Associations of a Sexually Transmitted Disease Diagnosis During a Relationship with Condom Use and Psychosocial Outcomes: (Short) Windows of Opportunity

Few studies have examined whether and how receiving an sexually transmitted disease (STD) diagnosis while in a romantic relationship relates to condom use and psychosocial sexual outcomes. Using dyadic data, we examined associations of a personal or a partner’s STD diagnosis during a relationship with condom use, monogamy intentions, condom intentions and attitudes, and STD susceptibility and communication. Because beliefs about how the STD was acquired may shape associations with behavior and cognitions, gender and suspecting that one’s partner had other sexual partners (i.e., partner concurrency) were examined as moderators. Participants were 592 individuals in 296 couples expecting a baby; 108 individuals had been diagnosed with an STD during the relationship. Personal STD diagnosis was unrelated to outcomes or was associated with increased risk. A partner’s diagnosis related to more positive condom intentions and attitudes. Among men who suspected concurrency, both a personal and a partner’s STD diagnosis were associated with less condom use. Receiving the STD diagnosis during pregnancy was associated with greater susceptibility and marginally greater condom use. Results suggest potential benefits of enhancing communication and encouraging joint risk reduction counseling among couples, engaging men more fully in preventive efforts, and capitalizing on the short window during which risk reduction occurs.     

Sexual sensation-seeking and worry about sexually transmitted diseases (STD) and human immunodeficiency virus (HIV) infection among Spanish adolescents

The target of this study is to assess the relationship between sexual sensation-seeking, worry about STD/HIV infection, and risky sexual behaviours among 182 adolescents aged 13-18 years. Results showed that participants who engaged in a wider range of potentially risky behaviours (e.g., sexual experience, higher number of sexual partners in last six months, and the last sexual contact with a casual partner) obtained higher sensation-seeking scores. It was also found that adolescents who engaged in sex with a casual partner in their last sexual contact reported being worried about STD/HIV infection, but adolescents having sex with a steady partner underestimated their risk of STD/HIV infection. These results support the idea that preventive programmes may benefit from including components aimed at teaching adolescents to satisfy their preferences for sexual sensation-seeking through novel and stimulating sexual behaviours involving minimum risk. Similarly, the need to include components aimed at making adolescents become realistically aware of the STD/HIV risk involved in unprotected intercourse with steady love partners is highlighted.     

Blurring Emotional Safety With Physical Safety in AIDS and STD Risk Estimations: The Casual/Regular Partner Distinction1

Research on the sexual behavior of young adults has documented a casual/regular partner distinction in terms of condom use and perceived risk of contracting sexually transmitted diseases (STDs). How this population distinguishes between the 2 partner types has not been known, making it impossible to assess the rationality of this strategy. In the present study, college students' conceptions of casual vs. regular partners were explored and used to create 3 sexual partner scenarios: casual, regular with insufficient risk information (regular emotionally safe), and regular with sufficient risk information (regular objectively safe). Participants rated the target partner in terms of emotional safety, AIDS/STD risk, and likelihood of condom use. Results showed participants to be blurring emotional with physical safety; i. e., employing an emotionally based strategy in rating perceived risk.     

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.     

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.     

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.     

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.     

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.     

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.     

Can Computer‐Mediated Interventions Change Theoretical Mediators of Safer Sex? A Meta‐Analysis

The purpose of this study was to conduct a meta‐analysis of computer‐mediated interventions (CMIs) aimed at changing theoretical mediators of safer sex. Meta‐analytic aggregation of effect sizes from k = 20 studies indicated that CMIs significantly improved HIV/AIDS knowledge, d = .276, p < .001, k = 15, N = 6,625; sexual/condom attitudes, d = .161, p < .001, k = 12, N = 5,816; and condom self‐efficacy, d = .186, p < .001, k = 10, N = 3,308. Although assessed in fewer studies, CMIs also significantly increased perceived susceptibility, condom communication, and condom intentions. Effect sizes were found to be of similar magnitude to human‐delivered interventions. Exploratory analysis of moderating influences detected few significant variables. Implications for the development and testing of CMIs are discussed.     

Relationship commitment and its implications for unprotected sex among impoverished women living in shelters and low-income housing in Los Angeles County.

OBJECTIVE: To examine how relationship commitment among impoverished women is associated with their frequency of unprotected sex. DESIGN: Cross-sectional analyses were conducted on survey data from a probability sample of 445 women initially sampled from shelters and low-income housing in Los Angeles County. MAIN OUTCOME MEASURE: Frequency of unprotected sex in a typical month was derived as the product of 2 items: how often the woman had sex with her partner in a typical month and how often a male condom was used. RESULTS: For both sheltered and housed women, relationship commitment predicted more frequent engagement in unprotected sex with their partner, even after controlling for the type of relationship (primary vs. casual). However, this association could not be accounted for by perceived partner monogamy, ability to refuse unwanted sex, perceived HIV susceptibility, and condom use self-efficacy. Among housed women only, never asking the partner to use a condom partially accounted for more frequent engagement in unprotected sex among women with stronger relationship commitment. CONCLUSION: Results emphasize the importance of relationship commitment issues in HIV prevention interventions with impoverished women, and the need for a better understanding of relationship commitment and its influence on condom use in this population.     

Intentions to Use the Female Condom Among African American Adults1

The present study tested whether the theory of reasoned action (TRA) and self‐efficacy for female condom use predicted intentions to use the female condom among African American adults. Participants were 137 men and women, 18 to 35 years of age, who were recruited from a community‐based organization. Results indicate that: (a) the TRA model has predictive utility for women's but not for men's intentions to use the female condom with both main and casual sex partners, and (b) the TRA model was a better predictor of intentions to use the female condom with main than with casual partners. Implications for female condom‐use promotion are discussed.     

