Comparison of Marine and College Women's HIV/AIDS-Relevant Sexual Behaviors1

This study compares the heterosexual risk behaviors, perceptions of vulnerability to HIV/AIDS, and predictors of condom use of two groups of women with very different sexual and contraceptive histories and habits–college women and women in Marine Corps recruit training. The Marines' s]exual behaviors put them at greater risk of contracting HIV than the college students; that is, Marines reported more frequent intercourse with more partners, used condoms less frequently, and had less knowledge about HIV/AIDS transmission. Consistent with these differences, college students displayed a larger illusion of unique invulnerability than did the Marines. In general, the women who had more sexual partners and more frequent sexual intercourse were less likely to report regularly using condoms. In addition, the data provide support for Weinstein and Nicholich's (1993) recent suggestion that the relation between risk perception and risk behavior is different for different groups of people.     

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.     

Sexually Explicit Media and Sexual Risk Behavior in a Sample of Men Who Have Sex with Men in Norway

The aim of this study was to explore the association between the consumption of sexually explicit media (SEM) depicting condom and non-condom use and HIV/STI-related sexual risk behavior among men who have sex with men (MSM) in Norway. We also explored whether the association between SEM consumption and STI-related sexual risk behavior is mediated by men’s sexual self-esteem and/or condom use self-efficacy. A cross-sectional online survey study was carried out in Norway in 2012. The final sample comprised 529 MSM in Norway. There was a bivariate association between the use of SEM picturing condom use and less STI-related sexual risk behavior. Further, the association between SEM consumption and sexual risk behavior was mediated by condom use self-efficacy. However, SEM did not influence sexual risk behavior via sexual self-esteem. The results offer important cross-cultural validation of recent comparative data from the US and may be used to promote HIV/STI prevention, in the sense that the actors in SEM may serve as role models in managing condom use in sexual contexts.     

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.     

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.     

Self-Assessed Risk of HIV and Other STIs Among Young Adults in Norway and Croatia

The purpose of the present study is to explore how sexually active young Norwegian and Croatian adults assess the risk of being infected with HIV and other STIs. Study results are based on a 2009–2010 large-scale national probability survey of young adults aged 18–24 in Croatia (n = 1,005) and Norway (n = 871). A majority of sexually active young adults in Croatia and Norway assessed the risk of becoming infected with HIV or other STIs as low or negligible. Among non-condom users, 85–98% determined they had low or no risk of getting infected with HIV. The corresponding figures for STIs were 77–79%. In both countries a higher HIV risk self-assessment was observed among those who had had same-sex sexual experience, those who reported a higher number of sex partners during the past year, and those who were single. When investigating the patterns of HIV/STI risk assessment, gender and country-related differences appeared. Condom use associated with higher risk assessment was significant only among Croatian men. The strong perception of condom use as being a male responsibility in Croatia may be the reason for a higher risk assessment for unwanted pregnancy and HIV/STIs when protection fails. The risk assessment for HIV/STIs was not associated with partner turnover in Croatian men. New campaigns need to develop gender-sensitive messages, particularly targeting men who believe that a great number of sexual partners is a sign of manliness and women who shy away from their responsibility to use protection.     

Changes in condom use among homosexual men in San Francisco

Employed data from two longitudinal surveys of gay men in San Francisco (a) to examine for cohort (Study 1) and attrition (Studies 1 and 2) bias effects on reported changes in condom use by gay men and (b) to investigate predictors of condom use (Study 2). Substantial increases in condom use were observed, and these changes were unrelated to attrition and cohort bias. In terms of predictors of condom use, men who always used condoms had higher levels of social support from informal sources of help, had more positive expectations that condoms would have positive interpersonal and personal consequences, and were more likely to be HIV positive than men who used condoms occasionally or never. The results are discussed in terms of their implications for HIV-prevention research.     

Correlates and predictors of HIV risk among inner-city African American female teenagers

OBJECTIVE DESIGN: For human immunodeficiency virus (HIV)-related prevention initiatives to be most effective, they should be broad-based and incorporate multiple domains of influence. This study tested how several ecodevelopmental domains influenced HIV-risk related attitudes and behaviors in a community sample of African American female teens (N = 242). MAIN OUTCOME MEASURES: Outcome measures were number of partners, frequency of intercourse, number of pregnancies, abstinence/condom use, HIV/AIDS-related attitudes and behaviors, and HIV testing. RESULTS: Structural Equation Modeling revealed many direct paths from ecodvelopmental domains to risky sexual behaviors. The findings include having more partners was associated with parental alcohol-related problems, more drug use, and a younger age at first intercourse. More frequent intercourse was associated with less cultural pride and more drug use. More pregnancies were related to a younger age at first intercourse and parental alcohol problems. HIV testing was associated with having experienced sexual abuse, an older age at first intercourse, and stronger self-efficacy. CONCLUSIONS: Prevention programs that focus on risk reduction could expand their focus beyond sexual behavior to include a broad-range of psychosocial domains that are associated with HIV-risk. The effectiveness of prevention programs should be monitored carefully for appropriateness in different ethnic groups.     

