Condom Use,Condom Refusal,and Substituted Sexual Behaviors Among Youth at Higher and Lower Risk for HIV Infection

ABSTRACT

The purpose of this study was to describe sexual behaviors that youth substitute for protected intercourse when a partner refuses to use a condom or a condom is not used. Participants included: (a) 120 adolescents (mean age 17.2 years) undergoing substance abuse treatment and (b) 171 university students (mean age 21.3 years). The treatment sample reported significantly higher levels of discrete risk factors for HIV exposure. While only a small proportion of each sample experienced outright refusals by partners to use condoms, the majority of participants in each sample used condoms inconsistently with main partners. The university sample reported more substituted behaviors (lower risk and total) when partners did not want to use condoms. Yet, substantial proportions of participants in each sample engaged in unprotected intercourse. Implications for social work and health promotion efforts directed toward youth at risk for HIV/STD exposures are discussed.     

Sexual health programming for vulnerable youth: Improving knowledge,attitudes, and behaviors

PurposeAmong girls in foster care, 48% become pregnant at least once by age 19 (Dworsky & Courtney, 2010). Youth in or at-risk for foster care (YFC) report limited knowledge about, access to, and use of condoms; ambivalent attitudes towards teen parenting; and participation in other risky behaviors. For the current study, we adapted and supplemented an evidence-based sexual health program called SiHLE, using a systematic adaptation framework (ADAPT-ITT, Wingood & DiClemete, 2008), to address the unique and targeted needs of youth living in a temporary shelter due to lack of housing. Youth in this study were either in foster care and awaiting placement, or having serious family problems and were at-risk of entering the foster care system.MethodsThirty-six youth participated in SiHLE-YFC during their stay at a temporary shelter. Four 90-minute sessions focused on increasing sexual health knowledge, improving attitudes towards and self-efficacy of condom use, and developing core skills such as problem-solving and communication.ResultsAs hypothesized, youth showed high satisfaction with the intervention and significant improvement in sexual health knowledge from pre to post. At one-month follow-up, youth continued to show significant improvement in sexual health knowledge, along with a significant reduction in risky sexual behaviors. Though not significant, there were moderate effect sizes for changes in attitudes towards teen pregnancy and condoms. There were no changes in attitudes towards teen parenting.ConclusionTaken together, findings suggest that sexual health education directly targeting the unique needs of YFC may improve sexual health knowledge and behavior, and are discussed in the context of challenges associated with intervention and research with this population.     

Investigating the Timing of First Sexual Intercourse Among Youth in EDO State,Nigeria in the Context of the Aids Epidemic

ABSTRACT

Objectives: This study examined the timing of sexual debut among youth in Edo state, Nigeria given the role that sexual abstinence plays in HIV prevention in sub-Saharan Africa. Methods: Survey data were collected from rural youth aged 11 to 17 years old enrolled in Junior Secondary Schools in Edo State, Nigeria. Discrete-time hazard techniques were used to examine the effects of theoretically relevant covariates on the timing of sexual debut among youth in Edo State. Results: Results indicate strong, significant relationships between psychosocial predictors and age at first sex for boys and girls. Youth with higher levels of knowledge about HIV as well as those who rejected common myths about HIV transmission delayed first sexual intercourse. Early sexual intercourse was strongly associated with experiencing pressure to engage in sex, while delay was associated with greater confidence that one could decline to participate in sex. On the other hand, youth with higher condom use self-efficacy engaged in first sexual intercourse at an earlier age. Conclusions: These results support the relevance of programs such as Nigeria's Family Life and HIV Education to contribute to delaying sexual intercourse focusing precisely on the forms of knowledge, myth rejection, motivation, and behavioral self-efficacy measured here. They provide policymakers with concrete evidence to increase support for such programming as a means to combat the spread of HIV among youth.     

