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.     

Health beliefs and teenage condom use: a prospective study

The authors investigated the extent to which Health Belief Model (HBM) measures can be used to predict subsequent sexual activity and consistency of condom use among teenagers, especially those who report having new sex partners. Results from a longitudinal survey of sex behavior and HIV-relevant cognitions among 258 sexually active 16 and 18 year olds in Dundee, Scotland, are reported. Participants responded to a confidential postal questionnaire on their demographic characteristics, previous sexual experience, prior condom use, beliefs specified by the HBM, peer norms regarding condom use, and condom use intentions. Measures of sexual behavior and condom use consistency were then included in a follow-up questionnaire 1 year later. Demographic and HBM measures, as determined through discriminant analysis, did not account for significant proportions of variance in the consistency of condom use or mediate the effects of prior sexual experience or demographic measures. The respondents who reported more frequent sexual intercourse were less likely to use condoms consistently while those who had used condoms previously reported more consistent use. Female respondents were less likely than the young men to follow through upon their intentions to consistently use condoms.     

Application of the Theory of Planned Behavior to Adolescents’ Condom Use: A Panel Study1

The authors report a longitudinal study of factors determining use of condoms with new sexual partners in a representative sample of 650 German youth. Measures derived from the theory of planned behavior (Ajzen, 1985) were obtained in 2 waves separated by 1 year. Consistent with the theory, intentions to use condoms could be predicted from attitudes, subjective norms, and perceived behavioral control with respect to this behavior; and actual condom use was strongly related to intentions and perceptions of control assessed in Wave 2. Due to changes in beliefs and attitudes over time, only about 10% of the variance in reported condom use was accounted for by intentions and perceived control assessed 1 year earlier. Reported condom use was found to exert a direct effect on later intentions, unmediated by their hypothesized antecedents. Theoretical and practical implications of these findings are discussed.     

Health beliefs and promotion of HIV-preventive intentions among teenagers: a Scottish perspective.

Beliefs concerning the spread of the human immunodeficiency virus (HIV) and preventive behaviors were examined in a sample of 351 sexually active Scottish teenagers. A postal questionnaire, including measures of variables specified by the health belief model (HBM) and preventive intentions, was employed. The relation between HBM measures and reported endorsement of HIV-preventive intentions was investigated. Results indicated that, in general, respondents intended to use condoms with new sexual partners. The majority also intended to carry condoms if they thought they might have sex with a new partner and to ask potential partners about their previous sexual history. Multiple-regression analyses showed that measures of health beliefs, gender, age, sexual experience, and previous condom use accounted for 17.8% to 24.3% of the variance in reported preventive intentions. Perceived barriers to preventive behaviors were found to be important predictors. However, the overall pattern of results raised questions concerning the adequacy of the HBM as a model of the determinants of HIV-preventive intentions, and the need for an extended model is discussed. Separate analyses were conducted for men and women and for 16- and 18-year-olds, and the implications for modeling intention formation in these subgroups are considered. The relevance of these findings to HIV-preventive campaigns is also discussed.     

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.     

The interplay between feelings and beliefs about condoms as predictors of their use

Objective: Negative feelings about condoms are a key barrier to their use. Using the behavioural affective associations model, we examined the joint effects of affective associations and cognitive beliefs about condoms on condom use.

Design: In Study 1 (N = 97), students completed measures of their affective associations and cognitive beliefs about sex and condoms, sexual activity and condom use. In Study 2 (N = 171), a measure of behavioural intentions and condom selection task were added.

Main outcome measures: Condom use measured in Study 1 as (1) current condom use, and (2) willingness to use condoms; in Study 2 as: (1) behavioural intentions, (2) number of condoms selected.

Results: Affective associations with sex and condoms were behaviour-specific, were directly associated with the respective behaviour, and mediated the relations of cognitive beliefs to behaviour, ps < .05. In Study 2, affective associations were associated with behavioural intentions and the number of condoms selected, ps < .05; cognitive beliefs were indirectly associated with these outcomes through affective associations, indirect effects: ps < .05.

