An Evaluation of an HIV/AIDS Prevention Program in a Nigerian Setting

The study examined the success of a group based behavioural intervention with Nigerian youths aimed at reducing the risk of contracting and spreading HIV/AIDS and other sexually transmitted illness (STI). Participants were 147 youths (males=75, females=72, age range 5 to 24 years). The study explored the influence of motivational factors (self efficacy), attitudinal factors (perceived personal risk), knowledge (instrumental knowledge of AIDS) and behavioural factors (refusal of high-risk behaviour) in predicting condom use amongst youth participating in a group-based HIV prevention intervention. Findings indicated that the intervention program reliably predicted participants' attitudinal dispositions to high risk heterosexual behaviour. Instrumental knowledge of HIV/AIDS, perceived self-efficacy, perceived personal risk of HIV/AIDS and refusal of risk behaviour were significant predictors of condom use.     

Influencing a partner to use a condom. A college student perspective

Little is known about the influence strategies that young heterosexual adults use to persuade a new sexual partner to use or avoid the use of condoms. College students'(N = 393) opinions about and experiences with six condom power strategies were examined. Overall, students gender-typed the strategies as "feminine" when the goal was to persuade a partner to use condoms and as "masculine" when trying to avoid condom use. Effectiveness and comfort ratings of the strategies varied both by students'gender and the particular tactic being evaluated. Gender differences also emerged in students'actual experiences with the strategies. When trying to encourage condom use, men utilized seduction most often; whereas, withholding sex was the most popular tactic used by women. For avoiding condom use, men were more likely than women to employ seduction, reward, and information. Implications for understanding the impact of gender and social influence in the domain of condom use are discussed.     

The condom purchase task: A hypothetical demand method for evaluating sexual health decision-making

Behavioral economic theory has proved useful for understanding the influence of delay and probability on sexual health decision-making. Demand is another principle at the intersection of microeconomics and psychology that has helped advance research relevant to health behaviors. The purpose of the present study was to develop and test a demand measure related to sexual health decision-making and the influence of sexually transmitted infection (STI) risk. Participants (N = 438) recruited using Amazon Mechanical Turk completed a commodity purchase task assessing hypothetical condom demand. Condom demand was evaluated at varied prices for use with hypothetical sexual partners that varied in STI risk. Demand was characterized by prototypic decreases in consumption with increases in cost. Higher partner STI risk was associated with greater intentions for condom-protected sex at no cost and smaller decreases in condom demand with increases in cost. Price sensitivity was also related to individual difference factors relevant to sexual health (e.g., alcohol use severity, lower STI knowledge). This study supports the utility of a condom purchase task for indexing condom valuation and capturing individual difference and contextual risk factors relevant to STI transmission. Future studies may leverage this methodology as a means to study sexual health decision-making.     

The relationship between attitude,assertiveness and condom use

The Australian study investigated condom-specific assertiveness and condom use as a means of prevention infection from sexually transmitted diseases. 211 men participated including 83 homosexual men (aged 19-62 years) and 128 heterosexual men (aged 17-49) who completed a questionnaire that comprised demographic details such as age, monogamy, and sexual activity as well as attitudinal and assertiveness measures. General assertiveness was measured by the Rathus Assertiveness Schedule (RAS) which had been widely used across a wide range of social situations. Assertiveness relating specifically to situations involving condoms was measured by the Condom Assertiveness Scale (CAS). Intention to use condoms was positively related to favorable attitudes, which were related to condom-specific assertiveness for both groups. For the heterosexual men only, general social assertiveness was negatively related to attitudes toward condoms. For both groups, the condom-specific measure of assertiveness was positively correlated with attitudes toward condoms. Condom-specific assertiveness was positively related to general social assertiveness as measured by the Rathus Assertiveness Schedule for the homosexual, but not for the heterosexual men. The negative relationship between general assertiveness and attitude to condoms among the heterosexual men implies that the risk reducing behavior of condom use did not seem to accord with the perceptions of masculinity and social assertiveness among heterosexual men. Thus, female partners of such heterosexual men exhibiting negative attitudes toward condom use combined with assertiveness would have to overcome resistance to insist on the use of condoms. Recently some advertising campaigns have been directed at women. The promotion of condom use among heterosexual men has to deal with the perceptions of condom use as unmasculine behavior.     