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.     

Predictors of risk for sexually transmitted diseases in ninth grade urban high school students

This study examined risk factors associated with acquisition of sexually transmitted diseases (STDs) including HIV in adolescents, using the AIDS Risk Reduction Model. The study participants were 985 students who were 54% female, ethnically/racially diverse, had a mean age of 14.7 years, and were mostly 9th graders (74%). Logistic regression was used to predict sexual experience. Linear regression was used to predict risky sexual behaviors and condom use within the previous month. The results indicate that demographic factors are associated with being sexually experienced, but few demographics are associated with specific STD-related risk behaviors. STD and AIDS knowledge are not associated with any risk behaviors. Use of alcohol and drugs is associated significantly with being sexually experienced and sexual risk. The results also indicate that peer affiliation, perceptions of peer norms, perceptions of risk, perceptions of self-efficacy, and social support are associated with STD-related risk among sexually experienced youth.     

HIV risk factors,condom use,and HIV antibody testing among heterosexual Hispanics: the National AIDS Behavioral Surveys (NABS)

Although Hispanics comprise only 9% of the US population, they account for 16% of AIDS cases. This study used data from the 4390 heterosexual Hispanics interviewed as part of the 1990-91 National AIDS Behavioral Survey to determine the prevalence and demographic correlates of HIV antibody testing and condom use among Hispanics at risk for HIV. Overall, 16.4% of respondents reported an HIV risk factor, primarily two or more sexual partners in the last 12 months (64%) or a high-risk main sex partner (26%). Those at risk tended to be highly acculturated unmarried males aged 18-29 years of European Spanish, South American, or Caribbean origin, with more than 12 years of education, an annual income under US$10,000, and infrequent church attendance. 35.3% of these high-risk persons had been tested for HIV; male gender and middle-income status were the strongest predictors of testing. Condoms were used at least half the time with a primary partner by 22.4% and with secondary partners by 44.7%, with higher use rates among acculturated Hispanics. The low prevalence of condom use and HIV testing among high-risk Hispanics underscores the need for campaigns that reinforce the acceptability of condom use as a social norm. Because US Hispanics are a heterogeneous group, such campaigns should target specific subgroups, including different national origins and levels of acculturation.     

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.     

Relationship Factors’ Impact on Condom Use Among College Students

Research indicates that a number of college students are at risk for HIV, sexually transmitted diseases, and unplanned pregnancy as a result of their sexual behaviors. Specific behaviors placing college students at risk include having sex with multiple partners, poor communication about safer sex practices with their sexual partners and not using condoms consistently and correctly when engaging in sexual activity. The purpose of this paper is to identify potential differences in safer sex practices and factors that influence condom use among college students. A four-page, 18-item survey was developed to determine participants’ condom use and the impact of relationship status and other demographic factors on condom use. Analyses revealed that the number of lifetime vaginal sexual partners and participants’ sex influenced condom use. There were no significant differences in relationship status, duration, trust, honesty and condom use. These findings should be considered with designing interventions to increase condom use among college students.     

Illusions of Safety in a Risky World: A Study of College Students' Condom Use

The role that costs, benefits, and perceptions of invulnerability play in condom use was examined in a sample of students ( N = 211) at 4-year and 2-year colleges. In multiple regression analyses, past condom use was related to relative invulnerability, low present risk, and inexperience. Less intended condom use was associated with high perceptions of relative invulnerability and low perceptions of present risk. It appears that many college students feel protected from HIV because they judge their current sexual environment to be safe due to monogamy, sexual history taking, and the ability to tell a partner's HIV status. Independent of that, feelings of relative invulnerability are associated with more condom use—perhaps an accurate judgment of past risky behavior.     

Factors affecting behaviors that address HIV risk among senior secondary school pupils in South Africa.

