HIV testing,perceptions of AIDS risk,and condom use motivation among US women

As STD infections including HIV increase in the United States, it has become increasingly important to policy makers to ascertain the extent to which knowledge and perceptions of AIDS risk affect an individual's probability of altering their sexual or contraceptive behavior to avoid infection. This paper examines the extent to which women's perceptions of their own and their partners' risk of HIV infection affects the probability of using a condom for protection against sexually transmitted diseases. This paper also examines the extent to which HIV testing may affect motivation for condom use. Crosstabulations reveal that prophylactic condom use is more prevalent among women who have been tested for HIV and increase as perceptions of their chance (and their partner's chance) of being positive increases. The multivariate results from this study indicate that having an HIV test significantly predicts the likelihood of using a condom for STD prevention for US women. Furthermore, women who perceive themselves to be at least somewhat likely to be HIV positive have a higher probability of using a condom to prevent sexually transmitted disease, and women who perceive their partners to be HIV positive are twice as likely as other women to use a condom for STD prevention. However, women who consider themselves likely to be HIV positive are no more likely to use a condom than those who consider themselves not at risk.     

Condom use among married and cohabiting women and its implications for HIV infection in Mahikeng,South Africa

Married and cohabiting women have been neglected in the promotion of condoms as the most effective prevention method of sexually transmitted infections (STIs) and HIV. As a result, HIV prevalence is increasing in this population group in high HIV prevalence settings. The study assesses the prevalence of and identifies the predictors of consistent use of male condoms among married and cohabiting women, and examines its implications for HIV transmission. The data used were obtained from a cross-sectional survey on sexual and reproductive health conducted among women aged 18–49 years of age in Mahikeng Local Municipality in 2012 using mixed methods. A structured questionnaire and in-depth interview guide were used to collect quantitative data from 568 and qualitative data from 33 married or cohabiting women. The data were analysed using logistic regression and thematic content analysis methods. The results show that only 16.2% of the women consistently used condoms. Women having no and 1–2 surviving children, educated women, women in relationships in which most sexual decisions were jointly made with husbands/partners, women having high risk perceptions of STIs and HIV infection and women who negotiate condom use with and know the HIV status of their husbands/partners were significantly more likely to have consistently used condoms. However, women who perceived that condoms reduce sexual pleasure, feared they would be blamed for infidelity by husbands/partners, trusted that their husbands/partners were faithful and feared condoms could lead to relationship instability used condoms inconsistently. We conclude that the prevalence of consistent use of condoms by married and cohabiting women in the study is low, indicating that promotion of condoms among married or cohabiting women is neglected, which could increase the risk of HIV transmission. Based on our findings, we recommend the review of condom programmes with a view to targeting married or cohabiting couples as an important group for condom promotion and uptake.     

Crack users' intentions to use condoms with different partner types

Purpose. Evidence suggests that farmworkers are practicing high risk behavior, particularly crack cocaine use and unprotected sex, that consequently places them at an increased risk for HIV transmission. This study examined the intention to use condoms with four different sexual partner types (loved partner, casual partner, paying partner, and new partner) among a sample of farm workers who were also cr Methods. Personal interviews (n = 205) were conducted with male and female farm workers who were crack users (confirmed by urine test). Participants were recruited from a Florida homebase community for migrant farmworkers. The questionnaire assessed sexual activity (including number of partners and partner type), drug use and attitudes and beliefs about condoms. Results. Hispanic males reported a significantly lower likelihood of condom use for all partner types. For commercial partners, intention to use condoms was reduced dramatically for Hispanics but was markedly higher among steadily employed subjects. Finally, women were half as likely as men to report that they intended to use a condom with a loved partner. Conclusions. This study indicates that ethnicity and the nature of sexual relationships both play important roles in determining whether subjects report that they intend to use condoms, even in a population known for the presence of multiple partners and a widely perceived epidemic of AIDS and other sexually transmitted diseases.     

Changes in the use of birth control methods

Abstract Information on changes in the methods of contraception used was collected from women in a KAP Survey of Trinidad and Tobago in 1970-71. Using methods analagous to those used in the study of internal migration, it is found that 54% of contraceptors were still using the method they first used, and 46% had changed. In general, the net changes tended to be from less to more efficient methods. This is demonstrated with data showing: 1. the number of changes from one method to another; 2. the number of changes these women have made, considering the first and last methods only; and 3. the number of changes, including intermediate changes. Nevertheless, there is also an appreciable movement away from the more effective methods either to other methods, or out of contraceptive practice entirely. The rate of dropout from contraception has been increasing in recent years for all methods, and, apparently, for all ages of women. The principal reasons given for stopping the use of the various methods were: 1. pregnancy; 2. that the method was uncomfortable or too much trouble; 3. that the method made the user ill (in the case of the pill and the IUD); and 4. that the partner disliked the method (in the case of the condom and withdrawal). More positive reasons include: 1. that the woman wanted more children; and 2. that she no longer had a partner.     

