Condoms,Sex, and Sexually Transmitted Diseases: Exploring Sexual Health Issues Among Asian-Indian College Students

Sexually transmitted infections (STIs) continue to pose a serious risk to college students in the US. According to the Centers for Disease Control, the highest rates of STIs are among college students and adolescents. Specifically regarding Asian-Indian students, more research is needed to thoroughly understand the knowledge, attitudes and sexual behaviors of this population. A comprehensive review of the literature found a paucity of studies involving Asian-Indian involvement in sexual activity. Therefore, the present study was undertaken to fill gaps in the research. The present study examined Asian-Indian college students’ involvement in sexual behaviors, overall STI knowledge, condom use rate, perceived benefits and barriers to condom use, and history of STIs and STI testing. A five page survey was completed by 122 Asian-Indian college students. Results indicated that overall STI knowledge was low. Females, students who perceived fewer barriers to condom use and students who had lived in the US for at least 3 years held significantly higher STI knowledge levels than their counterparts. Such findings could be used by community and university-based health educators to more effectively serve the needs of Asian-Indian students.     

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.     

Psychological and socio-demographic variables associated with sexual risk behavior for sexually transmitted infections/HIV

New diagnoses of sexually transmitted infections (STIs) and HIV are rising in the adult population. The main objective of this study was to analyze whether knowledge of STIs/HIV, worry about STIs/HIV and pregnancy, and self-efficacy to refuse sex are predictors of sexual risk behaviors among Spanish young and adults. The study sample was composed of 1,106 young and adults of both sexes aged between 17 and 55 years. Results showed that being single, homosexual, having been tested for HIV, having previously contracted an STI, having a college education and earning a monthly income of €900 or more were the characteristics associated with higher scores in knowledge of STIs/HIV. Self-efficacy to refuse sex predicted most vaginal and anal sexual behaviors (i.e., age at vaginal and anal sex initiation and the number of couples that have remained vaginal sex). We also found that participants with greater knowledge of STIs/HIV reported older age at vaginal sex initiation and higher condom use in the first vaginal sexual contact. We consider that these findings can be useful for the development of STI/HIV prevention programs.     

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.     

Community-Based Interventions to Reduce Low Income, African American Women's Risk of Sexually Transmitted Diseases: A Randomized Controlled Trial of Three Theoretical Models

A community-based sample of disadvantaged African American women (n = 445) was recruited to participate in 1 of 3 theoretically driven experimental interventions based on either the theory of gender and power, social learning theory, or cognitive behavioral theory. Intervention outcomes were compared with a waiting list control condition. From baseline to postintervention, women in the experimental interventions showed differential change on cognitive indices (knowledge and attitudes) and skill acquisition (partner negotiation skills, correct condom application, lubricant selection, and information-provision to social networks) whereas control participants were unchanged. Women in the 3 experimental interventions also completed follow-up assessments for 1 year following the interventions. In all 3 experimental conditions, condom use increased relative to the control group and there were no differences between the experimental interventions. Women who participated in one of the theoretically grounded interventions continued to increase condom use over the following year. Women entering new relationships reported significantly more condom use than did women who remained in ongoing relationships. The findings suggest that intervention models that have proven effective for women who engage in high-risk behavior may be less effective for women in established relationships for whom risk is primarily derived from the extrarelationship behavior of their partners.     

Randomized controlled trial of brief interventions to reduce college students' drinking and risky sex

The present study tested the proposition that an intervention to reduce alcohol use among college students will also reduce their risky sexual behavior. In a randomized controlled trial, 154 heavy-drinking, predominantly White, heterosexual college students at behavioral risk for infection with HIV and other sexually transmitted diseases were assigned to receive no intervention or a two-session, in-person, motivational interviewing-based intervention focused on (a) reducing alcohol risk behavior, (b) reducing HIV risk behavior, or (c) reducing both alcohol and HIV risk behavior. Three-month retrospective assessments of alcohol use and sexual behavior were conducted at intake and at 3-, 6-, 9-, 12-, and 15-month follow-up appointments. During follow-up, participants who received the single-focus alcohol risk-reduction intervention drank less frequently and consumed fewer drinks per drinking day as compared with no-intervention control participants, but did not differ from control participants in their frequency of intercourse without a condom or number of sexual partners. Participants who received the single-focus HIV risk-reduction intervention evidenced fewer unprotected sex events during follow-up, as compared with control participants. The number of sexual partners reported during follow-up did not differ by condition. Effects of the interventions did not vary significantly over time and were not moderated by participant gender. Results suggest that intervening to reduce alcohol use may not reduce risky sexual behavior among nonminority college students, but that a brief motivational intervention targeting HIV risk behavior may have utility for reducing the frequency of unprotected sex in this population.     

