Women's acceptance of the diaphragm: The role of relationship factors

The vaginal diaphragm is a candidate for a female‐controlled method that could reduce risk of HIV/STI acquisition. We examined the association between relationship and partner factors and three measures of diaphragm acceptability: current use, consistency of use, and satisfaction with use. We conducted a telephone survey with 448 female members of a managed care organization, aged 18–49, who currently used contraception (including 140 diaphragm users, 187 pill users, and 121 male condom users). Use of a specific contraceptive was significantly associated with relationship length, condom‐use negotiation self‐efficacy, importance of covert use, perceived motivation of partner to prevent HIV/STIs, and perceived satisfaction of partner with current method. In addition, among diaphragm users, communication about HIV/STIs and perceived partner motivation to use a diaphragm were related to consistent use. These results suggest that acceptability of contraceptive methods among women is influenced by their perceptions of their male partner and relationship factors.     

Social Support and College Student Contraceptive Use

The present study investigated the relative levels of four sources of perceived support for contraceptive use-mother, father, best same-sex friend, sexual partner-and motivation to comply with influence from those sources by young men and women who used or did not use effective contraception. Overall, best friend and coital partner were perceived as providing the most support, and the same-sex parent the least. However, among nonusers of effective contraception, best friend support exceeded partner support, which was seen as no greater than parental support. Only partner support was related to contraceptive use, and motivation to comply with partner was greater than for the other sources. Possible explanations for these findings are discussed.     

Contraceptive Method Choice Among Young Adults: Influence of Individual and Relationship Factors

Because decisions related to contraceptive behavior are often made by young adults in the context of specific relationships, the relational context likely influences use of contraceptives. Data presented here are from in-person structured interviews with 536 Black, Hispanic, and White young adults from East Los Angeles, California. We collected partner-specific relational and contraceptive data on all sexual partnerships for each individual, on four occasions, over one year. Using three-level multinomial logistic regression models, we examined individual and relationship factors predictive of contraceptive use. Results indicated that both individual and relationship factors predicted contraceptive use, but factors varied by method. Participants reporting greater perceived partner exclusivity and relationship commitment were more likely to use hormonal/long-acting methods only or a less effective method/no method versus condoms only. Those with greater participation in sexual decision making were more likely to use any method over a less effective method/no method and were more likely to use condoms only or dual methods versus a hormonal/long-acting method only. In addition, for women only, those who reported greater relationship commitment were more likely to use hormonal/long-acting methods or a less effective method/no method versus a dual method. In summary, interactive relationship qualities and dynamics (commitment and sexual decision making) significantly predicted contraceptive use.     

Body Appreciation and Contraceptive Use Among College Women: A Brief Report

Research suggests that body image and sexual behaviors are related, with poor body image associated with risky behaviors and positive body image related to protective behaviors. However, few studies explore the relationships between positive body image and contraceptive use. Accordingly, the current study investigated the relationship between body appreciation and barrier and hormonal contraceptive use among college women (N = 399). Body appreciation was significantly related to male condom use and to the use of both male condoms and a hormonal contraceptive. These findings are promising as dual contraceptive use is the best way to prevent unintended pregnancy and sexually transmitted infections (STIs).     

Opportunities for Woman-Initiated HIV Prevention Methods among Female Sex Workers in Southern China

Rapid changes in China over the past two decades have led to significant problems associated with population migration and changing social attitudes, including a growing sex industry and concurrent increases in STIs and HIV. This article reports results of an exploratory study of microbicide acceptability and readiness and current HIV prevention efforts among female sex workers in two rural and one urban town in Hainan and Guangxi Provinces in southern China. The study focused on these women's knowledge and cultural understandings of options for protecting themselves from exposure to STIs and HIV, and the potential viability and acceptability of woman-initiated prevention methods. We report on ethnographic elicitation interviews conducted with women working within informal sex-work establishments (hotels, massage and beauty parlors, roadside restaurants, boarding houses). We discuss implications of these findings for further promotion of woman-initiated prevention methods such as microbicides and female condoms among female sex workers in China.     

