Perceived Condom Use Self-Efficacy Among At-Risk Women

The objectives of this study are to assess the confidence in their ability to use condoms among at-risk women and identify predictors for the women's condom use self-efficacy. Structured interviews were conducted with 250 adult women in Atlanta, Georgia, between August 1997 and August 2000. Overall, the women reported feeling moderately to moderately–strongly confident in their ability to use condoms consistently. Multivariate analysis showed women with higher condom use self-efficacy were significantly younger, experienced childhood neglect, had higher self-esteem, communicated better with their sex partner, and had fewer drug problems. Findings suggest the importance of addressing condom use self-efficacy in HIV risk reduction programs with a specific focus on women and the need to be attuned to tailored needs for specific subgroups such as older women or women who encountered childhood neglect.     

Promoting Condom Use With Main Partners: A Behavioral Intervention Trial for Women

The Stages of Change (SOC) model was used to implement and evaluate a condom promotion intervention for HIV-positive and at-risk women who were recruited from clinic and community settings in Baltimore and Philadelphia. Participants were assigned to receive standard reproductive health services or enhanced services (standard plus SOC peer advocate intervention). Women who had a main partner at baseline and at a 6-month follow-up were included in the analysis (70 HIV positive, 471 at risk). Compared with the standard group, HIV-positive women in the enhanced group were significantly more likely to have progressed in the SOC model or to have maintained consistent condom use, and less likely to have relapsed or stayed in the precontemplation stage. Among the at-risk women, exposure to the intervention was associated with being at a higher SOC and being less likely to relapse relative to the standard group. The SOC model has promise for use in social and public health service settings that serve women at risk or living with HIV.     

Condom Use and Its Correlates Among Female Sex Workers in Hanoi, Vietnam

Knowledge of female sex workers’ (FSW) condom use behaviors in Vietnam is important for predicting the epidemic and designing interventions. Four hundred FSWs in Hanoi were studied in 2002. Consistent condom use in the past month was higher with irregular clients (62%), less with regular clients (41%), and lowest with “love mates” (5%). Reasons for not using condoms were partner objection, condom unavailability, and belief of partner's disease-free status. Twenty-seven percent reported not always having a condom available. Thirty-five percent reported increasing condom use in the previous 6 months. Reluctance to ask clients to use condoms and condom unavailability were independently associated with inconsistent condom use with both irregular and regular clients. Older age was also associated with inconsistent condom use with irregular clients. Condom promotion should focus on FSWs and their partners. Negative attitudes toward FSWs and condom promotion need to be changed to reduce stigmatization of FSWs and to make condom use a norm in the society.     

Condom Use Among South African Adolescents: Developing and Testing Theoretical Models of Intentions and Behavior

We developed and tested models of intentions and behavior among adolescents from Cape Town, South Africa. Data from 261 participants who completed an initial measure of attitudes, beliefs, and prior behavior were used to develop a model of intentions to use condoms based on the Theory of Planned Behavior (TPB) and additional constructs found to be important in previous research with adolescents. Of the initial sample, 227 (87%) completed a behavioral follow-up 4 months later, and approximately one-third of those (n=72; 44 boys and 30 girls) reported having had sex in the prior 4 months. Data from this smaller sample were used to develop a model of condom use behavior based on intentions (as per the TPB) and the additional sub-population relevant constructs. Analyses generally supported the validity of the TPB in this context for predicting intentions and behavior. HIV knowledge and positive outlook (self-esteem and future optimism) were significantly related to TPB predictors of intentions. Intentions, acceptance of sexuality, and gender were significant predictors of behavior. Implications for the status of the TPB and the design of interventions for South African adolescents are discussed.

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Longitudinal Study of Condom Use Patterns Among Women With or at Risk for HIV

The objectives of this paper are to compare the patterns of condom use at three times for sexually active HIV-infected women and a comparison group of uninfected women and to examine correlates of condom-use patterns. Data are reported from the first three visits (first year) of a longitudinal study of the biomedical and behavioral manifestations of HIV infection in women. Analyses were conducted on 386 HIV-infected and 203 uninfected sexually active women. Participants were interviewed at enrollment and at 6- and 12-month follow-up visits. HIV-infected and uninfected women received safer-sex counseling at each study visit and uninfected women were tested for HIV. Consistent condom use at all three times was reported by a higher percentage of HIV-infected than uninfected women (34% vs.13%; p .01) whereas inconsistent or nonuse was more common among the uninfected than infected women (21% vs.7%; p .01). Condom use differed by partner serostatus: 25% of the HIV-infected women with infected partners reported consistent condom use compared with 41% of those with partners whose serostatus was negative or unknown. For HIV-infected women with uninfected partners, injecting drugs and crack use were associated with inconsistent condom use. These findings suggest that HIV serostatus of women and their partners affects consistency of condom use. Despite greater condom use by HIV-infected women with partners of negative or unknown serostatus than by those with infected partners, the fact that condom use was far from universal suggests the need for interventions involving uninfected male partners of infected women.     

