Perceptions of the benefits and costs associated with condom use and unprotected sex among late adolescent college students

To assess the differential effects of the perceived benefits and costs associated with both condom use and unprotected sex on sexual risk behaviors, data were collected from 704 ethnically diverse male and female sexually experienced late adolescent college students (aged 17-25). Perceived benefits and costs for condom use and perceived benefits and costs for unprotected sex were measured separately through an anonymous self-report survey. In addition, participants completed measures of self-efficacy for practicing safer sex and temptation for unsafe sex in various situations, and three measures of sexual risk-taking (stage of change for condom use, consistency of condom use during the past month, and whether or not a condom was used for the last act of intercourse). Univariate analyses indicated that benefits and costs of condom use, benefits of unprotected sex, self-efficacy and situational temptation were all related to sexual risk-taking. Gender differences were identified, with females reporting more benefits of condom use and costs of unprotected sex, fewer benefits of unprotected sex and costs of condom use, greater self-efficacy for practicing safer sex, and less situational temptation for unsafe sex. Multivariate analyses indicated that sexual risk behaviors were most related to situational temptation, self-efficacy for safer sex, and perceived benefits of unprotected sex. The results suggest that, among late adolescents, perceived benefits of the unhealthy behavior (unprotected sex) were better determinants of sexual risk-taking than were perceived benefits (or costs) associated with the healthy behavior (condom use). Perceived costs associated with unprotected sex were unrelated to sexual behaviors. These findings support previous work identifying adolescents as more driven by their perceptions of the positive benefits associated with risky behaviors, rather than knowledge of the costs or dangers involved in risk-taking.     

HIV Risk Reduction for Substance Using Seriously Mentally Ill Adults: Test of the Information-Motivation-Behavior Skills (IMB) Model

The information-motivation-behavioral skills (IMB) model (Fisher & Fisher, 1992) was used as the theoretical framework for predicting unprotected sexual behavior among substance abusing men and women diagnosed with serious mental illnesses (n = 320; 150 men and 170 women, primarily of minority ethnicity). In a structural equation model, gender, HIV transmission knowledge, and motivational variables of pro-condom norms and attitudes, and perceived susceptibility predicted behavioral skills markers: condom use skills and condom use self-efficacy. Along with the other variables in the model, condom skills and condom self-efficacy were hypothesized to predict condom use over a six-month period. Results showed that greater condom skills were predicted by female gender, positive condom attitudes, and transmission knowledge. Engaging in lower rates of unprotected sex was predicted by pro-condom norms, less perceived susceptibility, and greater condom self-efficacy. Positive attitudes toward condoms had a significant indirect effect on rates of unprotected sex, exerting its influence through condom use self-efficacy. Results suggest that changing personal attitudes about condoms and reinforcing pro-condom attitudes among significant others will encourage condom use among seriously mentally ill (SMI) adults who are at high risk for HIV and other sexually transmitted diseases (STDs).     

Psychiatric comorbidity and gender difference among treatment-seeking heroin abusers in Taiwan

The objectives of the present study were to estimate the psychiatric comorbidity of Taiwanese heroin users seeking treatment and to identify the gender differences in psychiatric comorbidity and drug use behavior. Subjects were interviewed using a structured questionnaire on drug use behavior and the Mini International Neuropsychiatric Interview for psychiatric disorders. Of the subjects, 58.5% of the male and 62.5% of the female subjects had at least one non-substance-use axis I psychiatric disorder or antisocial personality disorder. Compared to male subjects, female subjects were younger, were less educated, had higher rates of unemployment and had earlier onset of illicit drug use. Female subjects were 11-fold more likely than male subjects to exhibit suicidal behavior. Among heroin abusers in the present study, female subjects were more widely exposed to unfavorable social factors and had substantially higher incidence of suicidal behavior than male subjects. Drug treatment centers should be aware of these gender differences and pay particular attention to comorbid depressive disorders and suicidal behavior of female heroin abusers.     