Determinants of contraceptive choice among Japanese women: ten years after the pill approval

The Japanese government approved the use of oral contraception (OC) in 1999, but OC users remain a small minority in Japan. Using the results of an online survey conducted in 2010, I examine the factors determining Japanese women’s choice of contraceptive method by estimating multinomial choice models. The estimation results indicate that OC use is positively associated with age, willingness to pay for contraceptive effectiveness, frequency of intercourse and experience with abortion or emergency contraception. These findings suggest that OC use increases as women learn from experience and that the low and declining frequency of intercourse in Japan offers one explanation for the slow diffusion of OC. Additionally, the findings indicate that OC use is more prevalent among women with a higher risk of unintended pregnancies. Subjective probabilities regarding each contraceptive method’s contraceptive effectiveness, disruption of romantic moods, partner disapproval, side benefits and minor, non-life-threatening side effects are important determinants of contraceptive choice. The perceived risk levels of OC side effects are significantly higher than the population-based probabilities, implying that increased medical knowledge might increase OC use.     

Opportunities for woman-initiated HIV prevention methods among female sex workers in southern China

Rapid changes in China over the past two decades have led to significant problems associated with population migration and changing social attitudes, including a growing sex industry and concurrent increases in STIs and HIV. This article reports results of an exploratory study of microbicide acceptability and readiness and current HIV prevention efforts among female sex workers in two rural and one urban town in Hainan and Guangxi Provinces in southern China. The study focused on these women's knowledge and cultural understandings of options for protecting themselves from exposure to STIs and HIV, and the potential viability and acceptability of woman-initiated prevention methods. We report on ethnographic elicitation interviews conducted with women working within informal sex-work establishments (hotels, massage and beauty parlors, roadside restaurants, boarding houses). We discuss implications of these findings for further promotion of woman-initiated prevention methods such as microbicides and female condoms among female sex workers in China.     

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.     

Social and attitudinal determinants of contraceptive choice: Using the health belief model

The factors associated with choice of birth control pills or a diaphragm were examined, using concepts derived from the Health Belief Model (Rosenstock, 1974). Women who visited a suburban family planning clinic completed a self‐administered questionnaire (N— 632) indicating their contraceptive choice, attitudes about different methods of contraception, and perceived threat of pregnancy. Using discriminant function analysis, pill users were distinguished from diaphragm users by (a) their reported perception of greater support from others for using the pill, (b) their reported belief the diaphragm was more inconvenient to use and the pill more convenient, (c) expressing less concern about the pill's side effects, (d) believing they were more protected from pregnancy when using the pill and more susceptible when not using it, and (e) knowing less about contraception in general. They also were younger and more likely to be involved in a committed sexual relationship. Results are consistent with the Health Belief Model and also support the inclusion of a subjective‐norm factor into the model.     

The Role of Attachment Behaviors in the Link between Relationship Satisfaction and Depression in Clinical Couples: Implications for Clinical Practice

Using dyadic, clinical data from 104 couples in committed relationships, the purpose of this study was to determine whether relationship satisfaction was associated with depression through perceived partner attachment behaviors—accessibility, responsiveness, and engagement—for both men and women. We found that one's satisfaction in the relationship was the lens through which they viewed their partner's attachment behaviors and—women's relationship satisfaction was the lens through which her male partner viewed her attachment behaviors. Finally, women's relationship satisfaction is associated with both individuals' depression through her perceived partner's accessibility, responsiveness, and engagement. The findings from this study are important because they provide clinically relevant and mutable constructs in which clinicians can intervene at an attachment level in distressed marriages with depressed partners.     

The gender asymmetric effect of intimate partner violence on relationship satisfaction

Our research examined the association between intimate partner violence and relationship satisfaction among victims. The negative association between victimization and relationship satisfaction was substantially stronger for females than for males. Comparisons between respondents reporting about same-sex relationships with those reporting about opposite-sex relationships provided evidence that the amplified victimization/satisfaction association among female victims is a victim-gender effect rather than an actor-gender effect. In other words, our findings suggest that aggression harms the quality of the intimate partnerships of females much more so than the partnerships of males regardless of whether a male or a female is the perpetrator. We supplemented dialogue about the direct implications of our findings with discussions about how these results may raise conceptual questions about the adequacy of the instruments scholars use to study partner aggression.     

