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.     

Beliefs about condoms and accessibility of condom intentions in Hispanic and African American youth

The construct accessibility model (CAM) holds that constructs are most likely to influence behavior when they are accessible in memory. While the theory of reasoned action sees intention as an important determinant of behavior, the CAM predicts that the intention to act upon a given health behavior is not likely to be acted upon unless the intention is in an accessible state. Therefore, people who frequently talk about or think about using condoms are likely to have condom related constructs available and use them when needed. This paper reports findings from the pilot phase of a project to identify beliefs which influence condom use in Hispanic and African-American youth living in Detroit. 15 male and 15 female Hispanics and 17 male and 17 female African-Americans aged 15-21 years of mean and median age 18.5, were interviewed face-to-face in 1989 with the goal of identifying condom beliefs which may influence their condom use. 80-82% of male participants, 53% of Hispanic females, and 100% of Black females had experienced sexual intercourse, with age at first intercourse ranging between 13.1 and 16.5 years. 88% of Black women and 7% of Hispanic women were pregnant at the interview. Regarding participants' level of preventive knowledge, all but 1 recently immigrated Hispanic female knew HIV was transmitted by needles and sexual intercourse. 87% of Hispanics and 94% of African-Americans responded that condoms protect against AIDS, but only 13% of Hispanics and 47% of African-Americans knew that nonlatex condoms do not. Some participants expressed concern that condoms reduce sensitivity and/or break during intercourse. Controlling for sexual activity, 25% of Hispanic females, 83% of Hispanic males, 71% of African-American females, and 80% of African-American males had ever used a condom; no Hispanic and 14% of Blacks reported using them consistently in the 12 month period preceding the interview. With 100% of African-American males and 97% of Black females reporting thinking about using condoms compared to 80% of Hispanics, the study findings suggest that condom intentions are more accessible in African-Americans than among Hispanics.     

An experimental comparison of two AIDS prevention interventions among young Zimbabweans.

In 1990, psychologists compared data on 42 student teachers at the University of Zimbabwe who underwent an information-based health education session designed to increase condom use with data on 42 other student teachers who underwent a skills-based health education session. They wanted to determine whether skills-based, participative interventions are more effective in changing attitudes toward AIDS and practices than are information interventions. Mean age for all student teachers was 23.1 years. All participants completed a questionnaire before the interventions and the same questionnaire 4 months after the interventions. The 1-hour information-based intervention included a talk about HIV transmission and prevention and a question and answer period after the talk. A condom fitting demonstration, individual practice, group formulation of behavioral self-management approaches, sketches of social and assertiveness skills used to negotiate condom use, pair role plays, group psychodrama about effects of AIDS, and a video about a popular African musician with AIDS comprised the 90-minute skills-based, participative intervention. The skills-based group exhibited more knowledge about condoms and their correct use (p.001), higher self-efficacy (p.05), fewer obstacles to condom use (p,05), and fewer acts of intercourse without condom use in the last 30 days (p.05) than the information-based group. These results were especially encouraging because risk reduction behaviors were maintained over 4 months. Thus more skills-based interventions and skilled AIDS educators are needed in Africa. The few psychologists in Africa can train educators, design training programs and manuals, and develop effective support and supervision systems.     

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 relationship between psychosocial factors and condom use among African-American adolescents

The present investigation explored the relationship between psychosocial factors and condom use by African-American adolescents. Two hundred twenty-nine males, aged 14 to 19 years, responded to a health behavior survey that gathered information on demographics, HIV knowledge, perceived certainty of future condom use, present and past use of condoms, and intention to use condoms in the next six months. Several psychological variables, including sexual self-efficacy and self-esteem, were also measured. It was found that the majority of participants were sexually active by age 13, had four or more lifetime sexual partners, and were using condoms regularly. Multiple linear regression analysis indicated that sexual self-efficacy predicted perceived certainty of condom use. In addition, self-esteem and sexual self-efficacy predicted intention to use condoms. These findings highlight the need to develop HIV prevention curricula for African-American male adolescents that not only emphasize the potential risks associated with having multiple sexual partners, but also include components to enhance self-worth and sexual self-efficacy.     

Moderation and Mediation of HIV-Prevention Interventions: Relationship Status,Intentions, and Condom Use Among College Students1

This study examined the effects of 2 HIV prevention interventions on condom use and mediators of condom use. College students were randomly assigned to a control condition or an intervention (communication skills or technical skills). Those who received either intervention had greater condom use self-efficacy, more positive condom use attitudes, and stronger intentions to use condoms than did controls. Furthermore, 3-month follow-up data revealed that students in either intervention who were not in a steady dating relationship reported more consistent condom use than did those in the control condition, whereas students who were in either intervention and in a relationship reported somewhat less consistent condom use than did those in the control condition. Analyses suggested that effects of the interventions on condom use were mediated by increased intentions to use condoms.     

