It has been suggested that consistent use of condoms is likely to reduce the risk of the transmission of human immunodeficiency virus (HIV), as well as other sexually transmitted infections (STIs) . Over the past several decades, public health agencies have implemented a variety of campaigns to increase the use of condoms, especially among vulnerable populations for HIV. However, in spite of such recognition and efforts, little is known about use of and attitudes towards condoms in Bangladesh [2, 3]. Whereas overall HIV prevalence is less than 1% in most key vulnerable population groups (e.g. sex workers, men who have sex with men, transgenders, migrant workers) but a high prevalence of HIV (5.3%) among injecting drug users(IDUs) in Dhaka has been documented [4–6]. Further, a number of studies consistently reported high levels of preventable and treatable STIs among mobile populations, transport workers, IDUs and sex workers (SW); and more than one third of the sex workers reported sexual contact with IDUs and mobile populations [4–9]. The overlap among “bridging populations” suggests that there is a risk of HIV transmission from one group to other group of vulnerable populations if the epidemic spreads to sex workers (and then from SWs to their clients) [5, 6].
Despite limitations of sampling, question design and variations on results, a range of studies consistently show that a high proportion of men in Bangladesh do not use condoms in the majority of their commercial (also non-commercial) sexual encounters [4–6, 10–14]. A synthesis of recent studies among diverse groups of vulnerable population (such as migrant taxi drivers, rickshaw pullers, fishermen, Injecting drug users and truckers) suggest that only between 6% and 25% (average 13%) have ever used condoms when buying sex and very few of them even realized that they were at risk of exposure to HIV and other STIs [4–6, 10–14]. A number of studies also reported that population like rickshaw pullers, internal migrant workers, truckers and fishermen are the key segment of clients of the SWs and have visited a sex worker on an average 3–4 times in the last month [10–13].
While exploring the questionnaires used by different studies for assessing condom use behavior in Bangladesh, it was noted that although limited work has been done to examine the prevalence of condom use [11–13], very few studies have measured attitudes towards condom using any culturally standardized scale . Thus, actual attitudes and barriers to condom use remain poorly understood. The reliable and valid measurement of attitudes towards condom use may enhance the efforts to design population specific interventions aimed at promoting more positive attitudes and increased use of condoms.
Although a variety of instruments have been used in a number of studies from different settings to measure attitudes towards, and barriers to, condom use with different populations [15–18], the most commonly used instrument to measure attitudes towards condom use in sexual health and HIV research is the ‘Attitude Towards Condoms Scale’ (ATCS), developed in the U.S. . This is a 40-item self-report instrument originally developed base on concepts of the theory of reasoned action [20, 21] and as an assessment instrument for use in research directed towards promotion of barrier methods of contraception . However, several studies with men and women had demonstrated the utility of the ATCS scale and provided further support for the criterion related validity of the instrument [15, 16]. Brown  suggested that a method-specific scale would be more appropriate than a general measure of condom use. Several sexual health/HIV studies have also used 10–15 items from this scale with or without modification in different combinations [22–24]. Brown and Chen  recently validated a 4-item scale among rural African-American women. One recent study among migrant workers in Kolkata, India adopted 10 items from this scale to measure attitudes towards condom use among the study population and demonstrated the utility of the short version . Further study among migrant workers in Kolkata, India re-validated a similar 10-item scale and tested out the feasibility of using only 6 items among same study population .
It is well known that measures that have demonstrated reliability and validity in one population may not necessarily be generaliseable to other populations. In each new population, it is important to assess an instrument’s cultural relevance and to re-validate it . Recognition of this has led to the concept of ‘cultural equivalence’, which can be defined as a psychological assessment tool’s applicability, reliability and validity with specific group of people who belong to a different cultural group from those with whom the tool was originally assessed . Although Brown’s ATCS scale is widely validated in western world and appropriate for English speaking (and writing) individuals, its utility and cultural applicability in vulnerable groups with low literacy rates has scarcely been evaluated.
It is important for a setting, where very low levels of condom use are consistently reported, to monitor attitudes towards and uptake of condoms on regular basis in order to scale-up HIV and STIs prevention initiatives. As there was no uniform-standardized condom attitude scale for Bangladeshi population, this study translated and cross-culturally adapted items from the English ATCS, and examined the validity and reliability aspects of the Bengali version of ‘attitudes towards condoms use (ATC-B) scale’ to be used in vulnerable population groups in Bangladesh.