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.     

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.     

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.     

Predicting Women's Intentions to Leave Abusive Relationships: An Application of the Theory of Planned Behavior1

A theoretically derived decision‐making model was applied to predict women's intentions to remain in or to terminate physically abusive relationships with male partners. Participants were 48 women residing in a shelter for battered women who responded to questionnaires assessing the components of the theory of planned behavior. Data provided support for the model. Specifically, women were found to have greater intentions to leave the relationships if they held positive attitudes toward leaving and believed they were in control of leaving the relationship. Normative beliefs were not predictive of intentions to leave. Empirically based suggestions for increasing the effectiveness of interventions are discussed.     

Understanding AIDS preventive behavior with casual and primary partners in homosexual men: The theory of planned behavior and the information-motivation-behavioral-skills model

Abstract

This study examined whether components from the Information-Motivation-Behavioral-Skills Model, in particular information, added explanatory power to factors derived from the Theory of Planned Behavior with respect to predicting AIDS-preventive behaviors among gay men. Participants were recruited from a longstanding cohort study in Amsterdam. Multivariate regression analyses showed that concepts from the Theory of Planned Behavior could account adequately for intentions to use condoms with casual as well as with steady partners. Actual behavior was best predicted by past behavior. In addition, structural equation modeling demonstrated that the causal paths as posited by Theory of Planned Behavior had a good fit to the data. From the presented findings implications for preventive interventions can be drawn. Specifically, interventions to increase condom use with casual partners need to focus at improving perceived behavioral control regarding this behavior, for instance through skills training. Interventions aimed at safer sex within steady relationships should take into account that the HIV-status of the individual and his partner plays an important role in the occurrence of unprotected anal sex in a romantic dyad.     

Cultural practices of Hispanics: implications for the prevention of AIDS

Hispanic Americans have one of the highest rates of HIV seroprevalence among all ethnics groups in the US, with high rates being especially noticeable among women and children. Were it known which cultural factors have the most influence on whether Hispanics engage in high-risk behavior for HIV transmission, prevention interventions could be targeted accordingly. To that end, this study was mounted to identify which Hispanic cultural factors relate to condom use. 117 males and 73 females aged 17-56 years of mean age 25.67 were surveyed in Washoe county, Nevada. These mostly young adults had recently immigrated to the western US. It was initially posited that fate orientation, male- female relationships, family relationships, machismo behavior, and religion would have equal influence with respect to condom use. Analysis found that condom use was largely associated with and determined by men who are the principal buyers of condoms. A machismo attitude toward protecting women by using condoms was also associated with condom use. Neither fate orientation with respect to AIDS, nor religion were important determinants of condom use, even though 86.5% of the respondents were Catholic. The degree to which respondents adhered to traditional Hispanic cultural values was influenced by the degree of education and acculturation. On the basis of these findings, the authors suggest targeting AIDS prevention messages to males, while emphasizing the protection of women through condom use. They also suggest that both education and acculturation levels be assessed before implementing prevention programs.     

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.     

Primacy of Affect Over Cognition in Determining Adult Men's Condom–Use Behavior: A Review1

Prior research suggests that failure to use condoms can be understood within the context of condom‐related attitudes. We reviewed quantitative and qualitative literature on adult men's condom‐use attitudes; condom‐related attitudinal beliefs were classified as cognitive (e.g., effectiveness) or affective (e.g., pleasure‐related), and their relationships to behavior were examined. To determine differences in the effects of cognitive and affective beliefs, we conducted a critical qualitative review, a meta‐analysis, and a “vote‐count.” In support of the primacy of affect hypothesis (Zajonc, 1984), cognitive beliefs were weaker predictors of condom use than were affective beliefs. Results suggest that HIV‐prevention interventions will have greater success by addressing negative affective reactions to condom use in addition to promoting the protective value of condoms.     

Cognitive,Behavioral, and Personality Correlates of HIV-Positive Persons' Unsafe Sexual Behavior1

This study examined sexually risky behaviors of HIV-positive men and women within the framework of social cognitive theory. Condom use was found to be associated with high self-efficacy, positive influeces from social models, and specific condom use expectancies. As risky sexual behavior may be the manifestation of a more general pattern of risk taking that emerges from personality dispositions such as impulsiveness or psychoticism, this possibility was explored with discriminant analyses. Self-reported impulsivity, substance abuse, promiscuity, and deception served as markers of the presumed disposition. While these variables did not reliably distinguish between consistent and inconsistent condom users, they did enhance significantly the classification of individuals who, during the past 6 months, had been sexually abstinent, monogamous, or nonmonogamous. Those who reported more sex partners scored higher on impulsivity, disclosed more involvement with illegal drugs, and showed greater willingness to mislead potential partners about their sexual history than monogamous or sexually abstinent persons with HIV.     

Persuasive communications to change actions: an analysis of behavioral and cognitive impact in HIV prevention.

This meta-analysis examined the validity of various theoretical assumptions about cognitive and behavioral change following a communication recommending condom use. The synthesis comprised 82 treatment and 29 control groups included in 46 longitudinal reports with measures of perceived severity and susceptibility, attitudes and expectancies, norms, perceptions of control, intentions, knowledge, behavioral skills, or condom use. Results indicated that across the sample of studies, communications taught recipients about facts related to HIV and also induced favorable attitudes and expectancies, greater control perceptions, and stronger intentions to use condoms in the future. Moreover, messages that presented attitudinal information and modeled behavioral skills led to increased condom use. Results are discussed in the context of theories of human behavior and change and in reference to HIV-prevention interventions.     

