Effects of a School‐Based Life Skills and HIV‐Prevention Program for Adolescents in Mexican High Schools1

A school‐based life skills and sexuality education HIV/AIDS program for adolescents was evaluated in Toluca, Mexico, through a quasi‐experimental pre–post design with 1,566 cases, divided over a control group and an experimental group. Based on a previously tested path model, 3 levels of variables were included as a guide for the contents of the program: personal variables (self‐knowledge, self‐efficacy regarding condom use, and decision making), intervening variables (subjective norms about, knowledge about HIV/AIDS, and attitudes toward condoms), and outcome variables (communication on sexuality and intentions to use condoms). Evaluation was conducted following these categories. Significant increases in all of these variables recognized as precursors of safer sex were found in the experimental group.     

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.     

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.     

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.     

Assessment of the Fiji-Based Condom Social Marketing (CSM) Program

This paper discusses the results of a systematic review of the Condom Social Marketing (CSM) program which was implemented in Fiji by a non-profit organization for a period of 5?years. The CSM program was introduced during a decade when Fiji was recording an escalating number of new Human Immunodeficiency Virus (HIV) infections. The aim of the program was to increase the awareness and utilization of safe sexual practices among the most vulnerable group??the youths??which had reported the highest incidences of sexually transmitted infections. Program assessment revealed that the CSM program had reportedly increased the acceptability, accessibility, and usage of their TRY TiME condoms in Fiji. We conducted a survey on a sample of sexually active people during January?CFebruary 2009 to examine their prevailing level of knowledge about HIV/AIDS, sexual behavior/practices, and risk perception. The results showed that, despite the high level of awareness about HIV/AIDS among survey participants, people did not consistently practice safe sexual behavior and commonly identified themselves as at low risk of acquiring HIV. This paper concludes that more extensive behavior change programs are needed in order to influence people to change their risky sexual practices and reassess their risk perceptions.     

The effectiveness of a joint mother–daughter sexual health program for Latina early adolescents

A culturally and cognitively adapted joint mother–daughter sexual health and HIV transmission curriculum was implemented for 96 Latina early adolescents and their mothers (48 mother–daughter dyads). Pretest and posttest surveys, interviews, and observations of participants' conversations about AIDS were used to assess program effectiveness in increasing knowledge and communication about sexuality and HIV transmission, and fostering daughters' positive attitudes toward using condoms in the future. At posttest, mothers and daughters reported an increase in the frequency of home communication about sexual topics and openness in general communication. Systematic observational analysis of videotaped mother–daughter conversations about AIDS revealed that, compared to the pretest, daughters were more engaged in posttest conversations as evidenced by an increase in their spontaneous sharing of information about HIV transmission and their offering of opinions. In addition, the posttest conversations focused on a broader discussion of HIV transmission risk behavior including condom use as a protective measure. Mothers who knew more about HIV transmission at posttest, and who reported more openness in general communication with daughters at posttest, asked their daughters more questions in the conversations about what they had learned in the program. Daughters who contributed more information and opinions to the posttest conversations, who were more knowledgeable about HIV transmission at posttest, and who reported more home communication about sexual topics in the posttest, also reported more positive attitudes toward using condoms in the future.     

Transmission risk behaviors in a subset of HIV-positive individuals: The role of narcissistic personality features

Most people living with HIV/AIDS (PLWHA) take steps to protect their sexual partners. However, a minority of PLWHA continue to engage in sexual risk behaviors that might contribute to the transmission of HIV. Psychiatric conditions, including certain pathological traits, are associated with sexual risk behaviors. Research examining the association between narcissistic traits as they relate to HIV transmission risk is limited. In the present study, 303 PLWHA were recruited from an infectious disease clinic and completed questionnaires assessing narcissistic characteristics, substance use, sexual risk behavior, and intentions to use condoms in the future. Narcissistic traits predicted unprotected sex with partners who are HIV-negative or whose HIV status was unknown as well as lower intentions to use condoms, after controlling for demographic factors and substance use. Interventions focused on reducing the transmission of HIV should take into account associations between sexual risk behavior and narcissism.     

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.     

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 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.     