Contraceptive use at first intercourse among Jewish women in Israel, 1962–1988

Using data from the 1987–1988 Study of Fertility and Family Formation,this study examines the family planning practices of Jewish Israeli womenwho first had intercourse between 1962 and 1988. The overwhelming majorityof women reported using no contraception at first intercourse, and among those who did practice birth control approximately half relied on modern techniques. While the likelihood that Israeli women used contraception at first sex changed little between 1962 and 1988, there has been a marked shift towards the adoption of efficient methods of birth control. Moreover, factors which promote female empowerment, including education and military service, have been positively associated with contraceptive use at first intercourse. Among those women who practiced contraception at first intercourse, those from Africa and Asia have been especially likely to make use of inefficient methods such as withdrawal.     

Sexual activity and weekly contraceptive use among young adult women in Michigan

Past studies on the influence of sexual activity on contraceptive behaviours are inconclusive, relying heavily on cross-sectional data. We used a population-based longitudinal sample of young women in Michigan to evaluate weekly associations between sexual activity and contraceptive use at three levels of measurement: comparing between women, among individual women’s partnerships, and from week to week within partnerships. We used multinomial logistic regression accounting for correlations within partnerships and women. Relative to use of least effective methods, weekly sexual activity was significantly associated with increased use of condoms, pills, and highly effective methods. For pills and highly effective methods, partnership-, woman-, and week-level effects were similar. For condoms, there was no significant woman-level effect. Evidence of immediate effects of sexual activity on contraceptive use highlights the importance of longitudinal data. These dynamics may be diluted or missed altogether when relying on cross-sectional data approaches that compare groups of individuals.     

Risk-taking and contraceptive behavior among unmarried college students

The contraceptive behavior of sexually active, never-married college women was examined using multiple regression analyses. Use of an effective method of contraception was highly situation-specific: length of relationship and frequency of intercourse were the variables most highly correlated with use of effective contraception, followed by method of contraception used at first coitus and knowledge of reproduction. Failure to use effective contraception was not associated with low estimates of pregnancy risk, nor with high utility of pregnancy, nor with uniquely high willingness to seek abortion. The results of the present study suggest that use or non-use of effective contraception is mediated by the predictability of sexual intercourse.We would like to thank Ira H. Bernstein for his assistance with computer programming and data analysis. Reprints are available from Ms. Irene Steeger, Center for Population and Family Health, Columbia Unviersity, New York.     

A gender comparison of HIV and drug use across the rural-urban continuum

Despite the central role of women drug users in escalating AIDS statistics, there is still a limited number of studies that examine the roles of gender and drug use type in HIV seroprevalence. This lacuna in the research literature has led to significant gaps in researchers' understanding of how and to what extent women may differ in their drug-using and HIV risk behaviors compared to their better-studied male counterparts. This study, derived from a sample of 3,555 out-of-treatment drug users residing in three South Florida urban and rural communities, attempts to compare the drug usage and needle and sexual risk behaviors of male and female drug users that put them at risk for HIV infection. The overall seropositivity rate for women drug users was 26.5% compared to 19.5% for their male counterparts. Results of multivariate analyses indicate that females compared to males were 1.4 times more likely to be HIV seropositive. Risk behaviors associated with this elevated seropositivity include living arrangements, homeless status, drug use, sexual trading behaviors, and history of STDs. Furthermore, there was a strong linear relationship between drug use type and HIV seroprevalence among women drug users. Compared to those who were neither crack smokers nor injectors of illicit drugs, those who were crack smokers only were 2 times more likely to be HIV seropositive, while those who were both crack smokers and injectors were 5 times more likely to be HIV seropositive, and those who were injectors only were 6 times more likely to be HIV seropositive. These findings indicate that among women, drug abuse and its associated risk behaviors, increase the vulnerability of this population for HIV and thus render them an extremely important priority population on which to focus HIV prevention and public health efforts and programs.     