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.     

Nature, decay, and spiraling of the effects of fear-inducing arguments and HIV counseling and testing: a meta-analysis of the short- and long-term outcomes of HIV-prevention interventions.

OBJECTIVE: To examine the long-term efficacy of both fear-inducing arguments and HIV counseling and testing at encouraging and maintaining knowledge about HIV transmission and prevention, as well as condom use. DESIGN: Analyses were conducted with a sample of 150 treatment groups and 34 controls and included measures of change at an immediate follow-up and a delayed follow-up. MAIN OUTCOME MEASURES: The main outcome measures were perceived risk of HIV infection, knowledge about HIV, and condom use. RESULTS: Results indicated that receiving fear-inducing arguments increased perceptions of risk at the immediate follow-up but decreased knowledge and condom use, whereas resolving fear via HIV counseling and testing decreased perceptions of risk and increased knowledge and condom use at both the immediate and delayed follow-ups. The effects on perceived risk [corrected] decreased over time, but the effects on knowledge [corrected] condom use became more pronounced. CONCLUSION: Inducing fear is not an effective way to promote HIV-relevant learning or condom use either immediately following the intervention or later on. However, HIV counseling and testing can provide an outlet for HIV-related anxiety and, subsequently, gains in both knowledge and behavior change immediately and longitudinally.     

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

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

Impact of Social and Structural Influence Interventions on Condom Use and Sexually Transmitted Infections Among Establishment-Based Female Bar Workers in the Philippines

This quasi-experimental study evaluated the influence of structural intervention components (e.g., changing organizational and social influence factors) in reducing biological sexually transmitted infections (STIs) and reports of unprotected sex among female bar workers (FBWs) in the Philippines (N = 369 at baseline). Recruited from four large southern Philippines cities, FBWs were exposed to a standard care, a manager influence, a peer influence, or a combined manager/peer influence condition. After the two-year intervention period, FBWs in the combined peer and manager intervention condition showed greater reductions in STIs and unprotected sex relative to those in the standard care condition. FBWs in the combined and the manager only conditions also showed a decrease in STIs compared to those in the standard care condition. Managers in the standard care condition reported lower positive condom attitudes and lower attendance at HIV/AIDS related training sessions compared to those in the combined condition. The combined effect of managers and peers had a positive, synergistic effect on condom use behavior and STI reduction compared to the standard care. This research provides empirical evidence that structural changes such as rules, regulations, and increased accessibility of condoms must be in combination with normative changes (individuals' attitudes, beliefs and normative expectancies) in order to achieve the greatest benefit in condom use behavior and STI reduction/prevention.     

Moderation and Mediation of HIV-Prevention Interventions: Relationship Status,Intentions, and Condom Use Among College Students1

This study examined the effects of 2 HIV prevention interventions on condom use and mediators of condom use. College students were randomly assigned to a control condition or an intervention (communication skills or technical skills). Those who received either intervention had greater condom use self-efficacy, more positive condom use attitudes, and stronger intentions to use condoms than did controls. Furthermore, 3-month follow-up data revealed that students in either intervention who were not in a steady dating relationship reported more consistent condom use than did those in the control condition, whereas students who were in either intervention and in a relationship reported somewhat less consistent condom use than did those in the control condition. Analyses suggested that effects of the interventions on condom use were mediated by increased intentions to use condoms.     

