Long-term female condom use among vulnerable populations in Brazil.

We carried out an evaluative study on factors associated with long-term use of female condoms for STI/HIV prevention. A total of 255 women and 29 men who were using female condoms for at least 4 months participated in qualitative/quantitative interviews. The study was conducted in six Brazilian cities. Four primary themes were identified as influencing acceptability and adoption of the female condom: (1) personal "assistance" (counseling) during the early adoption phase; (2) safety; (3) pleasure; and (4) increased sense of power for safer sex negotiation. Alternate use of male and female condoms was the norm among participants, but for approximately one third of the sample, the female condom was the preferred option for safer sex. The study findings suggest that providing clients with explicit and sustained intervention strategies may have a decisive influence on long-term adoption of female condoms.