***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To compare the performance and acceptability of 2 types of female condoms ( FCs )  among female sex workers ( FSWs ) in China . METHODS The present crossover survey trial was conducted in Enping City between September and December 2007 . RESULTS There were no significant differences between the 2 types of condoms in cumulative rates of episodes of misdirection ; participants experiencing discomfort or feeling the outer or inner ring of an FC ; or the clinical breakage or turning inside out of an FC . The rates of total clinical failures were similar for both FC types . Moreover , 59.5 % of the survey participants reported that either type was acceptable to them . CONCLUSION There were no statistically significantly differences in performance between the 2 types of FCs tested , and most participants would accept using either in the future BACKGROUND New design s of female condom have been developed to reduce costs and improve acceptability . To secure regulatory approvals , clinical studies are needed to verify performance . We aim ed to assess the functional performance and safety of three new condom types-the Woman 's Condom , the VA worn-of-women ( wow ) Condom Feminine , and the Cupid female condom-against the existing second-generation female condom ( FC2 ) . METHODS We did a r and omised controlled , non-inferiority , four-period crossover trial at three sites in Shanghai , China , and one site in Durban , South Africa , between May 1 , 2011 , and Jan 31 , 2012 . Participants aged 18 - 45 years who were sexually active , monogamous , not pregnant , and not sex workers , were eligible for inclusion if they were literate , had no known allergies to the study products ; used a reliable , non-barrier method of contraception , and had no visible or reported sexually transmitted infections . We used a computer-generated r and omisation sequence with a Williams square design of size four to assign patients ( 1:1:1:1 ) to the FC2 control device , or the Woman 's , VA wow , or Cupid condoms , with 12 potential allocations . R and omisation was stratified by site . Participants were not masked to condom type , but allocation was concealed from study investigators . The primary non-inferiority endpoints were total clinical failure and total female condom failure , with a non-inferiority margin of 3 % . Women were asked to use five of each condom type and were interviewed after use of each type . We also assessed safety data for each type . We did both per- protocol and intention-to-treat analyses . We calculated frequencies and percentages for each failure event and estimated differences in performance with a generalised estimating equation model . This study is registered , number DOH-27 - 0113 - 4271 . FINDINGS 616 women were assessed for eligibility , of whom 600 were r and omly assigned to condom-type order ( 30 , 120 , and 150 women in the three sites in China , and 300 women in the site in South Africa ) . 572 women completed follow-up , with at least one condom of each type . Total female condom failure was 3·43 % for FC2 , 3·85 % for the Woman 's Condom ( difference 0·42 % , 90 % CI -1·42 to 2·26 ) , 3·02 % for VA wow ( -0·42 % , -1·86 to 1·32 ) , and 4·52 % for Cupid ( 1·09 % , -0·60 to 2·78 ) ; total clinical failure was 2·88 % , 3·05 % ( 0·17 % , -1·48 to 1·81 ) , 2·49 % ( -0·25 % , -1·75 to 1·26 ) , and 3·87 % ( 0·99 % , -0·55 to 2·52 ) , respectively . Only two ( < 1 % ) participants , in South Africa , reported serious adverse events , unrelated to use of the study products . INTERPRETATION Non-inferiority was shown for all condom failure events for the three new devices versus the FC2 , within the predefined margin . FUNDING Universal Access to Female Condoms ( UAFC ) Objective To measure the impact on sexually transmitted infection ( STI ) prevalence of a female condom introduction and risk-reduction program at Kenyan agricultural sites . Design We conducted a cluster-r and omized trial to determine whether a replicable , community-level intervention would reduce STI prevalence . Methods Six matched pairs of tea , coffee and flower plantations were identified . The six intervention sites received an information/motivation program with free distribution of female and male condoms , and six control sites received only male condoms and related information . Participants were tested for cervical gonorrhea and chlamydia by ligase chain reaction on urine specimens , and vaginal trichomoniasis by culture , at baseline , 6 and 12 months . Results Participants at intervention ( n = 969 ) and control sites ( n = 960 ) were similar ; baseline STI prevalence was 23.9 % . Consistent male condom use was more than 20 % at 12 months . Consistent female condom use was reported by 11 and 7 % of intervention site women at 6 and 12 months . Unadjusted STI prevalence was 16.5 and 17.4 % at 6 months , and 18.3 and 18.5 % at 12 months , at the intervention and control sites , respectively . Logistic regression models confirmed the null effect of the female condom intervention . Conclusions Female condom introduction did not enhance STI prevention at these sites . It is unclear which aspects of the intervention – STI education , condom promotion , case management – were associated with decreased STI prevalence from baseline to follow-up In this 2000 - 2001 study , the authors compared the effectiveness of the male latex condom and the female polyurethane condom by assessing frequency and types of mechanical failure and by evaluating semen exposure during use . Eligible women from Birmingham , Alabama , were r and omly assigned to begin the study with 10 male condoms and then switch to 10 female condoms ( n = 55 ) , or vice versa ( n = 53 ) , and were trained to use both types . Data collection included question naires for each condom use and measurement of prostate-specific antigen in specimens of vaginal fluid taken before and after intercourse . Participants returned 700 male condoms and 678 female condoms  , and they reported mechanical problems for 9 % and 34 % , respectively . Moderate-high postcoital prostate-specific antigen levels ( > or = 22 ng/ml ) were detected in 3.5 % of male condom uses and 4.5 % of female condom uses ( difference = 1 % , 95 % confidence interval : -1.6 , 3.7 ) . Moderate-high prostate-specific antigen values ( > or = 22 ng/ml ) were more frequent with mechanical problems ( male condom , 9.6 % ; female condom , 9.4 % ) but less frequent with other problems ( 3.0 % and 0.9 % ) or correct use with no problems ( 2.7 % and 2.5 % ) . This study indicates that although mechanical problems are more common with the female condom than with the male condom , these