Risky Sexual Behavior of Multiple Partner Relations and Women’s Autonomy in Four Countries

Existent research reveals that inequitable gender-based power in relationships and intimate partner violence contribute to HIV rates among women in the developing world. This study uses a multi-country analysis to examine women’s autonomy in negotiating safe sex practices such as having sex with a partner with no other concurrent partner to reduce the risk of HIV/AIDS in Nigeria, Kenya, Malawi, and Nepal. The Demographic Health Survey data for Nigeria (2013), Kenya (2008–2009), Malawi (2010), and Nepal (2011) provide geographical variability as well as HIV risk variables. The sample included 16,540 women aged 15–49 years who self-identified as ever married. Factor analysis for women’s autonomy was conducted based on socio-cultural theory. Logistic regression was conducted and results identified decision-making, labor force participation, and individual autonomy as women autonomy factors significantly reduced the risk for HIV infection by having one sex partner who has only one sex partner. Other women autonomy factors related to lower risk for HIV include education, place of residence, and religion. Our study indicates that effective management of HIV transmission requires addressing women autonomy factors within the context of culture.     

Risky Sexual Behaviour Among Married and Cohabiting Women and its Implication for Sexually Transmitted Infections in Mahikeng,South Africa

Risky sexual behaviour continues to be the main means through which sexually transmitted infections (STIs) and HIV are spread in South Africa. However few studies have assessed risky sexual behaviour among married and cohabiting women in this high HIV prevalence country. The aim of this study was therefore to assess the prevalence and identify the predictors of risky sexual behaviour among married and cohabiting women in Mahikeng Local Municipality where HIV is generalized. The study used cross-sectional mixed methods data obtained from 568 women responding to a survey and 33 women participating in in-depth interviews in 2012. All the women were aged 18–49 years, married or cohabiting and were residing in rural and urban areas of Mahikeng Local Municipality at the time of the study. The data was analyzed by the use of the Chi square statistic and a parsimonious binary logistic regression model, and the thematic content analysis method. The study found that 4 in 10 of the women experienced risky sexual behaviour, which was significantly predicted by being in marriage or cohabitation for <5 years, having a partner working in agriculture, government and mining sectors, having sex to achieve motherhood, having the perception by the women that they were unlikely to contract STIs, having the belief that partners have the right to use force to obtain sex and having partners who were unwilling to use condoms. All the above predictors were exacerbated by culturally sanctioned gender inequality and structural factors. The findings suggest that risky sexual behaviour is prevalent among married and cohabiting women in the study area which has serious implication for the marital transmission of STIs and HIV. We suggest interventions that enhance gender equality in sexual decisions and initiatives that encourage men to change their sexual beliefs and values.     

Comparison of Marine and College Women's HIV/AIDS-Relevant Sexual Behaviors1

This study compares the heterosexual risk behaviors, perceptions of vulnerability to HIV/AIDS, and predictors of condom use of two groups of women with very different sexual and contraceptive histories and habits–college women and women in Marine Corps recruit training. The Marines' s]exual behaviors put them at greater risk of contracting HIV than the college students; that is, Marines reported more frequent intercourse with more partners, used condoms less frequently, and had less knowledge about HIV/AIDS transmission. Consistent with these differences, college students displayed a larger illusion of unique invulnerability than did the Marines. In general, the women who had more sexual partners and more frequent sexual intercourse were less likely to report regularly using condoms. In addition, the data provide support for Weinstein and Nicholich's (1993) recent suggestion that the relation between risk perception and risk behavior is different for different groups of people.     

“Getting to Know”: Exploring How Urban African American Women Conceptualize Safer and Risky Sexual Behaviors

The surge in the rate of the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) cases continues to be most prevalent for African American women between the ages of 18 and 29, with heterosexual transmission remaining the primary cause of HIV spread for this population. The high rates of HIV/AIDS among African American women continue to emphasize the need for understanding how members of this population conceptualize sexual safety and risk. A qualitative research study using grounded theory methods was conducted to explore how African American women define safer and risky sexual behaviors. Interviews were conducted with 14 African American women between the ages of 18 and 29. The study findings suggest that African American women’s definitions of safer and risky sexual behaviors, while in a consensual sexual relationship, are consistently influenced by sex partner type. The information garnered from this study can help inform the development of HIV prevention strategies, health education, counseling and reproductive health services that support African American women’s wellness.     

