Type of contraception method used at last intercourse and associations with health risk behaviors among US adolescents

Background

This study was conducted to examine associations with contraception methods used at last sexual intercourse among US adolescents.

Study Design

Data consisted of sexually active adolescents (9th–12th grade, weighted n=24,638) from the 1999–2007 Youth Risk Behavior Surveillance System (YRBSS). We performed multinomial multivariable logistic regression analyses with condom users at last sexual intercourse as the reference group.

Results

Males who used alcohol, cigarettes, marijuana and cocaine were more likely to use no method/unsure of method (OR=2.4, CI=1.7–3.4) or rely on withdrawal (OR=2.6, CI=1.5–4.3). Females with six or more sexual partners were more likely to rely on withdrawal (OR=2.9, CI=2.1–3.9) or contraception methods that offer no STI protection [i.e., birth control pills: OR=1.9, CI=1.4–2.5; and depot medroxyprogesterone acetate (DMPA, marketed as Depo-Provera): OR=2.6, CI=1.6–4.2]. Earlier age of sexual debut was also associated with nonuse.

Conclusion

Prevention efforts should focus on at-risk adolescents including substance-using males, females with six or more sexual partners, and those who initiate sexual intercourse at an early age.     

Knowledge about STD/AIDS and sexual behavior among high school students in Rio de Janeiro,Brazil

The incidence of AIDS and other sexually transmitted diseases (STDs) is increasing among adolescents. In order to better understand high-risk sexual behavior among students, a cross-sectional study based on a self-answered anonymous questionnaire was conducted in 10 public and private high schools in Rio de Janeiro, Brazil. Data were obtained on sociodemographics, knowledge of STD/AIDS, and sexual behavior. Among 945 students aged 13-21, 59% were sexually initiated, and the median age at first sexual intercourse was 15 years (range: 7-19). Although 94% reported being aware of the need for condom use for protection, only 34% informed always using condoms during sex. Low family income was associated with unsatisfactory knowledge (OR = 9.40; 95% CI = 6.05-14.60) and inconsistent condom use (OR = 11.60; 95% CI = 5.54-24.30). However, unsatisfactory knowledge was not associated with inconsistent condom use. School-based educational programs should focus on sexual behavior more than on transmission of knowledge, as well as targeting low-income students.     

Methamphetamine Use Is Independently Associated With Recent Risky Sexual Behaviors and Adolescent Pregnancy

BACKGROUND: Lifetime methamphetamine use among adolescents is estimated to be between 5% and 10%. Youth substance use in general is known to be associated with risky sexual behaviors, but the effect of methamphetamine use on recent risky sexual behaviors and adolescent pregnancy has received little attention. The purpose of this analysis was to evaluate the association between lifetime methamphetamine use and recent (past 3 months) risky sexual behaviors and lifetime adolescent pregnancy, adjusting for other substance use. METHODS: We analyzed data from the 2003 National Youth Risk Behavior Survey, a school‐based paper‐and‐pencil survey that assesses risky health behaviors among a nationally representative sample of 9th‐ to 12th‐grade students. Multivariable logistic regression was used to calculate adjusted odds ratios (AORs) to examine the association between methamphetamine use and being recently sexually active, having 2 or more recent sex partners, and ever being pregnant or getting someone pregnant. RESULTS: Lifetime methamphetamine use was reported by 7.6% of students. After adjustment for demographic covariates and lifetime use of cigarettes, alcohol, marijuana, and other illicit drugs, lifetime methamphetamine use was associated with recent sexual intercourse (AOR = 1.8, 95% confidence interval [CI] = 1.5‐2.3), having 2 or more recent sex partners (AOR = 3.0, 95% CI = 2.2‐4.2), and ever being pregnant or getting someone pregnant (AOR = 2.9, 95% CI = 2.1‐3.9). CONCLUSIONS: Adolescent methamphetamine use is common and is associated with recent risky sexual behaviors and adolescent pregnancy. Prevention strategies for high school students should integrate education on substance abuse, pregnancy, sexually transmitted infections, and human immunodeficiency virus.     