Self-cutting and sexual risk among adolescents in intensive psychiatric treatment

The purpose of this study was to identify the relationships between self-cutting, sexual abuse, and psychological variables in predicting infrequent condom use among 293 adolescents in intensive psychiatric treatment. Logistic regression analyses indicated that being female, being Caucasian, having been sexually abused, and reporting less impulse control were predictive of self-cutting. Further analysis found that those who self-cut were three and a half times more likely to report infrequent condom use than those who did not self-cut, even after the analysis controlled for sexual abuse history and HIV prevention self-efficacy. Self-cutting is strongly associated with sexual risk behaviors, and adolescents who engage in self-cutting should be assessed carefully for sexual risk behaviors.     

Impact of sexual abuse on the HIV-risk-related behavior of adolescents in intensive psychiatric treatment

OBJECTIVE: This study compared the HIV-risk-related behaviors and attitudes of adolescents with and without a history of sexual abuse who were in intensive psychiatric treatment. METHOD: Adolescent patients (N=208) completed measures of psychological functioning and HIV-related knowledge, attitudes, and behaviors. RESULTS: Among sexually active adolescents in psychiatric treatment (N=116), those with a history of abuse reported significantly less condom self-efficacy (emotional ability to use condoms), less knowledge of HIV, less impulse control, less frequent use and purchase of condoms, and significantly higher rates of sexually transmitted diseases than their peers. Multiple logistic regression indicated that a history of sexual abuse was strongly associated with inconsistent condom use. CONCLUSIONS: Sexual abuse was associated with HIV-risk-related attitudes and behaviors among adolescents in psychiatric treatment. Clinicians should thus view a history of sexual abuse as a marker for sexual behavior that puts adolescents at risk for HIV.     

Stimulant-induced enhanced sexual desire as a potential contributing factor in HIV transmission

OBJECTIVE: Stimulant abuse is associated with an increased risk of contracting human immunodeficiency virus (HIV). Although sharing of contaminated needles is one of the routes by which HIV is spread, noninjection abusers are also at high risk. The authors investigated the effect of the stimulant drug methylphenidate (given intravenously) on sexual desire as a possible contributing factor to risky sexual behavior associated with the contraction of HIV. METHOD: The effects of intravenous methylphenidate (0.5 mg/kg) on self-reports of sexual desire (rated from 0-10) were evaluated in 39 comparison subjects and 39 cocaine abusers. RESULTS: Intravenous methylphenidate significantly increased self-reports of sexual desire in comparison subjects (1.4 versus 3.7) and cocaine abusers (2.8 versus 4.8). CONCLUSIONS: Stimulant-induced enhancement of sexual desire could be one mechanism by which stimulant drugs such as cocaine and methamphetamine increase the risk for HIV transmission even when they are not injected.     

The effects of dating violence, substance use and risky sexual behavior among a diverse sample of Illinois youth

This study examines the relationship between dating violence, forced sexual intercourse (FSI), and four measures of sexual risk taking (i.e., age at first sex, number of recent (within the last three months) sex partners, alcohol/drug use at last sex, and condom use at last sex) among a sample of 1124 ethnically diverse sexually active adolescents in Illinois. Given conflicting reports regarding the role of gender in dating violence, and the dearth of research examining the role of gender in relations between dating violence, sexual violence, and sexual risk taking, we also examine whether gender moderates the relation between these constructs. The findings indicate significant relationships among dating violence and FSI and age at first sex, number of sexual partners, and condom use across various ethnic groups. Findings also show that when controlling for gender, dating violence and FSI are related to number of sexual partners and age at first intercourse regardless of ethnic group identification.     

