Sexual Behavior With Noncommercial Partners: A Concurrent Partnership Study Among Middle-Aged Female Sex Workers in China

Female sex workers (FSWs) often engage in concurrent partnerships, meaning they have multiple sexual relationships at the same time. The objective of this study was to investigate sexual concurrency and its associations with condom use and syphilitic infections among FSWs over age 35. Respondent-driven sampling was used to recruit 1,245 FSWs in Nanning, Hefei, and Qingdao, China. FSWs were asked to report whether they had concurrent partners in the past six months. Concurrency was defined as engagement in sex with commercial clients and (1) husbands and boyfriends (n = 167); (2) husbands only (n = 301); or (3) boyfriends only (n = 469). FSWs with only commercial clients were used as the comparison group (n = 308). Across all groups, the percentage of FSWs with prevalent and active syphilis ranged from 19.6% to 25.6% and 9.1% to 11.5%, respectively. Condom use was low with noncommercial sexual partners and was more likely to be used when FSWs’ boyfriends had other partners. Three components of the theory of planned behavior were significantly associated with consistent condom use. Concurrent relationships may lead to increased transmission of syphilis at the workplace and family levels. Effective interventions should target concurrency with both commercial and noncommercial partners.     

Can't Buy My Love: A Typology of Female Sex Workers' Commercial Relationships in the Mexico–U.S. Border Region

Female sex workers (FSWs) experience elevated risk for HIV and sexually transmitted infections (STIs) through unprotected sex with male clients, yet the complexity of these commercial relationships remains understudied. From 2010 to 2011, we explored FSWs' conceptualizations of various client types and related risk behavior patterns using semistructured interviews with 46 FSWs in Tijuana and Ciudad Juarez, Mexico, where FSWs' HIV/STI prevalence is increasing. Our grounded theory analysis identified four types of commercial relationships: nonregular clients, regular clients and friends, clients who “fell in love” with FSWs, and long-term financial providers who often originated from the United States. As commercial relationships developed, clients' social and emotional connections to FSWs increased, rendering condom negotiation and maintaining professional boundaries more difficult. Drug abuse and poverty also influenced behaviors, particularly in Ciudad Juárez, where lucrative U.S. clients were increasingly scarce. While struggling to cultivate dependable relationships in a setting marked by historical sex tourism from a wealthier country, some FSWs ceased negotiating condom use. We discuss the need for HIV/STI research and prevention interventions to recognize the complexity within FSWs' commercial relationships and how behaviors (e.g., condom use) evolve as relationships develop through processes that are influenced by local sociopolitical contexts and binational income inequality.     

“They Just Whisper in Their Hearts That He's Doing a Bad Thing”: A Qualitative Study of Tanzanian Perceptions of Cross-Generational Sex

HIV prevalence among young Tanzanian women is twice that of men, and risk doubles if a partner is ten or more years older. Cross-generational sex (CGS) is typified by transactions, economic asymmetries, power differentials, and inconsistent condom use. By investigating perceptions of CGS in families, schools, and communities, this study explored the role each plays in addressing or condoning CGS and where interventions are needed. Qualitative data were collected in Tanzania's Iringa and Pwani regions after a campaign to reduce CGS. Community leaders suggested key informants and provided household lists used to randomly select participants. Individual interviews were conducted with 20 women (M age = 20.7, SD = 3.1, range = 15 to 26) and 20 men (M age = 37.1, SD = 7.3, range = 30 to 56), focus groups with 15 women (M age = 20.4, SD = 2.9, range = 17 to 25) and 26 men (M age = 39.2, SD = 7.9, range = 30 to 55), and key informant focus groups with 10 women (M age = 47.6, SD = 10, range = 37 to 70) and 16 men (M age = 55.5, SD = 9.5, range = 37 to 67). CGS was viewed as detrimental to girls' education and a financial loss to parents, but barriers, including reluctance to approach parents and older men, prevented community action. Interventions may involve community leaders transcending restrictions on confronting older men and promoting communication between teachers, communities, parents, and young women regarding CGS.     

HIV Risk Behaviors Among Three Classes of Female Sex Workers in Vietnam

Increases in the rate of HIV infection in Vietnam among female sex workers and their clients require more effective preventive interventions based on a better understanding of this population and important subgroups within it. Because little was known about women in the hospitality sex industry, this study compared demographic and work characteristics, history of sexually transmitted infections (STIs), and condom use among a sample of 310 female sex workers in low-, middle-, and high-class hospitality businesses in Ho Chi Minh City (mean age = 26.77 years, SD = 6.17). Data were collected through individual, face-to-face, semistructured interviews. Logistic regression models were used to identify demographic predictors of the incidence of STIs and reported condom use. Low occupational status was most strongly associated with a history of STIs, and use of condoms with new and regular clients also differed by occupational class. Implications are discussed.     