An Evaluation of an HIV/AIDS Prevention Program in a Nigerian Setting

The study examined the success of a group based behavioural intervention with Nigerian youths aimed at reducing the risk of contracting and spreading HIV/AIDS and other sexually transmitted illness (STI). Participants were 147 youths (males=75, females=72, age range 5 to 24 years). The study explored the influence of motivational factors (self efficacy), attitudinal factors (perceived personal risk), knowledge (instrumental knowledge of AIDS) and behavioural factors (refusal of high-risk behaviour) in predicting condom use amongst youth participating in a group-based HIV prevention intervention. Findings indicated that the intervention program reliably predicted participants' attitudinal dispositions to high risk heterosexual behaviour. Instrumental knowledge of HIV/AIDS, perceived self-efficacy, perceived personal risk of HIV/AIDS and refusal of risk behaviour were significant predictors of condom use.     

Can Computer‐Mediated Interventions Change Theoretical Mediators of Safer Sex? A Meta‐Analysis

The purpose of this study was to conduct a meta‐analysis of computer‐mediated interventions (CMIs) aimed at changing theoretical mediators of safer sex. Meta‐analytic aggregation of effect sizes from k = 20 studies indicated that CMIs significantly improved HIV/AIDS knowledge, d = .276, p < .001, k = 15, N = 6,625; sexual/condom attitudes, d = .161, p < .001, k = 12, N = 5,816; and condom self‐efficacy, d = .186, p < .001, k = 10, N = 3,308. Although assessed in fewer studies, CMIs also significantly increased perceived susceptibility, condom communication, and condom intentions. Effect sizes were found to be of similar magnitude to human‐delivered interventions. Exploratory analysis of moderating influences detected few significant variables. Implications for the development and testing of CMIs are discussed.     

AIDS Knowledge,Self-Esteem,Perceived AIDS Risk,and Condom Use Among Female Commercial Sex Workers1

This paper explores the effects of type of sexual partner (customer vs. primary partner) and several social psychological enabling resources (self-esteem, perceived personal risk of HIV infection, and knowledge about AIDS/HIV) on condom use among 141 female commercial sex workers. The data examine condom use during the respondents' most recent sexual activity with a male partner. Logistic regression analysis supports earlier findings that commercial sex workers are significantly more likely to use condom during commercial sex with a customer, rather than relational sex with a spouse or significant other. Subsequent multiple logistic regression analysis indicates that, controlling for type of sexual partner (client vs. primary partner), the odds of condom use are significantly increased by the respondents' knowledge about AIDS, level of self-esteem, and personal sense of risk of AIDS infection.     

An experimental comparison of two AIDS prevention interventions among young Zimbabweans.

In 1990, psychologists compared data on 42 student teachers at the University of Zimbabwe who underwent an information-based health education session designed to increase condom use with data on 42 other student teachers who underwent a skills-based health education session. They wanted to determine whether skills-based, participative interventions are more effective in changing attitudes toward AIDS and practices than are information interventions. Mean age for all student teachers was 23.1 years. All participants completed a questionnaire before the interventions and the same questionnaire 4 months after the interventions. The 1-hour information-based intervention included a talk about HIV transmission and prevention and a question and answer period after the talk. A condom fitting demonstration, individual practice, group formulation of behavioral self-management approaches, sketches of social and assertiveness skills used to negotiate condom use, pair role plays, group psychodrama about effects of AIDS, and a video about a popular African musician with AIDS comprised the 90-minute skills-based, participative intervention. The skills-based group exhibited more knowledge about condoms and their correct use (p.001), higher self-efficacy (p.05), fewer obstacles to condom use (p,05), and fewer acts of intercourse without condom use in the last 30 days (p.05) than the information-based group. These results were especially encouraging because risk reduction behaviors were maintained over 4 months. Thus more skills-based interventions and skilled AIDS educators are needed in Africa. The few psychologists in Africa can train educators, design training programs and manuals, and develop effective support and supervision systems.     