Nature, decay, and spiraling of the effects of fear-inducing arguments and HIV counseling and testing: a meta-analysis of the short- and long-term outcomes of HIV-prevention interventions.

OBJECTIVE: To examine the long-term efficacy of both fear-inducing arguments and HIV counseling and testing at encouraging and maintaining knowledge about HIV transmission and prevention, as well as condom use. DESIGN: Analyses were conducted with a sample of 150 treatment groups and 34 controls and included measures of change at an immediate follow-up and a delayed follow-up. MAIN OUTCOME MEASURES: The main outcome measures were perceived risk of HIV infection, knowledge about HIV, and condom use. RESULTS: Results indicated that receiving fear-inducing arguments increased perceptions of risk at the immediate follow-up but decreased knowledge and condom use, whereas resolving fear via HIV counseling and testing decreased perceptions of risk and increased knowledge and condom use at both the immediate and delayed follow-ups. The effects on perceived risk [corrected] decreased over time, but the effects on knowledge [corrected] condom use became more pronounced. CONCLUSION: Inducing fear is not an effective way to promote HIV-relevant learning or condom use either immediately following the intervention or later on. However, HIV counseling and testing can provide an outlet for HIV-related anxiety and, subsequently, gains in both knowledge and behavior change immediately and longitudinally.     

Intention, Context, and Safe Sex: Australian Adolescents' Responses to AIDS

This study examined the applicability to condom use of Ajzen and Madden's (1986) theory of planned behavior by examining the predictors of intention to use a condom and actual condom use in a specific sexual situation. In a sample of 144 sexually active heterosexual males and females, limited support was found for the model. Intentions to use a condom immediately before a particular sexual encounter, and those assessed some time prior to this encounter were found to have direct and positive effects on condom use. In addition, perceptions of the disadvantages of condoms (a measure of attitudes to condoms in general) had direct negative effects on condom use and, together with perceptions of the advantage of condoms, also had indirect effects on condom use via prior intention. A number of the postulated predictors of safe sexual practice related neither to intentions nor behavior. The contextual variables of sexual arousal, condom availability, and degree of communication with a sexual partner all influenced condom use. Discussion centered on first, differences in the predictive ability of the model when compared to other studies of planned behavior, and second, the factors limiting the relationship between intention and behavior when the behavior in question is not under complete, volitional control.     

Illusions of Safety in a Risky World: A Study of College Students' Condom Use

The role that costs, benefits, and perceptions of invulnerability play in condom use was examined in a sample of students ( N = 211) at 4-year and 2-year colleges. In multiple regression analyses, past condom use was related to relative invulnerability, low present risk, and inexperience. Less intended condom use was associated with high perceptions of relative invulnerability and low perceptions of present risk. It appears that many college students feel protected from HIV because they judge their current sexual environment to be safe due to monogamy, sexual history taking, and the ability to tell a partner's HIV status. Independent of that, feelings of relative invulnerability are associated with more condom use—perhaps an accurate judgment of past risky behavior.     

Impact of Social and Structural Influence Interventions on Condom Use and Sexually Transmitted Infections Among Establishment-Based Female Bar Workers in the Philippines

This quasi-experimental study evaluated the influence of structural intervention components (e.g., changing organizational and social influence factors) in reducing biological sexually transmitted infections (STIs) and reports of unprotected sex among female bar workers (FBWs) in the Philippines (N = 369 at baseline). Recruited from four large southern Philippines cities, FBWs were exposed to a standard care, a manager influence, a peer influence, or a combined manager/peer influence condition. After the two-year intervention period, FBWs in the combined peer and manager intervention condition showed greater reductions in STIs and unprotected sex relative to those in the standard care condition. FBWs in the combined and the manager only conditions also showed a decrease in STIs compared to those in the standard care condition. Managers in the standard care condition reported lower positive condom attitudes and lower attendance at HIV/AIDS related training sessions compared to those in the combined condition. The combined effect of managers and peers had a positive, synergistic effect on condom use behavior and STI reduction compared to the standard care. This research provides empirical evidence that structural changes such as rules, regulations, and increased accessibility of condoms must be in combination with normative changes (individuals' attitudes, beliefs and normative expectancies) in order to achieve the greatest benefit in condom use behavior and STI reduction/prevention.     