Determinants Influencing Male Condom use Among University Students in Portugal

ABSTRACT. A self-administered questionnaire was carried out among university students in Portugal, with the aim to examine determinants influencing male condom use, according to the information–motivation–behavioral skills model (J. Fisher & Fisher, 1992). Students’ levels of information, motivation, and behavioral skills regarding preventive sexual behavior (male condom use) were ascertained and were used to determine their association with condom use among 880 male and 1,807 female students aged 18 to 35 years old. Although 86.9% of respondents indicated that they used a condom during their first sexual intercourse, only 32.8% used a condom always during sexual intercourse in the last 12 months. Most young people, especially women, had a good level of information regarding HIV/AIDS transmission/prevention. They also showed reasonable positive attitudes and had positive subjective norms and intentions toward HIV/AIDS preventive behaviors. Men presented a higher perceived difficulty and a lower perceived effectiveness of HIV/AIDS preventive behavior, therefore reporting higher risk acceptance. A path analysis revealed that preventive sexual behavior did not depend directly on information level but on motivation and behavioral skills (especially among men). Information about HIV prevention/transmission was not significantly associated with condom use. The finding that motivation and behavioral skills were the strongest determinants of condom use suggested that these may be important factors in effective sexually transmitted infection-prevention programs.     

The Association of Campus Resources for Gay,Lesbian, and Bisexual Students With College Students' Condom Use

Abstract

The author and colleagues examined campus resources for gay, lesbian, and bisexual (GLB) students at 119 US colleges to determine how the presence of such resources affected sexually active students' condom use. A random sample of unmarried, sexually active college students surveyed in 1999 completed questionnaires. Condom use was compared across schools with different levels of GLB resources. Condom use rates, analyzed by sex and sex-partner groups, ranged from 32% to 52%. With additional college variables controlled for, GLB resources were positively associated with the proportion of sexually active students who used condoms (p < .001). This association existed primarily for students with only opposite-sex partners. The author's findings suggest that campus resources for GLB students may be associated with college students' condom use.     

Sexual Coercion,Verbal Aggression,and Condom Use Consistency Among College Students

Abstract

Objective: The relationship between condom use and 2 less visible categories of intimate partner violence (IPV), sexual coercion and verbal aggression, was examined among college students. Methods: In March 2007 a random cross-sectional sample of undergraduates from the southeast region of the United States was taken to collect information about sexual coercion and verbal aggression, in addition to condom use consistency. Alcohol use was also assessed. Results: Of the 142 participants, 31.7% reported being victims of sexual coercion, and 78% reported having verbally aggressive partners. Participants who reported experiencing sexual coercion in their relationship were significantly less likely to consistently use condoms. Additionally, alcohol use before or during episodes of verbal aggression was negatively associated with condom use. Alcohol use was also significantly associated with heightened incidents of coercion and aggression. Conclusions: Results indicate that among college students, the presence of sexual coercion adversely affects condom use, as does alcohol use.     

General Statement of Ethical Principles and Guidelines

Objective: The authors examined the effects of relational commitment (high commitment versus low commitment) and relationship maintenance goals (high threat versus low threat) on decisions to request the use of a condom. Methods: The authors conducted a 2-part study using a survey of responses to hypothetical scenarios and decisions in actual relationships. Results: Results indicated that people with high relational commitment were less likely to request a condom than were people with low relational commitment. People who perceived threats to relationship maintenance goals if a condom was requested were less likely to request a condom than were people who did not perceive threats to relationship maintenance goals. Conclusions: Findings from this study highlight the influence that relational threats and commitment levels have on condom use decision making.     

The Trouble With Condoms: Norms and Meanings of Sexuality and Condom Use Among School-Going Youth in Kenya

ABSTRACT

Despite knowledge of the effectiveness of condoms in preventing HIV transmission, condoms continue to be reported in only a minority of sexual encounters even with nonpermanent partners. This study used focus-group discussions with youth and interviews with community leaders from 22 communities in the Nyanza and Rift Valley provinces, Kenya, to examine the sociocultural influences on condom use among school-going youth. Three overarching themes emerged from a thematic analysis of the data. Condoms did not fit with the purposes, meanings, and understandings of sexuality; in fact, condom use violated most of these. Condoms were also thought to be dangerous for girls and women, to contribute to the spread of HIV, and to be unnecessary for protection against HIV. Finally, given the hardships of life and multiple diseases and circumstances that threatened life, HIV was seen as just another trouble of living. Sex without a condom, within this context, was described as one of the pleasures of a short life. The complexities of sexuality evidenced in the discussions of these youth and adults challenge the viability of the ABC (abstain, be faithful, use a condom) message as a preventive measure against HIV transmission.     

