Attitudes toward condoms as AIDS prophylaxis in homosexual men: dimensions and measurement

Increases in condom use among homosexually active men are crucial to containing the spread of AIDS. The present study examined the components of attitudes and beliefs toward condom use in homosexual and bisexual men using a modified version of Brown's Attitude toward condoms scale. Factor analysis revealed 5 clear dimensions: viewing condoms as unreliable and unerotic; as protection from infection; as unavailable when needed; as interrupting sex; and viewing condoms as a responsibility and being comfortable with condom use. 5 subscales constructed from these dimensions differentiated significantly between homosexual men who used condoms frequently and infrequently or never. 4 of the subscales (except Protection form Infection subscale) differentiated frequency of oral condom use; only the Responsibility and Comfort with Condom Use subscale differentiated frequency of anal condom use. The Homosexual Attitudes toward Condom use scale demonstrates that: dimensions of beliefs and attitudes toward condom use in homosexually active men differ substantially from those in heterosexual individuals; a reliable and valid scale for measuring such attitudes now exists; factors influencing condom use in this population differ for oral and anal intercourse; and this scale enables further research on determinants of condom use, and effects of modifying attitudes toward condom use in homosexually active men to be carried out.     

Attitudes toward condoms as AIDS prophylaxis in homosexual men: Dimensions and measurement

Abstract

Increases in condom use among homosexually active men are crucial to containing the spread of AIDS. The present study examined the components of attitudes and beliefs toward condom use in homosexual and bisexual men using a modified version of Brown's Attitude toward condoms scale. Factor analysis revealed five clear dimensions: viewing condoms as unreliable and unerotic; as protection from infection; as unavailable when needed; as interrupting sex; and viewing condoms as a responsibility and being comfortable with condom use. Five subscales constructed from these dimensions differentiated significantly between homosexual men who used condoms frequently and infrequently or never. Four of the subscales (excepting the Protection from Infection subscale) differentiated frequency of oral condom use; only the Responsibility and Comfort with Condom Use subscale differentiated frequency of anal condom use. The Homosexual Attitudes toward Condom Use scale demonstrates that (1) dimensions of beliefs and attitudes toward condom use in homosexually active men differ substantially from those in heterosexual individuals; (2) a reliable and valid scale for measuring such attitudes now exists; (3) factors influencing condom use in this population differ for oral and anal intercourse; (4) this scale enables further research on determinants of condom use, and effects of modifying attitudes toward condom use, in homosexually active men to be carried out.     

The singles scene: safe sex practices and attitudes among at-risk heterosexual adults

Heterosexual transmission of HIV accounts for 80% of AIDS cases worldwide and is the main mode of transmission in sub-Saharan Africa and some Asian countries. The extent of heterosexual HIV transmission will likely increase in Western countries. The safe sex practices and attitudes of 58 male and 54 female heterosexuals in Melbourne, Australia, aged 20-40 years, of mean age 27.4 years, were assessed through interview and questionnaire. Study participants were recruited at discotheques and bars catering to single adults. Respondents' attitudes toward safe sex were generally positive, although those attitudes were not always reflected in actual sexual practice. High levels of sexual activity were reported, including high risk behaviors such as unprotected anal sex with casual and regular partners by both men and women. Situational and partner characteristics frustrated the practice of safe sex despite intentions to use condoms. Few men and half of the women explicitly discussed condom use with their sex partners. These findings are similar to those which one would expect from a sample of adolescents.     

Heterosexual and homosexual activity among gay males

Abstract

A total of 150 adult self‐professed homosexual men, age 20 to 40, living in three locales‐Manhattan, Suffolk County, (N.Y.), and Minneapolis‐were interviewed, in part to determine their heterosexual and homosexual activities. About two‐thirds (65%) said they had experienced intercourse with a woman at least once, but only 6% had done so in the year prior to the survey. The respondents with heterosexual experience (especially with several women) were more homosexually active currently than were those without it. This pattern holds true even when residence, age, bargoing, and education are controlled. The authors speculate that “action seeking” and sexual desirability account for the observed relationships. Even prior to taking on a homosexual identity, some men are more sexually active and seek out sexual “action” and are, in addition, sought out sexually. In a heterosexual sphere their activities will be heterosexual, but in a homosexual sphere their activities will be homosexual.     

Sex differences in evaluating heterosexual and homosexual promiscuity

Our research focused on men's and women's interpretations of homosexually and heterosexually promiscuous behavior. Study 1 involved 21 men and 21 women who rated perceived differences between homosexually and heterosexually promiscuous behavior following a discussion of impersonal sex in public restrooms. Men perceived the two types of promiscuous behavior as more different than did women. In Study 2, 41 men and 23 women rated their perceptions of the difference between homosexually and heterosexually promiscuous behavior without any prior discussion. No sex differences were found, though a significant correlation between age and rating was observed. Men and women may focus on different dimensions when evaluating sexual behavior.     

