The effects of two AIDS risk-reduction interventions on heterosexual college women's AIDS-related knowledge,attitudes and condom use

An intervention combining AIDS information with condom eroticization, condom normalization, and communication skills training was found to increase both AIDS-related knowledge and condom use among Canadian college students. 112 unmarried female undergraduates (mean age, 18 years) were randomly assigned to this combination intervention (n = 49), an information-only intervention (n = 44), or a pre-test/post-test control group (n = 19). 80% of students had engaged in vaginal intercourse and 14% in anal intercourse. 84% of coitally active women had engaged in unprotected intercourse in the past year and 48% had not used condoms consistently with any sexual partner. Condom use in the pre-intervention period was associated with positive attitudes toward the method and the perception that condom use was normative among peers. One month after the interventions, both the combination and information groups, but not controls, showed an increase over baseline in AIDS-related knowledge. However, among the 36 students who were coitally active in the 1-month periods before and after the intervention, only the combination intervention was associated with increased condom use. In the combination group, the percentage of episodes of intercourse protected by condoms increased from an average of 21.8% in the month preceding the study to 50% during the 4-week follow-up period. Due to the small sample size and design of the study, it was not possible to determine which component of the multifaceted educational intervention was most responsible for this change.     

Educational needs relative to human sexuality and AIDS among secondary school students and teachers in Lima

Between November 1989 and January 1990, a pilot study was conducted among state secondary school students and teachers in Lima Peru by questionnaires with the objective of determining their knowledge about human sexuality, sexual behavior, pregnancy, sexually transmitted diseases (STDs), AIDS, drug abuse, and sexual activity. 110 students (64 boys and 46 women) aged 13-18 of low and medium-low socioeconomic background from metropolitan Lima participated. 40 teachers (70% females) aged 40.1 + or - 9.3 years also took part. THe adolescent focus groups were anxious to talk openly about sexuality to dispel their doubts. The levels of knowledge reached 46% for human sexuality, 50% for physiology and pregnancy, 35% for STDs and preventive sexual behavior, 50-60% for AIDS (transmission and risk groups), and only 35% for prevention. 21 had heterosexual experiences: 19 males and 2 females. 6 youngsters had homosexual experiences: 4 males and 2 females, 3 of these also had heterosexual sex. 20 of students without sexual experience expressed on interest, in engaging in sexual behavior if they fell in love. 33 adolescents reported using alcohol, 1/4 of these had consumed more than 6 bottles the previous week. The report on drug use was low, because 32% failed to answer this question. 60-70% of the teachers knew about human sexuality, while 72% knew about AIDS. 76.5% of them considered sex education in schools inadequate. 88.2% thought that adolescents need an explicit preventive program which should start in primary school and continue through all grades. This would require additional school resources. The teachers deemed daily life more educational about sexuality than information from schools and universities. 52% said that AIDS education messages had to be clear about preventive sexual behavior. 32% believed that correct use of the condom had to be demonstrated in class. 78% identified the mass media for dissemination of AIDS information, and only 15% judged their knowledge about AIDS sufficient for imparting it to students.     

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.     

Knowledge,beliefs, peer norms,and past behaviors as correlates of risky sexual behaviors among college students

Abstract

HIV/AIDS knowledge, age at onset of sexual activity, perceptions of personal risk and peer norms were explored as correlates for risky sexual behaviors among college students. Ninety-nine male and 185 female college students completed a 66-item questionnaire. A majority reported being sexually active with most in mutually monogamous relationships or not currently in a sexual relationship. Multiple regression correlation analyses showed knowledge about HIV/AIDS to be very high but that this knowledge did not independently relate to the extent of risky behaviors. Perceptions of risk were positively related to number of partners and single-time partners but not condom usage. In contrast to previous studies, perceived peer norms did not independently relate to behaviors. Instead, age at first intercourse was found to have substantial overlap with current perceptions, attitudes, and likelihood for engaging in risky behaviors. The necessity for including previous behaviors in analyses of the impact of attitudes and perceived norms on behavioral intentions is discussed.     

Ambivalence and Unprotected Sex: Failure to Predict Sexual Activity and Decreased Condom Use1

Using a prospective design, we assessed whether ambivalence toward sexual activity is associated with decreased condom use. Undergraduates predicted whether they would have intercourse and use condoms in the next week. A week later, they reported their sexual and contraceptive behavior. Among 65 individuals who had intercourse and planned to use condoms, ambivalence toward sexual activity was negatively associated with condom use. Moreover, whether intercourse was planned mediated the relationship between ambivalence and condom use, such that ambivalence was negatively associated with accuracy in planning sex, and unplanned sex was less likely to be protected. Individuals who are ambivalent about sex may intend to use condoms, but fail to do so because they cannot predict when they will have intercourse.     

