Perceived sexual self-control and condom use with primary and casual sex partners: age and relationship agreement differences in a Portuguese sample

Abstract

Objective: Consistent condom use is still not ideal. Research showed that perceived sexual self-control is associated with greater likelihood of using condoms. However, this association seems to vary according to age and relationship agreement (i.e. non-consensual non-monogamy, NCNM vs. consensual non-monogamy, CNM).

Design: Cross-sectional study with 307 heterosexual users of a dating web site for romantically involved individuals (81.8% men; M_age = 42.24, SD?=?9.65, range: 23–76 years). All individuals were in a romantic relationship (M_length = 13.47 years, SD?=?9.39).

Measures: Demographic information, perceived sexual self-control, condom use frequency (casual sex partners; primary partner in the last 3 months) and relationship agreement.

Results: Independently of relationship agreement, perceived sexual self-control was positively associated with condom use frequency with casual sex partners among younger and middle age participants, but not older ones (>49 years). Regarding the primary partner, a similar pattern emerged for CNM participants. In contrast, no significant association between perceived sexual self-control and condom use frequency with the primary partner emerged for NCNM individuals, regardless of age.

Conclusion: Our findings can inform evidence-based strategies to promote consistent condom use as an effective behaviour to prevent sexually transmitted infections, especially among older and NCNM individuals.     

Determinants of intentions to practise safe sex among 16–25 year-olds

This study aimed at predicting intentions to avoid casual sex and to use condoms, through self-efficacy, attitudes, optimistic bias in perceived risk, knowledge and past sexual risk behaviour. To this end, a mixed-sex sample of high school and university students between 16 and 25 years completed questionnaires at two points in time. Intentions to avoid casual sex were predicted positively by the attitude towards avoiding casual sex and assertiveness in sexual relationships, and negatively by communication about sex. The intention to use condoms was predicted positively by the perceived benefits of condom use, and negatively by past sexual risk behaviour and fatalism. Gender and sexual experience were found to have a moderating influence, implying that AIDS education should use different messages for these target groups. Since the results show that condom use is quite a powerful habit and that sexually non-active subjects had more positive intentions towards safe sex, AIDS education should start at a young age in order to establish safe sex habits from the beginning. © 1997 John Wiley & Sons, Ltd.     

Romantic Ideals,Fear of Negative Implications,and the Practice of Safe Sex1

The present study examined how young heterosexuals’ beliefs about the power of condom use to destroy their romantic ideals and to lead to negative implications affected both their intentions and their actual behavior of using and discussing the use of condoms with sexual partners. The extra predictive power gained from considering these beliefs, in addition to subjects’ beliefs concerning whether condoms reduced their risk of contracting HIV, was examined within the context of Fishbein and Ajzen's (1975) theory of reasoned action. One-hundred-and-two sexually active heterosexual students participated in the study. At the first wave of data collection, beliefs concerning the potential of condoms to reduce risk, to destroy romance, and to lead to negative implications were assessed, as were norms and intentions. Measures of actual behavior were obtained three months later for both regular and casual/new partners. The results of the study indicated that norms and beliefs concerning the risk-reduction effects of condom use were the primary predictors of intentions to use condoms. Subjects’ beliefs concerning whether condoms destroyed their romantic ideals or led to negative implications did not influence their intentions with casual/new partners, although emotional concerns played a minor role in determining intentions with regular partners. In contrast, these emotional concerns had a major impact in determining actual behavior for all partner types. Although intentions partially predicted behavior, beliefs about reducing risk, destroying romance and fear of negative implications had strong and direct influences on behavior, especially in the case of casual/new partners. Additional analyses revealed gender differences in the determinants of behavior. Females, in contrast to males, were less able to act in accord with their attitudes about using condoms to reduce their risk of contracting HIV, and were also less able to act in conformity with their subjective norms with less well-known partners. Although both males and females were similarly affected by more emotional concerns with new and/or casual partners, gender differences occurred in how these emotional factors affected behavior with regular partners. Implications of the finding that behavior is determined to a large extent by more emotional concerns that are not factored in ahead of time when formulating intent are discussed.     

