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.     

Gender roles,HIV risk behaviors,and perceptions of using female condoms among college students

The purpose of this study was to examine relationships between gender roles and HIV risk behavior, and perceptions and acceptance of the female condom among college students (n = 410). It was hypothesized that high hyperfeminine females and high hypermasculine males – those adhering to traditional gender roles – would engage in more HIV risk behaviors, including alcohol and drug use and various sexual practices, than those with lower hyperfemininity and hypermasculinity. It was also hypothesized that higher hyperfeminine females as well as higher hypermasculine males would perceive the female condom more negatively and would be less likely to view the female condom as a viable form of protection in the future. It was also hypothesized that high hyperfeminine females and high hypermasculine males would not accept the female condom as an alternative form of protection. Implications for prevention interventions are discussed.     

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.     

Introducing the female condom to drug users in Brazil

Brazil is currently the number two country in the world for reported cases of AIDS, and the rate of heterosexually acquired cases is on the rise. Moreover, because of the changing focus of the epidemic, the ratio of male to female cases dropped from 28 : 1 in 1984 to 2.7 : 1 in 1997. While women's risk of infection continues to grow, there is evidence to suggest that traditional approaches to HIV risk reduction have not effectively addressed women's special needs. Within such a setting this study sought to introduce drug-involved women to the female condom – a female-controlled method of protection from HIV. As part of a larger HIV/AIDS intervention study targeting low-income, cocaine users, the primary aim of this initiative was to assess the level of acceptability of this new device among women at high-risk for HIV infection in Rio de Janeiro, Brazil. In conjunction with individual pre-test HIV prevention counseling, clients participated in a detailed education/demonstration session with the female condom. Women were asked to try the female condom with their partners and to report their experiences at two points of contact. Outcome data indicate that a sizable proportion (71.1%) of the sexually active women used the female condom during vaginal sex on one or more occasions. In addition, many women continued to use the female condom as a method of risk reduction over the three-month follow-up period. These data suggest that the female condom can have an important role in HIV prevention efforts in Brazil.     

Sex and sexual orientation: the effect of group membership on individuals' judgments about self and others' HIV risk

No previous study has directly compared homosexual and heterosexual men and women's perceptions of HIV risk. In fact, empirical research focusing on homosexual women's perception of HIV risk is scarce. This paper, therefore, examines whether homosexual and heterosexual women and men (N = 60) make varied self and other (peer and non-peer) HIV risk judgments. The paper also examines the roles of motivational (health anxiety) and cognitive (HIV knowledge) factors in relation to HIV risk judgments. The results show that each group held different perceptions of risk for various "other" groups. Only homosexual men showed evidence for an optimistic bias, whereas homosexual women showed evidence of realistic perceptions. Both cognitive and motivational factors were shown to be associated with risk judgments for homosexual women and heterosexual men. Methodologically the use of Multidimensional scaling as an analytic strategy is recommended.     

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.     

Incidence of AIDS and STD increasing in Shanghai

According to public health department statistics, 82 people in Shanghai had tested positive for HIV by October 1995. In the first 10 months of 1995, over 10,000 Shanghai residents were diagnosed with a sexually transmitted disease (STD)--a 31.5% increase from the previous year. The largest increase was recorded for syphilis. Moreover, the ratio of male:female STD cases changed from 2:1 in 1994 to 1.5:1 in 1995. A significant share of STD cases involve purchasing agents, long-distance truck drivers, sailors, and the self-employed. Of the 82 HIV cases to date, 43 were diagnosed in 1994 and 24 involved Shanghai citizens. Sexual transmission was present in 95% of cases.     

Social networks and HIV/AIDS risk perceptions

Understanding the determinants of individuals' perceptions of their risk of becoming infected with HIV and their perceptions of acceptable strategies of prevention is an essential step toward curtailing the spread of this disease. We focus in this article on learning and decision-making about AIDS in the context of high uncertainty about the disease and appropriate behavioral responses. We argue that social interactions are important for both. Using longitudinal survey data from rural Kenya and Malawi, we test this hypothesis. We investigate whether social interactions--and especially the extent to which social network partners perceive themselves to be at risk--exert causal influences on respondents' risk perceptions and on one approach to prevention, spousal communication about the threat of AIDS to the couple and their children. The study explicitly allows for the possibility that important characteristics, such as unobserved preferences or community characteristics, determine not only the outcomes of interest but also the size and composition of networks. The most important empirical result is that social networks have significant and substantial effects on risk perceptions and the adoption of new behaviors even after we control for unobserved factors.     