The Association Between Substance Use and Risky Sexual Behaviors Among Incarcerated Adolescents

Objectives: The purpose of this study is to examine the relationships between substance use and risky sexual behaviors and having acquired a sexually transmitted disease. Methods: The sample consisted of 210 incarcerated adolescents ages 12–17. Data were collected through 40-min interviews administered by trained research assistants. Multivariate analysis was used to examine the relationship between risky sexual behaviors and substance use when adjusting for other covariates. Results: Almost three-quarters (70.6%) of these incarcerated adolescents regularly use one or more substances. Inconsistent condom use and sex with multiple partners (>2) was reported by approximately 70% of those surveyed. The regular use of substances elevated the odds of having sex with multiple partners (OR = 11.88), exchanging sex for money or drugs (OR = 4.64), and inconsistent condom use (OR = 3.06). Conclusion: Given strong associations between risky sexual behavior and substance use, interventions should be more multiproblem-focused. Health interventions should attempt to address common causes of both behaviors. Effective interventions will be those that can successfully demonstrate effects on outcomes that measure both the intervention effects on substance use and risky sexual behaviors.     

Prevalence and correlates of condom use at last sexual intercourse among in-school adolescents in urban areas of Uganda

OBJECTIVES: Correct and consistent condom use remains an important public health intervention against the spread of Human Immunodeficiency Virus and other sexually transmitted infections. There is paucity of information on sexual behaviour of in-school adolescents in Uganda. We, therefore, used secondary data of the Uganda Global School-based Health Survey (UGSHS) conducted in 2003 to determine the prevalence and correlates of condom use at last sexual intercourse in urban areas of Uganda. METHODS: A two-stage cluster sampling technique was used to obtain a representative sample. Altogether 1709 students participated in the survey in urban areas of whom 179 (14.9% of males, and 7.9% of females) had sexual intercourse within 12 months before the survey. RESULTS: Overall 77.3% (79.7% of male, and 72.3% of female) adolescents used a condom at last sexual intercourse. Adolescents who drank alcohol and used drugs were 64% (OR = 1.64, 95% CI 1.54, 1.75) and 68%, (OR = 1.68, 95% CI 1.56, 1.81) more likely to have used a condom, respectively. Meanwhile, adolescents who ever got drunk, and who reported to ever had 2 or more sex partners were 55% (OR = 0.45, 95% CI 0.42, 0.48) and 35% (OR = 0.65, 95% CI 0.62, 0.68) less likely to have used a condom compared to those who had never got drunk, and who ever had 1 sex partner, respectively. Finally, adolescents who reported receiving no parental supervision were 45% (OR = 0.55, 95% CI 0.53, 0.58) less likely to have used a condom compared to those who reported receiving parental supervision. CONCLUSIONS: Parental supervision may be effective in promoting condom use among adolescents. Furthermore, drinking alcohol was associated with condom use probably due to peer pressure and easy access of condoms in drinking places as condoms are not actively promoted in schools. There is need for further research on how in-school adolescents could access condoms.     

Acceptability of condom promotion and distribution among 10 to 19 year-old adolescents in Mpwapwa and Mbeya rural districts, Tanzania

