Condom Negotiation in Heterosexually Active Men and Women: Development and Validation of a Condom Influence Strategy Questionnaire

The ability to negotiate condom use with a partner is a skill that sexually active men and women must have in order to avoid sexually transmitted diseases including HIV. Despite this fact, there is no psychometrically valid instrument in the literature to measure condom influence strategies. This investigation reports on the development and initial validation of the condom influence strategy questionnaire (CISQ). Exploratory and confirmatory analyses revealed and confirmed six influence strategies used by heterosexually active men and women to negotiate condom use. These CISQ subscales accounted for variance in safer sexual variables including sexual assertiveness, self-efficacy, and partner communication. Further, those who endorsed CISQ subscales were more likely to have intentions to use condoms consistently and to use condoms. Gender differences in subscales favoring women as the ones most likely to use influence strategies also emerged. Implications of these results as well as future directions for research are discussed.     

Factor structure of the Condoms Barriers Scale with a sample of men at high risk for HIV

This study assesses the psychometric properties of the Condom Barriers Scale (CBS), an instrument originally designed to measure women's perceptions and attitudes regarding male condom use, with a sample of men at high risk for human immunodeficiency virus (HIV). Participants include 590 male patients in drug abuse treatment involved in a gender-specific HIV prevention intervention for teaching safer sex skills. Second-order confirmatory factor analysis generally supported the underlying four-factor subscale structure of the CBS. However, exploratory factor analysis revealed a few specific discrepancies in the factor structure between men and women. Internal consistency and test-retest reliability estimates were moderate to high in value. CBS scores correlated with use of condoms for men with high-risk sexual partners, supporting criterion-related validity. Overall, the analysis indicates that the CBS is a potentially valid and reliable instrument and has utility for assessing barriers to condom use with men, but may need some item content modifications to allow appropriate assessment of gender differences and comparisons across studies.     

Are Transgender Persons at Higher Risk for HIV Than Other Sexual Minorities? A Comparison of HIV Prevalence and Risks

SUMMARY

Recent studies have shown that transgender people are at high risk for HIV. Few studies, however, have directly compared the HIV risks and sexual health of transgender persons with that of other sexual minority populations. This study used baseline data of intervention studies targeting transgender persons, men who have sex with men, and women who have sex with women and men to compare their HIV risk behavior and sexual health. No significant differences were found between transgender persons and nontransgender men or women in consistent condom use or attitudes toward condom use. Transgender persons were less likely to have multiple partners and more likely to be monogamous than men who have sex with men; no differences were found between transgender persons and the women in this respect. When combining data on condom use, monogamy, and multiple partners, transgender persons did not differ from either nontransgender group in their overall risk for HIV. Transgender persons were less likely than the men or the women to have been tested for HIV. With regard to HIV prevalence, 17% of the men compared to only one transgender person and none of the women reported being HIV-positive. Transgender persons were also less likely than men who have sex with men to use drugs; no differences were found in the use of alcohol. However, with regard to mental health, transgender persons were more likely than the men to have experienced depression and more likely than men or women to have considered or attempted suicide. Finally, transgender persons reported the lowest levels of support from family and peers. Thus, in our sample, transgender persons appear to be at lower risk for HIV but at higher risk for mental health concerns than men who have sex with men. Remarkably few differences were found between transgender persons and women who have sex with women and men-a finding which might reflect the impact of social stigma on sexual health and have implications for the design of future HIV/STI prevention efforts.     

The Development and Validation of a Model Explaining Sexual Behavior Among College Students Implications for AIDS Communication Campaigns

College students' risky sexual behavior places them at relatively higher than average risk for HIV infection. This study examines various explanations for college students' risky behavior, and proposes and tests a model of factors influencing college students' sexual behavior. A LISREL estimation of the model shows that the model fits the data. The results also show that (1) sensation-seeking predispositions and the sexual motive for a pleasurable relationship are indirectly or directly related to all measures of sexual behavior (i.e., number of partners, incidence of unprotected sex, and percentage of condom use); (2) sexual motives driven by concern for health have only an indirect effect on percentage of condom use; and (3) optimistic bias, personal relevance, perceptions about partners, and images of condoms are related to sensation seeking, sexual motives, and sexual behavior. In addition, interpersonal influence from sexual partners appears to both facilitate and inhibit safer sexual behavior. Suggestions are provided regarding campaigns designed for AIDS prevention among college students.     