“Whenever Jack sees a condom,he falls asleep”: experiences of condom use and erectile disorder among HIV positive men in a Zimbabwean rural setting

In this qualitative inquiry, we set out to explore the experience of condom use and erectile disorder (ED) among men living with HIV in a rural district of Zimbabwe. Data on condom use related erectile disorder with antiretroviral (ART) medication were collected from a purposive sample of 18 men living with HIV and AIDS (age range 23–54 years). These data were supplemented with those from a convenience sample of 23 women living with HIV who self-identified as partners of men living with HIV and AIDS (age range 26–37 years). The data were thematically analyzed. Results suggest that men attributed their experiencing of erectile problems to two main explanations: use of condoms and ART medication. These men reported inconsistent use of condoms and/or adherance to ART therapy due to a belief that these cause their ED. The women informants reported similar observations, including the shared gendered perspective that the men perceived a loss of sense of manhood from ED. Beliefs that influence health promotion with men living with HIV and AIDS are important to public health interventions with them.     

A six-month follow-up of adolescents' sexual risk-taking,HIV/AIDS knowledge,and attitudes to condoms

A follow-up study was conducted to investigate change in sexual behaviour, knowledge about HIV/AIDS transmission, and attitudes to condoms over a 6-month period in a sample of late-adolescent students. The study also obtained subjective reports of HIV/AIDS-relevant change. Overall there was a decrease in sexual risk-taking behaviour with casual partners but no change occurred in sexual behaviour with regular partners, knowledge about HIV/AIDS, attitude towards condoms, or intention to use a condom on next sexual encounter. Examination of individual data revealed that, for some adolescents where behavioural change had occurred, this was in the direction of less safe sex. There were few self-reports of change in sexual behaviour, intention to take precautions against HIV/AIDS, or concern about HIV/AIDS over the preceding 6 months. Subjective reports of behaviour change did not correspond with reports of actual behaviour. Low rates of behaviour change are attributed to the failure of adolescents to personalize the threat of AIDS and to their trust in the safety of sex with a regular partner as well as to the lack of relevance of HIV/AIDS education campaigns to this group.     

Cultural practices of Hispanics: implications for the prevention of AIDS

Hispanic Americans have one of the highest rates of HIV seroprevalence among all ethnics groups in the US, with high rates being especially noticeable among women and children. Were it known which cultural factors have the most influence on whether Hispanics engage in high-risk behavior for HIV transmission, prevention interventions could be targeted accordingly. To that end, this study was mounted to identify which Hispanic cultural factors relate to condom use. 117 males and 73 females aged 17-56 years of mean age 25.67 were surveyed in Washoe county, Nevada. These mostly young adults had recently immigrated to the western US. It was initially posited that fate orientation, male- female relationships, family relationships, machismo behavior, and religion would have equal influence with respect to condom use. Analysis found that condom use was largely associated with and determined by men who are the principal buyers of condoms. A machismo attitude toward protecting women by using condoms was also associated with condom use. Neither fate orientation with respect to AIDS, nor religion were important determinants of condom use, even though 86.5% of the respondents were Catholic. The degree to which respondents adhered to traditional Hispanic cultural values was influenced by the degree of education and acculturation. On the basis of these findings, the authors suggest targeting AIDS prevention messages to males, while emphasizing the protection of women through condom use. They also suggest that both education and acculturation levels be assessed before implementing prevention programs.     

Opinion on AIDS prevention and education among rural secondary school pupils in the northern province of South Africa

The study investigated perceptions of AIDS prevention and education among 308 Grade 11 pupils (132 boys and 176 girls), secondary school pupils (mainly Northern Sotho and Tsonga) in the Northern Province of South Africa. They were chosen randomly from three rural schools in Mankweng district and were ages 17 to 25 years (M age = 19.1 yr., SD = 2.8). Analysis of ratings given on items of a questionnaire on AIDS prevention and education indicated that 'Isolating people who are HIV positive' and 'How to protect yourself from getting HIV/AIDS' received the highest ratings. Factor analysis extracted three factors on AIDS education explaining 48% of the variance. The items loading strongly on the first factor were use of condoms (.54), giving information (.53), finding a cure (.52), and no sex outside marriage (.42). On AIDS education two factors were extracted accounting for 52% of the variance. The first factor had significant item loadings for 'sexual behaviour and HIV/AIDS' (.75), 'knowledge of self-protection' (.68), 'how AIDS/HIV affects the body' (.66), and 'alcohol and sexual behaviour'. These findings should contribute to the development of health promotion initiatives directed at AIDS/HIV.     