Association of Violence Victimization with Inconsistent Condom Use in HIV-Infected Persons

The association of violence victimization with current condom use in HIV-infected persons was examined in this cross-sectional study. The HIV—Alcohol Longitudinal Cohort (HIV-ALC) recruited HIV-infected participants with a history of alcohol problems. Interviews assessed violence histories and current sexual behaviors. Of the 349 participants (79% men), 38% reported inconsistent condom use and 80% reported a violence history. Lifetime sexual violence was reported by 40% and lifetime physical violence (without sexual violence) by 40%. Participants reporting lifetime sexual violence had greater odds of inconsistent condom use than participants without any history of violence. A history of childhood sexual violence was also associated with greater odds of inconsistent condom use than participants without a history of childhood sexual violence. A history of sexual violence may in part explain HIV-infected persons' greater risk for transmitting HIV through high-risk sexual behaviors.     

Contextual Determinants of Condom Use Among Female Sex Exchangers in East Harlem, NYC: An Event Analysis

Recent studies have revealed a variety of contexts involving HIV risk behaviors among women who exchange sex for money or drugs. Event analysis was used to identify the individual, relationship, and contextual factors that contribute to these high-risk sex exchange practices. Analyses were conducted on data obtained from 155 drug-using women who reported details of their most recent sex exchange event with male clients. The majority of sex exchange encounters (78%) involved consistent condom use. In multivariable analysis, protective behavior was associated primarily with situational and relationship variables, such as exchange location, substance use, sexual practices, and respondent/client discussion and control. In order to inform HIV prevention programs targeted to women sex exchangers, further research is needed on the contextual determinants of risk, especially with regard to condom-use negotiation and factors involving substance use that adversely affect women's ability to manage protective behavior in the context of sex exchange.     

Determinants of Condom Use Stage of Change Among Heterosexually-Identified Methamphetamine Users

There is a paucity of research on the association between methamphetamine use (meth) and sexual risk behavior among heterosexual meth users. This study used a multiple theories approach to identify factors associated with stage of change for condom use in a sample of 181 HIV-negative, heterosexually identified meth users. Background characteristics, drug use variables, and theoretical mechanism of change variables were examined in relation to Prochaskas contemplative and preparation stages of change. Sexual risk behavior was highest among those in the contemplation stage of change. When compared with those in the preparation stage of change, contemplators were more likely to be never married, more likely to have an STD, consumed larger amounts of meth and other illicit drugs, had lower scores on self-efficacy and outcome expectancies for condom use and negotiation of safer sex practices, and had less positive social norms in relation to AIDS preventive behaviors. A multivariate logistic regression revealed that the preparation stage of change was associated with increased self-efficacy for condom use, stronger social norms regarding condom use, and reduced occurrence of sexually transmitted diseases. The findings are discussed in relation to the development of sexual risk reduction interventions for heterosexual meth users.     

Social Service Delivery Preferences Among African American Women Who Use Crack Cocaine

Abstract

African American women involved in high-risk, substance use-related behaviors are affected by extremely high rates of HIV infection. While research has demonstrated that HIV is preventable, in order for prevention efforts to be successful in reducing disparities, perceptions of African American women who use crack cocaine need to be taken into account. This qualitative study presents results of eleven focus groups with eighty-nine African American women respondents presenting their perceptions of service needs and preferences for service delivery. The results indicate two important findings for social service providers: the respondents' lack of a perceived need for HIV prevention services as a spontaneously identified need, and respondents' desires for more basic services such as childcare, safe shelter, basic necessities, and especially substance abuse treatment before they could be approached about HIV prevention services. The findings are relevant for developing gender-and culture-specific prevention strategies to reduce the spread of HIV.     

Correlates of Condom Use and Reasons for Condom Non-Use Among Drug Users

Two hundred and seventy-seven drug using adults were interviewed regarding details of their most recent sexual encounter. Demographic, attitudinal, and context variables were associated with condom use and non-use. Greater perceived risk of STDs/HIV and positive attitudes toward condoms' effect on sexual pleasure were associated with greater likelihood of reporting condom use. Common reasons for not using condoms included lower perceived risk of contracting HIV/STDs, negative attitudes toward condoms' effect on pleasure, and lack of condom availability. Tailoring messages to modifiable perceptions of risk and condom attitudes may be useful in reducing sexual risk among drug-using individuals.     