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.     

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.     

Adolescents' perceptions of friends' and parents' attitudes to sex and sexual risk-taking

This study investigated the association between adolescents' perceptions of parental and peer attitudes towards sexuality and AIDS precautions, and the risky sexual behaviours of 1008 sexually active, heterosexual undergraduate students aged 17-20 years. Students were asked to rate the extent to which their mothers, fathers and friends would agree or disagree with 16 statements reflecting support of the adolescent engaging in sexual behaviour and using sexual precautions, including precautions against AIDS. The adolescents also indicated whether they were sexually active and their level of condom use in both ‘regular’ (or steady) and ‘casual’ relationships. Results indicated that adolescents perceived their parents as non-liberal in their sexual attitudes and relatively unlikely to discuss sex or precautions with them. Parents were viewed as more accepting of their sons' sexual behaviours than of their daughters'. Adolescents believed that peers were more likely to discuss sexuality and precautions than parents, and were more liberal in their sexual attitudes. Adolescent sexual risk-taking was related to the perceived attitudes of significant others in ways which varied across gender and type of relationship. Implications for interventions are discussed.     

Father–Daughter Communication About Sex Moderates the Association Between Exposure to MTV’s 16 and Pregnant/Teen Mom and Female Students’ Pregnancy-Risk Behavior

MTV’s hit programs 16 and Pregnant and Teen Mom have been the subject of national debate since their inception. Supporters contend that the shows inhibit pregnancy-risk behavior. Critics contend that the shows glamorize adolescent motherhood and encourage pregnancy-risk behavior. The present study explored the possibility that the association between viewing 16 and Pregnant and Teen Mom and student females’ pregnancy-risk behavior depends on the extent to which females’ parents communicated with them about sex while they were growing up. Survey data were gathered from 313 female students. A disordinal interaction was found between father–daughter sexual communication, viewing frequency, and recent intercourse behavior. Frequent viewing was associated with an increased probability of having engaged in recent intercourse for females whose fathers did not communicate with them about sex while growing up. Conversely, frequent viewing was associated with a decreased probability of having engaged in recent intercourse for females whose fathers often communicated about sex with them while growing up. No interaction was found between mother–daughter sexual communication, viewing frequency, and recent intercourse behavior. These results suggest that fathers may play an especially important role in determining how sexual media socialize their daughters.     

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.     

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.     

Sexual Socialization Messages on Entertainment Television: Comparing Content Trends 1997–2002

Previous content analyses of sex on television have relied on differing measures and sampling strategies, which makes it difficult to compare patterns of sexual portrayals over time. This large-scale study (N = 2,817 programs) examines the sexual messages presented on television across both broadcast and cable channels over a 5-year period, applying identical measures to three biennial samples of program content. Results demonstrate that sexual talk and behavior are highly frequent aspects of the television environment. Talk about sex is shown more often than sexual behavior, though both types of content increased significantly from 1997/1998 to 2001/2002. Over that time span, the percentage of shows portraying sexual intercourse doubled from 7 to 14%. Results also show that topics related to sexual risks or responsibilities (e.g., condom use, abstinence) are increasingly included on television, but nonetheless remain infrequent overall. Such safe sex messages occur most frequently in program environments where they are most relevant (i.e., when sexual intercourse is included in the story). The content analysis findings are discussed in terms of their implications for audience effects.     

The impact of AIDS/sex education by schools or family doctors on Hong Kong Chinese adolescents

Despite the rapid increases of HIV and sexually transmitted infections (STIs) in East Asia, the sex-related knowledge among Chinese adolescents is limited and the standard of sex education is both variable and inconsistent in Hong Kong. The aim of this study is to review the overall effectiveness of the school-based or doctor-based sexual health education currently provided for Hong Kong adolescents. In 1999 - 2000, a large survey on youth risk behaviours was carried out among 15 - 18-year-old students from 21 secondary schools. Of the 8,039 questionnaires, 377 students (4.7%) admitted sexual experience. Multiple logistic regression showed that students who had received school AIDS education were found to be less likely to have sexual intercourse in the past 3 months (odds ratio, OR 0.5; 95% confidence interval, CI 0.3 - 0.9) or use drugs or alcohol before the previous intercourse (OR 0.5; 95% CI 0.3 - 0.9). They were twice as likely to discuss emotional (95% CI 1.4 - 4.0) or puberty issues (95% CI 1.1 - 3.0). Although not statistically significant, sex education by family doctors showed a similar pattern. This result provides the strongest available evidence that school-based sex education programmes can modify sexual behaviour, which, in turn, reduces risk among Chinese students.     