The purpose of this study was to identify factors affecting HIV risk reduction among senior secondary school pupils in South Africa. The sample included 460 Grade 12, Secondary School pupils whose ages ranged from 16 to 30 years (M = 19.7 yr., SD = 2.5) and who were chosen at random from the total Grade 12 population throughout one region in the Northern Province of South Africa. Measures were of sexual behavior and condom use, knowledge about correct condom use, intention of condom use, behavioral norms, attitudes, normative beliefs, and subjective norms about condoms, HIV/AIDS vulnerability (likelihood to get it) and severity of the illness in the country, and condom use self-efficacy. Bivariate analysis gave positive significant relations among normative beliefs, subjective norms, and attitudes towards condom use as well as HIV/AIDS vulnerability and HIV risk behavior. Regression analysis indicated that for boys, younger age at first vaginal intercourse, less intention for condom use, and HIV/AIDS vulnerability were predictive for HIV/AIDS risk behavior and explained 39% of the variance. It is suggested that these predictors should be included in intervention programs for HIV prevention.     

The impact of internalized homophobia on HIV preventive interventions

A growing body of research implicates internalized homophobia—the internalization of society's antihomosexual sentiments by gay and lesbian people—as a factor contributing to HIV-related sexual risk behavior in gay and bisexual men. Although accumulating evidence links internalized homophobia and sexual risk behavior, no study has explored the impact of internalized homophobia on efforts to prevent these behaviors. This paper examines the effect of internalized homophobia on gay and bisexual men's awareness of, participation in, and perceptions of programs offered by a community-based HIV prevention organization. In Study 1, 595 gay and bisexual men reported their levels of awareness of and participation in HIV prevention programming offered by one community organization. Internalized homophobia was negatively related to men's awareness of the services offered by the organization. However, among the men who were aware of at least one service, internalized homophobia did not further predict service utilization. Study 2 examined 89 gay and bisexual men who participated for a single session in a group-structured, community-based HIV preventive intervention. Pre- to immediate postintervention change in perceptions of condom use self-efficacy was inversely related to internalized homophobia. Internalized homophobia was also a significant negative predictor of the extent to which participants felt similar to and related well with other members of the group. Together, these findings suggest that internalized homophobia may pose multiple barriers to community-based HIV prevention efforts.     

Drugs,Sex, and Condoms: Identification and Interpretation of Race‐Specific Cultural Messages Influencing Black Gay and Bisexual Young Men Living with HIV

Black gay and bisexual young men carry a disproportionate burden of HIV in the United States. This study explored Black gay and bisexual young men living with HIV's identification and interpretation of race‐specific cultural messages regarding substance use, sexual activity, and condom use. A total of 36 Black gay and bisexual young men living with HIV (ages 16–24, mean = 20.6 years) from four geographically diverse regions of the United States participated in qualitative in‐depth interviews. Results from this study elucidate the ways in which these young men interpret various forms of race‐specific cultural messages and experiences regarding substance use, sexual activity, and condom use. Participants discussed cultural messages and experiences promoting and discouraging condoms and substance use. Regarding sexual activity, only messages and experiences promoting sex were reported. Across all three categories, messages and experiences promoting risk were predominant. Data further revealed that socially transmitted cultural messages received by young men emanated from multiple sources, such as family, peers, sexual partners, community/neighborhood, and the broader society. Race‐specific cultural messages and experiences should be addressed in interventions for this population, and programs should assist young men in developing a critical consciousness regarding these messages and experiences in order to promote health and well‐being.     

Risk Factors for Suicidality Among a Nationally Representative Sample of High School Students

Using the 2005 Youth Risk Behavior Surveillance data (n = 13,917) of high school students, we examined the association between four domains of risk factors (alcohol/drug use, aggression, HIV risk‐related behaviors, and health problems) and indicators of suicidality (considering a suicide attempt, making a plan to attempt suicide, and actually attempting suicide). Logistic regressions showed that drug use (e.g., recent smoking, drinking before 13), victimization (e.g., threatened at school, hit by girl/boyfriend), risky sexual behavior (e.g., forced to have sex, used a condom) and two health problems (health as fair/poor, has disability/health problem) were associated with all three indicators of suicidality. These findings suggest that programs to prevent alcohol/drug use, address aggression, promote safety, and prevent unsafe sexual practices may also prevent suicidality.     

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.     

HIV‐Related Behaviors Among Prison Inmates: A Theory of Planned Behavior Analysis1

Prison inmates have high prevalence rates for both HIV and AIDS, creating a great need for HIV prevention efforts. We tested the theory of planned behavior (TPB) in 3 domains: intention to engage in condom use when released, intention to not share tattoo equipment in prison, and intention to not share needles or tattoo equipment when released. A total of 478 inmates (87% male) completed TPB and sexual and needle‐use risk behavior measures. TPB constructs accounted for a significant variance in intention to use condoms among African American, Hispanic, and Caucasian inmates, though the strength of the relationships differed by ethnicity. The TPB was less successful for intention to share tattooing equipment and not to share needles or tattoo equipment after release.