A Qualitative Exploration of Rural African American Youth Perceptions about the Effect of Dating Violence on Sexual Health

Adolescent dating violence (ADV) remains a significant concern, particularly among rural African Americans. Few studies have explored adolescents’ perceptions about the link between ADV and sexual health and none have targeted this population. Employing qualitative methods based in Community-Based Participatory Research and theory, this study explored rural African American adolescents’ knowledge, perceptions and beliefs about the impact of ADV on sexual health. Secondary data analysis of 20 semi-structured individual interviews, conducted with older adolescents (aged 18–21), revealed participants understood the link between ADV and sexual health consequences, specifically as it related to STI and HIV prevention, condom use, and refusal of sex; and the negative impact refusing sex, communicating about HIV and other STI prevention, and negotiating condom use can have on ADV. This included: (a) negative relationship outcomes, including ADV and fear; and (b) factors that impact one’s ability to refuse sex, communicate about HIV and STI prevention, and negotiate condom use. Findings underscore the need for comprehensive ADV prevention programs for rural African Americans.     

Effective communication of risks to young adults: using message framing and visual aids to increase condom use and STD screening

Sexually Transmitted Diseases (STDs)-including HIV/AIDS-are among the most common infectious diseases in young adults. How can we effectively promote prevention and detection of STDs in this high risk population? In a two-phase longitudinal experiment we examined the effects of a brief risk awareness intervention (i.e., a sexual health information brochure) in a large sample of sexually active young adults (n = 744). We assessed the influence of gain- and loss-framed messages, and visual aids, on affective reactions, risk perceptions, attitudes, behavioral intentions, and reported behaviors relating to the prevention and detection of STDs. Results indicate that gain-framed messages induced greater adherence for prevention behaviors (e.g., condom use), whereas loss-framed messages were more effective in promoting illness-detecting behaviors (e.g., making an appointment with a doctor to discuss about STD screening). The influence of the framed messages on prevention and detection of STDs was mediated by changes in participants' attitudes toward the health behaviors along with changes in their behavioral intentions. Moreover, when visual aids were added to the health information, both the gain- and loss-framed messages became equally and highly effective in promoting health behaviors. These results converge with other data indicating that well-constructed visual aids are often among the most highly effective, transparent, fast, memorable, and ethically desirable means of risk communication. Theoretical, economic, and public policy implications of these results are discussed.     

Impact of a social influence intervention on condom use and sexually transmitted infections among establishment-based female sex workers in the Philippines: a multilevel analysis.

The authors assessed the relative impact of structural and social influence interventions on reducing sexually transmitted infections (STIs) and HIV risk behavior among female sex workers in the Philippines (N = 897). Four conditions included manager influence, peer influence, combined manager-peer influence, and control. Intervention effects were assessed at the establishment level in multilevel models because of statistical dependencies among women employed within the same establishments. Control group membership predicted greater perceived risk, less condom use, less HIV/AIDS knowledge, and more negative condom attitudes. Combination participants reported more positive condom attitudes, more establishment policies favoring condom use, and fewer STIs. Manager-only participants reported fewer STIs, lower condom attitudes, less knowledge, and higher perceived risk than peer-only participants. Because interventions were implemented at the city level, baseline and follow-up city differences were analyzed to rule out intervention effects due to preexisting differences.     

