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.     

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.     

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.     

Using the Theory of Planned Behavior to Predict Intention to Use Condoms Among Male and Female Injecting Drug Users

This study tested the utility of the theory of planned behavior (TPB) for understanding and predicting condom use intentions among male and female injecting drug users (IDUs). Interviews were conducted with 405 male and 315 female sexually active IDUs. Participants indicated their intentions to use condoms with main and nonmain sexual partners as well as attitudes, social norms, partner norms, and perceived behavioral control relevant to condom use with each partner type. The TPB accounted for 36 to 48% of the variance in intentions to use condoms. Intentions were related to attitudes, regardless of partner type. Partner norms were related to intentions to use condoms with main partners (men and women) and nonmain partners (men only). Social norms did not predict intentions, regardless of partner type. Perceived behavioral control was related to intentions to use condoms with main partners (men and women) and nonmain partners (women only). The findings are interpreted in light of the roles of cooperation, intimacy, and concern about self-protection.     

Women,men, and condoms: attitudes and experiences of heterosexual college students

Little is known concerning gender and ethnic differences in attitudes about condoms or about the impact of attitudes on condom use. College students ( N = 393) rated many features of condoms. Overall, students were mildly positive about condoms, believing they offer effective protection but detract from sexual sensation. Both past condom use and future intentions to use condoms were higher among students with more favorable global attitudes toward condoms and more favorable specific beliefs about the interpersonal dynamics of condom use. Future intentions to use condoms were also associated with greater worry about sexually transmitted diseases and fewer previous sexual partners. Women were more favorable toward condoms than men. Gender differences also emerged in the predictors of condom use. Implications for assessing condom attitudes and for increasing condom use among young heterosexuals are discussed.     

Sexual risk behaviour among HIV-infected women in the first twelve months after delivery in South Africa

This study aimed to assess sexual risk behaviour and its social correlates in HIV-infected women living in rural South Africa at six and twelve months post-partum. Participants were 699 HIV-positive women recruited prenatally by systematic sampling from twelve community health centres in Mpumalanga province, South Africa (mean age = 28.4 years, SD = 5.7; married =41.1%; serodiscordant or unknown partner status = 74.9%). They self-reported on their sexual activity six to twelve months after delivery; including use of condoms and partner involvement. Generalised linear mixed models were utilised to estimate unsafe sex outcomes from a prevention of mother to child transmission (PMTCT) intervention, socio-demographic factors, disclosure, and male involvement. About 20% of sexually active women in the past week had used condoms inconsistently at six and twelve months after delivery. Moreover, 16% and 18% of the women had not used a condom at last sex and 11% and 13% had unprotected sex with HIV-uninfected or unknown-status partners following delivery at six and twelve months, respectively. Higher inconsistent condom use was likely with lower male involvement. Promotion of condom use post-partum, as well as male involvement in sexual decisions, are important for safer sex post-partum by seropositive women.     

How Gendered Attitudes Relate to Women’s and Men’s Sexual Behaviors and Beliefs

This study examines associations between endorsement of a sexual double standard, gender role attitudes, and sexual behaviors and beliefs. First year university students in the northeastern United States (N = 434; 52 % female; 33 % Black, 29 % Latino, 39 % White; ages 17–19) participated during their first year of college. Endorsement of a sexual double standard was associated with more conventionally gender-stereotyped sexual behaviors and beliefs, specifically, more sexual partners and fewer perceived barriers to condom use for young men, and more perceived barriers to condom use for young women. Women who were more conventional about men’s roles in society tended to use condoms less, whereas women who were more conventional about women’s roles tended to use condoms more. Men who were more conventional about men’s roles tended to have fewer sexual partners. Findings suggest the importance of examining gender’s role in sexual behaviors and beliefs by assessing multiple gendered attitudes, rather than simply considering biological sex.     

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.     

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.     

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.     