One love: explicit monogamy agreements among heterosexual young adult couples at increased risk of sexually transmitted infections

HIV prevention strategies among couples include condom use, mutual monogamy, and HIV testing. Research suggests that condom use is more likely with new or casual partners, and tends to decline as relationships become steady over time. Little is known, however, about explicit mutual monogamy agreements and HIV testing within heterosexual couples. This study used data from 434 young heterosexual couples at increased risk of HIV and sexually transmitted infections (STIs) to assess (a) couple concordance on perceptions of a monogamy agreement, sustained monogamy, and HIV testing; and (b) the associations of relationship and demographic factors with monogamy agreement, sustained monogamy, and HIV testing. Results indicated only slight to fair agreement within couples on measures of monogamy agreement and sustained monogamy. Overall, 227 couples (52%) concurred that they had an explicit agreement to be monogamous; of those, 162 (71%) had sustained the agreement. Couples with greater health protective communication and commitment were more likely to have a monogamy agreement. Couples of Latino and Hispanic ethnicity and those with children were less likely to have a monogamy agreement. Only commitment was related to sustained monogamy. Having children, greater health protective communication, and perceived vulnerability to HIV and STIs were associated with HIV testing within the couple.     

Competing Priorities: Partner-Specific Relationship Characteristics and Motives for Condom Use Among At-Risk Young Adults

Condoms protect against human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) and unintended pregnancy and are essential to sexual health efforts targeting young adults, who are disproportionately affected by both outcomes. Understanding condom use motives is critical to increasing condom use. Research in this area is limited, particularly regarding the roles of partners and relationship factors. Using a longitudinal sample of 441 young adults and 684 reported partnerships we examined associations between relationship factors and condom use motives (pregnancy prevention, disease prevention, or dual protection). Simultaneous multilevel models identified variables associated with motives; level-specific models identified the levels (individual, partnership, time) variables impacted motives. Participants reported choosing condoms for pregnancy prevention, disease prevention, and dual protection in 51%, 17%, and 33% of partnerships, respectively. Partner-specific factors varied, to a differing degree, across the three levels. Seven variables (duration, condom self-efficacy, commitment, sexual decision-making, power, and vulnerability to harm [HIV/STIs] and pregnancy) distinguished condom use motives. The level of this association varied but was most pronounced at the partner and individual levels. Researchers and practitioners should consider the impact of both individual- and partner-level factors on condom use motives, in both research and sexual health programs.     

Legal abortions in Roumania

This study investigated the relationship between perceived attributes of the contraceptive sponge and use of this innovative method. Data were collected from a national sample of 779 women: 372 current sponge users and 407 former sponge users. Current users at initial interview also participated in a six‐month follow‐up interview. While in one of two samples current sponge users view attributes of the sponge much more positively than do former users, perceptions of the characteristics of the sponge do not prospectively predict who will later continue or discontinue use. Importance ratings, however, can prospectively and retrospectively discriminate between women who continue to use and those who stop using the sponge. Women who remain sponge users believe it is more important that a method be available without contact with a physician and that it have certain vaginal method conveniences.     

Socio-Demographic Characteristics of Contraceptive Users in Ghana

ABSTRACT

This paper describes the social and demographic characteristics of contraceptive users in Ghana, using the Ghana Demographic and Health Survey (GDHS) data (1993). Analysis has revealed that contraceptive use among women is quite low. Women's age, marital status, educational level, and place of residence are some of the factors that relate significantly to contraceptive use. The reasons most frequently cited for non-use of a modern birth control method are the desire to have children, lack of knowledge, and health concerns. The data show little motivation among women to practice family planning. Suggestions for effective family planning are provided.     

Relationship among differentiation of self, relationship satisfaction, partner support, and depression in patients with chronic lung disease and their partners

The purpose of the present study is to test the relationships among differentiation of self, relationship satisfaction, perceived partner support, and depression in a sample of patients with chronic lung disease (CLD) and their partners. The sample consisted of 52 patients with CLD and their partners. Hierarchical multiple regression was used for data analysis. The results indicate that (a) patients' differentiation of self is significantly lower than partners' differentiation of self, (b) patients' relationship satisfaction is positively correlated with partners' relationship satisfaction, (c) patients' relationship satisfaction predicts perceived partner supportive behavior, (d) perceived partner unsupportive behavior predicts patients' depression, (e) partners' differentiation of self predicts partners' relationship satisfaction, (f) partners' relationship satisfaction predicts partner supportive behavior, and (g) partners' differentiation of self and relationship satisfaction predicts partners' depression. The study serves to highlight the fact that the patient is part of a system, and that taking the system into account is relevant to the well-being of both the patient and the partner, in particular for patients with CLD, a heretofore unstudied population. The results of such studies have significant implications for couple and family therapists.     