Body Image Satisfaction and Involvement in Risky Sexual Behaviors Among University Students

This study examined the impact of body image satisfaction on university students’ (N = 465) involvement in risky sexual behaviors. A valid and reliable survey instrument was designed and administered to students in their classrooms at a Midwestern university. Of 465 participants, 53.8 % reported having low levels of body image satisfaction and 78.9 % indicated they had engaged in sexual intercourse during their lifetime. Of the sexually active students, 80 % have had sexual intercourse without the use of a condom, 76 % have had sexual intercourse while intoxicated, and 21 % have had sexual intercourse following illegal drug use. Students who had high body image satisfaction were significantly more likely to have ever engaged in sexual intercourse. These results should be considered when developing and implementing sexual education efforts for university students. Future studies should seek to identify specific strategies to increase body image satisfaction and decrease risky sexual behaviors among this high-risk population.     

Sexuality attitudes and behaviors of self-described very religious urban students in middle school

Data from a survey of 869 students aged 11 to 15 years and attending six urban middle schools were analyzed to identify differences in sex attitudes and behaviors between self-reported very religious students and their less religious peers. The two groups were demographically similar. They differed on only two attitude items, one suggesting that intercourse was a normal part of teenage dating and the other suggesting intercourse was alright if the two people were in love. The groups did not differ in their estimation of their peers' sexual activity or attitude or in terms of their own intercourse behavior or future intentions.     

Condom Use Among South African University Students in the Province of KwaZulu-Natal

South Africa has one of the highest HIV infection rates in the world, with young people particularly affected. Condoms are an effective preventative method against HIV among sexually active adults. This study assessed the level of condom usage among university students in South Africa and their attitudes towards condom usage, negotiation efficacy and confidence in condom usage. It was a cross-sectional study conducted amongst South African university students living at the university residences. Students were randomly selected and required to complete a self-administered questionnaire. The mean age of participants (n?=?441) was 22.7?±?4.3 years. The mean age of sexual debut was 17.7?±?3.0 years with 1.4?±?1.47 (range 0–13) current partners. Less than half of the students used a condom at sexual debut and only 28.5% used condoms during recent sexual activity. Those students who used a condom at first sexual intercourse had marginally more positive attitudes about condom usage than those who did not do so (p?=?0.056). Students with a single current partner had more positive attitudes about condom usage than those with multiple current partners (p?=?0.021). Only 32.5% (n?=?127) of the students were very confident in using condoms. Similarly, only 33.0% (n?=?130) of the participants felt that they could definitely negotiate condom use with their partners. We conclude that condom use among South African students is low and that they lack the confidence to use condoms. We recommend that programmes to step up condom use must also incorporate educational interventions on usage.     

HIV/AIDS prevention support resourcing with family and peers: University student perspectives

This study explored how students construct family and peers as resources for their HIV prevention. The participants were 20 education students from a South African technology education university (female = 60%, black = 85%; age range = 18 to 24). They completed a semi-structured interview on their access to family and peers talking about HIV/AIDS prevention in the context of perceived cultural influences. The data was thematically analysed using open-coding. Findings suggest that students shared information about HIV/AIDS prevention with peers, and less so with family. They perceived cultural taboos around sex talk to be a barrier to open discussion of HIV/ADS. Students may need to acquire strategies to negotiate HIV/AIDS prevention approaches with family in the context of culture.     

Commitment to “Safer” Sex as a Predictor of Condom Use Among 16-20-Year-Olds1

The AIDS risk reduction model (ARRM) is explored in the context of a prospective study of adolescent condom use. This three-stage model characterizes the social and psychological facilitation of change in attitudes and sexual behaviors related to HIV transmission. The social and behavioral consequences of AIDS for 63 adolescents (aged 16-20 years), from an urban part of North West London, were mapped over a one-year period. Indices were created according to the proposed model which reflect (a) labelling of a high risk behavior as problematic (e.g., unprotected sexual intercourse) (b) commitment to change (e.g., desiring and valuing “safe” sex), and (c) seeking and enacting appropriate solutions (e.g., use of condoms). Nested regression analysis enabled the inter-relationship between significant social and psychological predictors (Time 1) and behavior (Time 2) to be traced. Overall the model accounted for 30% of the variance in condom use. Contemporaneous behavior was also modeled to identify baseline social and psychological predictors. Twenty-seven percent of the variance in condom use is explained. The social and psychological patterning of the indices is compared with that evidenced for prospective behavior. It appears that social representations which embody normative and value considerations underlie commitment to safer sex (at a general level) and override intentions (at a specific level) in the explanation of prospective behavior. The methodological and theoretical implications of this are identified and discussed.     

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.