Barriers to Condom Use and Safer Sex Talk among College Dating Couples

Using an open-ended questionnaire response format, this study examined self-generated barriers to condom use and safer sex talk among 119 heterosexual college dating couples at the University of New Mexico (total N=238). Data were collected from both members of these dyads. Reasons for abstaining from intercourse were also elicited. Several general response categories emerged including no perceived risk; spontaneity; deliberate choice; negative attitudes; and a lack of perceived self-efficacy for enacting condom use and safer sex discussion. Explanations for abstinence included religious/moral prohibitions; lack of readiness for intercourse; and a fear of being emotionally hurt. Few differences emerged across gender, ethnicity (Caucasian vs Hispanic), and prior sexual experience (participant had intercourse prior to current relationship vs did not). Selected reasons for not using a condom and/or discussing safer sex (e.g. partner is monogamous) were cross-validated with the self-reported behavior of the respondent's dating partner. In general, participants reasons for perceived non-risk were not supported by their partner's reported behavior. Implications of these findings for sexual risk reduction programs include: establishing realistic goals for safer sex behavior and talk within committed relationships, acknowledging the impact of passion on safer sex, and addressing knowledge gaps in risk perception.     

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.     

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.     

A six-month follow-up of adolescents' sexual risk-taking,HIV/AIDS knowledge,and attitudes to condoms

A follow-up study was conducted to investigate change in sexual behaviour, knowledge about HIV/AIDS transmission, and attitudes to condoms over a 6-month period in a sample of late-adolescent students. The study also obtained subjective reports of HIV/AIDS-relevant change. Overall there was a decrease in sexual risk-taking behaviour with casual partners but no change occurred in sexual behaviour with regular partners, knowledge about HIV/AIDS, attitude towards condoms, or intention to use a condom on next sexual encounter. Examination of individual data revealed that, for some adolescents where behavioural change had occurred, this was in the direction of less safe sex. There were few self-reports of change in sexual behaviour, intention to take precautions against HIV/AIDS, or concern about HIV/AIDS over the preceding 6 months. Subjective reports of behaviour change did not correspond with reports of actual behaviour. Low rates of behaviour change are attributed to the failure of adolescents to personalize the threat of AIDS and to their trust in the safety of sex with a regular partner as well as to the lack of relevance of HIV/AIDS education campaigns to this group.     

AIDS Knowledge,Self-Esteem,Perceived AIDS Risk,and Condom Use Among Female Commercial Sex Workers1

This paper explores the effects of type of sexual partner (customer vs. primary partner) and several social psychological enabling resources (self-esteem, perceived personal risk of HIV infection, and knowledge about AIDS/HIV) on condom use among 141 female commercial sex workers. The data examine condom use during the respondents' most recent sexual activity with a male partner. Logistic regression analysis supports earlier findings that commercial sex workers are significantly more likely to use condom during commercial sex with a customer, rather than relational sex with a spouse or significant other. Subsequent multiple logistic regression analysis indicates that, controlling for type of sexual partner (client vs. primary partner), the odds of condom use are significantly increased by the respondents' knowledge about AIDS, level of self-esteem, and personal sense of risk of AIDS infection.     

College Women and Condom Use: Importance of Partner Relationship

Because women who want to use condoms as protection against STDs must gain compliance from their male partners, women's use of condoms was examined within the context of their relationships with their sexual partners. Sexual history, condom attitudes, and relationship information were gathered from a sample of 272 heterosexual college women. For the 121 women with a current sexual partner, logistic regression analyses revealed that both regular condom use and completely consistent condom use were more likely in shorter relationships and for women who perceived lower barriers to use. Regular condom use was also greater in relationships described as high in trust, whereas consistent condom use was greater for women in their first sexual relationships. In addition, many women reported using condoms early in their relationships, but changing to lower levels of use later. Implications of the current findings for safer-sex interventions are discussed.     