Twenty years of student sexual behavior: subcultural adaptations to a changing health environment

This twenty-year study analyzes changes in sexual behavior among students at Okanagan University College in British Columbia, Canada. Surveys conducted in 1980, 1990, and 2000 reveal a steady increase in safer sexual practices. Most students now question potential partners about their past, use condoms with a new sexual partner, and maintain fairly long-term monogamous relationships. Three sexual subcultures continue to coexist in fairly stable proportions: celibacy (about 30%), monogamy (about 60%), and free experimentation (about 10%). Each subculture has created its own response to the danger of HIV/AIDS: celibates exaggerate the danger they face, monogamists rely on love and fidelity for protection, and free experimenters have increased their use of condoms. While romantic feelings lead many monogamous couples to abandon condoms without objective HIV/AIDS knowledge, free experimenters still face the highest risk. Although they now use condoms more than half the time, their lifestyle, which involves multiple partners, risky sexual acts, and frequent drug and/or alcohol use, clearly remains dangerous. The persistence of distinct subcultures has implications for health education programs, which would be most effective if based on key values held by specific target groups.     

Correlates of condom use and condom‐use motivation among young South Africans

A survey of South African secondary school students aged 12–17 years (n = 893) included measures designed to investigate relationships between beliefs about HIV/AIDS, condom use, interpersonal relationships, and two dependent measures: motivation to use condoms and reported condom use. We predicted that motivation would be an important correlate of reported condom use and that traditional cultural beliefs included in social cognition models would predict condom use motivation. Hierarchical multiple regression showed that 10% of the variance in reported condom use was accounted for by condom use motivation and age. Condom self‐efficacy, beliefs about condoms and injunctive norms accounted for much of the variance. Other beliefs included susceptibility to HIV and attribution of HIV to asexual sources such as witchcraft indicating that an expanded model of modifiable cognitions may be optimal when designing HIV interventions among young South Africans.     

The prediction of condom use intention among South African university students

A questionnaire was administered to 294 sexually active, unmarried undergraduate students to investigate the role of social norms in the prediction of the intention to use condoms. Components of social cognitive theory and the theory of reasoned action and planned behaviour were integrated with those of the Health Belief Model to predict future intention to use condoms with a new partner. Logistic regression analyses of selected risky sexual behaviours on the intention to use condoms showed that, among males, attitudes towards using condoms and the Health Belief Model component of perceived barriers predicted the intention to use condoms. The Health Belief Model component of perceived benefits could not be interpreted. Attitudes, subjective norms and perceived self-efficacy were associated with female students' intention to use condoms. Implications for strategies of HIV/AIDS prevention are discussed.     

Predicting Condom Use in African American STD Patients: The Role of Two Types of Outcome Expectancies1

This study examined the association of two types of condom use outcome expectancies (self-approval and partner reaction) with patterns of safer sexual behavior among predominantly African American patients at a sexually transmitted diseases (STD) clinic. As expected, both individuals' own self-approval outcome expectancies and their partner reaction outcome expectancies predicted consistency of condom use, although partner reaction expectancies predicted condom use above and beyond the effects of self-approval expectancies. Furthermore, individuals who believed that they and their partner shared positive condom use outcome expectancies reported the greatest use of condoms. These findings suggest that HIV prevention programs should address both types of condom use outcome expectancies in order to maximize behavior change.     

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.     

Mapping an HIV/STD prevention curriculum for Zambian in-school settings

HIV/AIDS poses grave risk to human development in sub-Saharan Africa. Evidence-based interventions that are rooted in local culture could help efforts to prevent threats to human development from HIV/AIDS. We used concept mapping (Concept System, 2006 ) to construct the components and content of a locally developed HIV/AIDS curriculum for use by secondary schools in Lusaka, Zambia. Participants were school counsellors (n = 14), youth health program officers (n = 7), and regular education teachers (n = 3) from the education, health, and youth development agencies in Lusaka, Zambia (males = 11; females = 13; mean age 38; SD = 15 years). Concept mapping yielded six statement clusters defining preliminary components of a locally grounded in-school HIV/AIDS prevention curriculum and the content items that define these components: (1) life skills education (18 items), (2) sexuality and reproductive health (10 items), (3) treatment, care and support (13 items), (4) counselling (12 items), (5) basic facts about HIV/AIDS (11 items), and (6) dissemination of information about HIV/AIDS (11 items). Zambian locally constructed constructs for an HIV/STD prevention curriculum overlap those promoted by public health programs in the country and internationally.