ABSTRACT: BACKGROUND: The HIV/AIDS pandemic remains a leading challenge for global health. Although condoms are acknowledged for their key role on preventing HIV transmission, low and inappropriate use of condoms persists in Tanzania and elsewhere in Africa. This study assesses factors affecting acceptability of condom promotion and distribution among Tanzanian adolescents. METHODS: Data were collected in 2011 as part of a larger cross-sectional survey on condom use among 10-19 year-olds in Mpwapwa and Mbeya rural districts of Tanzania using a structured questionnaire. Associations between acceptability of condom promotion and distribution and each of the explanatory variables was tested using Chi Square. Multivariate logistic regression model was used to examine independent predictors of the acceptability of condom promotion and distribution using STATA (11) statistical software at 5% significance level. RESULTS: Mean age of the 1,327 adolescent participants (50.5% being males) was 13.5 years (SD=1.4). Acceptance of condom promotion and distribution was found among 37% of the adolescents. Being sexually active and aged 15-19 was the strongest predictor of the acceptability of condom promotion and distribution (OR=7.78, 95% CI 4.65-12.99). Others were; not agreeing that a condom is effective in preventing transmissions of STIs including HIV (OR=0.34, 95% CI 0.20-0.56), being a resident of Mbeya rural district (OR=1.67, 95% CI 1.28-2.19), feeling comfortable being seen by parents/guardians holding/buying condoms (OR=2.20, 95% CI 1.40-3.46) and living with a guardian (OR=1.48, 95% CI 1.08-2.04). CONCLUSION: Acceptability of condom promotion and distribution among adolescents in Mpwapwa and Mbeya rural is low. Effect of sexual activity on the acceptability of condom promotion and distribution is age-dependent and was the strongest. Feeling comfortable being seen by parents/guardians buying or holding condoms, perceived ability of condoms to offer protection against HIV/AIDS infections, district of residence and living arrangements also offered significant predictive effect. Knowledge of these factors is vital in designing successful and sustainable condom promotion and distribution programs in Tanzania. Key words Acceptability, condom promotion and distribution, adolescents, Tanzania.     

Knowledge, risk perception of AIDS and reported sexual behaviour among students in secondary schools and colleges in Tanzania.

A questionnaire survey was carried out among 1041 students in secondary schools and colleges in Dar-es-Salaam, Tanzania to evaluate the relationship between HIV-risky sexual behaviour and anti-condom bias, as well as with AIDS-related information, knowledge, perceptions and attitudes. Self-reportedly, 54% of students (75% of the boys and 40% of the girls) were sexually active, 39% had a regular sexual partner and 13% had multiple partners in the previous year. The condom use rate was higher than previous reports. However, 30% of sexually active respondents did not always use condoms (Risk-1 behaviour) and 35% of those with multiple partners in the previous year did not always use condoms (Risk-2 behaviour). Multiple logistic regression analyses indicated that 'sex partner hates condom' had association with both Risk-1 behaviour (OR 2.47; 95% CI 1.58-3.85) and Risk-2 behaviour (OR 2.47; 95% CI 1.10-5.48). 'Use of condom prevents HIV infection' also had association with both Risk-1 behaviour (OR 2.09; 95% CI 1.19-3.67) and Risk-2 behaviour (OR 3.73; 95% CI 1.28-11.03). Students engaging in risky behaviour were aware of the risk, even though they failed to change their behaviour. Reasons for the AIDS epidemic among Tanzanian students and the importance of more effective AIDS education are also discussed.     