Neighborhood Environment, Sexual Risk Behaviors and Acquisition of Sexually Transmitted Infections Among Adolescents Diagnosed with Psychological Disorders

The association between neighborhood environment and prevalence of STIs, sexual partner variables and condom use among adolescents with psychological disorders was examined. Cross-sectional data in three urban areas of the US (Southeast, Northeast and Midwest) were obtained from 384 sexually active male and female participants who provided urine samples for laboratory-confirmed testing of Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. A total of 15.4% of participants tested positive for one of the three STIs. Results indicated that relative to adolescents living in low risk neighborhood environments, those living in high risk environments were significantly more likely to have a STI and to report having casual partners. Findings suggest that in high risk neighborhoods, STI acquisition may be less dependent on condom use and more dependent on other contextual factors. The importance of expanding public health research to include assessment of neighborhood context as a determinant of sexual risk-taking is emphasized.     

Individual attitudes and perceived social norms: Reports on HIV/AIDS‐related stigma among service providers in China

This study examined HIV/AIDS‐related stigma among Chinese service providers by comparing their personal attitudes toward people living with HIV/AIDS with their perception of social norms related to people living with HIV/AIDS. We randomly selected three provincial hospitals, four city/prefecture hospitals, 10 county hospitals, 18 township health clinics, and 54 village clinics from Yunnan, China. Doctors and nurses were randomly sampled proportionally to the doctor–nurse ratio of each hospital or clinic. Lab technicians were over‐sampled in order to include an adequate representation in the analysis. A total of 1,101 service providers participated in a voluntary, anonymous survey where demographic characteristics, individual attitude and perceived social norms toward people living with HIV/AIDS, discrimination intent at work, general prejudicial attitude and knowledge on HIV/AIDS were measured. A majority of the sample demonstrated a similarity between their personal views and what they thought most people in society believe. Multiple logistic regressions revealed that participants who were younger or reported personal contact with people living with HIV/AIDS were significantly more likely to report personal attitudes toward the population that were more liberal than their perceived social norms. Holding a more liberal personal attitude toward people living with HIV/AIDS than perceived social norms was significantly and negatively related to the level of discrimination intent at work, perceived discrimination at interpersonal level and the level of general prejudicial attitude toward people living with HIV/AIDS. Results underscored the importance of understanding social norms and personal attitudes in studying HIV‐related stigma and called for the incorporation of existing human capital into future HIV stigma reduction programs.     

Barriers to Condom Use and Safer Sex Talk among College Dating Couples

Using an open-ended questionnaire response format, this study examined self-generated barriers to condom use and safer sex talk among 119 heterosexual college dating couples at the University of New Mexico (total N=238). Data were collected from both members of these dyads. Reasons for abstaining from intercourse were also elicited. Several general response categories emerged including no perceived risk; spontaneity; deliberate choice; negative attitudes; and a lack of perceived self-efficacy for enacting condom use and safer sex discussion. Explanations for abstinence included religious/moral prohibitions; lack of readiness for intercourse; and a fear of being emotionally hurt. Few differences emerged across gender, ethnicity (Caucasian vs Hispanic), and prior sexual experience (participant had intercourse prior to current relationship vs did not). Selected reasons for not using a condom and/or discussing safer sex (e.g. partner is monogamous) were cross-validated with the self-reported behavior of the respondent's dating partner. In general, participants reasons for perceived non-risk were not supported by their partner's reported behavior. Implications of these findings for sexual risk reduction programs include: establishing realistic goals for safer sex behavior and talk within committed relationships, acknowledging the impact of passion on safer sex, and addressing knowledge gaps in risk perception.     

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.     

Predictors of Condom Use Among African American Males at High Risk for HIV1

This study compared the influence of HIV risk behaviors and condom use attitudes on condom use among heterosexual African American males. Three models were tested: (a) HIV risk, (b) condom use attitudes, and (c) a model combining the previous two. Brief street intercept interviews were administered to African American males in 2 matched pairs of census tracts. Results are based on 589 males reporting vaginal sex in the last 30 days. The General Linear Test (GLT) was used to test the ability of regression models to reduce error variance. The condom use, attitude model was sufficient to predict frequency of condom use regardless of partner type. The strongest predictors of condom use were condom use enjoyment, social norms, self-efficacy, and social influence.