Encouraging Safer Sex: Mediating and Moderating Effects on Condom Use Among Italian Girls

ABSTRACT

Objectives: The present study investigated the effects of condom availability, peer norms, and negotiation self-efficacy on girls’ perception of male condom use. Methods: Participants were presented with a vignette in which condom availability, peer norms, and negotiation self-efficacy were manipulated. Results: Condom availability and peer norms interacted in determining condom use, such that protected sex was more likely when a condom was available and when peer norms approved, rather than disapproved, of condom use. The effect of peer norms on condom use was mediated by intentions to use a condom and communication between partners about condom use. Condom communication, identified as a direct antecedent of condom use, was influenced by negotiation self-efficacy. Conclusions: These results suggest that interventions aimed at reducing risky sexual behavior should not only make condoms available but also address key psychosocial variables, such as peer norms. Condom communication should be taken into account as well, considering that it can be affected directly by negotiation self-efficacy and can be affected indirectly by peer norms.     

Sexual Communication Between Early Adolescents and Their Dating Partners,Parents, and Best Friends

This study assessed early adolescents’ sexual communication with dating partners, parents, and best friends about six sexual health topics: condoms, birth control, sexually transmitted diseases (STDs), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), pregnancy, and abstinence/waiting. Using a school-based sample of 603 youth (ages 12 to 15; 57% female; 46% Caucasian), we examined communication differences across demographic and developmental factors, tested whether communication with parents and best friends was associated with greater communication with partners, and examined associations between communication and condom use. More than half of participants had not discussed any sexual topics with their dating partners (54%), and many had not communicated with parents (29%) or best friends (25%). On average, communication was more frequent among adolescents who were female, African American, older, and sexually active, despite some variation in subgroups across partner, parent, and friend communication. Importantly, communication with parents and friends—and the interaction between parent and friend communication—was associated with increased communication with dating partners. Further, among sexually active youth, increased sexual communication with partners was associated with more frequent condom use. Results highlight the importance of understanding the broader family and peer context surrounding adolescent sexual decision making and suggest a possible need to tailor sexual communication interventions.     

Sex Partner Type,Drug Use and Condom Use Self-Efficacy Among African Americans from Disadvantaged Neighborhoods: Are Associations with Consistent Condom Use Moderated by Gender?

Gender inequalities in sexual behavior are explored from the perspective of the theory of gender and power. This study focused on the effect of sex partner type (steady versus casual), drug use, and condom use self-efficacy regarding consistent condom use (CCU) among a community-based sample of adults. The sample included 1,357 African American men and women (M age 37.0, SD 13.1 years; 44% women, 66% men) from 61 disadvantaged census block groups in Atlanta, GA as part of a study of individual and neighborhood characteristics and HIV risk-taking. Having a steady partner decreased the odds of CCU, while higher condom use self-efficacy increased the odds of CCU. Among non-drug users, having a drug-using partner was associated with decreased odds of condom use for women only. Women with drug-using partners, especially a steady partner, were least likely to report CCU. Therefore, interventions intended to empower CCU among women need to expand beyond acknowledging the reduced control that women who use drugs demonstrate to also consider those who have drug-using sexual partners.     

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 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.     

Social,Relational and Network Determinants of Unprotected Anal Sex and HIV Testing Among Men Who Have Sex with Men in Beirut,Lebanon

Objectives: We examined the social, relational and network determinants of condom use and HIV testing among men who have sex with men (MSM) in Beirut. Methods: Two-hundred thirteen men were recruited via respondent driven sampling and administered a survey. Results: Sixty-four percent reported unprotected anal intercourse (UAI), including 23% who had UAI with unknown HIV status partners (UAIU); 62% of participants had tested for HIV. In multivariate analysis, being in a relationship was associated with UAI and HIV testing; lower condom self-efficacy was associated with UAIU and HIV testing; gay discrimination was associated with UAIU; MSM disclosure was associated with UAI, UAIU and HIV testing; and network centralization was associated with HIV testing. Conclusions: Multi-level social factors influence sexual health in MSM.     