Underestimating Protection and Overestimating Risk: Examining Descriptive Normative Perceptions and Their Association with Drinking and Sexual Behaviors

Individuals who engage in risky sexual behavior face the possibility of experiencing negative consequences. One tenet of social learning theory is that individuals engage in behaviors partly based on observations or perceptions of others’ engagement in those behaviors. The present study aimed to document these norms–behavior relationships for both risky and protective sexual behaviors, including alcohol-related sexual behavior. Gender was also examined as a possible moderator of the norms–behavior relationship. Undergraduate students (n = 759; 58.0% female) completed a Web-based survey, including various measures of drinking and sexual behavior. Results indicated that students underestimate sexual health-protective behaviors (e.g., condom use and birth control use) and overestimate the risky behaviors (e.g., frequency of drinking prior to sex, typical number of drinks prior to sex, and frequency of casual sex) of their same-sex peers. All norms were positively associated with behavior, with the exception of condom use. Furthermore, no gender differences were found when examining the relationship between normative perceptions and behavior. The present study adds to the existing literature on normative misperceptions as it indicates that college students overestimate risky sexual behavior while underestimating sexual health-protective behaviors. Implications for interventions using the social norm approach and future directions are discussed.     

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.     

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.     

Social Ecological Factors of Sexual Subjectivity and Contraceptive Use and Access Among Young Women in the Northwest Territories,Canada

Adolescent women in the Northwest Territories (NWT), Canada, experience many sexual health challenges that are linked to a history of colonization and intergenerational effects of trauma. This study was informed by social ecological theory and explored how young women in the NWT develop sexual subjectivity within the context of contraception use and access during this time of decolonization. A total of 41 participants (aged 13 to 17 years) attended the Fostering Open eXpression among Youth (FOXY) body-mapping intervention in six NWT communities and then completed semistructured interviews. Framework analysis identified barriers to the development of sexual subjectivity that included a culture of stigma and shame surrounding sexuality; pervasive alcohol use in communities; predatory behaviors by older men; poor quality sexual health education offered in schools; and issues with accessing health services. In addition, analysis identified the following facilitators: comprehensive sexual health education; widespread access to free condoms; and positive health support networks with female relatives, peers, and some teachers. Our findings suggest the need for multiple intervention strategies within a complex social ecological framework, including arts-based interventions that focus on developing self-esteem and self-efficacy of youth, combined with interpersonal interventions that strengthen communication skills among supportive adults, and community-level campaigns that target stigma reduction and shift cultural norms.     

Alcohol,Sex, and Screens: Modeling Media Influence on Adolescent Alcohol and Sex Co-Occurrence

Alcohol use and sexual behavior are important risk behaviors in adolescent development, and combining the two is common. The reasoned action approach (RAA) is used to predict adolescents’ intention to combine alcohol use and sexual behavior based on exposure to alcohol and sex combinations in popular entertainment media. We conducted a content analysis of mainstream (n = 29) and Black-oriented movies (n = 34) from 2014 and 2013–2014, respectively, and 56 television shows (2014–2015 season). Content analysis ratings featuring character portrayals of both alcohol and sex within the same five-minute segment were used to create exposure measures that were linked to online survey data collected from 1,990 adolescents ages 14 to 17 years old (50.3% Black, 49.7% White; 48.1% female). Structural equation modeling (SEM) and group analysis by race were used to test whether attitudes, norms, and perceived behavioral control mediated the effects of media exposure on intention to combine alcohol and sex. Results suggest that for both White and Black adolescents, exposure to media portrayals of alcohol and sex combinations is positively associated with adolescents’ attitudes and norms. These relationships were stronger among White adolescents. Intention was predicted by attitude, norms, and control, but only the attitude–intention relationship was different by race group (stronger for Whites).     