A Study of Condom Acceptability Among Men in an Urban Population in South India

This study examines the acceptability of condoms to men from Chennai, South India. A sample of 150 male respondents who, in the main, had at least one risky sexual experience with a commercial sex worker or multiple partners was interviewed. The respondents included HIV-positive and HIV-negative individuals at sexually transmitted disease clinics, college students, and homosexuals. Awareness of condom usage was high, and 83% had used condoms at least once. The reasons for using condoms were protection from disease (43%), protection from AIDS (20%), and partner insistence (25%). Seventy-three percent of the respondents expressed dissatisfaction. Of those who used condoms for the first time, 72% were HIV negative, compared to 34% among those who did not use condoms. This indicates the need for developing the "condom habit," as using condoms at the first sexual experience is a strong predictor of future condom use.     

Perceived Neighborhood Social Cohesion and Condom Use Among Adolescents Vulnerable to HIV/STI

The relationship between neighborhood social dynamics and adolescent sexual behavior has not been well explored. We conducted a cross-sectional survey with 343 adolescents recruited from two health clinics in Baltimore. Multivariate logistic regression was utilized to assess the influence of perceived neighborhood social cohesion and collective monitoring of youth on condom use at last sex, controlling for family and individual factors. Condom use was significantly higher among participants who perceived their neighborhoods as high, 54.7%, versus low, 40.4%, in social cohesion. Neighborhood cohesion was significantly associated with condom use in multivariate analyses, as was parental communication, family structure, and gender. No association between perceived neighborhood collective monitoring of youth and condom use was found. We conclude that perceived neighborhood social cohesion is positively associated with condom use among adolescents vulnerable to HIV/STI and should be encouraged in the context of community-based prevention efforts.     

Prevalence and Correlates of Condom Use and HIV Testing Among Female Sex Workers in Tashkent,Uzbekistan: Implications for HIV Transmission

Little is known about sex work in Tashkent, Uzbekistan, despite rapid increases in HIV infection. Consistent client condom use and prior HIV testing are described among 448 female sex workers (FSW) completing a self-administered questionnaire, health provider interview, and HIV testing between April 2003 and March 2004. Participants were recruited through outreach workers using modified snowball sampling. Consistent client condom use was more likely for FSW who were married, knew condoms prevent HIV, and from countries in south Central Asia. Prior HIV testing was less likely for FSW younger than 21 years, who shared drugs with clients, initiated sex work at 18 years or less and had engaged in sex work less than 2 years. Low rates of condom use, particularly by those with risky drug behaviors, indicate that targeted risk-reduction interventions are urgently needed.     

HIV/STD Risk and Sexual Strategies Among Women Family Planning Clients in New York: Project FIO

This report describes among 360 family planning clients in an HIV epicenter, women's HIV/STD risk characteristics, the barriers and facilitators of condom use within the context of relationships, and the use of alternative strategies for protection. Women attending the clinic were recruited for an HIV/STD preventive intervention and interviewed at baseline. At least 1 risk factor was reported by 77%, including a diagnosis of an STD within the last year for 30%. Recent STD diagnosis was associated with having a risky partner, but not with number of current partners. Women reporting consistent condom use had higher quality of couple communication, stronger intentions to prevent pregnancy, more positive reactions to condoms themselves and from their partners. Alternative risk reduction strategies, including using a barrier method other than condoms, refusing sex, engaging in nonpenetrative sex, leaving a relationship due to STD concerns, or undergoing mutual HIV testing had been used by 39% of women in the past 3 months.     

The Role of Relationship Intimacy in Consistent Condom Use Among Female Sex Workers and Their Regular Paying Partners in the Dominican Republic

Prior research has demonstrated an important link between relationship intimacy and condom use. Limited research has been conducted on this connection within the realm of female sex work. We examined the association between perceived relationship intimacy and consistent condom use among 258 female sex workers and 278 male regular paying partners who participated in a cross-sectional survey in the Dominican Republic. In multivariate analysis, higher intimacy among sex workers and regular paying partners was negatively associated with consistent condom use. Among those reporting higher perceived intimacy, male participants were more than twice as likely to report consistent condom use as female participants. Female sex workers in relationships of higher perceived intimacy are at greater risk of HIV/AIDS than their male regular paying partners. Gender-sensitive HIV prevention programs are needed to address the differential influence of relationship intimacy on condom use in the context of sex work.     

