The Use of Protection for Sexually Transmitted Infections (STIs) and Unwanted Pregnancy among Norwegian Heterosexual Young Adults 2009

This paper explores the use and none-use of condoms among young heterosexual adults in Norway. To what extent do young heterosexuals use condoms and other types of contraception, and in which context does the use take place? What are the motives underlying both use and non use of condoms? The results are based on a 2009 national web panel survey among 16–24 year-olds in Norway (n = 871). Most respondents reported having met their most recent sex partner via friends or family, and 62% referred to the sex partner as a sweetheart. One out of two claimed they had not used condoms during the first sexual intercourse with this partner. A factor analysis revealed 2-D of motivation for not using condoms, referred to here as ‘Fear of Suspicion’ and ‘Mutual Trust’. Multiple linear regression analysis revealed that, when controlled for gender, age, and number of sex partners in one’s life, ‘Mutual Trust’ had a statistically significant relationship to coital frequency and the number of years coitally active. None of the predictor variables had a statistically significant relationship with “Fear of Suspicion”. The most commonly reported motives for the most recent sexual intercourse were having been ‘sexually aroused’ and ‘in love’. A total of 56% reported using hormonal contraception, while 20% used condoms. The most important reasons for not using condoms were: ‘used other contraception’, ‘did not worry about STIs’, ‘more pleasurable without’, ‘had none available’, and ‘unprepared for intercourse’. The most important reasons for condom use were to ‘avoid pregnancy’, ‘avoid STIs’, and ‘avoid HIV’.     

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.     

Women's perceptions of female contraceptive behavior: experimental evidence of the sexual double standard

A social perception study was conducted to examine the effect of the sexual double standard on impressions of a female target. As part of a "social memory" study, 57 female undergraduates read a fictitious woman's diary describing a sexual encounter where the woman provided a condom, the man provided a condom, or the couple had unprotected intercourse. Participants made behavioral judgments and interpersonal judgments about the couple, and rated the female target on several personality traits. Women rated the target's behavior more negatively, and as more inappropriate, when she provided a condom, than when her partner provided a condom. Participants also assumed that the target's partner would feel less positive about her when she provided a condom than if he provided a condom or if they had unprotected intercourse. These results are discussed with respect to the continued existence of the sexual double standard, and its impact on women's contraceptive behavior.     

Adolescent males' sexual behavior and contraceptive use: implications for male responsibility

A recent US survey of single 17-21 year old men, indicated that 17.1% used a condom at 1st intercourse and 15.5% used a condom at the most recent intercourse. Withdrawal is also used: 10.0% and 7.4% respectively. Condom use was correlated with being older at 1st intercourse, having a higher educational level, closer association to partner, and sense of male contraceptive responsibility. The data used for this analysis was taken from a sub-sample of 624 sexually active males in 1979. The mean age at 1st intercourse was 14.8 years and mean age at most recent was 18.9 years. The pill was also used at 1st intercourse (8.8%) and a total of 43.5% used some method of contraception. In the most recent intercourse cases, 64.7% used some method of birth control and the pill was used 26.5% , condom 15.5%, and withdrawal 7.4%. Conclusions from this data indicate that male methods are important in teen contraception. Condom use at 1st and most recent intercourse was related to both positive and negative characteristics. It appears that males show some contraceptive responsibility initially but later give the responsibility to females. The declining use of condoms indicates it to be a transitional form of birth control. Programs should promote continued use of condoms since use of the pill is low and unwanted pregnancy risk is high. Communication on contraception should be encouraged, so both partners are aware if neither one is contracepting. With the acquired immunodeficiency syndrome epidemic, condom use takes on a whole new context in relation to the decline in use by adolescents.     

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.     

The fallacy of intimacy: sexual risk behaviour and beliefs about trust and condom use among men who have sex with men in South Africa

The objective of this study is to assess (1) whether beliefs about trust and condom use affect sexual risk behaviour, and (2) if beliefs about trust and condom use impact sexual risk behaviour directly or if this relationship is mediated by other determinants. The Information-Motivation-Behavioural Skills model was used as a framework for the mediation analysis. A diverse cohort of three hundred 18-40 year old men who have sex with men (MSM) residing in Pretoria, South Africa, were recruited and surveyed for this project. Findings indicate that men who report a high frequency of past unprotected anal intercourse are more likely to believe that it is not necessary to use condoms with a trusted or steady partner regardless of their current partnership status. This fallacy of intimacy appears to affect sexual risk behaviour through intentions and attitudes regarding safer sex practices. Based on these findings, we recommend that more attention be given in gaining a better understanding of how beliefs about trust and condom use are formed and how they can be changed among MSM in South Africa.     

Differences Between Condom Users and Condom Nonusers in Their Multidimensional Condom Attitudes

In two studies, we examined multidimensional condom attitudes of college students separately for (a) condom users vs. condom nonusers, (b) women vs. men, and (c) partnered individuals vs. single individuals (Study 1). Almost all single people (97%) expected to use condoms during each incident of sexual intercourse during the next 2 months. Across both studies, condom users were distinguished from nonusers by the attitude that condom use would interfere with sexual pleasure, and by skepticism that they would be able to use condoms in the face of obstacles (i.e., the action-maintenance dimension of condom attitudes). These effects held for expected future condom use, as well as current condom use. One gender difference also emerged across both studies: Men were more concerned about condoms interfering with sexual pleasure than were women. Implications for condom-use promotion are discussed.     