Using the Theory of Gender and Power to Examine Experiences of Partner Violence,Sexual Negotiation,and Risk of HIV/AIDS Among Economically Disadvantaged Women in Southern India

This article uses the Theory of Gender and Power to examine women's vulnerability to HIV/AIDS in order to: understand the vulnerability of female sex workers/poor women due to poverty and lack of educational resources; explore women's vulnerability in the context of client/partner violence, alcohol use, male partner's high-risk behaviors, and women's lack of control in their intimate relationships; and explore the role of traditional heterosexual gender norms in the outcomes of sexual negotiation. Ethnographic data were collected from 32 women and 38 men in India as part of an ongoing National Institute of Mental Health study. Results highlighted women's vulnerability to HIV/AIDS stemming from partner violence, alcohol use, poverty, dangers of sex work environments, and tacit acceptance of cultural/gender norms.     

Gender Roles,Power Strategies,and Precautionary Sexual Self-Efficacy: Implications for Black and Latina Women's HIV/AIDS Protective Behaviors

This cross-sectional study tested a conceptual model of women's HIV/AIDS protective behaviors using gender roles, relationship power strategies, and precautionary sexual self-efficacy as predictors in a predominantly Black and Latina community sample of heterosexual women (N = 125). Results revealed no support for the full model, but partial confirmation for several components of the model. Education significantly predicted gender roles, and gender roles and use of direct power strategies were significant predictors of sexual self-efficacy. Most of the participants were married or partnered and were unconcerned about contracting HIV, suggesting that if women perceive that they are at low or no risk, their gender roles, power strategies, and precautionary sexual self-efficacy will be inconsequential to their HIV/AIDS risk reduction practices.     

The singles scene: safe sex practices and attitudes among at-risk heterosexual adults

Heterosexual transmission of HIV accounts for 80% of AIDS cases worldwide and is the main mode of transmission in sub-Saharan Africa and some Asian countries. The extent of heterosexual HIV transmission will likely increase in Western countries. The safe sex practices and attitudes of 58 male and 54 female heterosexuals in Melbourne, Australia, aged 20-40 years, of mean age 27.4 years, were assessed through interview and questionnaire. Study participants were recruited at discotheques and bars catering to single adults. Respondents' attitudes toward safe sex were generally positive, although those attitudes were not always reflected in actual sexual practice. High levels of sexual activity were reported, including high risk behaviors such as unprotected anal sex with casual and regular partners by both men and women. Situational and partner characteristics frustrated the practice of safe sex despite intentions to use condoms. Few men and half of the women explicitly discussed condom use with their sex partners. These findings are similar to those which one would expect from a sample of adolescents.     

The Influence of Gender-related Factors on HIV Prevention among Chinese Women with Disrupted Marital Relationship

Two-hundred-and-thirty-one Chinese women were individually interviewed on their HIV-prevention behavior and gender-related psychosocial factors. Compared to women with intact marriages, women with marital disruption endorsed more inaccurate information about HIV/AIDS, had less worry about contracting HIV from their husbands, and were less likely to use condoms in current and future sexual activities. Among sexually active Chinese married women, rates of condom use in the past 6 months were 60% for the intact group and 38% for the disrupted group. Factors that discriminated between condom non-users and users among sexually active women in the disrupted group included: conservative gender attitudes toward sexuality and sexual decision-making, negative attitudes toward condom use, and lack of concern about contracting HIV from their husbands.     