Testing a New Measure of Sexual Health Knowledge and Its Connections to Students' Sex Education,Communication, Confidence,and Condom Use

ABSTRACT

This study investigates the nature of college students' sexual health knowledge, prior sex education coverage, and sexual communication and confidence. We created a new, comprehensive sexual health knowledge measure to assess 347 undergraduates' knowledge of reproductive health, contraception, condom use, sexually transmitted diseases (STDs), and HIV/AIDS. Overall, students demonstrated a fairly poor understanding of sexual health issues. Women were more knowledgeable than men, specifically on the topics of contraception and STDs. Prior exposure to sex education covering mainstream reproductive health issues or newer contraception methods was correlated with greater knowledge across all domains, particularly for men. Greater knowledge was also correlated with greater sexual assertiveness and confidence with condoms among women.     

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.     

Exploring Dimensions of Racism,Homophobia, and Social Network As Concomitant Predictors of Condom Use in a Sample of Black MSM

With a convenience sample of 148 Black men who have sex with men (MSM) who primarily resided in the Washington, District of Columbia, metropolitan Area, the purpose of this research was to concomitantly use dimensions of racism, homophobia, and social network constructs in a regression model to predict condom use. In the model, analysis indicated that condom nonusers versus consistent users experienced more conversations with friends regarding salient topics (i.e., HIV status) (odds ratio [OR] = .86, p < .01) and fewer discussions with sexual partners about salient topics (OR = .77, p = .02). Furthermore, inconsistent condom users versus consistent users experienced higher levels of internalized homophobia (OR = 1.12, p = .04) and less racism associated with physical characteristics (OR = .89, p = .04). Notably, all of the racism dimensions identified in this research were nonsignificant as positive predictors of condom use. Overall, based on the findings, internalized homophobia may need to be isolated or targeted as an HIV-risk factor when implementing individual- and group-level HIV-prevention strategies for Black MSM. Moreover, improved communication skills among Black MSM pertaining to discussing salient topics (i.e., HIV status) with their sexual partners could also be used as a possible HIV-prevention strategy.     

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.     

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.     

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.     

Gender Differences in the Sexual Well-Being of Mexican Adolescents

Objective: This study examines the associations of gender roles and sexual power with the sexual wellbeing of Mexican adolescents. Particularly we look at the role played by adolescent’s attitudes toward gender roles and sexual power regarding three aspects of their sexual well-being: satisfaction with one’s sex life; consistent condom use; and the refusal of unwanted sexual contact with one’s partner. Methods: we used logistic regression models to analyze possible associations between attitudes toward gender roles, and sexual power, with the sexual well-being of adolescents, using a random and representative sample of 4,738 sexually active teenagers from three Mexican states. Results: egalitarian attitudes are positively associated to high sexual satisfaction for female adolescents, whereas for males they favor the refusal of unwanted sex. Sexual power shows significant associations with consistent condom use for both males and females, and it also significantly increases the likelihood of high sexual satisfaction and refusal of unwanted sex among females. Conclusions: the findings suggest the relevance of overcoming traditional sex roles to achieve adolescent sexual well-being. In this sense, health and population policies should direct more substantial efforts in the promotion of gender equality among the adolescents and in the development of critical attitudes towards traditional gender norms.     

The Influence of Trauma History and Relationship Power on Latinas’ Sexual Risk for HIV/STIs

ABSTRACT

A community sample of Latinas completed surveys that included measures of sexual abuse and intimate partner violence history, relationship power, negotiating power regarding condom use, perceived HIV/sexually transmitted infection (STI) risk for sexual partner, and sexual behavior. More than half of the women reported a history of intimate partner violence in the past year and/or sexual abuse in their lifetime. Intimate partner violence was correlated with lower overall sexual relationship power scores, while sexual abuse was correlated with lower condom-use negotiating power. More extensive intimate partner violence had the strongest association with higher HIV/STI risk, while controlling for relationship status, sexual abuse, and relationship power.     

Evaluation of two school‐based HIV prevention interventions in the border city of Tijuana,Mexico

This research project examined the individual and combined effectiveness of an HIV prevention workshop and a free condom distribution program in four high schools in Tijuana, Mexico. Adolescents (N = 320) completed baseline measures on sexual practices and theoretical correlates and participated in a two‐part study. In Study I, students were randomly assigned to an HIV prevention workshop or a control condition, with a 3‐month follow‐up assessment. Results indicate three significant workshop benefits regarding HIV transmission by altering sexual initiation, access to condoms, and traditional beliefs regarding condoms. In Study 2, we set up a condom distribution program at two of the participating schools, and students completed a 6‐month follow‐up assessment. Results indicate that exposure to the workshop followed by access to the condom distribution program yielded two beneficial results for reducing HIV transmission: moderating sexual initiation and increasing condom acquisition. Access to the condom distribution program alone had no effects on behavioral and psy‐chosocial correlates of HFV transmission. We discuss implications of these results.     