Health beliefs and teenage condom use: a prospective study

The authors investigated the extent to which Health Belief Model (HBM) measures can be used to predict subsequent sexual activity and consistency of condom use among teenagers, especially those who report having new sex partners. Results from a longitudinal survey of sex behavior and HIV-relevant cognitions among 258 sexually active 16 and 18 year olds in Dundee, Scotland, are reported. Participants responded to a confidential postal questionnaire on their demographic characteristics, previous sexual experience, prior condom use, beliefs specified by the HBM, peer norms regarding condom use, and condom use intentions. Measures of sexual behavior and condom use consistency were then included in a follow-up questionnaire 1 year later. Demographic and HBM measures, as determined through discriminant analysis, did not account for significant proportions of variance in the consistency of condom use or mediate the effects of prior sexual experience or demographic measures. The respondents who reported more frequent sexual intercourse were less likely to use condoms consistently while those who had used condoms previously reported more consistent use. Female respondents were less likely than the young men to follow through upon their intentions to consistently use condoms.     

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.     

Sexual risk behaviour among HIV-infected women in the first twelve months after delivery in South Africa

This study aimed to assess sexual risk behaviour and its social correlates in HIV-infected women living in rural South Africa at six and twelve months post-partum. Participants were 699 HIV-positive women recruited prenatally by systematic sampling from twelve community health centres in Mpumalanga province, South Africa (mean age = 28.4 years, SD = 5.7; married =41.1%; serodiscordant or unknown partner status = 74.9%). They self-reported on their sexual activity six to twelve months after delivery; including use of condoms and partner involvement. Generalised linear mixed models were utilised to estimate unsafe sex outcomes from a prevention of mother to child transmission (PMTCT) intervention, socio-demographic factors, disclosure, and male involvement. About 20% of sexually active women in the past week had used condoms inconsistently at six and twelve months after delivery. Moreover, 16% and 18% of the women had not used a condom at last sex and 11% and 13% had unprotected sex with HIV-uninfected or unknown-status partners following delivery at six and twelve months, respectively. Higher inconsistent condom use was likely with lower male involvement. Promotion of condom use post-partum, as well as male involvement in sexual decisions, are important for safer sex post-partum by seropositive women.     

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.     

Condom Influence Strategies in a Community Sample of Ethnically Diverse Men and Women1

Few studies have examined comprehensively the ways in which men and women at risk for HIV infection influence their partners to use condoms. This study examines the condom influence strategies (CISs) of an ethnically diverse community sample of 113 (55% male) heterosexually active men and women. Results indicate that individuals at risk for HIV endorse a variety of CISs (withholding sex, direct request, seduction, relationship conceptualizing, risk information, deception, and pregnancy prevention) when attempting to procure condom use with a sexual partner. These CISs were related significantly and meaningfully to a set of safer sexual variables including 3 measures of condom use. Significant gender differences in CISs were not found. Results suggest that safer sexual behavior theories should continue to focus on interpersonal aspects of condom use and underscore the importance of an interpersonal approach to safer sexual intervention.     

Gay Identity and HIV Risk for Black and Latino Men Who Have Sex with Men

Strong gay identity among white men who have sex with men (MSM) has been associated with decreased HIV risk, but data for black and Latino MSM (BLMSM) are inconclusive. We examined gay identity and HIV risk among BLMSM to inform social and structural HIV intervention strategies. BLMSM were administered a computerized survey as part of an HIV research study during 2011–2012 conducted in New York City. We used a brief scale of Gay Identity Questionnaire. After data analysis, Stage I (not fully accepting) and Stage II (fully accepting) gay identity were determined based on participant responses. We used logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the association between gay identity with HIV risk and social determinant factors. Among 111 self-identified BLMSM (median age = 32 years, 68.4% with some college or higher education), 34.2% reported receptive anal sex without condoms in the previous three months. Gay Identity Questionnaire Scale assessment indicated that 22 (19.8%) were Stage I, and 85 (76.6%) were Stage II in this BLMSM sample. Stage II gay identity was more likely seen among BLMSM with high involvement in the gay community (aOR 3.2; CI 1.00, 10.26) and less likely among BLMSM who exchanged sex for food or shelter (aOR 0.15; CI 0.02, 0.98). Fully accepting gay identity may be protective for BLMSM as it relates to transactional sex; these factors warrant further research and consideration as part of HIV prevention strategies.     

College Students Use Implicit Personality Theory Instead of Safer Sex1

Many college students engage in high levels of unsafe sexual behavior that puts them at risk for HIV infection. To better understand the dynamics underlying college students' unsafe behavior, focus group discussions were conducted with 308 students (146 men and 162 women). The results showed that, instead of consistently using condoms, many college students use implicit personality theories to judge the riskiness of potential sexual partners. Specifically, partners whom college students know and like are not perceived to be risky, even if what students know about these individuals is irrelevant to HIV status. The students determine the riskiness of partners they do not know well based on superficial characteristics that are also generally unrelated to HIV status. Therefore, AIDS prevention interventions for college students must expose the ineffectiveness of the students' use of implicit personality theories to determine potential partners' riskiness, and the “know your partner” safer sex guideline should be abandoned.     