云南省MSM人群成瘾性物质使用情况及影响因素

目的  了解云南省男男性行为者(men who have sex with men, MSM)人群成瘾性物质的使用情况,分析影响MSM人群使用成瘾性物质的相关因素。 方法  以云南省MSM社会组织为基础,招募年龄≥18岁、MSM或性取向为男性的调查对象。通过问卷调查收集人口学信息、性行为特征、成瘾性物质使用情况及HIV相关知识和检测情况等信息。采用多因素logistic回归分析模型分析影响MSM人群成瘾性物质使用情况及影响因素。 结果  共调查2 411名MSM,成瘾性物质的终生使用率为15.06%(363/2 411),最近半年的使用率为10.24%(247/2 411),其中85.02%(210/247)的调查对象以使用亚硝酸酯类吸入剂(rush poppers)为主。多因素logistic回归分析模型分析结果显示：边境州(市)(OR=1.79,95% CI：1.33~2.44)、18~＜25岁组[与18~＜25岁组相比,25~35岁组(OR=0.49,95% CI：0.34~0.72);＞35岁组(OR=0.47,95% CI：0.34~0.64)]、文化程度为高中以上(OR=1.65,95% CI：1.29~2.11)、主要性角色为被插入(OR=1.65,95% CI：1.24~2.21)、最近半年有多性伴(OR=2.29,95% CI：1.72~3.06)、不坚持使用安全套[与不坚持使用安全套相比,使用安全套(OR=0.59,95% CI：0.46~0.75)]和HIV/AIDS知识知晓情况差[与HIV/AIDS知识知晓情况差相比,HIV/AIDS知识知晓情况好(OR=0.52,95% CI：0.35~0.76)]的MSM人群使用成瘾性物质的比例更高。 结论  应加强对云南省MSM人群,尤其是边境州(市)MSM人群成瘾性物质和HIV/AIDS相关知识的宣传教育。此外,还需加强MSM人群中以rush poppers为代表的成瘾性物质使用情况的监测和监管及HIV等性传播疾病患病情况的监测,从而减少成瘾性物质的使用及性传播疾病的危害。     

Intergenerational Associations Between Parental Incarceration and Children's Sexual Risk Taking in Young Adulthood

Purpose

Research on parental incarceration and the health of offspring is relatively scarce despite studies linking childhood adverse experiences to a range of physical and mental health conditions. This study aimed to estimate the associations between parental incarceration and sexual risk outcomes (early sexual onset, inconsistent condom use, and sexually transmitted infections [STIs]) in young adulthood.

Does knowledge about sexually transmitted infections increase the likelihood of consistent condom use?

BACKGROUND: We aimed to assess the association between knowledge about sexually transmitted infections (STIs) and consistent condom use among university students controlling for selected socio-demographic factors. METHOD: An anonymous questionnaire survey was carried out among 720 undergraduate students (76% women) at the University of Tirana, Albania, in October-November 2002. The questionnaire included socio-demographic data, 10 multiple-choice test questions on knowledge about STIs, sexual activity and use of condoms. Two hundred seventy-nine students reported having sexual experience and provided data on condom use as well as knowledge about STIs. Binary logistic regression was used to assess the "independent" association between knowledge about STIs and condom use. RESULTS: In multivariable models, there was an overall association of knowledge about STIs with consistent condom use (OR = 1.74, 95% CI = 1.37-2.23, P < 0.001). There was evidence for an interaction between knowledge and parental education (P = 0.04): there was a positive association among students with highly educated parents (OR = 1.48, 95% CI = 1.11-1.99, P = 0.01), and particularly so among students with low-and-middle educated parents (OR = 4.75, 95% CI = 2.03-11.08, P < 0.01). CONCLUSIONS: Knowledge about STIs is an independent predictor of consistent condom use among university students. Augmentation of knowledge per se should be a component of school-based prevention programs along with the intensification of efforts toward improving students' sexual practices.     

Tobacco Use and Other Risk Behaviors among Adolescents in an STD Clinic

Background. This study examined the potential for tobacco use and other health risk behavior interventions in the context of an urban sexually transmitted diseases (STD) clinic.Methods. A cross-sectional survey of two populations. Adolescents seen at an STD clinic or at the teen clinic of a community health center completed a self-administered computer survey in 1996. Risk behaviors, attitudes, and readiness to stop smoking were analyzed for 225 patients at the STD clinic and 248 patients at the teen clinic.Results. Compared with adolescents in the teen clinic, adolescents in the STD clinic were more likely to have smoked frequently (OR 1.7, 95% CI 1.1, 3.0), used any illegal drug (OR 2.7, 95% CI 1.3, 5.5), recently binged on alcohol (OR 1.7, 95% CI 1.0, 2.8), and had more than 10 lifetime sexual partners (OR 1.9, 95% CI 1.0, 3.4). Weapon carrying, readiness to stop smoking, and attitudes toward smoking did not differ between sites.Conclusions. Cigarette smoking and other health risk behaviors are more prevalent among adolescents in an STD clinic than among adolescents in a community health center. STD clinics are potential sites for cigarette, alcohol, and drug use interventions among “hard to reach” adolescents.     