A meta-analysis of research on adolescent contraceptive use

Meta-analysis was used to summarize the results of 134 studies of adolescent contraceptive use in relation to two major explanatory models, the career model and the decision model. There was evidence in support of both models, although there has been less research conducted on variables related to the decision model. The major variables found to affect young women's contraceptive use were partner influence to use contraception, acceptance of one's sexuality, future orientation, positive attitudes toward contraception, an exclusive sexual relationship, and frequency of intercourse. The major variables affecting young men's contraceptive use were partner influence, frequency of intercourse, and positive attitudes toward contraception; however, there was relatively little research on young men compared to young women. A number of possible future directions for research are noted.We would like to thank Nancy Adler and Catherine Chilman for their comments on an earlier version of this article. Portions of this research were presented at the 1984 meeting of the American Psychological Association.Requests for reprints should be addressed to Bernard E. Whitley, Jr., Department of Psychological Science, Ball State University, Muncie, Indiana, 47306.     

Non-Heterosexuality,Relationships, and Young Women’s Contraceptive Behavior

Non-heterosexual young women have a higher rate of unintended pregnancy than their heterosexual peers, but their fertility behaviors are understudied. We use longitudinal data from the Relationship Dynamics and Social Life study to investigate mechanisms contributing to non-heterosexual women’s higher pregnancy risk. These data include weekly reports of relationships, sex, and contraceptive use over 30 months. We compare the relationships and fertility behaviors of three groups: exclusively heterosexual (consistent heterosexual behavior, identity, and attraction); mostly heterosexual (heterosexual identity with same-sex behavior and/or same-sex attraction); and LGBTQ (any non-heterosexual identity). We find that mostly heterosexual and LGBTQ women behave differently from exclusively heterosexual women in ways likely to elevate their risk of unintended pregnancy: more distinct partners during the study period, more sexual intercourse with men, less frequent contraceptive use, less use of a dual method (condom plus hormonal method), and more gaps in contraceptive coverage. Mostly heterosexual women resemble LGBTQ women in their contraceptive behavior but have significantly more intercourse with men, which may increase their pregnancy risk relative to both LGBTQ and exclusively heterosexual women. We conclude by considering implications for LGBTQ health and the measurement of sexual minority populations.     

Dynamics of contraceptive use and breastfeeding during the post-partum period in Peru and Indonesia

This paper examines the interaction between contraceptive use and breastfeeding in relation to resumption of intercourse and duration of amenorrhea post-partum. We used data from the month-by-month calendar of reproductive events from Demographic and Health Surveys (DHS) in Peru and Indonesia. The analyses show that breastfeeding women were less likely than non-breastfeeding women to have resumed sexual intercourse in the early months post-partum in both countries. In Peru, but not in Indonesia, breastfeeding women had a significantly lower odds than non-breastfeeding women of adopting contraception. Although the likelihood of contraceptive adoption was highest in the month women resumed menstruation in both countries, about ten per cent of subsequent pregnancies occurred to women before they resumed menses. These results emphasize the importance of integrating breastfeeding counselling and family planning services in programmes serving post-partum women, as a means of enabling those who wish to space their next birth to avoid exposure to the risk of a pregnancy that may precede the return of menses.     

Women's autonomy,women's status and fertility-related behavior in Zimbabwe

Women's household decision-making autonomy is a potentially important but less studied indicator of women's ability to control their fertility. Using a DHS sample of 3,701 married black African women from Zimbabwe, I look at women who have no say in major purchases, whether they should work outside the home,and the number of children. When men dominated all household decisions, women were less likely to approve of contraceptive use, discuss their desired number of children with their spouse, report ever use of a modern method of contraception, and to intend to use contraception in the future. However, women's decision-making autonomy was not associated with current modern contraceptive use. Women who had no decision-making autonomy had 0.26 more children than women who had some autonomy. These autonomy measures provide additional independent explanatory power of fertility-related behavior net of traditional measures of women's status such as education and labor force participation.     

Psychosocial maturity and teenage contraceptive use: An investigation of decision-making and communication skills

The developmental factors influencing teenage women's contraceptive decision-making with first sexual partner are investigated. A discriminant function analysis of results of a study of 17- to 19-year-old women shows the following: Pill users are distinguished from women who have not used any method by having had a longer relationship with their partner, having a more negative attitude towards becoming premaritally pregnant themselves, being older at the time of their sexual debut, engaging in more frequent sexual intercourse, being more trusting of their partner, and perceiving the risks of unprotected pregnancy as greater. Women who are protected by the use of condom are distinguished from women not protected by any method by having had more discussions with male friends about a variety of topics, having better role-taking skills, having a less negative attitude about becoming premaritally pregnant, and having discussed their sexual debut with their partner beforehand. Results are consistent with a conceptualization which distinguishes contraceptive methods on the basis of the psychosocial costs their use incurs for young women.Research supported by Grant #HD09813, National Institute of Child Health & Human Development. Thanks are due to Robin Halliday, Allyson Myhre, and Carolyn Scheve for help in conducing this investigation.     

