examined whether a five-session HIV prevention intervention (Safer Sex Skills Building [SSB]), including presentation, discussion, and practice with female condoms, improved female condom skills and attitude among women in outpatient substance abuse treatment. Mixed-effects modeling was used to test the effect of SSB on skills and attitude over 3- and 6-month posttreatment among 515 randomized women. SSB was significantly associated with increases in skills and attitude, and the female condom demonstration session was primarily responsible for skills improvement. Attitude was a partial mediator of the intervention effect in reducing unprotected sex. Findings emphasize the utility of integrating female condom messages targeting proximal behavioral outcomes into HIV prevention. The study supports the use of female condom skill instruction via brief, hands-on exercises, as well as further research to enhance attitudinal change to reduce sexual risk.