Links between sex-related expectations about alcohol, heavy episodic drinking and sexual risk among young men in a shantytown in Lima, Peru

CONTEXT: Alcohol use is frequently identified as a contributor to risky sexual behaviors; however, research results are mixed. Given the conflicting evidence, researchers have focused on other factors, such as expectations about alcohol's effects that might help explain the relationship of alcohol use and risky sexual behaviors. METHODS: Cross-sectional data from 312 sexually experienced males aged 18-30 in a shantytown in Lima, Peru, were used in logistic regression models to identify associations of heavy episodic drinking and sex-related expectations about alcohol with sexual risk behaviors. RESULTS: Heavy episodic drinking was associated with having had two or more sexual partners and having had sex with a casual partner in the past year (odds ratios, 2.8 and 2.5, respectively). After controlling for alcohol consumption, sex-related expectations about alcohol were associated with these high-risk sexual behaviors, as well as with not using a condom at last sex (1.2) and not using a condom at last sex with a casual partner (1.3). CONCLUSION: Beliefs about the effect of alcohol on sexual performance could help explain links between alcohol consumption and risky sexual behavior not completely accounted for by the pharmacological effects of alcohol.     

Safe and Unsafe Sexual Intentions and Behavior: The Effects of Norms and Attitudes1

A study of 85 heterosexual men, 85 heterosexual women, and 82 homosexual men was undertaken to examine the variables that influence intentions to engage in different sexual practices and actual sexual behavior. On the basis of Fishbein and Ajzen's (1975) theory of reasoned action, it was predicted that the strength of intentions would be related to whether behavior was in accord with intentions. Consistent with expectations, the strength of intention to engage in six different sexual practices (e. g., vaginal intercourse, anal intercourse, oral sex) and the three strategies that modify the risk of HIV transmission (sex with an exclusive partner, sex wearing a condom, and looking for a new partner) predicted actual behavior. Second, it was proposed that attitudes toward one's sexual practices and norms would be related to intentions to engage in safe sex. To reflect differential levels in the safety of behavioral intentions, five safety intention groups were formed: (a) nonpenetrative sex, (b) penetrative sex in an exclusive relationship with a condom, (c) penetrative sex in an exclusive relationship without a condom, (d) penetrative sex in a nonexclusive relationship with a condom, and (e) penetrative sex in a nonexclusive relationship without a condom. Norms, rather than attitudes, distinguished the five safety intention groups. the groups intending to engage in safe sex (nonpenetrative sex or penetrative sex with a condom) perceived lower levels of social approval for their sexual practices than the noncondom groups. Additional analyses showed that past behavior had a stabilizing effect on the intention-behavior relationship, but only for the nonpenetrative and noncondom safety intention groups.     

Sexual behaviour in injecting drug users

A survey of the self-reported sexual behaviors of 1239 intravenous drug users recruited off the streets in Sydney, Australia, highlighted the impact of both sexual orientation and gender on the risk of human immunodeficiency virus (HIV) infection in this population. The sample included 908 men (mean age, 27.9 years) and 331 women (mean age, 26.3 years), the majority of whom were unemployed or receiving social security benefits. Among male respondents, 50 were homosexual, 117 were bisexual, and 719 were heterosexual; for females these numbers were 10, 95, and 220, respectively. Oral and vaginal sex were the most commonly reported practices among heterosexuals, while homosexuals primarily reported manual stimulation and oro-genital contact. The regular sexual partners of male intravenous drug users tended not to be addicts, while female drug users were primarily involved with male partners who also abused drugs. Among male respondents, condom use was highest among homosexuals, followed by bisexuals, and lowest among heterosexuals; there were no significant differences by sexual orientation in female respondents' condom use. Overall, condoms were most likely to be utilized in anal sex and least likely in the case of oral sex. Condom use was about 5% lower when a regular as opposed to casual sexual partner was involved. Most of the 64 HIV-positive respondents were homosexuals, suggesting that sexual orientation rather than drug abuse was the primary risk factor. Given the finding that there is substantial variation in condom use among subgroups of intravenous drug abusers, it is recommended that HIV prevention programs adopt a diversified rather than uniform approach.     

Integration of five health behaviour models: Common strengths and unique contributions to understanding condom use

The purpose of this research was to select from the health belief model (HBM), theories of reasoned action (TRA) and planned behaviour (TPB), information–motivation–behavioural skills model (IMB) and social cognitive theory (SCT) the strongest longitudinal predictors of women's condom use and to combine these constructs into a single integrated model of condom use. The integrated model was evaluated for prediction of condom use among young women who had steady versus casual partners. At Time 1, all constructs of the five models and condom use were assessed in an initial and a replication sample (n?=?193, n?=?161). Condom use reassessed 8 weeks later (Time 2) served as the main outcome. Information from IMB, perceived susceptibility, benefits, and barriers from HBM, self-efficacy and self-evaluative expectancies from SCT, and partner norm and attitudes from TPB served as indirect or direct predictors of condom use. All paths replicated across samples. Direct predictors of behaviour varied with relationship status: self-efficacy significantly predicted condom use for women with casual partners, while attitude and partner norm predicted for those with steady partners. Integrated psychosocial models, rich in constructs and relationships drawn from multiple theories of behaviour, may provide a more complete characterisation of health protective behaviour.     