The influence of three genes on whether adolescents use contraception, USA 1994-2002

In a further contribution to recent investigations of the relevance of genetic processes for demographic outcomes, we investigate genetic associations with whether adolescents use contraception. Using data from the National Longitudinal Study of Adolescent Health, we find that variants in the dopamine transporter gene DAT1, the dopamine receptor gene DRD2, and the monoamine oxidase gene MAOA are associated with unprotected sexual intercourse. Consistent with previous analyses of these data, the genotypes DRD2*A1/A2, DRD2*A2/A2, DAT1*9R/10R, and MAOA*2R/ are associated with higher odds of unprotected sexual intercourse than other genotypes at these loci. The DRD2 associations apply to both men and women, whereas the other associations apply to women only. These results are robust to controls for population stratification by continental ancestry, do not vary by contraceptive type, and are consistent with previous research showing that these genetic variants are associated with higher rates of impulsivity.     

Why women who don't want to get pregnant don't use contraception

In the developing world about 120 million women have an unmet need for contraception. They want to postpone childbearing, yet they do not use contraception, often because of the unavailability of services and supplies. However, according to a recent article by John Bongaarts, the primary factors are lack of knowledge about a contraceptive method, concern about side effects, and the disapproval of the male partner in developing countries. Lack of knowledge means inability to describe the uses of a contraceptive, its side effects, and the locale of its availability. An approximate knowledge index was calculated for such women, which showed that knowledge level positively correlated with contraceptive prevalence. Countries where the index was below 50% had a contraceptive prevalence of 8% only. The determinant reasons why women were reluctant to use the pill, IUD, and sterilization had to do with health and the fear of side effects, such as nausea and increased bleeding. The contraceptive prevalence among these women was reduced by 71% for the pill, 86% for the IUD, and 52% for sterilization. In Sub-Saharan countries nearly 70% of women cited partner disapproval of contraception, although they had never discussed family planning with their partners. The central concept for reducing unmet need is access with quality, which means that services are voluntary, safe, and appropriate in delivery. Some of the recommendations to reduce the unmet need for contraception include: one-on-one same-sex discussions to increase contraceptive knowledge and acceptability; sensitive responses by programs to their client's health concerns; support by service providers to women negotiating with male partners in order to mitigate male disapproval; and sex education and family planning services to reduce unwanted and early sexual contact and pregnancy while girls develop identities apart from mothering roles.     

Gender differences in substance use and initiation of sexual activity

Even though widespread efforts have focused on educating young adults about HIV and AIDS, many individuals continue to engage in behaviors that place them at risk. These behaviors include frequent experimentation with alcohol and other drugs prior to sex, engaging in sexual activity with different partners, and inconsistent safe sex practices (Butcher et al. 1991). The combination of these risky behaviors causes increased concern about the spread of HIV among those of college age. This study focused on two behaviors by examining the relationship between substance use during adolescence and early initiation of sexual activity in a sample of 950 subjects aged 19–21 in a mid-sized southern city. Results indicate that early use of alcohol and marijuana relates to earlier initiation of sexual activity and subsequent risky sexual behavior among young adults. Also, gender differences were observed for frequent users of marijuana and alcohol with males engaging in riskier sexual practices. Recommendations for interventions are made.     

Environmental Change,Risky Sexual Behavior,and the HIV/AIDS Pandemic: Linkages Through Livelihoods in Rural Haiti

Local natural resources are central to rural livelihoods across much of the developing world. Such “natural capital” represents one of several types of assets available to households as they craft livelihood strategies. In order to explore the potential for environmental scarcity and change to contribute to perpetuation of the HIV/AIDS pandemic, we examine the association between declining natural capital and engaging in risky sexual behaviors, as potentially another livelihood strategy. Such an association has been demonstrated in Kenya and Tanzania, through the fish-for-sex trade. To explore the possibility of this connection within rural Haitian livelihoods we use Demographic and Health Survey data, with a focus on rural women, combined with vegetation measures generated from satellite imagery. We find that lack of condom use in recent sexual encounters is associated with local environmental scarcity—controlling for respondent age, education, religion and knowledge of AIDS preventive measures. The results suggest that explicit consideration of the environmental dimensions of HIV/AIDS may be of relevance in scholarship examining factors shaping the pandemic.     