devices may involve a similar risk of semen exposure . Objective ly assessed semen exposure is associated with self-reported mechanical problems BACKGROUND The widespread distribution of  female condoms ( FCs )  in developing countries has been hindered by high unit cost , making new less expensive devices a priority for donor agencies . STUDY DESIGN R and omized , crossover study assessing product preference , safety , acceptability and function of three new FCs ( PATH Woman 's Condom , FC2 and V-Amour )  among 170 women in Durban , South Africa . A subsequent " simulated market " study provided participants with free choice of FCs and assessed condom uptake over 3 months . RESULTS Of the 160 women who used at least one FC of each type , 47.5 % preferred the PATH Woman 's Condom ( WC ) , 35.6 % preferred FC2 and 16.3 % preferred V-Amour ( p<.001 ) . Women rated the WC better than FC2 and V-Amour for appearance , ease of use and overall fit and better than V-Amour for feel . WC was rated worse than FC2 and V-Amour for lubrication volume . The simulated market demonstrated similar preferences . Total clinical failure rates ( i.e. , the types of failures that could result in pregnancy or STI ) were low ( < 4 % ) , regardless of condom type . CONCLUSIONS Three new FC types functioned similarly and were generally acceptable . Most participants preferred WC and FC2 over V-Amour , and WC was preferred over FC2 in several acceptability measures Background : Few studies have measured female condom use for more than a 6‐month period or among persons at high risk of STD . Objective : To measure long‐term use of the female condom  among couples at high risk of HIV infection and to evaluate the effect of female condom use on unprotected coital acts . Study Design : Ninety‐nine Zambian couples with symptomatic sexually transmitted diseases ( STD ) received female condoms , male condoms , and spermicides and were counseled to use either condom plus spermicide for each coital act . Couples were followed up at 3‐ , 6‐ , and 12‐month visits .  Barrier contraceptive use was measured prospect ively by coital log . Results : Among the 99 couples enrolled , 51 , 38 , and 30 couples were successfully followed up for 3 , 6 , and 12 months , respectively .  Female condoms  were reportedly used in 24 % , 27 % , and 23 % of coital acts and by 86 % , 79 % , and 67 % of the returning couples during each time interval . Higher‐level female condom users used male condoms less often but had fewer unprotected coital acts ( 5 % vs. 14 % ; p < 0.05 ) than lower‐level female condom users . Conclusion : A majority of couples at high risk of HIV infection used the female condom in conjunction with other barrier methods over a 1‐year period . The addition of female condoms accompanied by appropriate counseling to the barrier method mix may reduce unprotected sex among couples at high‐risk of HIV infection STUDY OBJECTIVE : To compare the association between different measures of condom use and  prevalent HIV infection .  DESIGN : R and omised cross sectional study to assess association between HIV infection and different measures of self reported condom use . Female sex workers were r and omised to one of five different face to face question naires on condom use . Three question naires used always to never scales to measure use but differed in the reference period for use ; a fourth asked about use in the last 10 coital acts ; and the fifth was a retrospective log of coital acts in the past two weeks . Use was assessed with new clients , repeat clients , and non-clients . SETTING : Yaoundé and Douala , Cameroon . PARTICIPANTS : 2266 female sex workers . MAIN RESULTS : The association between condom use and prevalent HIV infection varied for different measures of condom use . None of the five level measures showed a dose response protective effect of condom use . Measures aim ed at reducing recall bias ( measures based on the past 10 coital acts or a coital log ) showed little or no association with prevalent infection . Measures based on the past month or six months had a stronger association with prevalent infection . Regardless of the type of measure or reference period , the strongest association between use and infection was for use with partners who were not clients . CONCLUSION : These findings underscore challenges described by others of measuring condom use and interpreting the association between use and prevalent infection CONTEXT Whereas the female condom has been evaluated in many hypothetical acceptability or short-term use studies , there is little information about its suitability for the prevention of sexually transmitted diseases ( STDs ) or HIV over extended periods of time . METHODOLOGY As part of a six-month prospect i ve follow-up study of 1,159 STD clinic patients , clients were interviewed during their initial visit , exposed to a behavioral intervention promoting condoms , given a physical examination and provided with instructions on completing a sexual diary . Potential predictors of trying the female condom were evaluated using logistic regression , and three condom-use groups ( exclusive users of female condoms , exclusive users of male condoms and users of both types of condoms ) were compared using multinomial regression . RESULTS Among 895 women who reported having engaged in vaginal intercourse during the study period , one-half had sex with only one partner , while one-quarter each had two partners or three or more partners . A total of 731 women reported using the female condom  at least once during the follow-up period--85 % during the first month of follow-up . Multiple logistic regression analyses indicated that employed women and those with a regular sexual partner at baseline were significantly more likely to try the female condom . By the end of the follow-up period , 8 % of participants had used the female condom exclusively , 15 % had used the male condom exclusively , 73 % had used both types of condom and 3 % had used no condoms . Twenty percent of women who tried the female condom used it only once and 13 % used it twice , while 20 % used 5 - 9 female condoms and 32 % used 10 or more . Consistent condom users ( N=309 ) were predominantly users of both types of condom ( 75 % ) , and were less often exclusive users of the male condom ( 18 % ) or the female condom ( 7 % ) . According to a multivariate analysis , women who used the female condom exclusively or who mixed condom types were more likely to be black , were more likely to 
    Output:
    
The use of female plus male condoms is more effective than use of male condoms only in preventing STIs and may be as effective as the male condom only in preventing HIV .