A Preliminary Examination of Sexual Orientation as a Social Vulnerability for Experiencing HIV/AIDS-related Stigma

This investigation is a preliminary examination of sexual orientation as a social vulnerability for experiencing HIV/AIDS-related stigma, specifically concerns about disclosure and public attitudes. Participants were 36 heterosexual men and 82 gay men with HIV/AIDS. Consistent with prediction, a heterosexual sexual orientation was significantly associated with HIV/AIDS disclosure concerns. This effect was evident after controlling for various demographic variables, CD4 T-cell count, time since HIV diagnosis, self-esteem, and coping styles. Also, as predicted, similar levels of enacted stigma were evident regardless of sexual orientation. Further work is needed to understand the process of HIV/AIDS disclosure for heterosexual men with this illness and to differentiate the experience of HIV/AIDS-related stigma among gay and straight men with HIV/AIDS.     

When are AIDS patients to blame for their disease? Effects of patients' sexual orientation and mode of transmission

This study examined three factors affecting college students' attributions of blame for an AIDS patient's disease: sexual orientation of the patient, mode of HIV transmission, and the sex of the subject. 148 subjects read one of six vignettes describing an hypothetical AIDS patient who was described as either an heterosexual or an homosexual man who contracted HIV through one of three avenues: blood transfusion, sexual contact, or IV drug use. The homosexual AIDS patient was considered more to blame for his illness than the heterosexual AIDS patient, but only when mode of transmission was sexual contact. In addition, mode of HIV transmission was a significant factor in attributions of responsibility, as the patient who contracted HIV through a blood transfusion was rated as less responsible than the patient who contracted HIV through sexual behavior or IV drug use. Women consistently rated the AIDS patient as less responsible than did men.     

Correlates of relationship, psychological, and sexual behavioral factors for HIV risk among Indian women

The rate of HIV/AIDS among women in India is expected to rise yet few studies have examined factors related to HIV risk among Indian women. The objective of this prospective, cross-sectional study was to characterize similarities and differences in the relationships, psychological well-being, and sexual behaviors among Indian women (N=459). Both HIV positive (N=216) and negative (N=243) women from urban and rural areas in India were included in this study. Chi-square, analysis of variance, and logistic regression analyses revealed that in both geographic groups, HIV-positive women were significantly more likely to report marital dissatisfaction, a history of forced sex, domestic violence, depressive symptoms and husband's extra marital sex when compared to the HIV-negative women. Findings also indicate that specific factors related to the quality of the marital relationship such as domestic violence, martial dysfunction, and depressive symptoms may be related to HIV-related risks for women. Implications for future research and culturally relevant interventions are discussed.     

Educational needs relative to human sexuality and AIDS among secondary school students and teachers in Lima

Between November 1989 and January 1990, a pilot study was conducted among state secondary school students and teachers in Lima Peru by questionnaires with the objective of determining their knowledge about human sexuality, sexual behavior, pregnancy, sexually transmitted diseases (STDs), AIDS, drug abuse, and sexual activity. 110 students (64 boys and 46 women) aged 13-18 of low and medium-low socioeconomic background from metropolitan Lima participated. 40 teachers (70% females) aged 40.1 + or - 9.3 years also took part. THe adolescent focus groups were anxious to talk openly about sexuality to dispel their doubts. The levels of knowledge reached 46% for human sexuality, 50% for physiology and pregnancy, 35% for STDs and preventive sexual behavior, 50-60% for AIDS (transmission and risk groups), and only 35% for prevention. 21 had heterosexual experiences: 19 males and 2 females. 6 youngsters had homosexual experiences: 4 males and 2 females, 3 of these also had heterosexual sex. 20 of students without sexual experience expressed on interest, in engaging in sexual behavior if they fell in love. 33 adolescents reported using alcohol, 1/4 of these had consumed more than 6 bottles the previous week. The report on drug use was low, because 32% failed to answer this question. 60-70% of the teachers knew about human sexuality, while 72% knew about AIDS. 76.5% of them considered sex education in schools inadequate. 88.2% thought that adolescents need an explicit preventive program which should start in primary school and continue through all grades. This would require additional school resources. The teachers deemed daily life more educational about sexuality than information from schools and universities. 52% said that AIDS education messages had to be clear about preventive sexual behavior. 32% believed that correct use of the condom had to be demonstrated in class. 78% identified the mass media for dissemination of AIDS information, and only 15% judged their knowledge about AIDS sufficient for imparting it to students.     