Predictors of sexual risk behaviour among adolescents from welfare institutions in Malaysia: a cross sectional study

Background

In welfare institutions, it is essential to address the health-related needs of adolescent populations who often engage in sexual activities. This study examines the association between individual and interpersonal factors concerning sexual risk behaviour (SRB) among adolescents in welfare institutions in Malaysia.

Methods

Data were derived from a cross-sectional study of 1082 adolescents in 22 welfare institutions located across Peninsular Malaysia in 2009. Using supervised self-administered questionnaires, adolescents were asked to assess their self-esteem and to complete questions on pubertal onset, substance use, family structure, family connectedness, parental monitoring, and peer pressure. SRB was measured through scoring of five items: sexual initiation, age of sexual debut, number of sexual partners, condom use, and sex with high-risk partners. Multivariate logistic regression analysis was used to examine the various predictors of sexual risk behaviour.

Results

The study showed that 55.1% (95%CI = 52.0-58.2) of the total sample was observed to practice sexual risk behaviours. Smoking was the strongest predictor of SRB among male adolescents (OR = 10.3, 95%CI = 1.25-83.9). Among females, high family connectedness (OR = 3.13, 95%CI = 1.64-5.95) seemed to predict the behaviour.

Conclusion

There were clear gender differences in predicting SRB. Thus, a gender-specific sexual and reproductive health intervention for institutionalised adolescents is recommended.

     

Risky Sexual Behavior across Extremes of Wealth in sub-Saharan Africa: A Meta-Analysis of Demographic and Health Surveys

BackgroundRisky sexual behavior increases the risk of contracting sexually transmitted disease including HIV and other reproductive health problems. There have been varying assumptions and different reported result explaining the relationship between risky sexual behavior and wealth. This review was intended to examine the disparity of risky sexual behavior among the two extremes of wealth in sub-Saharan African countries.MethodThis study reviewed demographic and health survey reports of sub-Saharan African countries. We excluded older reports and reports published in languages other than English. Finally, reports from 16 countries were considered for review. Data were entered in excel and transported to stata for analysis. Metaprop and Metan command were used to compute proportions and odds ratio. Standard chi-square and I square tests were used to assess heterogeneity.ResultPooled prevalence of having multiple sexual partner ranges from 2 to 12%. Over 80% of the countries reported that more than half of the individuals did not use condom at their last risky sexual intercourse. Poorest females were 0.62 [OR: 0.62, 95% CI (0.50, 0.78)] times less likely to have multiple sexual partners than males. Both males and females from the poorest wealth quantile had higher odds of not using condom at their last risky sexual intercourse, 1.41 [OR: 1.41, 95% CI (1.29, 1.53)], 1.41 [OR: 1.46, 95% CI (1.23, 1.73)], respectively.ConclusionMultiple sexual partners is relatively low in the region. Condom non-use is high in both genders. Additionally, poorest males and females were at higher risk of not using a condom at last risky sexual intercourse.     

Violent behaviour among adolescents in Iceland: a national survey

BACKGROUND: Violence among adolescents may have serious developmental, physical, and mental health consequences for the affected individuals. In this study, we assessed the prevalence of violent behaviour and its correlates among 15-16 year old schoolchildren in Iceland. METHODS: In 1997, a cross-sectional survey was conducted among a random half of all Icelandic schoolchildren aged 15-16 years. The overall response rate was 91% (N = 3872). In the present study, socio-demographic background, social support, negative life events, psychological distress, and substance use were considered in relation to violent behaviour using logistic regression techniques. RESULTS: The majority of the respondents reported having committed violence within the last year. Boys were more likely to use violence than girls (odds ratio [OR] = 5.6; 95% CI: 4.7, 6.6). Respondents who had experienced >/=4 negative life events in the past year were more likely to use violence than respondents with no negative life events (OR = 3.0; 95% CI: 2.2, 4.2). Smokers were more likely than non-smokers to use violence (OR = 1.7; 95% CI: 1.2, 2.2), and adolescents who had used alcohol >20x in their lifetime were more than twice as likely to commit violence compared with those who had never used alcohol (OR = 2.5; 95% CI: 1.8, 3.4). CONCLUSION: Rates of violent behaviour among Icelandic schoolchildren were high. Gender, parental support, life stress, anger/aggression, and substance use were all significantly related to the perpetration of violent acts.     