Factors Influencing Condom Use Among African American Women: Implications for Risk Reduction Interventions

Examined factors associated with condom use in a community-based sample of 423 sexually active African American women. Measures were selected to reflect the components in prevailing models of health behavior. Condom users were higher on AIDS health priority, prevention attitudes, stage of change, behavioral intentions, reported more frequent and comfortable sexual communication with partners, perceived greater partner and peer approval for condom use, and reported that peers also used condoms. Women in exclusive relationships evidenced earlier stage of change, lower intentions to use condoms, fewer peers who engaged in preventive behaviors, perceived themselves to have lower risk, and had lower rates of condom use, higher education, and family income. Women in fluid relationships were at particularly high risk, with lower rates of condom use relative to women not in a relationship and greater sexual risk for HIV. Implications for HIV-risk reduction interventions with African American women 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.     

Bringing up condom use and using condoms with new sexual partners: Intentional or habitual?

Abstract

A prospective study of 94 Dutch adults who have casual sexual partners examined whether two important aspects of safe sex, namely bringing up condom use (BCU) and actual condom use (ACU) are intentional or habitual. For each of these aspects, a model based on the Theory of Planned Behaviour (TPB: Ajzen, 1991) was pitted against a similar model that was extended with a path from past to later BCU and ACU, respectively. The results suggest that bringing up the issue of condom use was equally predicted by intentions and past BCU. However, among people with casual partners, using condoms - and more importantly not using condoms - was especially predicted by past ACU, suggesting a strong habitual component. These results are discussed in terms of their implications for safe sex education and the use of theories in safe sex promotion campaigns.     

Factors Explaining the Intention to Use Condoms Among Injecting Drug Users Participating in a Needle‐Exchange Program1

This study identified the psychosocial factors related to condom‐use intention, based on Triandis’ (1980) theory of interpersonal behavior, among 261 injection drug users participating in a needle‐exchange program. With regular partners (n= 139), condom‐use intention was explained by normative beliefs, self‐efficacy, length of relationship with last regular sexual partner, and taking oral contraceptives. Condom‐use intention with casual partners (n= 157) was also associated with self‐efficacy and normative beliefs, on top of cognitive dimension with attitudes and lending used needles. Neither the perception of being HIV‐positive, nor the habit of using a condom was associated with intention. It is thus suggested that interventions aimed at promoting condom use among this clientele be oriented toward the reinforcement of personal convictions as well as toward the development of competencies needed to overcome obstacles, since both relate to the intention to adopt this behavior.     

Integration of five health behaviour models: common strengths and unique contributions to understanding condom use

The purpose of this research was to select from the health belief model (HBM), theories of reasoned action (TRA) and planned behaviour (TPB), information-motivation-behavioural skills model (IMB) and social cognitive theory (SCT) the strongest longitudinal predictors of women's condom use and to combine these constructs into a single integrated model of condom use. The integrated model was evaluated for prediction of condom use among young women who had steady versus casual partners. At Time 1, all constructs of the five models and condom use were assessed in an initial and a replication sample (n?=?193, n?=?161). Condom use reassessed 8 weeks later (Time 2) served as the main outcome. Information from IMB, perceived susceptibility, benefits, and barriers from HBM, self-efficacy and self-evaluative expectancies from SCT, and partner norm and attitudes from TPB served as indirect or direct predictors of condom use. All paths replicated across samples. Direct predictors of behaviour varied with relationship status: self-efficacy significantly predicted condom use for women with casual partners, while attitude and partner norm predicted for those with steady partners. Integrated psychosocial models, rich in constructs and relationships drawn from multiple theories of behaviour, may provide a more complete characterisation of health protective behaviour.