Alcohol use, expectancies, and sexual sensation seeking as correlates of HIV risk behavior in heterosexual young adults.

Most theoretical models of HIV risk behavior have not considered the role of personality factors, and few studies have examined mechanisms accounting for dispositional influences on sexual risk taking. This study elaborated on a conceptual model emphasizing sexual sensation seeking, alcohol expectancies, and drinking before sex as key predictors of HIV risk (S. C. Kalichman, L. Tannenbaum, & D. Nachimson, 1998). Multiple groups structural equation modeling was used to determine whether gender moderated relationships among these variables in a sample of 611 heterosexual, young adult drinkers (49% women, 76% Caucasian, mean age = 25 years). The model provided an excellent fit to the data, and gender differences were not substantiated. Sexual sensation seeking predicted HIV risk directly as well as indirectly via sex-related alcohol expectancies and drinking in sexual contexts. Findings suggest that expectancies and drinking before sex represent proximal mechanisms through which dispositional factors influence sexual risk outcomes. Moreover, these relationships appear to be similar in men and women. Interventions could benefit from targeting alcohol expectancies and drinking before sex in individuals with a dispositional tendency toward sexual risk taking.     

Information and attitudes about HIV/AIDS in Portuguese adolescents: state of art and changes in a four year period

The incidence of infection with HIV/AIDS among the heterosexual population has been increasing in young adults. The goal of this research was to deepen knowledge of preventive sexual behavior in Portuguese adolescents, including knowledge and attitudes about HIV/AIDS, and assessing whether they changed from 2002 to 2006. Data were collected through a self-administered questionnaire from the Portuguese sample of the Health Behavior in School-aged Children (HBSC), a collaborative WHO study. The study provides national representative data of 7093 Portuguese adolescents, randomly chosen from those attending 8th and 10th grade of high school. Results showed there was an increase in the age of first sexual intercourse and a decrease in the number of teenagers who reported having had sexual intercourse, also in the level of information regarding HIV/AIDS transmission/prevention and in positive attitudes towards people with HIV/AIDS. In general, adolescents have good knowledge about how to protect themselves from becoming infected. However, comparing to 2002, there was a reduction of knowledge and consequent increase in the doubts regarding HIV/AIDS. Given the incipient state of sex education in 2006, the results cannot be attributed to sex education, but they will be relevant for comparison with the 2010 HBSC results.     

Listening to the Sound of Silence: Gender Roles and Communication about Sex in Puerto Rico

Puerto Rican women are at high risk for the heterosexual transmission of HIV. I examined social and interpersonal aspects of communication about sex in regard to safer sex practices within a specific cultural context. Participants in this study were 42 heterosexual Puerto Rican adults living in Puerto Rico, who ranged in age from 18 to 56 years. Participants were interviewed regarding their sexual communication, sexual practices, and their perceptions regarding the roles of culture and gender in the practice of safer sex. Inductive qualitative analysis showed that three factors limit meaningful communication about sex in Puerto Rico: (1) machismo, (2) the changing role of virginity, and (3) the silencing of both men and women. Implications for theory-based inventions informed by an interpersonal communication perspective are discussed.This research was supported by the Northeastern University Provost’s Research and Development Fund.     

Predictors of Risky and Precautionary Sexual Behaviors Among Single and Married White Women1

Risky and precautionary sexual behaviors were examined in a community sample of 260 single and married/cohabitating White women. Structural equation modeling was used to assess the ability of age, socioeconomic status (SES), marital status, religiosity, and 9 health belief constructs to predict risky sexual behavior with one's partner, using a barrier method of birth control, unintended pregnancies, and number of sexual partners in the past year. The pattern of results suggests that single White women appear to feel more vulnerable to HIV and STD infection and more likely to engage in risky sexual behavior than do married White women. The discussion focuses on the importance of sociocultural factors in understanding risk behaviors within the social context of relationship status, the complexity of the concept of risk reduction, and the need for going beyond the health belief model in order to develop different HIV prevention strategies for single and married White women.     