Conclusions: Affective associations are a behaviour-specific and proximal predictor of condom use, mediating the effect of cognitive beliefs, suggesting they may be a particularly viable intervention target.     

Some factors in condom use amongst first-year Nigerian University students and black and white South Africans

A questionnaire was administered to 213 sexually active first-year Nigerian university students and 150 Black and 150 White South African adults. Nigerian students gave 90% correct answers on 6 of the 10 items of a measure of condom knowledge (M = 6.1). The most common mistakes with respect to condom use were ignorance about putting a condom on just before ejaculation (37%), the use of an oil-based lubricant with a condom (29%), and when to take off a condom (28%). For the South African sample utility of the Health Belief Model and Theory of Reasoned Action for HIV prevention could be confirmed by intention to use condoms. Race and preventive benefits were predictive for current condom use. Findings have relevant implications for developing culturally diverse HIV intervention programs if confirmed with larger diverse groups.     

Predicting intention to use condoms in homosexual men: an application and extension of the theory of reasoned action

A questionnaire based upon the Theory of Reasoned Action was developed and tested to identify predictors of intention to use condoms. Behavioral intentions, attitudes and subjective normative beliefs, behavioral norms, and age of HIV-positive status were included on the questionnaire. Internal consistency of the four components was high, with Cronbach's alpha coefficients of 0.76-0.87. Qualitative data were collected over 2 months from 194 homosexual men who participated in Sydney's homosexual community. Participants aged 17-64 years of mean age 29.5 attended individual interviews or small focus groups to discuss their views concerning condom use. 15% reported having tested HIV-positive, 59% tested negative, and 26% reported not knowing their HIV serostatus. According to logistic modeling, the significant predictors of intentions to use a condom were attitudes and behavioral norms, while HIV antibody positive status and age directly influence behavioral intentions to use a condom. About 50% of men over age 25 years intended to use a condom, irrespective of HIV status. Overall, 59% of men aged 25 years and younger intended to use a condom; 22% of HIV-positive men and 63% of HIV-negative men.     

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.     

The association of idealization and intimacy factors with condom use in gay male couples

The purpose of this study was to assess the relationship of idealization and three specific intimacy factors (relationship satisfaction, excitement, and closeness) to reported condom use in gay male couples. It was expected that there would be negative associations of idealization and the intimacy factors with condom use. Both members of 45 gay male couples completed a questionnaire that assessed these factors. This study found (a) idealization to have a significant negative correlation with condom use, suggesting that the more the individuals idealized each other, the less likely that condoms were used during sex; (b) a significant negative association between relationship satisfaction and condom use, implying that as the couples experienced more satisfaction within their relationships, condom use decreased; (c) a significant negative correlation between excitement and condom use, suggesting that as excitement increased, condom use decreased; and (d) no significant association between closeness and condom use.     

The relationship between attitude,assertiveness and condom use

Abstract

This study investigated the relationships between attitudes, assertiveness and intention to use and actual use of condoms as a means of preventing infection from sexually transmitted disease. Both homosexual (n = 83) and heterosexual men (n = 128) participated in the survey. It was found that the homosexual men held more favourable attitudes, and reported greater intended and actdal condom use than the heterosexual men. Intention to use condoms was positively related to favourable attitudes, which were related to condom-specific assertiveness for both groups. For the heterosexual men only, general social assertiveness was negatively related to attitudes toward condoms. It was concluded that condom use was reassuringly frequent among homosexual men, but not for heterosexual men. Efforts to increase condom use among the latter will need to take into account negative attitudes and, in particular, the possible perception of condom use as an effeminate behaviour.     

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.     

Factors shaping condom use among South African university students: a thematic analysis

This study aimed to investigate contextual influences on condom use by South African university students. Twenty one-to-one, semi-structured interviews were conducted with male and female South African undergraduates. The data were thematically analysed. Results revealed that condom use was transient and often unrelated to disease prevention. Condom use was impeded by closer perceived intimacy, gender dynamics, and social stigma against proposing use of condoms in a presumably committed relationship. Public health policies regarding condom, pill and injection pricing / promotion, and religious toleration also hampered condom use, by encouraging a preference over hormonal contraception or proscribing contraceptive measures altogether. The results provide a basis for considering the impact of immediate and wider social contexts on condom use, as proposed by socio-ecological models of HIV risk behaviour.     