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

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

‘Sluts’ or ‘Sleazy Little Animals’?: Young People's Difficulties with Carrying and Using Condoms

Qualitative data from a Western Australian study of sexual behaviour in young people were used to describe difficulties experienced in carrying and using condoms. Both men and women were concerned for their sexual reputation if they carried condoms, although this was more of a problem for the women than the men. However, these fears were not matched by the attitudes of the opposite gender: in general, there was less negativity about condom-carrying than was feared. Many of those who described using condoms had experienced condom failure and other difficulties, and it appeared that they were unfamiliar with the correct way to use condoms. It is suggested that many of these barriers to condom use can be removed with appropriate education and information strategies.     

Gender differences in subjective distress to emotional and sexual infidelity: Evolutionary or logical inference explanation?

Men and women were asked to imagine a romantic partner being sexually unfaithful and/or emotionally unfaithful. Three hypotheses regarding gender differences in subjective distress to sexual and emotional infidelity, and in the inferences linking the infidelities were tested. The results indicated that more men than women were distressed by imagining a partner enjoying passionate sexual intercourse with another person, and more women than men were distressed by imagining a partner forming a deep emotional attachment to another person. Asking another group of women and men to imagine a partner committing both infidelities at the same time, and then to indicate which component of the combined infidelity was the most distressing, produced the same sexual asymmetries. The prediction that men will infer from a partner's sexual infidelity the co-occurrence of emotional infidelity and that women will infer from a partner’s emotional infidelity the co-occurrence of sexual infidelity was not supported. An evolutionary perspective, rather than an alternative analysis emphasizing the different inferences men and women draw from sex and love, provided a satisfactory explanation of the sexual asymmetries in the cues to jealousy.     

Gender differences in subjective distress to emotional and sexual infidelity: Evolutionary or logical inference explanation?

Men and women were asked to imagine a romantic partner being sexually unfaithful and/or emotionally unfaithful. Three hypotheses regarding gender differences in subjective distress to sexual and emotional infidelity, and in the inferences linking the infidelities were tested. The results indicated that more men than women were distressed by imagining a partner enjoying passionate sexual intercourse with another person, and more women than men were distressed by imagining a partner forming a deep emotional attachment to another person. Asking another group of women and men to imagine a partner committing both infidelities at the same time, and then to indicate which component of the combined infidelity was the most distressing, produced the same sexual asymmetries. The prediction that men will infer from a partner's sexual infidelity the co-occurrence of emotional infidelity and that women will infer from a partner’s emotional infidelity the co-occurrence of sexual infidelity was not supported. An evolutionary perspective, rather than an alternative analysis emphasizing the different inferences men and women draw from sex and love, provided a satisfactory explanation of the sexual asymmetries in the cues to jealousy.     

Self-Efficacy to Use Condoms in Unmarried Latino Adults

Measures of self-efficacy to use condoms can clarify the barriers to condom use Latinos encounter. A 20-item scale, that differed slightly for men and women, and was based on extensive elicitation interviews, was used in a random digit dial household survey of 1,600 unmarried Latino adults in 10 states with large Latino populations. Self-efficacy was related to condom use for both men and women. Factor analyses revealed five correlated factors: Regular Partner, Impulse Control, Partner Resistance, STD Thoughts, and Condom Discussion. Both men and women reported lowest self-efficacy for impulse control and using condoms with a regular partner. Less-educated men and women had lower self-efficacy to discuss condoms, to manage partner resistance, to use condoms with a regular partner, and to control impulses, but there were few other demographic differences in self-efficacy. The scale can be helpful in the design and evaluation of HIV prevention.     

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.     

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,condom use and prediction in attenders at sexually transmitted disease clinics—implications for counselling

A cohort of 260 clinic attenders completed an inventory to examine sexual behaviour, condom use and appraisal and to determine whether situational factors in their last sexual encounters were predictive of condom use. Response to health education compaigns promoting condoms in the light of HIV were also examined. It was found that risk exposure was consistently high. A subsample induldged in anal intercourse, which was unprotected in over two-thirds of instances. Condom uptake was varied Difficulties with condoms were widespread and fell into physical and psychological categories. The only predictor of condom use was the desire for unprotected sex. This data seems to indicate that sex is not a drive out of conscious control, but that individuals weigh up costs and benefits which may be marginally influenced by some situational variables such as alcohol. This has profound implications for counselling which can be aimed at addressing the misconceptions and beliefs that some individuals hold. Such misconceptions may result in risky behaviour which may potentially expose them to HIV. Such understanding is an important prerequisite for effective interventions. Differences between responses for heterosexual and homosexual men and women were examined.     

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.     

SUBJECT TO ROMANCE

Safer sex campaigns directed at heterosexuals have increasingly targeted women to encourage them to take responsibility for condom use. It appears, however, that many women are unable or unwilling to accept this role. In this article we report on one particular kind of obstacle that some women face in initiating condom use. We draw on data from interviews with 14 women, aged 22 to 43 years, about their experiences with, and views of, condoms. There was considerable variability, as well as commonalities, among the women interviewed in the way they regarded condoms. Using a feminist poststructuralist form of discourse analysis, we explored two women's accounts of being unable to initiate condom use despite their stated intentions not to have intercourse without a condom and having condoms in their possession. We suggest that this particular dynamic results from the passivity women can experience through being positioned in a discourse of heterosexual feminine sexuality in general and a discourse of heterosexual romance in particular. We discuss how this passivity can be experienced by women who are otherwise assertive and committed to sexual equality, making it confusing and disconcerting for them and others.     

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.