Behavioral Risk for HIV Infection Among Adults with a Severe and Persistent Mental Illness: Patterns and Psychological Antecedents

Behaviors associated with transmission of the human immunodeficiency virus (HIV) were measured in a sample of 60 adults with a severe and persistent mental illness (SPMI). Results revealed that 68% had sex in the last year; 13% of men and 30% of women reported two or more male partners, and 24% of men also reported two or more female partners. Condom use was inconsistent. Sex partners were often met in a psychiatric clinic or bar, and a substantial number were injection drug users or known to be non-monogamous. Overall,48% of men and 37% of women reported at least one risk factor. Hypothesized psychological antecedents of HIV-related risk behavior were also measured, including knowledge, motivation for risk reduction, and self-efficacy regarding risk-reduction. Many participants were misinformed regarding HIV transmission and risk reduction. Motivational indices indicated that attitudes toward condoms were slightly positive, and that social norms were generally supportive of condom use. However, participants tended to rate themselves at only slight risk for infection, undermining their motivation for condom use. Participants indicated only modest levels of self-efficacy in situations requiring sexual assertiveness. These findings, coupled with the elevated seroprevalence of HIV among persons having a SPMI, point to the need for risk assessment and counseling by mental health care providers.     

The effects of self-efficacy in bifurcating the relationship of perceived benefit and cost with condom use among adolescents: A cusp catastrophe modeling analysis

This study tested the complex relationship among the perceived benefit from and cost of condom use, self-efficacy and condom use among adolescents as a nonlinear dynamic process. Participants were 12th graders in public Bahamian high schools who reported having had sex and frequency of condom use. Results revealed that the perceived benefit and perceived cost as asymmetry variables were significantly associated with condom use (p < 0.001) after controlling for covariates. The association was bifurcated by the variable self-efficacy (p < 0.001). Furthermore, the cusp model was better than linear and logistic regression models in predicting the dynamic changes in condom use behavior, judged by the AIC and BIC, and R² criteria. These results suggest that adolescent condom use may follow a nonlinear rather than linear dynamic process. Emphasizing bifurcation variables such as self-efficacy that promote sudden change could be essential to strengthen current evidence-based intervention programs in encouraging condom use.     

Patterns and predictors of HIV risk among urban American Indians

A preliminary survey of HIV risk and service preferences among American Indians residing in the New York metropolitan area included 68 women and 32 men (M age=35.8 years). Overall, the sample was knowledgeable about the mechanisms of HIV transmission, and 58 percent reported having taken an HIV test. However, of the 63 percent who reported sexual activity in the last six months, 73 percent reported engaging in vaginal or anal sex without a condom with at least 1 partner, and 52 percent used condoms none of the time during vaginal and anal sex. Almost half (43 percent) reported alcohol or other drug (AOD) use for non-ceremonial purposes in the last six months. Alarmingly, 44 percent reported lifetime trauma, including domestic violence (20 percent) and physical (29 percent) or sexual (26 percent) assault by a family member or stranger. Bivariate and multivariate analyses indicated trauma and drug use were factors that may place respondents at risk for sexual transmission of HIV. Trauma variables were better predictors of HIV risk behaviors than social cognitive variables providing preliminary support for the use of a postcolonial framework in American Indian HIV studies.     

Adding the Female Condom to HIV Prevention Interventions for Women with Severe Mental Illness: A Pilot Test

We evaluated the efficacy of a gender-specific intervention to reduce sexual risk behaviors by introducing female-initiated methods to urban women with severe mental illness. Seventy-nine women received 10 sessions of an HIV prevention intervention or a control intervention. The primary outcome was unprotected oral, anal, or vaginal intercourse, expressed using the Vaginal Episode Equivalent (VEE) score. Knowledge and use of the female condom were also assessed. Women in the HIV prevention intervention showed a three-fold reduction in the VEE score at the 3-month follow-up compared to the control group, but the difference was not significant. These women were significantly more likely to know about female condoms, have inserted one and used it with a sexual partner at the 3-month follow-up and to have inserted it at 6 months compared to controls. The female condom may be a useful addition, for a subset of women with SMI, to comprehensive HIV prevention programs.     

Understanding the influence of depression on self-efficacy, work status and condom use among HIV clients in Uganda

Objectives

Depression is common among persons living with HIV/AIDS in sub-Saharan Africa, yet few studies in the region have assessed the relationship of depression to economic well-being and risk-reduction behavior. Among HIV clients in Uganda, we examined whether depression is directly related to self-efficacy, work status, and condom use, as well as indirectly through its interaction with physical health functioning.