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.     

Exploring teenagers' adaptive and maladaptive thinking in relation to the threat of hiv infection

Abstract

Teenagers' HIV-preventive cognitions were explored within a protection motivation theory framework. Five hundred and seven adolescent men and women from two cohorts (sixteen and eighteen) completed a confidential postal questionnaire. The effect of demographic variables, previous sexual experience and appraisal of threat and coping resources upon HIV-relevant cognitions was investigated using path analysis. Cognitions promoting (adaptive) and inhibiting (maladaptive) preventive behaviour were considered. Anticipated condom use, intention to limit number of sexual partners and willingness to consider an HIV antibody test were included as adaptive HIV-preventive cognitions. Coping appraisal measures were strongly associated with anticipated condom use but threat appraisal measures were not. Gender, previous sexual experience, coping appraisal measures and denial accounted for 33% of the variance in anticipated condom use. Overall the results provided qualified support for Protection Motivation Theory. Implications for health education are highlighted.     

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.     

Alcohol use and serial monogamy as risks for sexually transmitted diseases in young adults.

Alcohol and condom use were assessed using global, situational, and event-level analyses in a sample of young adults (N = 305). Results varied by methodology, event, and partner type; an inverse association between alcohol and condom use was found only at the event level. Participants with strong sex-related expectancies used condoms less frequently when drinking at the time of 1st intercourse with their current partner. For most recent event with a regular partner, alcohol use was unrelated to condom use, but gender, relationship duration, and oral contraceptive use accounted for more than 25% of the variance. Thus, alcohol may increase risky sex early in a relationship, whereas partner familiarity and alternate contraceptive use play a larger role as relationships develop.     

AIDS and condom-related knowledge,beliefs, and behaviors in Mexican migrant laborers

A survey of 87 Mexican migrants (55 males and 32 females) who have lived and worked in the US since 1982 assessed AIDS and condom-related knowledge, beliefs, and sexual practices. Although respondents were highly knowledgeable about major modes of HIV transmission, one-third to one-half believed that HIV could be contracted from mosquito bites, public bathrooms, kissing, and the HIV test. Only 15% knew someone with AIDS. Ever-use of condoms was reported by 70.9% of men and 41.9% of women. Of the 68 subjects who had been sexually active in the year preceding the survey, 20 reported two or more partners. Among sexually active respondents, 16.2% always used condoms with their primary partner, while 43.0% used condoms consistently with occasional partners. 48.9% of men and 57.1% of women never used condoms with their primary partner; with casual partners, these rates were 30.8% and 44.4%, respectively. Worry about contracting AIDS, self-rated on a scale from 1 (very often) to 4 (never), averaged 2.84, with higher worry scores among those 18-31 years of age and with multiple partners. Respondents did not anticipate negative consequences of condom use (e.g., reduced sexual pleasure), but females expressed concern that carrying condoms would cause them to be viewed as promiscuous.     

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

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

Does Past Condom Use Moderate the Future Condom Use Intention-Behavior Relationship? Results from a Ghanaian Sample

Behavioral intention is an important predictor of actual behavior. Yet, people often fail to act on their intentions. This study used panel data to examine whether intention interacts with past behavior in determining future behavior. Young people in the Eastern Region of Ghana (N = 956, 495 = female, 461 = male) completed a structured self-administered questionnaire, assessing intentions to use condoms and past condom use behavior at Time 1, and future condom use behavior at Time 2. Hierarchical multiple regression analyses indicated that intentions to use condoms and past condom use behavior accounted for a significant proportion of the variance in future condom use behavior. In addition, past condom use moderated the future condom use intention–behavior relationship. These results demonstrate the usefulness of considering young people's past experiences with condoms in informing the design of condom use skills training. In other words, a condom use skills training intervention that uses the pedagogical approach of starting from the “known” to the “unknown” might benefit young Ghanaians.