Influence of Partner Type on Acceptability and Likelihood of Use of a Rectal Microbicide Among Young Men Who Have Sex With Men in the United States and Puerto Rico

This study examined how acceptability of placebo gel with receptive anal intercourse (RAI) and likelihood of future rectal microbicide use varied across partner types. Because no rectal microbicide is available yet, use of placebo permitted the study of gel use behavior in real-life circumstances. A total of 87 men who have sex with men (MSM) aged 18 to 30 years inserted placebo gel rectally before RAI during 12 weeks. Using mixed-methods design, participants completed a behavioral questionnaire and in-depth interview. In all, 62 men (71.3%) reported gel use with a lover (i.e., spouse equivalent, boyfriend), 32 (36.8%) with a one-night stand (i.e., man with whom you had sex once), and 29 (33.3%) with an “other” male partner. While gel acceptability was high across partner types, use with lovers was facilitated by trust and familiarity; yet trust made participants believe protection was less necessary. Conversely, participants expressed high likelihood of using gel with one-night stands, whom they perceived as riskier; yet they felt less comfortable discussing gel with them, often resorting to covert use or forgoing gel. A successful microbicide will be positioned as a sexual pleasure enhancer so that men can present it to their lovers and other partners as a gel that improves sex and secondarily prevents human immunodeficiency virus (HIV).     

The risk of Telling: A Dyadic Perspective on Romantic Partners’ Responses to Child Sexual Abuse Disclosure and Their Associations with Sexual and Relationship Satisfaction

Among 70 community couples who reported childhood sexual abuse (CSA) and disclosure to their partner, this study examined associations between survivors’ perception of partner responses to their disclosure, and both partners’ sexual and relationship satisfaction. Participants completed self‐report questionnaires online. Results of path analyses within an actor–partner interdependence model indicated that survivors’ perceived partner responses of emotional support to disclosure were associated with their own and their partners’ higher sexual satisfaction. Survivors’ perceived responses of being stigmatized/treated differently by the partner were associated with their own and their partners’ poorer relationship satisfaction. Findings suggest that survivor‐perceived partner responses to the disclosure of CSA can have a positive and a negative impact on the sexual and relationship satisfaction of both partners.     

Factors Associated with HIV Sexual Risk Behavior in Male Couples of Mixed HIV Status

Abstract

There are concerns that rates of unprotected anal intercourse and new HIV infections among some gay men have remained at or returned to dangerous levels, similar to those seen in the first decade of the epidemic. Most research on sexual risk behavior of gay men has focused on individuals even though several studies have indicated that unprotected anal intercourse (the most risky of sexual behaviors) is most likely to occur between two men who are regular partners.

This study was conducted with 75 HIV serodiscordant (“mixed HIV status”) male couples. The goals were to assess the types and prevalence of sexual risk behaviors within these dyads, to identify reasons given for engaging in risk behavior with their partner of opposite HIV status, and to examine the association, if any, between risk behaviors and potential individual and partner related factors and context. Both members of the couple were included in all assessments.

There was a tendency for unprotected anal sex to occur more often among younger men, newer couples, Latino men, and men with less education. Lower risk perception and self-efficacy for condom use, desire for sexual spontaneity, intimacy, and personal and partner satisfaction were all related to sexual risk behavior. The men in these relationships also used specific “harm reduction” strategies, based on their own understanding of transmission risk. Therefore it is important to integrate biological and behavioral knowledge to develop effective prevention campaigns. And prevention programs need to consider the ongoing emotional needs of both the HIV seronegative (HIV-) and HIV sero-positive (HIV+) partner.     

Relational Ethics,Depressive Symptoms,and Relationship Satisfaction in Couples in Therapy

The purpose of this study was to examine depressive symptoms and relationship satisfaction as problems related to relational ethics in one's family of origin and current partner relationships in a sample of 68 other‐sex couples seeking therapy at a large university clinic. We used the Actor Partner Interdependence Model to analyze dyadic data collected prior to beginning therapy. Specifically, we found significant actor effects between relational ethics in one's family of origin and depressive symptoms, as well as between depressive symptoms and low relationship satisfaction for both male and female partners. We also found significant partner effects for relational ethics in current partner relationship, depressive symptoms, and low relationship satisfaction. Clinical application of contextual therapy theory is discussed.