Racial and ethnic differences in patterns of adolescent tobacco users: A latent class analysis

BackgroundLittle is known about how tobacco use varies among youth of different racial and ethnic groups and how these patterns are related to levels of nicotine dependence.ObjectivesThis study investigated the tobacco use patterns of White, African American, and Hispanic high school students. We further explored whether tobacco use patterns were associated with levels of nicotine dependence and gender.MethodsData were analyzed from the 2014 National Youth Tobacco Survey (NYTS) of high school students who endorsed at least one form of tobacco use in their lifetime (n = 4691). Three separate latent class analysis (LCA) models were estimated using seven different types of tobacco products as indicators. Also, the level of nicotine dependence was compared with one class to another class in three racial/ethnicity groups.ResultsFour classes of White youth were identified: (1) “Non-user” (67%), (2) “Polytobacco” (6%), (3) “Chewing Tobacco” (8%), and (4) “(E-)Cigarettes” (19%) classes. The “Polytobacco” class had the highest nicotine dependence followed by “Chewing Tobacco,” “(E-)cigarettes,” and “Non-user.” Among African American youth, two tobacco patterns were identified: “Non-user” (91%) and “Cigarette/Cigar” (9%). The “Cigarette/Cigar” class had greater nicotine dependence than the “Non-user” class. Among Hispanic youth, three subgroups were identified: “Non-user” (78%), “(E-)Cigarette/Cigar” (14%), and “Hookah” (18%). “(E)Cigarette/cigar” had the highest nicotine dependence in Hispanic youth followed by the “Hookah” and “Non-users” classes.ConclusionWe found distinct classes of youth tobacco use by race/ethnicity. Although poly-tobacco use was common, White, African American, and Latino youth used different tobacco types, suggesting that racially and ethnically targeted prevention strategies may be indicated.     

Asking Only “Did You Use a Condom?” Underestimates the Prevalence of Unprotected Sex Among Perinatally HIV Infected and Perinatally Exposed But Uninfected Youth

Among young adults who use condoms, incomplete condom use (putting a condom on after beginning or taking a condom off before finishing sex) and condom failure (condom breaking or slipping off during sex) are common. Therefore, sexual behavior surveys that ask only if a condom was used are likely to underestimate the actual prevalence of unprotected sex. This study examined data from 135 sexually active perinatally HIV-infected (PHIV+) youth and perinatally exposed but uninfected (PHIV?) youth, ages 13 to 24. Participants were asked whether they used a condom on their first and their most recent occasion of vaginal sex. Youth who reported using a condom were asked a follow-up question about whether there was any time during that occasion when sex was not protected by a condom. This follow-up question identified additional participants— almost double the proportions who initially said they did not use a condom—who had unprotected sex. Incomplete condom use was similar among PHIV+ and PHIV?youth, boys and girls, Latinos and African Americans, and younger and older youth. These findings illustrate the importance of asking specifically about whether any unprotected behavior occurred from start to finish of sex to achieve more valid estimates of sexual risk behavior.     

Condom Use Completeness,Perceptions, and Sexual Quality at Most Recent Sexual Event: Results from a U.S. Nationally Representative Probability Sample

Abstract

Objectives: To explore perceptions of condoms associated with complete use and evaluate relationships between condom perceptions, condom use, and sexual quality.

Methods: Using data from a U. S. nationally representative probability sample, we assessed individuals’ condom use perceptions and related characteristics of their most recent sexual event through bivariate and regression analyses (n?=?234).

Results: Most participants reported complete condom use and neutral or positive perceptions of condoms. Though incomplete use was associated with orgasm among women, arousal and pleasure did not differ by gender or duration of condom use.

Conclusions: We found no evidence that delayed application or early condom removal increased sexual arousal or pleasure, which may help sexual health promotion interventions address negative cultural ideas about condoms.     

The Cedar Project: Understanding Barriers to Consistent Condom use over Time in a Cohort of Young Indigenous People who use Drugs

ABSTRACT Little information exists on the use of condoms as protective barriers to sexually transmitted infections (STIs) among indigenous people in Canada. This study explores risk factors of inconsistent condom use (during consensual sex) over time among participants in the Cedar Project, a prospective cohort study of indigenous young people living in Vancouver and Prince George, British Columbia, who use drugs. Due to the serial measurements for each study subject, generalized estimating equations modeling with logit link was used to accommodate the temporal correlation within subjects. For young women, inconsistent condom use over time was predicted by having a recent STI (adjusted odds ratio [AOR] = 1.76, 95% confidence interval [CI] [1.12, 2.79]), smoking crack daily (AOR = 1.63, 95%CI [1.02, 2.61]), and having experienced recent sexual abuse (AOR = 2.07, 95%CI [1.20, 3.56]). Among young men, living in Prince George (AOR = 1.63, 95%CI [1.14, 2.39]) and daily crack smoking (AOR = 1.56, 95%CI [1.02, 2.40]) were associated with inconsistent condom use over time. Among participants who used injection drugs, inconsistent condom use was associated with smoking crack daily (AOR = 1.59, 95%CI [1.04, 2.43]) and sharing needles (AOR = 1.78, 95%CI [1.26, 2.51]). The availability and effectiveness of sexual health services must be prioritized for indigenous people, and the design of culturally safe sexual health programs requires the meaningful involvement of young indigenous people.     