Relationship Factors’ Impact on Condom Use Among College Students

Research indicates that a number of college students are at risk for HIV, sexually transmitted diseases, and unplanned pregnancy as a result of their sexual behaviors. Specific behaviors placing college students at risk include having sex with multiple partners, poor communication about safer sex practices with their sexual partners and not using condoms consistently and correctly when engaging in sexual activity. The purpose of this paper is to identify potential differences in safer sex practices and factors that influence condom use among college students. A four-page, 18-item survey was developed to determine participants’ condom use and the impact of relationship status and other demographic factors on condom use. Analyses revealed that the number of lifetime vaginal sexual partners and participants’ sex influenced condom use. There were no significant differences in relationship status, duration, trust, honesty and condom use. These findings should be considered with designing interventions to increase condom use among college students.     

Sexually Explicit Media and Sexual Risk Behavior in a Sample of Men Who Have Sex with Men in Norway

The aim of this study was to explore the association between the consumption of sexually explicit media (SEM) depicting condom and non-condom use and HIV/STI-related sexual risk behavior among men who have sex with men (MSM) in Norway. We also explored whether the association between SEM consumption and STI-related sexual risk behavior is mediated by men’s sexual self-esteem and/or condom use self-efficacy. A cross-sectional online survey study was carried out in Norway in 2012. The final sample comprised 529 MSM in Norway. There was a bivariate association between the use of SEM picturing condom use and less STI-related sexual risk behavior. Further, the association between SEM consumption and sexual risk behavior was mediated by condom use self-efficacy. However, SEM did not influence sexual risk behavior via sexual self-esteem. The results offer important cross-cultural validation of recent comparative data from the US and may be used to promote HIV/STI prevention, in the sense that the actors in SEM may serve as role models in managing condom use in sexual contexts.     

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.     

Using Sex-Related Alcohol Expectancies to Predict Condom Use Among a General Sample of Men and Women in the United States

Sex-related alcohol expectancies (SRAE) are known to moderate the relationship between alcohol use and risky sexual behavior in high risk populations; however, SRAEs have not been thoroughly explored in populations traditionally viewed at lower risk for HIV and/or STI. Participants (n = 649) were recruited through internet-based direct marketing in the United States. Predictors of SRAE vary by gender. Controlling for alcohol use and other predictors, age predicted condom use among women, and SRAE was correlated with condom use for men. Sexual health programming geared towards non-traditionally identified high-risk populations is necessary and provides unique opportunities to increase condom usage.     

Belief in a Just World and Condom Use in a Sample of Gay and Bisexual Men1

Research has shown that, under certain conditions, people with a strong belief in a just world (BJW) perceive themselves to be less at risk for serious negative events (e.g., contracting AIDS). We extended this work by investigating the relation between BJW and high‐risk sexual behavior Gay and bisexual men (N= 102) responded to a questionnaire that measured individual differences in BJW, personality characteristics related to perceived relationship threat (e.g., interpersonal control), and frequency of condom use and anal intercourse. Results generally supported predictions. For example, among respondents low in interpersonal control, a strong BJW was associated with less frequent condom use. These results have implications for research on BJW, as well as research on the predictors of high‐risk sexual behavior.     

The fallacy of intimacy: sexual risk behaviour and beliefs about trust and condom use among men who have sex with men in South Africa

The objective of this study is to assess (1) whether beliefs about trust and condom use affect sexual risk behaviour, and (2) if beliefs about trust and condom use impact sexual risk behaviour directly or if this relationship is mediated by other determinants. The Information-Motivation-Behavioural Skills model was used as a framework for the mediation analysis. A diverse cohort of three hundred 18-40 year old men who have sex with men (MSM) residing in Pretoria, South Africa, were recruited and surveyed for this project. Findings indicate that men who report a high frequency of past unprotected anal intercourse are more likely to believe that it is not necessary to use condoms with a trusted or steady partner regardless of their current partnership status. This fallacy of intimacy appears to affect sexual risk behaviour through intentions and attitudes regarding safer sex practices. Based on these findings, we recommend that more attention be given in gaining a better understanding of how beliefs about trust and condom use are formed and how they can be changed among MSM in South Africa.     