Condom use in steady and casual sexual relationships: Planning, preparation and willingness to take risks among adolescents

Condom use within steady and casual sexual relationships was examined among 14-16 year old Dutch adolescents from secondary school (N?=?140). It was hypothesised that among adolescents sex and subsequently condom use with casual sex partners is less likely to be considered in advance, more context-dependent and less habitual; whereas the opposite is true for steady relationships. Therefore, preparatory behaviours (buying and carrying condoms and communicating about condom use) were expected to mediate the intention-behaviour relation in the context of steady relationships, but not in the context of casual sex. Results confirmed that condom use with steady sex partners was explained by preparatory behaviours, habits, and to some extent, behavioural willingness, and that preparatory behaviours mediated the intention-behaviour relationship. Condom use with casual sex partners was predicted by risk willingness and intentions, without any mediation by preparatory behaviours. The results indicate that it is essential to increase awareness among adolescents that unexpected sexual situations may occur and to train them to take preparatory actions.     

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.     

Effect of Persuasive Appeals in AIDS PSAs and Condom Commercials on Intentions to Use Condoms1

The study compared the effect of five persuasive appeals used in AIDS PSAs and condom commercials (fear arousal-no sex/condom theme; fear arousal-sex/condom theme; erotic; humorous; factual) on 122 male and 114 female college students' i]ntentions to use and taking of condoms. Results showed that the two fear appeals were more effective than other appeals in increasing intentions to use condoms with a new partner. The fear appeal–no sex/condom theme was more effective than other appeals for increasing intentions to use condoms with a steady partner. Compared to men, women rated commercials as more effective for increasing intentions to use condoms with a new partner. Persuasive appeals had no effect on the taking of free condoms. The best predictor of commercial effectiveness was the degree to which a commercial evoked a high fear of AIDS. Other significant predictors were subjects' a]ttitude toward condom use and commercial qualities of being humorous, romantic, credible, and factual. Implications are that all five types of appeals are potentially effective for use in AIDS PSAs. Recommendations include combining appeals (e.g. fear with erotic) and emphasizing the positive features of condom use.     

Predicting Condom Use in African American STD Patients: The Role of Two Types of Outcome Expectancies1

This study examined the association of two types of condom use outcome expectancies (self-approval and partner reaction) with patterns of safer sexual behavior among predominantly African American patients at a sexually transmitted diseases (STD) clinic. As expected, both individuals' own self-approval outcome expectancies and their partner reaction outcome expectancies predicted consistency of condom use, although partner reaction expectancies predicted condom use above and beyond the effects of self-approval expectancies. Furthermore, individuals who believed that they and their partner shared positive condom use outcome expectancies reported the greatest use of condoms. These findings suggest that HIV prevention programs should address both types of condom use outcome expectancies in order to maximize behavior change.     

The AIDS Risk Reduction Model: Examining Intentions to Use Condoms Among Injection Drug Users1

This paper uses the AIDS Risk Reduction Model (ARRM) to examine psychosocial factors involved in adopting safer sex practices in a sample of Los Angeles injection drug users (IDUs; n= 161) who reported having more than one sex partner in the year preceding the interview. The ARRM hypothesizes that behavior change is a process occurring in three stages: (a) labeling one's behavior as problematic, (b) making a commitment to behavior change, and (c) taking action to accomplish that change. We test the first two stages of the model using a measure of perceived risk of HIV infection (Stage I), and intentions to use condoms always during vaginal or anal sex in the next year (Stage 2). We examine differences in the predictive value of the ARM between IDUs who reported using condoms in the year prior to the interview and those who reported not using them. We identify leverage points in the model-factors which appear to have a major influence on intentions to use condoms and which may be amenable to change through educational or other types of intervention. For both condom users and non-users, susceptibility to AIDS predicted perceived infection risk (Stage I). For condom users, knowledge about AIDS also predicted perceived risk. For both groups, self efficacy, peer norms concerning condom use, and the perceived pleasure of using condoms predicted intentions to use condoms (Stage 2). Our findings do not support either direct or indirect relationships between the Stage 1 and Stage 2 outcome variables for either group.     

Having “The Talk”: Individual,Family, and Partner Factors on Unprotected Sex among Female Adolescent Offenders

This study assessed the influence of individual age and substance use, family support and communication, and partner support and communication on the frequency of unprotected sex among incarcerated adolescent females. Subjects (n = 273) completed a survey on psychosocial correlates and risk behaviors for sexually transmitted infections (STI). Communication with male partners and sex while under the influence have a significant impact on condom use. Findings highlight the necessity of providing assertive communication skills training and increasing self-efficacy as STI/HIV prevention components for adolescent females thus empowering their decision-making processes.     

Incorporating adolescent females' perceptions of their partners' attitudes toward condoms into a model of female adolescent condom use

The highest rates of sexually transmitted infections in the U.S. occur among adolescent females. One prevention strategy promoted for sexually active adolescents is condom use: therefore, influences on correct and consistent condom use are worth examining. Because interventions and observational research into predicting and increasing condom use have yielded mixed results, we hypothesized that a theoretically driven model incorporating female adolescents' perceptions about partner sentiments along with their own perceptions, intentions, and behaviours would improve condom use predictions. We also measured condom use errors and consistency for a more precise estimate of effective use than is common in the literature. In three structural equation models tested on a sample of 519 female adolescents, we found that intentions were associated with both correct and consistent condom use; that females' expectancy beliefs about condom use were associated with intentions; and that females' expectancy beliefs about partners' sentiments reduced the impact of their expectancy beliefs about condom use. The implications of these relations upon condom use correctness and consistency are discussed with respect to informing interventions, among other future research.     

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.