Risk factor analysis among men referred for possible acquired immune deficiency syndrome

Responses to a lifestyle questionnaire among 13 patients with Kaposi's sarcoma and 18 with an opportunistic infection were compared with those of 29 symptom-free referred individuals. Odds ratios (OR) with 95% confidence limits were calculated as an estimate of risk. Significantly elevated odds ratios (P less than 0.05) were found for cigarette smoking (OR = 3.4), marijuana use (OR = 3.7), nitrite use (OR = 5.5), frequenting bathhouses (OR = 7.6), prior syphilis (OR = 3.4), and fist-rectal sexual practices (OR = 3.5). A response gradient for the risk estimates was found for marijuana use (OR = 2.7 for occasional, OR = 4.3 for frequent use); nitrites (OR = 4.0 for occasional; OR = 6.3 for frequent use); and prior syphilis (OR = 2.9 for one to two previous infections and 9.0 for three or more). We believe the evidence is now sufficient to recommend preventive practices which may reduce the male homosexual's risk for developing acquired immune deficiency syndrome, Kaposi's sarcoma, and/or opportunistic infections. These include cessation of cigarette smoking, marijuana use, and nitrite inhalation; reduction in number of anonymous sexual partners to decrease risk of sexually transmitted diseases; and avoidance of fisting.     

Support for Texting-Based Condom Negotiation Among Forcibly Displaced Adolescents in the Slums of Kampala,Uganda: Cross-sectional Validation of the Condom Use Negotiated Experiences Through Technology Scale

BackgroundPromoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents’ confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature.ObjectiveThis study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale.MethodsUsing peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala’s slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples to conduct exploratory and confirmatory factor analyses to establish and validate the scale. CuNET measured participants’ support levels for texting-based condom negotiation via sexting based on gender, and multivariable logistic regression was used to explore its associations with sexual health outcomes (recent consistent condom use, access to sexual and reproductive health services, and lifetime sexually transmitted infection testing).ResultsThe one-factor CuNET with the validation sample was valid (χ²₄=5.3; P=.26; root mean square error of approximation=0.05, 90% CI 0.00-0.16; comparative fit index=0.99; Tucker-Lewis index=0.99; standardized root mean square residual=0.006), and reliability (Cronbach α=.98). Adolescent girls showed significantly lower levels of support for using sexting to negotiate condom use (mean 13.60, SE 0.70 vs mean 21.48, SE 1.23; P=.001). In multivariable analyses, a 1-point increase in the CuNET score was associated with increased odds of recent consistent condom use (adjusted odds ratio [aOR] 1.73, 95% CI 1.24-2.41) but not with access to sexual and reproductive health services (aOR 1.51, 95% CI 0.99-2.30) or lifetime sexually transmitted infection testing (aOR 0.90, 95% CI 0.64-1.26).ConclusionsThe unidimensional CuNET scale is valid and reliable for forcibly displaced adolescents living in slums in Kampala, gender-sensitive, and relevant for predicting consistent condom use among urban displaced and refugee adolescents. Further development of this scale will enable a better understanding of how adolescents use digital tools for condom negotiation.     

Substance use and other factors associated with risky sexual behavior among pregnant adolescents.