Methods

Baseline data from a prospective longitudinal cohort of 602 clients entering HIV care were examined. In separate multivariate analyses, we examined whether depression [both depressive severity and clinical depression, as measured by the nine-item Patient Health Questionnaire (PHQ-9)], physical health functioning, and their interaction were predictors of current work status, consistent condom use, and general self-efficacy, controlling for measures of social support, stigma, and demographics.

Results

Mean PHQ-9 score was 5.2 (S.D.=3.9; range=0-24) and 13% had scores ≥10 (indicator of clinical depression). Not being depressed, better physical health, and their interaction were predictors of working, while lower depressive severity, lower physical health, and their interaction were associated with always using condoms. Better physical health was predictive of greater self-efficacy, but not depression; general self-efficacy was predictive of both work status and condom use.

Conclusions

Effective diagnosis and treatment of depression may be critical to maximizing the benefits of HIV treatment with regard to both HIV prevention and restoring the social and economic health of persons living with HIV.     

Comparison of comprehensive and abstinence-only sexuality education in young African American adolescents

The purpose of this study was to identify predictors of sexual behavior and condom use in African American adolescents, as well as to evaluate the effectiveness of comprehensive sexuality and abstinence-only education to reduce adolescent sexual behavior and increase condom use. Participants included 450 adolescents aged 12–14 years in the southern United States. Regression analyses showed favorable attitudes toward sexual behavior and social norms significantly predicted recent sexual behavior, and favorable attitudes toward condoms significantly predicted condom usage. Self-efficacy was not found to be predictive of adolescents' sexual behavior or condom use. There were no significant differences in recent sexual behavior based on type of sexuality education. Adolescents who received abstinence-only education had reduced favorable attitudes toward condom use, and were more likely to have unprotected sex than the comparison group. Findings suggest that adolescents who receive abstinence-only education are at greater risk of engaging in unprotected sex.     

Efficacy of a behavioral intervention for increasing safer sex behaviors in HIV-negative,heterosexual methamphetamine users: Results from the fast-lane study

Background: The risk of acquiring HIV is particularly high among persons who use methamphetamine, which is often associated with unprotected sex and high numbers of sexual partners.Purpose: This study examined the efficacy of a behavioral intervention emphasizing motivational interviewing and social cognitive theory for increasing safer sex behaviors in the context of ongoing methamphetamine use in a sample of HIV-negative, heterosexual methamphetamine users.Methods: Four hundred fifty-one participants from San Diego, California, were randomly assigned to receive one of three treatment conditions: (a) a safer sex behavioral intervention (Fast-Lane [FL]), (b) the FL intervention with boosters (FL+B), or (c) a time-equivalent diet-and-exercise attention-control (D&E) condition. Random effects regression analyses were used to evaluate change in safer sex behaviors over an 18-month period.Results: Compared to those in the D&E condition, participants in the FL+B condition (p=.019) and FL condition (p=.020) significantly increased their engagement in protected sex acts over the active intervention phase. Also, compared to the D&E condition, those in the FL condition demonstrated a significant decrease in unprotected sex (p=.005) and an increase in percent protected sex (p=.001) during the active intervention. Finally, relative to D&E participants, FL participants demonstrated significant improvements in self-efficacy for negotiating safer sex (p=.011), and change in self-efficacy mediated the efficacy of the FL condition for increasing safer sex behaviors (p=.033).Conclusions: These results suggest that our behavioral intervention was successful in terms of reducing high-risk sexual behaviors in the context of ongoing methamphetamine use among HIV-negative heterosexuals. Reductions in high-risk sexual behavior were likely because of the impact of the intervention on participants’ self-efficacy for negotiating safer sex. This research was supported by the National Institute of Mental Health award MH061146 and the Veterans Affairs Center for Excellence on Stress and Mental Health (CESAMH).     

The AIDS awareness and sexual behaviour of young people in the South-west of England.