The Relationship Between Sexual Orientation and Gender Identification Among Males in a Cross-Cultural Analysis in Brazil, Turkey and Thailand

This study measures and compares the level of congruency between male sexual orientation and gender identification using the Kinsey Scale in three cultures: Brazil (Florianópolis), Turkey (Istanbul) and Thailand (Bangkok) with social class as the control mechanism. Quantitative techniques are utilized in comparing the self-evaluation of sexual orientation and gender identification among young men with same-sex, opposite-sex and both-sex orientations or behaviors. Results: In all three cultures, homosexuals were much more likely than bisexuals or heterosexuals to enjoy receiving anal sex and performing fellatio. Bisexual and heterosexual men, as expected, reported enjoying vaginal penetration and cunnilingus more than homosexual men. Same-sex oriented male self-evaluations of homosexual orientation and feminine gender identification scored similarly on the Kinsey Scale (0–6) in all three countries. These data support the traditional identity trichotomy used in the field: homosexuality, bisexuality and heterosexuality. When controlling for nationality only small differences were found amongst the participants; however, social class or level of education did have a significant effect on the relationship between self-evaluation of sexual orientation and gender identification.     

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

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

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.     

Male-female differences in sexual activity,enjoyment and fantasies

Gender differences in sexuality were examined by comparing the sexual experience, enjoyment of various activities, and favourite fantasies of 1862 men and 2905 women readers of a national newspaper. Frequency of experience was no clear guide to enjoyment, especially for women, many of whom engaged in activities they found distasteful. Oral sex was enjoyed by both men and women, whereas anal sex was enjoyed by men and disliked by women. On the other hand, homosexual contact was enjoyed more by women than men. Content analysis of fantasies revealed a male preoccupation with group sex and voyeurism, and a female concern for committed partners and romantic settings. It is argued that fantasies and enjoyment are better indicators of sexual instinct than attitudes and behaviour.     

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.     

Social context,sexual practices,and risks for HIV transmission among men who have sex with men: The south beach health survey

In a population-based sample of 193 men who had sex with men in South Beach, Miami-Dade County, Florida, two indicators of social context—choice of sexual relationships and perceived HIV-infection status—were used to analyze residents who engaged in certain sexual practices with their partners. The vast majority (88.6%) of respondents reported engagement in anal sex during the previous 12 months; 20.2% reported unprotected anal intercourse (UAI) with ejaculation with any partner and 12.4% reported UAI with ejaculation with one or more casual partners. Findings supported the hypothesis that primary partner relationships and perceived HIV status are important variables for understanding engagement in UAI with ejaculation. Men who engaged in such behaviors with casual partners were more likely to have negative attitudes towards condoms, report difficulty communicating desires for safer sex, disagree with the belief that AIDS is fatal, and be intoxicated during anal intercourse. Men who reported engaging in anal intercourse, but who never shared unprotected ejaculations, were most likely to be unknowingly infected with HIV, suggesting that many men may become infected while following what they believe to be “safer sex practices.” In designing effective interventions, public health authorities need to take into account socially embedded risk-negotiating practices.     

FEMALE PARTNERS OF BISEXUAL MEN What They Don't Know Might Hurt Them

Individual interviews with 350 behaviorally bisexual men aged 18–30 revealed that 71% of their female sexual partners and 59% of their steady female sexual partners in the past 6 months had not been aware of their homosexual activity. Rates of nondisclosure were higher for African-American than White men. Compared to nondisclosers, men who disclosed to all their female partners were less self-homophobic and perceived their friends, families, and neighbors as more accepting of their homosexual behavior. Compared to men who had disclosed, the nondisclosers had more female partners and used condoms less consistently with women.     

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.     

The relationship between attitude,assertiveness and condom use

The Australian study investigated condom-specific assertiveness and condom use as a means of prevention infection from sexually transmitted diseases. 211 men participated including 83 homosexual men (aged 19-62 years) and 128 heterosexual men (aged 17-49) who completed a questionnaire that comprised demographic details such as age, monogamy, and sexual activity as well as attitudinal and assertiveness measures. General assertiveness was measured by the Rathus Assertiveness Schedule (RAS) which had been widely used across a wide range of social situations. Assertiveness relating specifically to situations involving condoms was measured by the Condom Assertiveness Scale (CAS). Intention to use condoms was positively related to favorable 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. For both groups, the condom-specific measure of assertiveness was positively correlated with attitudes toward condoms. Condom-specific assertiveness was positively related to general social assertiveness as measured by the Rathus Assertiveness Schedule for the homosexual, but not for the heterosexual men. The negative relationship between general assertiveness and attitude to condoms among the heterosexual men implies that the risk reducing behavior of condom use did not seem to accord with the perceptions of masculinity and social assertiveness among heterosexual men. Thus, female partners of such heterosexual men exhibiting negative attitudes toward condom use combined with assertiveness would have to overcome resistance to insist on the use of condoms. Recently some advertising campaigns have been directed at women. The promotion of condom use among heterosexual men has to deal with the perceptions of condom use as unmasculine behavior.     