Drug dependency and HIV testing among state prisoners

HIV and drug use are higher among prisoners than the general US population. This study examines drug dependency/use and differences between prisoners who volunteered for HIV testing and those who did not in a less densely populated state. It was hypothesized that prisoners who volunteered for an HIV test were engaged in more drug use and other risky behaviors than those who did not. Survey data were collected from 600 randomly selected inmates (567 males and 33 females) from 15 state prisons. Subjects were male (95%), white (63%), never married (43%), and 44% volunteered for an HIV test since entering prison. Ninety-two percent of inmates met DSM criteria for drug dependence in their lifetime. Those who volunteered for HIV testing were 2.6 times more likely to ever have used PCP; 1.5 times more likely to ever have used cocaine; 1.4 times more likely to ever have had a problem with drugs; 1.3 times more likely to have used opiates, and 1.6 times more likely to report having been sexually or physically abused. Implications for interventions are discussed.     

Are young people in the Philippines taking chances with HIV / AIDS?

The numbers of AIDS cases and HIV infections detected in the Philippines have risen slowly but steadily since the first AIDS case in the country was diagnosed in 1984. By the end of 1995, 234 AIDS cases and 470 HIV infections had been reported to the country's Department of Health. However, given the limited extent to which people have been tested for HIV infection, there are most likely many more cases than reported. The HIV/AIDS epidemic is spreading within the Filipino population. The country's substantial commercial sex trade, reports suggesting that many unmarried young men have sexual intercourse with girlfriends and acquaintances, and IV drug use among a small number of young people are factors which contribute to the potential for a serious HIV/AIDS epidemic in the Philippines. Findings from the 1994 national Young Adult Fertility and Sexuality Study, a household survey covering 10,879 men and women aged 15-24 years in 959 different communities, are presented. Almost all respondents had heard of AIDS, but there was some degree of ignorance and misinformation on the modes of HIV transmission. 13% of all single men reported having had only one sex partner, 10% reported two or more partners, and 3% reported five or more. 98% of sexually active men had heard of condoms, 58% knew that condom use can protect against HIV infection, 23% reported ever having used one, and 4% reported using a condom during the most recent act of sexual intercourse.     

The prevalence and incidence of HIV among injection drug users: A five year panel study

Six hundred and one injection drug users (IDUs) who attended drug treatment programs in Miami, Florida, were enrolled in a panel study to determine the prevalence and incidence of human immunodeficiency virus (HIV) and associated risk factors. A structured questionnaire which elicited injection and sexual behaviors was administered and blood was obtained by venipduncture. All participants were reassessed at six month intervals for 5 years. The baseline prevalence of HIV was 16.3%. African–Americans had a prevalence of HIV (37.1%) that was significantly higher than that of non-Hispanic whites (7.6%); the prevalence of HIV among Hispanics was 27.2%. Persons who were more than thirty years of age were more likely to test HIV positive (17.8%) than were younger participants (9.7%). The annual incidence per 1000 person-years of exposure for the 503 initially seronegative participants was consistently low for each year of the study. The 5 year incidence was 4.1 per 1000 person years; 7.5 for men and 1.7 for women, 7.5 for African–Americans and 3.8 for non-Hispanic whites. No Hispanic participants seroconverted. Multivariate logistic techniques were used to identify the independent risk factors for HIV prevalence. Earlier injection, ethnicity, and income were independently associated with HIV serostatus. A history of a sexually transmitted disease was marginally associated with HIV prevalence. Low incidence probably is a function of the reduction of risk behavior that occurred over the course of the study and the stage of the epidemic.     

Midlife and older women’s experiences and advice about sex with men,risk behaviors,and HIV prevention education

This article reports on older women’s experiences and advice on condom use, male-female relationships, HIV risk, and prevention education. It reports on findings from five written, open-ended questions with 110 ethnically and economically diverse women, 40–80 years old. Analysis revealed four themes: (a) Gap between condom use advice and condom use behavior; (b) invisibility with age; (c) negative expectations of men; and (d) desire for education that breaks the silence on sex. The article discusses the meaning of the findings as they relate to current knowledge about HIV prevention education and midlife and older women and offers recommendations for research and education.     