“Jimmy Cap Before You Tap”: Developing Condom Use Messages for African American Women

This study examined which characteristics of persuasive communications are most effective in changing African American women’s condom use attitudes. Focus groups were convened with 40 African American women (M_age = 25.54, SD = 4.67) to assess their opinions on current effective strategies used to promote condom use among their peers. Participants discussed effective characteristics of messaging campaigns (i.e., source, message type, channel) and how these could be used in future prevention messages. Findings revealed that making messages that are fun, catchy, and informative, delivered frequently through social media, TV, or radio by a peer or celebrity would be perceived as most effective in changing young African American women’s attitudes. Other themes that emerged were that condom use is more strongly associated with pregnancy prevention than HIV prevention and that sexual partners were perceived to have negative condom use attitudes. Recommendations centered on increasing exposure of HIV prevention messages by placing messages on the Internet and including a funny phrase or jingle in the message so that it is easy to remember and could potentially serve as a conversation starter for discussing safe sex with partners.     

Emotional Intimacy Power Predicts Different Sexual Experiences for Men and Women

Those who are more emotionally invested in relationships have less power than their partners. Furthermore, less powerful individuals may attempt to equalize power imbalances by offering rewards to their partner and using sex and condom use as exchange resources. Australian young adults reported their condom use and pressured sex experiences in both romantic (n = 708) and casual (n = 118) relationships. Results showed that greater power (lower relative emotional investment) predicted more condom use among those wanting to use condoms. In casual relationships, an interaction with gender showed that women in particular used condoms more when they had more power. Power also interacted with gender for pressured sex and, unexpectedly, men who had more power experienced more pressured sex. The possibility that condom use and pressured sex have different meanings for men and women is explored.     

Work and Sexual Trajectories Among African American Youth

The beneficial or deleterious effects of employment on youth and well-being have been highly contested. This study explores whether work influences youths' sexual risk correlates in a sample of African Americans (N = 562; 55% females; M = 14.5 years, SD = 0.6 years) followed longitudinally from adolescence to early adulthood. The study used growth curve modeling to test the association between number of hours worked and condom use, sex partners' age differences, and number of partners over time. Working a greater number of hours was associated with less condom use, with the effect varying by youths' grade point average. Working a greater number of hours was associated with older sex partners among female youth. No association was found between work and number of partners. The findings suggest that working during adolescence and early adulthood increased participants' sexual activity, thus lending some support for the work consequences perspective. The implications for future research and youth development programs are discussed.     

Associations of Alcohol and Marijuana Use With Condom Use Among Young Adults: The Moderating Role of Partner Type

This study used multiple levels of analysis to examine associations of alcohol and marijuana (AM) use with condom use, including the moderating role of partner type, in a general sample of 754 sexually active young adults (mean age = 18.6, SD = 0.63; 77% non-White). Multivariable models examined associations over the past 30 days (global) and at the most recent sexual event (event specific). Over the past 30 days, participants who had a recent casual partner and used both substances reported a higher proportion of condom-protected sexual events during this period compared to AM nonusers, whereas those who had a recent steady partner and used alcohol, marijuana, or both substances reported a lower proportion of condom-protected sexual events compared to AM nonusers. At the most recent sexual event, participants who used both substances were four times more likely than AM nonusers to have condom-protected sex if the event involved a casual partner; however, there were no significant associations if the event involved a steady partner. Marijuana use, particularly combined with alcohol use, deserves greater attention in the context of condom use. Future research should consider different levels of analysis and partner types to fully understand these complex associations.     

Peer,social media,and alcohol marketing influences on college student drinking

Objective: To investigate how alcohol marketing and peers may promote college students' alcohol use through social media. Participants: College students (N = 682) aged 18 to 22 years from a large Southern university completed paper surveys in April 2014. Methods: Structural equation modeling was used to investigate relationships among variables as well as moderation by gender and race. Results: Drinking behavior was directly related to perceived norms and attitudes toward alcohol that develop, in part, from direct and indirect interactions with their online and offline peers, as well as engagement with alcohol-related content on social media. Gender and ethnicity moderated some effects. Conclusions: College student drinking is influenced by friends' alcohol-related content posted on social networking sites and by greater engagement with traditional and online alcohol marketing. College campus alcohol misuse interventions should include components to counter peer influences and alcohol marketing on social media.     

Barriers to Remarriage Among Older People: Viewpoints of Widows and Widowers

We conducted this research based on a qualitative approach to describe the opinions of older widows and widowers on remarriage obstacles. Based on purposive sampling and inclusion criteria, we chose 48 participants on maximum diversity of sex, age, education, employment, and socioeconomic status. Two thirds of the participants were female, 40% had spent more than 10 years widowed, and 65% were living with their children. We collected data individually through semistructured, face-to-face interviews. Based on conventional content analyses, 2 independent researchers implemented data analysis manually. Barriers to remarriage were finally categorized into 4 main themes: personal, normative, interactive, and financial factors. Results of this study showed that older people are more concerned about public opinions and social norms surrounding remarriage. As long as these thoughts and norms are not changed, the concept of remarriage among widows and widowers remains a vital taboo and concern.     