African American Women,AIDS, and Resiliency

ABSTRACT

Ongoing shifts in the populations affected by the AIDS epidemic are reflected in the increasing proportion of AIDS cases in women-particularly women of color. While African American women represent approximately 13% of the U.S. female population, in 2000, 63% of all reported AIDS cases in women in the United States were among African American/non-Hispanic women. Despite these statistics, relatively few studies in the area of HIV research target African American women exclusively. As part of a larger study, we asked 105 African American women to describe in their own words how their lives have changed since becoming HIV positive. Despite multiple past and current stressors, the majority of participants provided responses that were decidedly positive. Clinical implications as well as future research directions based on these findings are discussed.     

Determinants of HIV Risk Reduction Behaviors Among Female Partners of Men with Hemophilia and HIV Infection

Determinants of safer sexual behaviors (abstinence or consistent condom use) among female partners of HIV-infected adult men with hemophilia were examined. A model was proposed predicting that emotional adjustment, communication skills, self-efficacy, and perceived advantages of condom use would influence the practice of safer sexual behaviors. Confidential surveys were completed by 119 seronegative female partners of men with hemophilia and HIV infection who received care from one of 27 hemophilia treatment centers across the United States. The proposed model was tested using LISREL, and the model explained 40% of the variance in safer sexual behaviors. Emotional adjustment was a significant predictor of both intimate and emotional communication skills. Intimate and emotional communication skills were related to self-efficacy for communicating about safer sex, which in turn influenced both communication about safer sex and perceived advantages of condom use. Communication about safer sex with a partner and perceived advantages of condom use had direct effects on safer sexual behaviors. HIV prevention interventions with women known to have seropositive partners should be multifaceted. Skill-building interventions emphasizing communication skills, increasing self-efficacy for communication about safer sex with a partner, and promoting positive attitudes about safer sex should be considered.     

Drug Use and Risk for HIV Among Women Arrestees in California

The rate of women entering the criminal justice system, particularly from drug-related crimes, is increasing. This study examined the characteristics and HIV risk behaviors of drug-using women arrestees in 13 California counties (N = 532). The injecting drug users (IDUs) (18%) were compared with the noninjecting drug users. The IDUs were older, more often White than African American, and were more likely to have a history of STDs, previous arrest, and polydrug use. Although the IDUs were at higher risk for HIV from their injection drug use and greater involvement in sex work, a substantial number of non-IDUs also engaged in high-risk sexual behaviors. Only a small percentage of the women sampled tested positive for HIV antibodies, however, the generally high-risk profile of this sample of drug-using women arrestees suggests that they would benefit from interventions that link them with needed treatment and services.     

Knowledge, Perception of Risk for HIV, and Condom Use: A Comparison of Registered and Freelance Female Sex Workers in Cebu City, Philippines

The HIV infection rate is lower in the Philippines than would be expected based on the numbers of people believed to engage in high-risk behaviors. A national behavioral surveillance system has been implemented to monitor selected behaviors among vulnerable populations. This paper reports on an interview survey of 360 registered and 360 freelance sex workers in Cebu City, the Philippines, from 1997 to 1999. All of the women had engaged in sexual activity in exchange for money during the week preceding the interview. The freelance workers reported more sexual partners than the registered sex workers (p < .00001), assessed themselves as more at risk for HIV (p < .00001), and were less likely to always use condoms during sex (p < .00001). The groups were comparable on a measure of knowledge about HIV transmission. As these women continue to engage in risky behaviors, some form of intervention will be necessary to prevent the escalating HIV/AIDS rates seen in other Southeast Asian countries.     

Introducing and Negotiating the Use of Female Condoms in Sexual Relationships: Qualitative Interviews with Women Attending a Family Planning Clinic

Safe sex skills training often teach women to be assertive in condom use negotiations. However, it has been suggested that assertiveness training may be inappropriate for women who lack power in their sexual relationship. Our qualitative study of 62 women attending a family planning clinic explored various communication styles they used to introduce and negotiate female condom use in their sexual relationships. We further examined how different introduction and negotiation styles were related to actual use of the device. The device was introduced using a direct, semidirect, indirect, or nonverbal communication approach. Use of the female condom was negotiated by avoiding sex, using humor, discussing the possibility of using the condom, or being argumentative with partners. The outcome of introducing and negotiating female condom use was often mediated by other factors including partner characteristics, relationship power dynamics, situational context, and use of additional discourse strategies (e.g., describing the female condom as a sexual toy or taking the opportunity to educated partners about the female condom). Less direct approaches appeared to be as effective in facilitating use of the female condom as more direct approaches. Female condom introduction and negotiation styles that continued to engage their partners by using additional discourse strategies led to more frequent use of the device. Implications of our findings for HIV risk reduction program development are discussed.