Marital strategies for regulating exposure to HIV

In a setting where the transmission of HIV occurs primarily through heterosexual contact and where no cure or vaccine is available, behavioral change is imperative for containing the epidemic. Abstinence, faithfulness, and condom use most often receive attention in this regard. In contrast, this article treats marriage as a resource for HIV risk management via mechanisms of positive selection (partner choice) and negative selection (divorce of an adulterous spouse). Retrospective marriage histories and panel data provide the evidence for this study and results indicate that men and women in Malawi increasingly turned to union-based risk-avoidance strategies during the period that the threat of HIV/AIDS materialized. Although both sexes strategize in a similar fashion, men are better equipped than women to deploy these strategies to their advantage. The article concludes with reflections on the long-term and population-level implications of these coping mechanisms.     

Do perceptions of their partners’ childbearing desires affect young women’s pregnancy risk? Further study of ambivalence

We explore whether young women’s perceptions of their sexual partners’ childbearing desires contribute to their risk of pregnancy. We used weekly journal data collected from 787 young women to measure their childbearing desires and their perceptions of their partners’ childbearing desires. We then conducted hazard modelling to predict pregnancy risk with variables based on interactions between the women’s desires and their perceived partners’ desires. Models that include perceived partners’ desires perform better than one based on women’s desires alone. The best model contains three significant predictors: one confirms the importance of pronatal, ambivalent, and indifferent desires for pregnancy risk; one indicates that the perceived partners’ antinatal desires reduce women’s pregnancy risk; and one suggests that women who both perceive their partners accurately and are in agreement with them have a lower pregnancy risk. The results indicate that perceived partner data can improve prediction and enhance our understanding of pregnancy risk.     

Same-sex domestic partnerships and lower-risk behaviors for STDs, including HIV infection

To determine the association between domestic partnership status and risk behaviors for sexually transmitted diseases, including HIV infection, we analyzed data from a population-based interviewer-administered telephone survey of 2,881 gay men in San Francisco, Los Angeles, New York and Chicago conducted in November 1996 to February 1998. Men in domestic partnerships had a statistically significantly lower prevalence of multiple partnerships, "one-night stands," and unprotected anal intercourse with a non-primary partner than either men with steady partners not identified as domestic partners or men without a steady partner. These findings were independent of age. Men in domestic partnerships had decreased risk behaviors for sexually transmitted diseases, including HIV infection, suggesting but not proving, that conferring legal status to same-sex unions might decrease sexual risk behavior.     

Social Responsibility,Substance Use,and Sexual Risk Behavior in Men Who Have Sex With Men

Considerable public health literature focuses on relationships between problematic human characteristics (e.g., psychopathology) and unhealthy behaviors. A recent movement termed positive psychology emphasizes the advantages of assessing relationships between human strengths (e.g., altruism) and beneficial health behaviors. The present study assessed social responsibility, an orientation to help or protect others even when there is nothing to be gained as an individual, and its relationship to HIV-relevant behaviors. In our sample of 350 men who have sex with men (MSM), social responsibility was negatively correlated with substance use and HIV risk behaviors. Men who had been tested for HIV and knew their HIV status—a behavior that helps men protect their partners but does not protect themselves from the virus—also scored higher in social responsibility. Interventions designed to reduce HIV risk behavior in MSM may benefit from efforts to promote human strengths.     

Migration,Marital Change,and HIV Infection in Malawi

Research on the relationship between migration and HIV infection in sub-Saharan Africa often suggests that migrants are at higher risk of HIV infection because they are more likely to engage in HIV risk behaviors than nonmigrants, and they tend to move to areas with a relatively higher HIV prevalence. Although migration may be a risk factor for HIV infection, I instead focus on the possibility that the HIV positive are more likely to migrate. Using a longitudinal data set of permanent rural residents and migrants from Malawi, I find that migrants originating from rural areas are indeed more likely than nonmigrants to be HIV positive and to have engaged in HIV risk behaviors. The increased HIV risk among migrants may be due to the selection of HIV-positive individuals into migration; I find that HIV-positive individuals are more likely to migrate than those who are HIV negative. The explanation for this phenomenon appears to be marital instability, which occurs more frequently among HIV-positive individuals and leads to migration after marital change.     

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.