Psychological and socio-demographic variables associated with sexual risk behavior for sexually transmitted infections/HIV

New diagnoses of sexually transmitted infections (STIs) and HIV are rising in the adult population. The main objective of this study was to analyze whether knowledge of STIs/HIV, worry about STIs/HIV and pregnancy, and self-efficacy to refuse sex are predictors of sexual risk behaviors among Spanish young and adults. The study sample was composed of 1,106 young and adults of both sexes aged between 17 and 55 years. Results showed that being single, homosexual, having been tested for HIV, having previously contracted an STI, having a college education and earning a monthly income of €900 or more were the characteristics associated with higher scores in knowledge of STIs/HIV. Self-efficacy to refuse sex predicted most vaginal and anal sexual behaviors (i.e., age at vaginal and anal sex initiation and the number of couples that have remained vaginal sex). We also found that participants with greater knowledge of STIs/HIV reported older age at vaginal sex initiation and higher condom use in the first vaginal sexual contact. We consider that these findings can be useful for the development of STI/HIV prevention programs.     

Improving Predictions of Condom Behavioral Intentions With Partner-Specific Measures of Risk Perception

Inconsistent findings regarding the predictive validity of perceptions of risk for a sexually transmitted disease (STD) and HIV may be related to the use of nonspecific measures. The objective of this study was to determine whether more specific measures of perceptions of risk for SI Ds and HIV are associated with intentions to use a condom. We interviewed 490 male and female adolescents, 14 to 19 years old, from a free municipal STD clinic. Controlling for whether a condom was used at last sex, the association between perceptions of risk for an STD and HIV with a casual sex partner and intentions to use a condom with a casual sex partner was significant (β_HIV= 14, p < .01, and β_STD=.20, p < .01), as was the association between perceptions of risk for an STD and HIV with a main sex partner and intentions to use a condom with a main sex partner (β_HIV= .31, p <.001, and β_STD= .32, p < .001). This supports the continued inclusion of this construct in models of sexual and other health-related behaviors.     

Risk drinking and contraception effectiveness among college women

Risk drinking, especially binge drinking, and unprotected sex may co-occur in college women and increase the risks of STI exposure and pregnancy, but the relationships among these behaviors are incompletely understood. A survey was administered to 2012 women of ages 18–24 enrolled in a public urban university. One-quarter of the college women (23%) drank eight or more drinks per week on average, and 63% binged in the past 90 days, with 64% meeting criteria for risk drinking. Nearly all sexually active women used some form of contraception (94%), but 18% used their method ineffectively and were potentially at risk for pregnancy. Forty-four percent were potentially at risk for STIs due to ineffective or absent condom usage. Ineffective contraception odds were increased by the use of barrier methods of contraception, reliance on a partner's decision to use contraception, and risk drinking, but were decreased by the use of barrier with hormonal contraception, being White, and later age to initiate contraception. In contrast, ineffective condom use was increased by reliance on a partner's decision to use condoms, the use of condoms for STI prevention only, and by risk drinking. Thirteen percent of university women were risk drinkers and using ineffective contraception, and 31% were risk drinkers and failing to use condoms consistently. Risk drinking is related to ineffective contraception and condom use. Colleges should promote effective contraception and condom use for STI prevention and consider coordinating their programs to reduce drinking with programs for reproductive health. Emphasizing the use of condoms for both pregnancy prevention and STI prevention may maximize women's interest in using them.     

The relationship between attitude,assertiveness and condom use

Abstract

This study investigated the relationships between attitudes, assertiveness and intention to use and actual use of condoms as a means of preventing infection from sexually transmitted disease. Both homosexual (n = 83) and heterosexual men (n = 128) participated in the survey. It was found that the homosexual men held more favourable attitudes, and reported greater intended and actdal condom use than the heterosexual men. Intention to use condoms was positively related to favourable attitudes, which were related to condom-specific assertiveness for both groups. For the heterosexual men only, general social assertiveness was negatively related to attitudes toward condoms. It was concluded that condom use was reassuringly frequent among homosexual men, but not for heterosexual men. Efforts to increase condom use among the latter will need to take into account negative attitudes and, in particular, the possible perception of condom use as an effeminate behaviour.     

Sexual Self‐Control and Male Condom‐Use Outcome Beliefs: Predicting Heterosexual Men's Condom‐Use Intentions and Behavior1

A model of condom‐use intentions and behavior that we previously developed for women was replicated and extended with heterosexual men (n= 203; M age = 20.1 years). The general determinants of intentions to use condoms were consistent for men and women. The predictors of general condom attitudes and condom‐use self‐efficacy differed across gender. Male condom‐use outcome beliefs and sexual self‐control emerged as predictors of sexually experienced men's condom attitudes and self‐efficacy, respectively. In a 3‐month follow‐up, intentions and sexual self‐control predicted condom‐use behavior. These findings have implications for specificity vs. generality in the correlates of common behaviors across groups, the study of gender differences in condom use, and the development of intervention content targeted to specific populations.     