A programme of surveys was undertaken in collaboration with District Health Authorities to assess the AIDS awareness and sexual behaviour of young people, in order to help the development and implementation of HIV/AIDS risk-reduction strategies. Given that the patterns of findings were strongly replicated in the different districts, the data is presented in terms of a combined data set comprising 2955 respondents aged 16-24. The surveys indicate fairly reasonable levels of knowledge about HIV/AIDS but very low personally perceived vulnerability to infection. The sexual culture is one of fairly early ages of first intercourse, moderate levels of partner change and low (one third) levels of condom use. The findings are discussed in terms of their implications for HIV/AIDS risk-reduction strategies.     

Gender differences in juvenile arrestees' drug use, self-reported dependence, and perceived need for treatment.

OBJECTIVES: The authors examined gender differences in drug use, self-reported dependence, and perceived need for treatment in a national sample of juvenile arrestees and detainees between the ages of nine and 18 years. METHODS: A sample of 4,644 boys and girls, drawn from the Juvenile Drug Use Forecasting Survey from 1992 to 1995, was matched by sex within each of seven sites by survey year. In anonymous interviews, respondents were asked about their living arrangements, drug use, and need for drug treatment. Questions about drug use covered marijuana, cocaine, crack, heroin, crystal methamphetamine, amphetamines, and phencyclidine (PCP). Logistic regression was used to identify significant predictors of drug dependence and perceived need for treatment. RESULTS: Girls were significantly more likely than boys to report dependence but were no more likely to report a need for treatment. Among those who reported current, frequent drug use, girls were significantly less likely than boys to report a need for treatment. Girls who reported having more severe drug problems were more likely than their male counterparts to report dependence and a need for treatment. CONCLUSIONS: The ways in which juvenile arrestees report drug dependence and need for treatment differ by gender. Clinicians should assess and reduce barriers to treatment perceived by girls in particular to engage them in services before their drug use escalates.     

Denial of HIV/AIDS and preventive behaviour among Israeli adolescents

A national sample of 1082 Israeli adolescents, aged 14-18, was questioned on the following topics: Respondents' sexual habits and HIV/AIDS prevention behaviours, HIV/AIDS-related knowledge and attitudes, and six kinds of HIV/AIDS-related denial. The main results showed that infrequent condom use was associated with a high level of denial, denial of personal relevance and of responsibility being the most salient. These results suggest that denial may constitute a major factor in HIV/AIDS-related risk behaviours, with implications for intervention programmes aimed at adolescents.     

Latino cultural values as protective factors against sexual risks among adolescents

The study objective was to examine the associations between cultural values and sexual risk factors among Latino youth. A sample of 226 Latino adolescents ages 13–16 completed a survey on cultural and sexual variables. Results indicate higher levels of Latino cultural orientation were related to greater sexual self-efficacy and fewer sexual partners for female adolescents and greater condom use self-efficacy for both males and females. Greater endorsement of simpatia (belief in interpersonal relationship harmony) was associated with sexual abstinence and greater sexual self-efficacy for all adolescents, and with being older at sexual debut for females. Stronger endorsement of respeto (respect towards parents and other authority figures) was correlated with a lower intention to have sex during secondary school and greater condom use self-efficacy. American cultural orientation was associated with less condom use. Our findings indicate Latino cultural values may serve as protective factors against sexual risk behaviors among Latino youth.     

Suicide attempt and sexual risk behavior: relationship among adolescents.

The objective of this study was to examine the relationship between a history of suicide attempt and a range of current sexual risk behaviors in a large sample of sexually high-risk adolescents. Baseline data from 1,245 sexually active 15 to 21 year olds were collected as part of a multi-site, randomized trial of a brief HIV prevention program. Measures were collected using audio computer assisted self-interviews. Accounting for demographic, contextual, and substance use variables, a lifetime history of suicide attempt significantly added to multivariate regression models predicting sexual risk. Inconsistent condom users were almost twice as likely to have attempted suicide, and adolescents with an STI diagnosis were approximately twice as likely to have a history of suicide attempt. A history of suicidal behavior can be identified by clinicians and appears to be an important marker for sexual risk, which may represent an expression of emotional distress or a passive form of self-injury for suicidal adolescents.