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.     

Use of Drinking Protective Behavioral Strategies and Sexual Perceptions and Behaviors in U.S. College Students

Alcohol use among college students is linked to an increased likelihood of engaging in risky sexual behaviors, including casual sex and unprotected sex. These behaviors increase college students' risks for negative social and health-related consequences. This study examined the relationship between drinking behaviors and protective behavioral strategies (PBS), expectancies and perceptions of sexual risk, and actual alcohol-related sexual behaviors and consequences. Sexually active college students completed Web-based self-report measures of drinking behaviors and use of PBS, alcohol expectancies and perceptions of risk, and sexual behaviors and related consequences (n = 524; 57.1% women). Findings indicated that PBS were related to lower expectancies of sexual risk and sexual disinhibition, and among lighter drinkers, lower expectancies of sexual enhancement from alcohol. PBS were also related to decreased perceptions of sexual-related risks, some alcohol-related sexual behaviors, including number of drinks before/during sex, and number of sexual consequences, but were not related to abstaining during sex, frequency of alcohol-related sexual behaviors, or general condom use. These findings demonstrate a disconnect between perceived and actual risks among college students, such that decreased perceptions of risk may not be associated with protective behaviors. Prevention and intervention implications are discussed.     

Social Network Factors Associated with Sexually Transmitted Infections Among Formerly Incarcerated Latino Men

ABSTRACT. The objectives of this study were to describe demographic factors and self-reported sexually transmitted infection (STI) rates, as well as to explore to what extent social factors were associated with self-reported STIs among formerly incarcerated Latino men (FILM) in New York City. FILM ages 18 to 49 years old (N = 259) who had been incarcerated within the past 5 years completed a closed-ended, self-administered survey. Bivariate and multivariate logistic regression analyses were performed to explore the association among social network factors (i.e., friends, spouses, relatives, parents) and self-reported STIs in the prior 12 months. More than one third (35.1%) of the sample reported at least one STI in the prior 12 months. Friendship networks were protective against STI risk. In our bivariate and multivariate models, having an STI in the prior 12 months for FILM was associated with: low quality of spousal relationship and high drug connectedness with relatives. STI risk reduction initiatives for FILM should consider: (1) the effect that drug use has on close kinship networks to increase STI risk during reentry, and (2) the potential of targeting friendship and kinship networks (i.e., spouses, family, relatives) to address drug dependence through peer and group counseling.     

Extramarital Sex Among Vietnamese Married Men: Results of a Survey in Urban and Rural Areas of Northern and Southern Vietnam

Research on extramarital sex (EMS) is commonly conducted from a perspective that implicitly understands this behavior as a violation of the marital relationship. In contrast, Vietnamese cultural norms have, at some points in history, condoned if not outright encouraged EMS in the name of preserving family lineage. Yet little is known about the prevalence of EMS among contemporary Vietnamese men and its association with marriage quality. This is a notable gap, given the enormous sociocultural and ideological shifts the country has experienced over the past several decades. Drawing upon a sample of 126 married men (Mean age = 45.56; SD = 10.52) surveyed in urban (Hanoi and Ho Chi Minh City) and rural areas (Ha Tay and Can Tho) in Vietnam, we examined the relationship between EMS and geographic region, demographic characteristics, sexual values, quality of marriage, and sexual satisfaction within marriage. Our results show that geographic location had a strong impact on EMS, while most marital relationship quality variables did not impact the odds of EMS for married men in Vietnam.     

Safer sex in a digital world: A Web-based motivational enhancement intervention to increase condom use among college women

ABSTRACT

Objective: This study is a randomized trial of a Web-based intervention to increase condom use among college women. Participants: From October 2012 to March 2013, N = 422 completed baseline questionnaires and intervention procedures. n = 216 completed 3-month follow-up. Methods: Participants completed a decisional balance exercise examining their sex acts over the past 3 months and wrote an essay encouraging young girls to use condoms. All procedures were conducted online. Results: The intervention improved intentions to use and attitudes towards condoms for 3 subscales of condom attitudes. Attitudes following the intervention significantly predicted condom use at 3-month follow-up, and this relationship was mediated by condom intentions immediately post intervention. The relationship between intentions and condom use was moderated by group. Conclusions: The intervention improved condom attitudes and intentions immediately post intervention, and immediately post intervention intentions had a greater impact on condom use at 3-month follow-up among those in the condom intervention compared with those in the control group.