Development of Sexual Expectancies among Adolescents: Contributions by Parents,Peers and the Media

To expand the scant research on sexual expectancies development among non–sexually active adolescents, we examined the relationship between adolescents' exposure to four socializing agents—mother/female guardian, father/male guardian, peers, and television programs with high sexual content—and their endorsement of four sexual expectancies: social benefit, pleasure, social risk, and health risk. Data are from Waves 2 and 3 of a three-wave annual longitudinal study conducted among California adolescents, the majority of whom were not sexually active (N = 914, 84%). Structural equation models were conducted to examine cross-sectional and longitudinal associations between the socializing agents and the sexual expectancies. Cross-sectional results indicate associations between peer sexual communication and social benefit, pleasure, and social risk expectancies. A positive association was found between exposure to music videos and social benefit expectancies, and a negative association was found between exposure to music videos and health risk expectancies. Longitudinal results suggest that communication with peers positively predicted pleasure expectancies and negatively predicted social risk expectancies. No other socializing agents were associated with any sexual expectancies. An invariance test found that significant correlations were similar across the different age groups. Results suggest that efforts to support positive sexual decision making among non–sexually active adolescents should target peer sexual communication.     

Relative Efficacy of a Pregnancy,Sexually Transmitted Infection,or Human Immunodeficiency Virus Prevention–Focused Intervention on Changing Sexual Risk Behavior Among Young Adults

Abstract

Objectives: Despite findings suggesting that young adults are more concerned about experiencing an unplanned pregnancy or contracting a sexually transmitted infection (STI) than becoming human immunodeficiency virus (HIV) infected, no empirical work has investigated whether the specific focus of an intervention may be more or less efficacious at changing sexual behavior. Participants: Participants were 198 college students randomized to 1 of 4 conditions: pregnancy intervention, STI intervention, HIV intervention, or a control condition during 2008–2009. Methods: The authors compared the efficacy of 3 theory-based, sexual risk–reduction interventions that were exactly the same except for an exclusive focus on preventing pregnancy, STI, or HIV. Condom use and risky sexual behavior were assessed at baseline and 4-week and 8-week follow-up. Results: Participants exposed to the pregnancy or STI interventions reported greater condom use and less risky sexual behavior than those exposed to the HIV intervention. Conclusions: The focus of sexual risk–reduction interventions may lead to differential behavior change among young adults.     

Predictors of Safer Sex on the College Campus: A Social Cognitive Theory Analysis

Abstract

In April and May 1989, the authors surveyed a sample of students enrolled on four college campuses in New Jersey (N ? 923) concerning their HIV transmission-related behavior, knowledge, and a variety of conceptual variables taken primarily from social cognitive theory that were thought to be potentially predictive of safer sexual behavior. Analyses of sexually active, unmarried students' responses indicated that men expected more negative outcomes of condom use and were more likely to have sexual intercourse while under the influence of alcohol or other drugs, whereas women reported higher perceived self-efficacy to practice safer sex. Regression analyses indicated that, among the factors assessed, stronger perceptions of self-efficacy to engage in safer behavior, expecting fewer negative outcomes of condom use, and less frequency of sex in conjuction with alcohol or other drug use significantly predicted safer sexual behavior. Enhanced self-efficacy to discuss personal history with a new partner was associated with a greater number of risky encounters. Implications of these findings for intervention efforts with students are discussed.     

Context of First Same‐Sex Condom Use and Nonuse in Young Black Gay and Bisexual Males

Despite high human immunodeficiency virus (HIV) rates among young Black men who have sex with men (YBMSM), there are limited data about condom use during first same‐sex (FSS). This study sought to understand socio‐contextual factors of 50 YBMSM aged 15–19 years that influenced condom use during FSS. Condom use was influenced by individual, partner, and community factors. Individual factors—recent illness or sexually transmitted infections (STI)—prompted condom use, while frequent HIV testing prompted nonuse. Partner factors—proactive encouragement from partners—prompted condom use, while trust and condom discomfort prompted nonuse. Larger community factors—such as presence of females—were key for use, while limited sexual health information combined with peers who discouraged condoms prompted nonuse. A multilevel approach may be useful in developing sexual health programming for these young men.