“Whenever Jack sees a condom,he falls asleep”: experiences of condom use and erectile disorder among HIV positive men in a Zimbabwean rural setting

In this qualitative inquiry, we set out to explore the experience of condom use and erectile disorder (ED) among men living with HIV in a rural district of Zimbabwe. Data on condom use related erectile disorder with antiretroviral (ART) medication were collected from a purposive sample of 18 men living with HIV and AIDS (age range 23–54 years). These data were supplemented with those from a convenience sample of 23 women living with HIV who self-identified as partners of men living with HIV and AIDS (age range 26–37 years). The data were thematically analyzed. Results suggest that men attributed their experiencing of erectile problems to two main explanations: use of condoms and ART medication. These men reported inconsistent use of condoms and/or adherance to ART therapy due to a belief that these cause their ED. The women informants reported similar observations, including the shared gendered perspective that the men perceived a loss of sense of manhood from ED. Beliefs that influence health promotion with men living with HIV and AIDS are important to public health interventions with them.     

Toward an Understanding of (Em)Power(Ment) for HIV/AIDS Prevention with Adolescent Women

Adolescent females, particularly urban and low-income youth of color, are at particular risk for HIV infection. This article uses an empowerment perspective to consider the degree to which intrapersonal and interpersonal power dynamics in heterosexual relations have an impact on condom use among high-risk youth. Participants in this study were 333 African American and European American urban youth, ages 14–19 years, who were heterosexually active. Measures focused on interpersonal and intrapersonal factors thought to be associated with condom use. This model was most useful in predicting condom use among women and least useful in predicting condom use among male participants. Implications for empowerment theory and future research are discussed.     

Sexual behaviour,condom use and prediction in attenders at sexually transmitted disease clinics—implications for counselling

A cohort of 260 clinic attenders completed an inventory to examine sexual behaviour, condom use and appraisal and to determine whether situational factors in their last sexual encounters were predictive of condom use. Response to health education compaigns promoting condoms in the light of HIV were also examined. It was found that risk exposure was consistently high. A subsample induldged in anal intercourse, which was unprotected in over two-thirds of instances. Condom uptake was varied Difficulties with condoms were widespread and fell into physical and psychological categories. The only predictor of condom use was the desire for unprotected sex. This data seems to indicate that sex is not a drive out of conscious control, but that individuals weigh up costs and benefits which may be marginally influenced by some situational variables such as alcohol. This has profound implications for counselling which can be aimed at addressing the misconceptions and beliefs that some individuals hold. Such misconceptions may result in risky behaviour which may potentially expose them to HIV. Such understanding is an important prerequisite for effective interventions. Differences between responses for heterosexual and homosexual men and women were examined.     

Childhood experiences and psychosocial influences on HIV risk among adolescent Latinas in southern California

This study determined how adverse childhood experiences influenced risky sexual behavior in a community sample of Latina adolescents in Los Angeles (N = 904) within a modified ecodevelopmental perspective. Psychosocial, sociocultural, and environmental mediators of the relations between childhood experiences and risky sexual behavior were tested. Many direct and mediated paths were revealed using structural equation modeling. Childhood maltreatment was associated with risk sexual practices, including more partners, less condom use, more frequent intercourse, and less HIV testing. Drug use and general self-efficacy mediated several relationships. Reducing childhood maltreatment reduced HIV risk and improved psychosocial functioning. Many factors tested did not influence HIV risk. Much of what is known about HIV risk among other populations may not apply to young Latina women.     