Alcohol use and serial monogamy as risks for sexually transmitted diseases in young adults.

Alcohol and condom use were assessed using global, situational, and event-level analyses in a sample of young adults (N = 305). Results varied by methodology, event, and partner type; an inverse association between alcohol and condom use was found only at the event level. Participants with strong sex-related expectancies used condoms less frequently when drinking at the time of 1st intercourse with their current partner. For most recent event with a regular partner, alcohol use was unrelated to condom use, but gender, relationship duration, and oral contraceptive use accounted for more than 25% of the variance. Thus, alcohol may increase risky sex early in a relationship, whereas partner familiarity and alternate contraceptive use play a larger role as relationships develop.     

Self-Assessed Risk of HIV and Other STIs Among Young Adults in Norway and Croatia

The purpose of the present study is to explore how sexually active young Norwegian and Croatian adults assess the risk of being infected with HIV and other STIs. Study results are based on a 2009–2010 large-scale national probability survey of young adults aged 18–24 in Croatia (n = 1,005) and Norway (n = 871). A majority of sexually active young adults in Croatia and Norway assessed the risk of becoming infected with HIV or other STIs as low or negligible. Among non-condom users, 85–98% determined they had low or no risk of getting infected with HIV. The corresponding figures for STIs were 77–79%. In both countries a higher HIV risk self-assessment was observed among those who had had same-sex sexual experience, those who reported a higher number of sex partners during the past year, and those who were single. When investigating the patterns of HIV/STI risk assessment, gender and country-related differences appeared. Condom use associated with higher risk assessment was significant only among Croatian men. The strong perception of condom use as being a male responsibility in Croatia may be the reason for a higher risk assessment for unwanted pregnancy and HIV/STIs when protection fails. The risk assessment for HIV/STIs was not associated with partner turnover in Croatian men. New campaigns need to develop gender-sensitive messages, particularly targeting men who believe that a great number of sexual partners is a sign of manliness and women who shy away from their responsibility to use protection.     

Adaptation of an HIV Medication Adherence Intervention for Adolescents and Young Adults

Rising rates of human immunodeficiency virus (HIV) infection among adolescents and young adults underscore the importance of interventions for this population. While the morbidity and mortality of HIV has greatly decreased over the years, maintaining high rates of adherence is necessary to receive optimal medication effects. Few studies have developed interventions for adolescents and young adults and none have specifically been developed for sexual minority (lesbian, gay, and bisexual; LGB) youth. Guided by an evidence-based adult intervention and adolescent qualitative interviews, we developed a multicomponent, technology-enhanced, customizable adherence intervention for adolescents and young adults for use in a clinical setting. The two cases presented in this paper illustrate the use of the five-session positive strategies to enhance problem solving (Positive STEPS) intervention, based on cognitive-behavioral techniques and motivational interviewing. We present a perinatally infected heterosexual woman and a behaviorally infected gay man to demonstrate the unique challenges faced by these youth and showcase how the intervention can be customized. Future directions include varying the number of intervention sessions based on mode of HIV infection and incorporating booster sessions.     

Predictors of Condom Use Among African American Males at High Risk for HIV1

This study compared the influence of HIV risk behaviors and condom use attitudes on condom use among heterosexual African American males. Three models were tested: (a) HIV risk, (b) condom use attitudes, and (c) a model combining the previous two. Brief street intercept interviews were administered to African American males in 2 matched pairs of census tracts. Results are based on 589 males reporting vaginal sex in the last 30 days. The General Linear Test (GLT) was used to test the ability of regression models to reduce error variance. The condom use, attitude model was sufficient to predict frequency of condom use regardless of partner type. The strongest predictors of condom use were condom use enjoyment, social norms, self-efficacy, and social influence.