A study of the relationship between substance use and risky sexual behavior was conducted among 241 unmarried pregnant adolescents aged 17 and younger who lived in a metropolitan area in the Northwest. The respondents had comparable or higher lifetime use rates for all substances than did women in a national sample of high school seniors, even though the pregnant adolescents were younger. Ninety-four percent had used alcohol, 78% marijuana, 30% cocaine and 30% stimulants, compared with 92%, 48%, 14% and 23%, respectively, among women in the national sample. Among the pregnant adolescents, 84% had had more than one sexual partner, 39% had had a sexually transmitted disease and 60% had used contraceptives during less than half of their sexual encounters. At the bivariate level, use of cigarettes and alcohol in general and use of alcohol and drugs during sex were positively associated with risky sexual behavior. However, when other characteristics associated with risky sexual behavior--family bonding, parental monitoring, commitment to conventional values, peer associations, self-esteem and delinquent activities--were included in the multivariate analysis, the effect of substance use disappeared.     

Correlates of consistent condom use among HIV-positive African American women.

INTRODUCTION: African American women are the fastest growing group at risk of contracting HIV, as over 68% of women diagnosed with HIV are African American. The present study used social-cognitive theory and the theory of gender and power to identify correlates of consistent condom use among African American women living with HIV. METHODS: We recruited 366 women, 18-50 years of age and living with HIV from several HIV/AIDS clinics in the southeastern United States. The majority of women, 84.2% (N = 308), were African American. Women completed a baseline interview assessing sociodemographic, psychosocial, and partner-related factors potentially associated with consistent condom use, defined as reported use of condoms during every vaginal sex episode with a male sexual partner in the past 30 days. RESULTS: Among those HIV-positive African American women reporting use of a condom in the past 30 days (n = 234, 70%), consistent condom use was reported by 67.1% of women. This rate was lower (51.6%) among women having an HIV-positive male sexual partner; the rate was higher (74.1%) among women having an HIV-negative male sexual partner. Compared to women who were inconsistent condom users, women with HIV were more likely to use condoms if they: had high partner communication self-efficacy (OR = 7.77, 95% CI = 3.3-18.6, p = .001), had a HIV-negative male sex partner (OR = 4.62, 95% CI = 1.9-11.5, p = 0.001), had low partner-related barriers to condom use (OR = 4.68, 95% CI = 1.8-12.2, p = 0.001), and had perceived peer norms supportive of condom use (OR = 2.38, 95% CI = 1.0-5.7, p = 0.03). CONCLUSION: These findings suggest that HIV interventions may enhance consistent condom use among African American women living with HIV by targeting women's self-efficacy to communicate with their partners and women's perception of personal and partner-related barriers to condom use.     

Emerging Adults’ Discussion of Substance Use and Sexual Behavior with Providers

Emerging adulthood (ages 18–25) is a time of increased autonomy and associated with a high rate of risky substance use and sexual behavior. As emerging adults (EA) increasingly have more independence, they have the ability to make health decisions, including whether to see a provider (primary care (PCP) and/or gynecologist (GYN)) and whether to discuss substance use and sexual behavior. The current study aimed to determine: (1) factors associated with PCP and GYN health-care seeking by sexually active EA who use alcohol and/or marijuana; (2) gender differences in substance use and sexual risk topics initiated by providers; (3) whether PCPs compared to GYNs discuss different topics with women. Alcohol and/or marijuana-using, sexually active EA (n = 500) were recruited as part of a health behaviors study. Among participants, 39% did not see a PCP in the previous year. Women, White individuals, and EA with health insurance were most likely to attend a PCP appointment. Even among participants who saw a provider, many participants reported that providers did not initiate a discussion about substance use (approximately half discussed substance use) and sexual behavior (about half discussed STI history, two-thirds discussed condom use, and three-quarters discussed sexual partners). Among women with a PCP and GYN provider, discussions on substance use were more likely to be initiated by a PCP while sexual issues were more likely to be initiated by a GYN. Thus, even among sexually active, substance-using EA, central topics – specifically substance use and sexual behavior – are not routinely brought up by providers.