Multisystemic Treatment of Juvenile Sexual Offenders

Abstract

Multisystemic therapy (MST)is an ecologically-based treatment model that has proven effective with violent and chronic juvenile offenders and that holds promise with juvenile sexual offenders. This article describes the empirical underpinnings, theoretical foundation, and clinical features of MST and provides a brief review of MST outcome studies with juvenile sexual offenders. The theoretical foundation and clinical features of MST draw upon empirical findings regarding the multidetermined nature of serious antisocial behavior as well as upon social-ecological models of behavior in which the youth and family's school, work, peers, and neighborhood are viewed as interconnected systems with dynamic and reciprocal influences on the behavior of family members. In two randomized trials with juvenile sexual offenders, MST has had positive effects on key social-ecological factors (e.g., family affective relations, peer relations, school performance) associated with sexual offending and has demonstrated long-term reductions in criminal activity and incarceration. The success of MST can be attributed primarily to (a) the match between MST intervention foci and empirically identified correlates/causes of sexual offending in youths and (b) the flexible use of well-validated intervention strategies in the natural environment.     

HIV-Negative Seroconcordant Gay Male Couples' Attitudes,Intentions, and Perceived Behavioral Control for Planned Condom Use Within and Outside of Their Relationships

ABSTRACT

Despite high HIV rates among gay male couples, limited research exists about their attitudes, intentions, social norms, and perceived behavioral control for planned condom use within and outside of their relationships. Our cross-sectional study used multilevel modeling with dyadic data from 142 HIV-negative gay male couples to examine and identify which factors were statistically associated with planned condom use within and outside the relationship. Several differences for planned condom use were also noted based on the sample's prior history of unprotected anal intercourse and relationship type. Findings suggest additional prevention tools are needed for some HIV-negative gay male couples who are at risk for HIV.     

The moderating effect of alcohol use on protective and risky sex behaviors among college students in the Southeast United States

ABSTRACT

Objective: College students are a high-risk population for new human immunodeficiency viruses (HIV) diagnoses. Although condom use self-efficacy and HIV knowledge can protect against risky sexual behavior (RSB), these same protective factors have been shown to exacerbate RSB. The influence of alcohol use can further complicate these protective factors to influence RSB. Participants: 689 African American/Black and non-Hispanic White college students attending a public university in the Southeast United States. Method: This study sought to examine the relations between condom use self-efficacy and HIV knowledge with RSB and the moderating effect of alcohol use. Results: Findings showed positive associations between RSB and HIV knowledge and alcohol use. Unexpectedly, low frequency drinkers with high condom use self-efficacy were at increased risk for RSB compared to high frequency drinking counterparts. Conclusions: Findings point to the need to target prevention services for low-risk drinkers in college settings.     

The Relationship Between Use of Sexually Explicit Media and Sexual Risk Behavior in Men Who Have Sex with Men: Exploring the Mediating Effects of Sexual Self-Esteem and Condom Use Self-Efficacy

ABSTRACT

Objectives: This study tests the following 3 hypotheses: (1) there is a direct association between consumption of sexually explicit media (SEM) depicting non-condom use and sexually transmitted infection (STI)-related sexual risk behavior among men who have sex with men (MSM); (2) the association between SEM consumption and STI-related sexual risk behavior is mediated by men's sexual self-esteem; and (3) the relationship between SEM consumption and sexual risk behavior is mediated by condom use self-efficacy. Methods: A cross-sectional, Internet-based survey on exposure to SEM and sexual behavior of 1,391 MSM in the United States was conducted in 2011. Results: The results confirmed Hypotheses 1 and 3, while Hypothesis 2 was rejected. Accordingly, a significant association between the use of SEM picturing condom use and STI-related sexual risk behavior among MSM was found. Likewise, we found that the association between the use of SEM and sexual risk behavior was mediated by condom use self-efficacy in an indirect path. However, SEM did not influence sexual risk behavior via sexual self-esteem. Conclusions: To promote STI prevention, the actors in SEM may be used as role models in managing condom use in sexual contexts.     