The role of risk perception and efficacy cognitions in the prediction of HIV-related preventive behavior and condom use

The salience of the Protection Motivation Theory to HIV preventive behavior was investigated in a sample of 468 heterosexual men 20-45 years of age recruited in Germany and at vacation spots in Spain. This theory conceptualizes self-protective behaviors as a function of the severity of the threat, perceived personal vulnerability to this threat, the availability of coping responses, and the effectiveness of these responses. Cognitive variables measured included perceived severity of the threat of AIDS, sexual self-efficacy expectancy, self-efficacy expectations in terms of sexual communication skills, response efficacy, and attitude toward condom use. On a scale of 1 (low) to 6 (high), perceived severity of the AIDS threat averaged 5.3, individual susceptibility ratings averaged 3.5, and susceptibility of peers had a mean of 4.9. Although 33% of respondents had made behavioral changes in response to the AIDS epidemic, only 15% always used condoms while 12% used them occasionally. Self-efficacy expectancy with regard to assertiveness and use of preventive measures emerged as the most significant predictor of HIV-related behaviors. The causal analyses indicated that high communicative self-efficacy expectancy is associated with high-risk sexual behaviors, while self-efficacy expectancy regarding assertiveness and the use of preventive measures promotes risk reduction. These associations were strongest in men over 26 years of age, singles, and tourists. These findings suggest a need for interventions for couples such as assertiveness training and guidance on communicating about sex and AIDS. Also demonstrated was the need for AIDS education programs to identify where participants are in terms of perceiving the threat of and coping with the AIDS epidemic and promote conditions that will help people advance to the next stage.     

Commitment to the Relationship,Extradyadic Sex,and AIDS Preventive Behavior1

This study was conducted among 251 heterosexual adults in The Netherlands that included a substantial number of individuals who had had unprotected sex with a new partner. Relationship status and commitment had independent effects upon the willingness to engage in extradyadic sex above and beyond the effects of past extradyadic sex and satisfaction, and commitment was the only psychological predictor of the intention to use condoms in extradyadic sexual contacts. Commitment predicted the willingness to inform the steady partner about one's unsafe extradyadic sex and to protect the steady partner against the possible risk of HIV infection after unsafe extradyadic sex. The implications for AIDS prevention are discussed.     

The 90's: gender differences in AIDS-related sexual concerns and behaviors,condom use and subjective condom experiences

To evaluate gender differences in the subjective experience and use of condoms, 193 heterosexual patrons at 13 bars in New York City were interviewed on site in 1991. Most respondents were single, middle class, and White; their ages ranged from 18 to 51 years. The data analysis was restricted to the 155 men and women who had at least 1 new partner in the 3 years preceding the survey. Respondents worried most about acquired immunodeficiency syndrome (AIDS) when engaging in sex with a new partner. 86% indicated concern about AIDS had affected their sexual behavior, most often by increasing their condom use and decreasing casual sex. 91% of women and 79% of men said that condoms give them greater peace of mind. Women worried more than men about AIDS when they had a new sexual partner and were more likely to limit their number of partners, work harder on an existing sexual relationship, give up casual sex, or give up sex with new partners. Men's subjective condom experiences were related to their penile functioning (erection and ejaculation) and the threat of loss of sexual pleasure. Multiple regression equations revealed that, among men, condom use with new partners was associated with worrying about AIDS and younger age; among women, peace of mind was a positive predictor. With casual partners, more partners led to increased condom use among women and worrying about AIDS was a predictor for men; peace of mind was predictive for both genders. 53% of men compared to 21% of women expected to meet a new sexual partner at the bar where they were interviewed, and 36% of men and 19% of women were carrying condoms with them.