Predictors of Condom Use in Mexican Migrant Laborers

The purpose of this study was to explore predictors of condom use with occasional sex partners and regular sex partners, as well as carrying condoms in a new high-risk group for HIV infection, Mexican migrant laborers. This study extends previous findings by (1) exploring additional predictors not previously examined, (2) utilizing a large sample of male and female Mexican migrant laborers, (3) carefully controlling for the effects of various demographic and lifestyle variables related to condom use, and (4) assessing the interactive effects of gender on predictors of condom use. Snowball sampling was used to survey 501 adult Mexican migrant laborers. Results revealed that condom use with occasional sex partners was predicted by carrying condoms and condom self-efficacy and that women were more likely to use condoms with occasional partners when both men and women knew someone with HIV/AIDS. Condom use with regular sex partners was predicted by procondom social norms, less negative attitudes toward condoms, not knowing someone with HIV/AIDS, and condom self-efficacy. Carrying condoms was predicted by procondom social norms, less negative attitudes toward condoms, condom self-efficacy, worry about contracting HIV/AIDS, and women were more likely than men to carry condoms when both men and women were married. Understanding these findings, future research directions, and implications for condom promotion strategies with Mexican migrant laborers are discussed.     

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.     

‘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.     

Barriers to condom use in primary and nonprimary relationships among Hispanic STD clinic patients

Some programs designed to reduce the spread of AIDS and other STDs encourage consistent condom use among sexually active, at-risk individuals. A random sample of 283 Hispanic men and women seeking services at a public STD clinic in New York City were surveyed in an examination of differences in their attitudinal patterns, normative beliefs, and practices related to condom use with primary and nonprimary sex partners. 60% of the participants were male. The group was of mean age 30.9 years, with 46% having graduated from high school. 44.5% were born in the US, although 73.8% had lived in mainland US for the previous ten years or longer. 52.7% were single, 19.8% married, and the remaining 27.5% were either divorced, separated, or widowed. Only 3.2% of men and women reported having same-sex relationships, although the authors suggest that the respondents may have underreported the extent of their bisexual and homosexual behavior. 58.3% of men and 53.3% of women reported having had a prior STD, 82.2% of men and 74.8% of women had experience using a condom, and 31.3% of men and 13.3% of women reported having nonprimary partners. Both the men and women report that they are more likely to use condoms in nonprimary than primary relationships and that they perceive fewer barriers to doing so. Issues related to trust and social acceptability are more salient in primary relationships. Interventions to promote condom use among Hispanics must acknowledge the different psychosocial influences upon condom use in different relationships and target the specific attitudinal and behavioral changes desired.     

Keeping it real: Young adult women's authenticity in relationships and daily condom use

The role of relationship authenticity in shaping women's daily condom use was investigated. Forty‐seven sexually active women in dating relationships completed a measure of relationship authenticity and then reported on their daily condom use and relationship events for 14 consecutive days. Inauthentic women were less likely than more authentic women to use condoms, particularly on days with frequent negative events such as major disagreements with a romantic partner. These critical Person × Situation interactions remained significant after controlling for the use of another form of birth control, sexual frequency, knowledge of a partner's sexual history, and relationship satisfaction. Implications for sexual risk‐taking behaviors and future research using daily experience methods to study sexuality in dating relationships 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.     

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.     

Condom use in steady and casual sexual relationships: Planning, preparation and willingness to take risks among adolescents

Condom use within steady and casual sexual relationships was examined among 14-16 year old Dutch adolescents from secondary school (N?=?140). It was hypothesised that among adolescents sex and subsequently condom use with casual sex partners is less likely to be considered in advance, more context-dependent and less habitual; whereas the opposite is true for steady relationships. Therefore, preparatory behaviours (buying and carrying condoms and communicating about condom use) were expected to mediate the intention-behaviour relation in the context of steady relationships, but not in the context of casual sex. Results confirmed that condom use with steady sex partners was explained by preparatory behaviours, habits, and to some extent, behavioural willingness, and that preparatory behaviours mediated the intention-behaviour relationship. Condom use with casual sex partners was predicted by risk willingness and intentions, without any mediation by preparatory behaviours. The results indicate that it is essential to increase awareness among adolescents that unexpected sexual situations may occur and to train them to take preparatory actions.