Lights,camera, condoms! Assessing college men's attitudes toward condom use in pornography

ABSTRACT

Objective: Investigate male college students' attitudes toward actors' use of condoms in pornography. Participants: Two hundred thirteen undergraduate males attending a large, state-supported midwestern university in the fall semester, 2012. Methods: Using a Web-based procedure, participants completed questionnaires assessing their pornography use, sexual history characteristics, and their attitudes toward condom use by adult performers. Results: Factor analysis of the 11-item condom use attitudes questionnaire supported 2 distinct subscales: Condom Supportive Attitudes and Condom Critical Attitudes. Although participants typically agreed with statements supportive of condom use and generally disagreed with statements critical of condom use in pornography, gay men had significantly higher condom supportive subscale scores than did heterosexual men. Neither subscale was correlated with weekly viewing of pornography. Conclusions: Although some producers of adult films argue that actors wearing condoms will displease many viewers, current findings suggest that young men express support for use of condoms by pornographic film actors.     

Trends in long-acting reversible contraceptive (LARC) use,LARC use predictors,and dual-method use among a national sample of college women

Objective: Assess long-acting reversible contraceptive (LARC) and other contraceptive use trends, identify LARC use predictors, and examine dual method use. Participants: Women in the American College Health Association-National College Health Assessment (ACHA-NCHA) II, aged 18–24 years, who reported having vaginal sex (N = 37,899). Methods: Secondary analyses of Fall 2011–2014 ACHA-NCHA II data. Results: Statistically significant increases in LARC usage and, specifically, implant usage, were found. Characteristics associated with LARC use included age, race/ethnicity, relationship status, and school type. Students reporting LARC use had lower odds of condom usage compared with non-LARC hormonal method users. Conclusion: This analysis of LARC predictors and dual LARC/condom use has implications for research and health promotion efforts. Findings suggest that college health services are well positioned to meet the sexual and reproductive health needs of diverse populations of students. College health professionals should elicit students' individual and/or relationship priorities to tailor messaging/services offered for pregnancy/STI prevention.     

Sexual Self-Efficacy and Gender: A Review of Condom Use and Sexual Negotiation Among Young Men and Women in Sub-Saharan Africa

Sexual self-efficacy (SSE), one’s perceived control of or confidence in the ability to perform a given sexual outcome, predicts sexual behavior; however, important questions remain regarding whether gender modifies observed associations. In a comprehensive review of peer-reviewed HIV-prevention literature focusing on youth (ages 10 to 25) in sub-Saharan Africa, we measured and assessed the influence of SSE on condom use and sexual refusal, overall and by gender. Our results, after reviewing 63 publications, show that SSE is inconsistently measured. Most studies measured condom use self-efficacy (CUSE) (96.8%) and/or sexual refusal self-efficacy (SRSE) (63.5%). On average, young men had higher CUSE than young women, while young women had higher SRSE than young men. While cross-sectional studies reported an association between high SSE and sexual behaviors, this association was not observed in interventions, particularly among young women who face a disproportionate risk of HIV acquisition. In all, 25% of intervention studies demonstrated that fostering CUSE increased condom use among young men only, and one of two studies demonstrated that higher SRSE led to reduced frequency of sexual activity for both men and women. Future research and HIV-prevention interventions must be gender targeted, consider improving CUSE for young men, and move beyond limited individual-level sexual behavior change frameworks.     

Psychosocial Correlates of Condom Use Intentions among Junior High School Students in the Bolgatanga Municipality of Ghana

ABSTRACT

Objectives: We explored sociodemographics, sexual experience, and psychosocial factors influencing condom use intentions of adolescents in Northern Ghana. Methods: Based on social cognitive theories and previous empirical studies investigating condom use, a cross-sectional survey was conducted among 2,018 adolescents (M age = 15.8 years) in Bolgatanga, Ghana. Correlations and multinomial logistic regressions were performed. Results: Findings showed that attitudes toward condom availability, injunctive norms toward condom use, sex experience, perceived susceptibility towards STIs, and perceived behavioral control toward buying as well as using condoms differentiated between people with different levels of intentions to use condoms. Conclusions: Implications for intervention development are discussed.