HIV Risk among Pregnant Teenagers with a History of Interpersonal Violence

This study examined the relationship among interpersonal violence, depressive symptoms, and HIV risk behaviors among pregnant teenagers. A sample of 116 pregnant teenagers was recruited in Rhode Island. Multivariate logistic regressions tested whether or not the relationship between history of interpersonal violence and HIV risk remained after controlling for age and education. Participants reported a young age of sexual debut and low rates of condom use. Multivariate logistic regressions indicate a significant relationship between interpersonal violence and HIV risk but not in degree of depression symptoms and HIV risk. Pregnant teenagers with a history of interpersonal violence could benefit from interventions that address HIV risk.     

Predictors of Condom Use in Mexican Migrant Laborers

The purpose of this study was to explore predictors of condom use with occasional sex partners and regular sex partners, as well as carrying condoms in a new high-risk group for HIV infection, Mexican migrant laborers. This study extends previous findings by (1) exploring additional predictors not previously examined, (2) utilizing a large sample of male and female Mexican migrant laborers, (3) carefully controlling for the effects of various demographic and lifestyle variables related to condom use, and (4) assessing the interactive effects of gender on predictors of condom use. Snowball sampling was used to survey 501 adult Mexican migrant laborers. Results revealed that condom use with occasional sex partners was predicted by carrying condoms and condom self-efficacy and that women were more likely to use condoms with occasional partners when both men and women knew someone with HIV/AIDS. Condom use with regular sex partners was predicted by procondom social norms, less negative attitudes toward condoms, not knowing someone with HIV/AIDS, and condom self-efficacy. Carrying condoms was predicted by procondom social norms, less negative attitudes toward condoms, condom self-efficacy, worry about contracting HIV/AIDS, and women were more likely than men to carry condoms when both men and women were married. Understanding these findings, future research directions, and implications for condom promotion strategies with Mexican migrant laborers are discussed.     

Sexual Communication in Relationships: When Words Speak Louder Than Actions

Sexual communication for expressing sexual desires and gathering HIV risk information were examined as interpersonal constructs related to HIV risk reduction. Community women (n = 816) with at least one heterosexual HIV risk factor (79% Euro-American, 86% some college) completed surveys assessing assertive communication with a sexual partner, HIV risk, and demographic, sexual history, interpersonal negative, and cognitive/attitudinal constructs which formed a hierarchical predictor model. In relationship context comparisons, women with a known partner HIV risk responded more negatively on most measures. Multiple regressions suggested communication is part of an overall cognitive/attitudinal approach to HIV risk, although specific predictors differ by type of communication and partner risk level. Implications for interventions considering relational context, interpersonal power, and counteracting silence are discussed.     

The Theory of Reasoned Action and the Role of External Factors on Heterosexual Men's Monogamy and Condom Use1

Although the majority of prevention efforts have focused on women, reduction of heterosexual transmission of STDs also requires interventions for men, necessitating understanding of men's safer sex decision making. In a random sample of 486 heterosexually active men, the theory of reasoned action (TRA) was used to predict intentions to use condoms with casual partners, as well as 2 steady‐partner safer sex behaviors: mutual monogamy and condom use. The basic TRA model fit the data well. Expanded models identified the mediated (via attitudes, social norms, and self‐efficacy) and, for some, direct effects on intentions and behavior of selected intrapersonal, interpersonal, and sociocultural variables. Results suggest that the role of external variables might vary depending on the behaviors in question.     

Partner-Specific Risk Perception: A New Conceptualization of Perceived Vulnerability to STDs

Two studies were conducted to test a new conceptualization of risk perception, focusing on the risk posed by a specific sexual partner at a specific time rather than a generalized perception of vulnerability to HIV or sexually transmitted diseases. Study 1 used a cross-sectional design and found support for a model with the following domains as antecedents of partner-specific risk perception (PSRP): generalized perception of HIV risk, partner's sexual history, and characteristics of relationship with the partner. However, PSRP was not associated with condom use in Study 1. Study 2, which used a longitudinal design, replicated the domains predictive of PSRP and also demonstrated the influence of PSRP on condom use 4 weeks later while controlling for past condom use. The findings support the utility of this conceptualization of risk perception.