The Moderating Role of Self-Efficacy Beliefs in the Relationship Between Anticipated Feelings of Regret and Condom Use1

This prospective study examined how the feelings of regret and self-blame one anticipates after engaging in unsafe sex affect condom use in new sexual relationships. The central theoretical question is whether self-efficacy perceptions can moderate the relationship between anticipated feelings and actual condom use. Consistent with theories of anticipated regret and social cognitive learning, participants were most likely to use condoms between the first and second waves of data collection when they anticipated negative feelings as a result of not using condoms (and positive feelings after having used condoms), particularly when they also believed that they had the power to exercise control over the sexual situation (high self-efficacy). The implications for interventions aimed at promoting safer sex 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.     

Condom use among high-risk adolescents: testing the influence of alcohol use on the relationship of cognitive correlates of behavior.

The goal of this study was the exploration of distal effects of alcohol use on condom use. Criminally involved adolescents completed an initial measure of attitudes, beliefs, and prior behavior. Of the 300 who completed the initial measurement, 267 (89%) completed a behavioral assessment 6 months later. Analyses validated a theoretical model of condom use intentions and indicated that intentions and attitudes measured at baseline were significant predictors of condom use behavior 6 months later. Neither alcohol use nor alcohol problems moderated relationships among model variables or the influence of intentions and attitudes on behavior. The findings do not support a distal role for alcohol use in altering the cognitive correlates of condom use intentions and behavior among high-risk adolescents.     

The effects of safer-sex stories on college students' attitudes toward condoms

Social learning theory predicts that reading non-erotic stories involving condom use will be as effective as reading erotic stories with condom use in producing positive attitudes toward condoms. Werner's orthogenetic principle, however, predicts that reading erotic condom stories will be most effective because of the link created between sexual arousal and cognitive information about condoms. 168 male and 149 female undergraduates enrolled in Introductory Psychology at a small, private, southern university participated in a study to test the validity of these two theories. The students read one of the following types of stories: erotic with condom placement described, erotic without condom use, or non-erotic with a model for discussing condoms. The men and women who read the non-erotic stories were most positive about condoms and reported the strongest intentions to use condoms in the future. These findings suggest that erotica is not necessary to produce positive attitudes toward condoms.     

Preventing HIV infection in heterosexual women: What do we know? What must we learn?

Women are becoming infected with HIV via heterosexual activity at an accelerating rate, both in the United States and globally. Although a number of evaluations of behavioral risk-reduction interventions for women have been reported, many suffer from methodological problems that weaken confidence in their findings, and furthermore it is clear that many women are unable to respond to the interventions that have been tested. Most women infected through heterosexual activity are infected by their primary partner, yet achieving consistent condom use with this partner can be highly challenging for women. The present article presents recent work and innovative ideas for intervention strategies that may be more feasible, and thus more effective, for women at risk for HIV infection by their primary male partner.     

Get the Message: Targeting Beliefs to Develop Risk Reduction Intervention Messages for African American Adolescents

Risk reduction interventions that promote condom use, a vital component of most HIV prevention interventions, have been successful in increasing condom use among African American adolescents. Understanding theoretical components that lead to behavior change and selecting relevant risk reduction messages remain important considerations for targeting new interventions and tailoring existing interventions. The present study sought to (1) identify the most important theoretical determinants of condom use intention in African American adolescent males and females, separately, using the integrative model of behavior prediction, and (2) identify underlying beliefs within the determinants that were good candidates for message development in similar interventions. Using 446 African American adolescents, multi‐group SEM indicated that the gender‐specific IM exhibited a better fit than the overall model. Specifically, the IM had a stronger capacity for predicting condom use intention and condom use behavior for adolescent boys. Using a specific criteria for message selection, specific condom use beliefs were discussed as potential candidate messages for both African American males and females.     

Examining the Role of Gender in the Relationship Between Use of Condom-Related Protective Behavioral Strategies when Drinking and Alcohol-Related Sexual Behavior

The present research aimed to examine the relationships among gender, condom-related protective behavior strategies (PBS), and condom use during alcohol-related sexual behavior. Heavy drinking, sexually active U.S. undergraduate college students from a large northwest university (N?=?454; 61.7% female) completed a web-survey that included measures of drinking, sexual behavior, and condom-related PBS. MANOVA findings suggested that males were more likely to use condom-related PBS than females. Negative binomial regression results suggested that use of condom-related PBS by both genders was positively associated with condom use during alcohol-related sexual behavior, but especially for women. These results suggest that condom-related PBS may be useful to incorporate in interventions targeting alcohol-related sexual behavior among heavy drinking college students.     

Low-income African American women's attempts to convince their main partner to use condoms

In this cross-sectional study the authors examine condom use attempts and condom use among 305 high-risk, low-income African American women who reported having a main partner. Women who had recently attempted to convince their main partner to use condoms were almost 10 times more likely to have recently used condoms with their partner than women who had not made an attempt. Among the subsample of 116 women who had recently made a condom use attempt with their main partner, having a history of childhood abuse and having one's main partner raise infidelity questions in response to the condom use attempt were negatively associated with recent condom use with this partner. Findings provide initial insights into the importance of women's condom use attempts, as well as subgroups of women who may encounter special challenges convincing their main partner to use condoms.     

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.     

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.