Psychosocial factors associated with adolescent boys' reports of dating violence

The prevalence of dating violence, as well as its association with psychosocial factors, was examined among a nationally representative sample of 9th- through 12th-grade U.S. boys (N = 7,434) who completed the 1999 Youth Risk Behavior Survey. The dependent variable was physical dating violence; the independent variables were violence, suicide, substance use, and sexual risk behavior. Unadjusted odds ratios (OR) and 95% confidence intervals (CI) were examined. Multivariate logistic regression was used to examine all significant independent variables from the univariate models. Adjusted OR and 95% CI were examined to assess the significance of these relationships. In terms of prevalence, 9.13% of the boys reported physical dating violence. Boys who reported sad/hopeless feelings (OR = 1.68), had attempted suicide (OR = 2.22), reported fighting (OR = 1.81), had multiple sex partners (OR = 3.53), and reported nonuse of condoms (OR = 1.66) were more likely to report physical dating violence. These findings indicate that physical dating violence among adolescent boys may be a more serious problem than has previously been recognized. It was concluded that intervention programs should include a focus on boys as not only perpetrators but also recipients of dating violence.     

Brief counseling to reduce AIDS risk in intravenous drug users and their sexual partners: Preliminary results

Intravenous drug users (N = 88) and their sexual partners (N = 45) were randomly assigned to either a brief counseling intervention or an information-brochure only condition (aimed at reducing behavioral risk for HIV infection). At 10 day follow-up, intravenous drug users exposed to brief counseling were more knowledgeable about risk behaviors, and reported higher levels of self-efficacy and communication skill, and more frequent use of condoms and sterilisation of needles. At 90 day follow-up, intravenous drug users were more accepting of guidelines to reduce sex-related risk and reported greater self-efficacy in relation to drugs. Sexual partners who received brief counseling showed a small reduction in unprotected sex (at 90-day follow-up), while those receiving brochures were slightly less likely to use condoms. Methodological problems of the study are discussed.     

Demographic correlates of constant condom use among sex workers in Tangail, Dhaka, Bangladesh

Consistent condom use, particularly by promiscuous individuals, is a major safeguard against sexually transmitted diseases, including HIV/AIDS. This study examines some demographic factors that may affect such use among Bangladeshi female commercial sex workers at a brothel in Tangail (n = 196; mean age = 23.44 years), and the streets of Dhaka (n = 112; mean age = 25.92 years). The chi2 results indicated that sex workers over 19 years of age were 2.52 times more likely than adolescents under 19 to work on the street rather than at a brothel (chi2 = 8.73, p < .0.01, OR = 2.52, 95% CI = 1.35-4.72). Brothel sex workers aged over 19 years reported 3.26 probability to regularly use condom with clients than those adolescents aged below 19 years (chi2 = 6.23, p < 0.01, OR = 3.26, 95% CI = 1.25-8.53). This study found age to be a significant demographic correlate of regular condom use, particularly, among the brothel workers.     

HIV prevention among drug users: outcome of a network-oriented peer outreach intervention.

A network-oriented HIV prevention intervention based on social identity theory and peer outreach was implemented for HIV positive and negative drug users. A community sample of 250 were randomly assigned to an equal-attention control condition or a multisession, small-group experimental condition, which encouraged peer outreach; 94% of participants were African American, and 66% used cocaine or opiates. At follow-up, 92% of participants returned, and experimental compared with control group participants were 3 times more likely to report reduction of injection risk behaviors and 4 times more likely to report increased condom use with casual sex partners. Results suggest that psychosocial intervention emphasizing prosocial roles and social identity, and incorporating peer outreach strategies, can reduce HIV risk in low-income, drug-using communities.     

The role of sexual arousal and sexual partner characteristics in HIV+ MSM's intentions to engage in unprotected sexual intercourse

OBJECTIVE: This study investigated the effects of sexual arousal and sexual partner characteristics as determinants of HIV+ men who have sex with men's (MSM) intentions to engage in unprotected sex. DESIGN: In a computer-based controlled experiment, 67 HIV+ MSM underwent a sexual arousal manipulation and indicated their intentions to engage in unprotected sex with hypothetical partners who differed in terms of HIV serostatus, physical attractiveness, relationship type, and preference for condom use. MAIN OUTCOME MEASURES: Computer-delivered questions assessed HIV+ MSM's intentions to engage in various sexual acts with each hypothetical partner. RESULTS: As predicted, sexually aroused HIV+ MSM indicated stronger intentions to engage in unprotected sex than nonaroused HIV+ MSM; and having a partner who was attractive, HIV+, long term, or who preferred not to use condoms, also led to riskier intentions. Several significant interactions among these factors were found, which were generally consistent with predictions and with theory and research on cognitive processing and decision making. CONCLUSIONS: These findings have implications for understanding risky sexual behavior among HIV+ individuals and for the development of interventions to reduce this risk.