Understanding calendar rhythm

Rhythm has been among the family planning methods endorsed since the start of the National Population Program in the Philippines, but it has not been given as much emphasis as the other methods such as oral contraception (OC), the IUD, and sterilization. For several years, no systematic effort was made to promote the effective use of rhythm. The 1978 Community Outreach Survey (COS) tried to determine the extent to which contraceptive methods were being used in the Outreach Project areas. The project covered 2,000 barangay service points (BSPs) with 1.76 million married couples of reproductive age (MCRA), representing 32% of the estimated total MCRA in the Philippines. The COS findings revealed that, of the total sexually active married women aged 15-49, 48% were using contraceptive methods. Of these, only 11.4% were using modern methods, 20% were using other program methods (rhythm, condom, and combination of rhythm and condom); and 16.7% were using nonprogram methods (withdrawal, abstinence, and others). When used in combination with other methods, rhythm had a monthly continuation rate of 96%; when used alone, 94%. The COS data showed that the rhythm method is practiced by a large number of Filipino couples. With the renewed interest in rhythm, it became imperative for the program to help rhythm acceptors use the method more effectively and thus reduce user failure. There continues to be need for data on the "product image" of rhythm. These include the emotions that come into play in the acceptance or rejection of rhythm, the perceived side effects as well as advantages of the method, the ways women communicate their "safe" and "unsafe" days to their husbands, the manner in which couples prevent sexual contact during "unsafe" days, and the attitude of couples toward abstinence. Among important study findings were the following: couples choose rhythm because it does not disturb the sexual act, has no side effects, and poses no religious objections; 1 of the problems of rhythm users is that they get varied explanations and instructions from service delivery personnel on the correct way to practice rhythm; and many rural women do not have a clear understanding of the menstrual cycle. Requirements of successful rhythm practice include cooperation, regular cycle, and the couple's age.     

Facilitators and barriers to substance-free pregnancies in high-income countries: A meta-synthesis of qualitative research

BackgroundPrevious studies have associated substance use (alcohol, illicit drugs and smoking) to negative pregnancy outcomes, including higher risk of stillbirth.AimThis study aims to identify facilitators and barriers reported by women to remain substance free during pregnancy.MethodsA systematic search was conducted in six databases from inception to March 2019 and updated in November 2020. Qualitative studies involving pregnant or post-partum women, from high-income countries, examining women’s experiences of substance use during pregnancy were eligible. Meta-ethnography was used to facilitate this meta-synthesis.FindingsTwenty-two studies were included for analysis. Internal barriers included the perceived emotional and social benefits of using substances such as stress coping, and the associated feelings of shame and guilt. Finding insensitive professionals, the lack of information and discussion about risks, and lack of social support were identified as external barriers. Furthermore, the social stigma and fear of prosecution associated with substance use led some women to conceal their use. Facilitators included awareness of the health risks of substance use, having intrinsic incentives and finding support in family, friends and professionals.DiscussionPerceived benefits, knowledge, experiences in health care settings, and social factors all play important roles in women’s behaviours. These factors can co-occur and must be considered together to be able to understand the complexity of prenatal substance use.ConclusionIncreased clinical and community awareness of the modifiable risk factors associated with substance use during pregnancy presented in this study, is necessary to inform future prevention efforts.     

Barriers to women's disclosure of and treatment for substance use during pregnancy: A qualitative study

IntroductionThe use of alcohol and or illicit drugs during pregnancy is a complex public health issue. There are many adverse short- and long-term health implications of substance use during pregnancy that can potentially affect the mother-foetal dyad. Although prevention and treatment options — such as counselling, pharmacotherapy, rehabilitation, support and case management and withdrawal management — are available, a range of barriers impedes women's ability to disclose their substance use, which limits access and engagement with available services.ObjectiveThis research explored barriers women encountered in disclosing substance use and accessing substance use treatment in pregnancy.MethodsParticipants were recruited from a longitudinal cohort study of people with a history of injecting drug use from metropolitan Melbourne. One-on-one in-depth interviews with 15 participants were conducted using a semi-structured interview guide. To be included in this study, participants must have reported a history of substance use during one or more of their pregnancies.ResultsThe fear of losing child custody associated with the involvement of the child protection services was one of the main barriers to disclosing substance use during pregnancy and accessing treatment and rehabilitation services. Other barriers including stigma and perceived limited treatment options impacted women in various ways.ConclusionPregnancy is an important time for women and offers opportunities for service providers to support women who are using substances. While not all barriers can be removed, careful consideration of individual cases and circumstances may help service providers to tailor interventions that are likely to be more successful.