Do homosexual teachers account for about half of news stories of molestations of pupils? A Boston Globe replication

Homosexual interaction was involved in 11 (48%) of 23 and 10 (45%) of 22, that is, about half of two nationwide databases of newspaper stories about teachers sexual involvement with pupils reported by Cameron and Cameron in 1998. Whether this relationship holds at a local level was examined by searching all indexed 'sex crimes' in the Boston Globe from 1991 through 1998 for local stories about sex between pupil and teacher. Of the 21 teachers in 20 stories, 11 (52%) interacted homosexually with pupils. Thus it appears that nationally and locally, as reported in newspapers, about half of the molestations by teachers are homosexual.     

Sexual behaviour in injecting drug users

A survey of the self-reported sexual behaviors of 1239 intravenous drug users recruited off the streets in Sydney, Australia, highlighted the impact of both sexual orientation and gender on the risk of human immunodeficiency virus (HIV) infection in this population. The sample included 908 men (mean age, 27.9 years) and 331 women (mean age, 26.3 years), the majority of whom were unemployed or receiving social security benefits. Among male respondents, 50 were homosexual, 117 were bisexual, and 719 were heterosexual; for females these numbers were 10, 95, and 220, respectively. Oral and vaginal sex were the most commonly reported practices among heterosexuals, while homosexuals primarily reported manual stimulation and oro-genital contact. The regular sexual partners of male intravenous drug users tended not to be addicts, while female drug users were primarily involved with male partners who also abused drugs. Among male respondents, condom use was highest among homosexuals, followed by bisexuals, and lowest among heterosexuals; there were no significant differences by sexual orientation in female respondents' condom use. Overall, condoms were most likely to be utilized in anal sex and least likely in the case of oral sex. Condom use was about 5% lower when a regular as opposed to casual sexual partner was involved. Most of the 64 HIV-positive respondents were homosexuals, suggesting that sexual orientation rather than drug abuse was the primary risk factor. Given the finding that there is substantial variation in condom use among subgroups of intravenous drug abusers, it is recommended that HIV prevention programs adopt a diversified rather than uniform approach.     

Emotional and sexual jealousy as a function of sex and sexual orientation in a Brazilian sample

The goal of the present study was to compare the relative distress of homosexual and heterosexual Brazilian men and women on scenarios in which they imagined their partners sexually or emotionally involved with another person, using a forced-choice paradigm and continuous measures. Participants were 68 heterosexual men, 72 heterosexual women, 42 homosexual men, and 35 homosexual women. On the forced-choice questions heterosexual men (39 on one question and 37 on the other) were more upset than their female counterparts (21 on one question and 15 on the other) by scenarios of sexual infidelity than those of emotional infidelity. On questions using continuous measures no significant difference was found between pleasurable sex and attachment scenarios for heterosexual women or heterosexual men. On the highly upsetting scenarios heterosexual men discriminated between flirting and both pleasurable sex and attachment scenarios, being less disturbed by the former. In contrast, heterosexual women were equally distressed by the three scenarios. Scores for the homosexual men and homosexual women fell in between those of the heterosexual men and heterosexual women and did not show a clear cut preference for the sexual infidelity or the emotional alternative on the forced-choice paradigm. However, on the continuous measures of jealousy homosexuals resembled heterosexuals of the opposite sex. There was no evidence that jealousy would be less intense among homosexuals although reproductive outcomes were not at risk.     

Are over a third of foster parent molestations homosexual?

50% of foster parent abuse in a general population survey and 34% of abuse as determined by the Illinois DCFS was homosexual. In news stories in the 50 largest newspapers and wire services 1980-2003, 175 foster parents sexually abused 351+ charges. For the 169 whose sex of victim could be determined: 149 (88%) were men; 76 (53%) victimized homosexually; and 85 (50%) were unmarried. Men assaulted 319 (91%) victims, homosexual practitioners 222 (63%), and the unmarried 164 (47%). From 1980-1994 57% of the victims were girls; after 1994 56% were boys. In 21 group homes, the molestation was homosexual in 15 (71%) and 31 of the 32+ perpetrators were male and at least 334 of 349+ victims were boys.     

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.     

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.