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PubMed1993

Why don't young adults protect themselves against sexual transmission of HIV? Possible answers to a complex question.

Using theories of health behavior, this study aimed to advance the understanding of risk-taking regarding human immunodeficiency virus (HIV) infection among young adults by describing: (a) their representation (i.e., schema) about HIV infection, (b) their problems with use of condoms and comfort with safe-sex practices, and (c) situations associated with risky sexual behavior and reported reasons for risk-taking. Participants were 272 young adult college students whose average age was 19.3 years (SD = 2.4). They completed an extensive questionnaire developed for the study. The representation of HIV infection in this sample lacked the specific and detailed information necessary to guide sexual behavior. For example, participants were aware of the causes of sexual transmission of HIV, but many persons indicated uncertainty about the effectiveness of various preventive strategies (e.g., latex condoms, birth control devices). A number of specific problems with using condoms were identified or expected by participants. These included inadequate lubrication, poor fit, and breaks or leaks during intercourse. The majority of the sample (85.3%) reported at least one occurrence of unprotected sexual intercourse. For 60% of them, the stated reason for the risk-taking was that the intercourse was unplanned or spontaneous; 50% reported that they "just knew" the partner was safe and not infected with HIV. Implications for health education programs are discussed.

Adolescent↗
PubMed1997

Attitudes about AIDS education and condom availability among parents of high school students in New York City: a focus group approach.

This paper describes parents' views of the New York City Public High School's AIDS Education and Condom Availability Program. It presents findings from 12 focus groups with 81 parents of students at six representative high schools. Focus groups were conducted as part of an independent, comprehensive 3-year evaluation of the program, consisting of both qualitative and quantitative components. Participants were mostly supportive of the program, citing intense concern about AIDS among adolescents, fear that teenagers do not adequately perceive themselves as being vulnerable, and personal experiences with infected relatives and friends. Implications of these findings for program development are discussed and recommendations for social policy changes are presented.

Acquired Immunodeficiency Syndrome↗
PubMed2000

AIDS and STD knowledge, condom use and HIV/STD infection among female sex workers in Bali, Indonesia.

The objectives of this paper were to examine changes in AIDS/STD knowledge and behaviour from 1992-1998, current levels of STD infection and psychosocial and demographic determinants of condom use and STD infection among female sex workers. Data for the study were drawn from cross-sectional surveys of female sex workers conducted in 1992, 1994 and 1997-8. For each survey, women participated in a face-to-face interview in the brothel complexes. Survey questions included information on AIDS/STD knowledge, demographics, sexual history and psychosocial factors related to condom use. After the last survey, women were offered a vaginal exam for STD diagnosis and treatment. Sera were tested for HIV infection (anonymous, Elisa/Western blot) and syphilis (TYPHA, RPR). Cervical mucous was tested for chlamydia (LcX), gonorrhea (LCx), herpes (pcr) and HPV (pcr). Knowledge of AIDS and awareness of STDs has increased tremendously in this population since 1992. Reported condom use has also increased substantially (69.9%). Perceived susceptibility toward HIV infection remains low. Ineffective preventive strategies such as medication use continue to be common. HIV infection remains very low in this population (0.2%), although the prevalence of other STDs such as gonorrhea (60.5%), chlamydia (41.3%) and HPV (37.7%) were very high. STD knowledge and self-efficacy were significantly related to condom use as were the sex workers' perceived susceptibility to STD and HIV infection. Women with a larger number of partners were more likely to be infected with gonorrhea, chlamydia and HIV. Women who had come to Bali recently were more likely to be infected with HIV and gonorrhea.

Adult↗
PubMed1998

Views of Cameroonian sex workers on a woman-controlled method of contraception and disease protection.

Five hundred and twenty female Cameroonian sex workers participating in a clinical trial of the effectiveness of nonoxynol-9 (N-9) contraceptive film to prevent HIV infection were interviewed to determine their experience with this woman-controlled method. The sex workers liked the film, with over 80% stating they would continue to use it if it were shown to be effective against HIV and were to become widely available. However, they were much more likely to use condoms and films simultaneously with their clients (40%) than with their regular partners (16%). The advantages ascribed to the film were that its use was under the woman's control; it could be used without the partner's knowledge; it allowed direct contact between partners; and it provided back-up protection in case of condom breakage. Data from this small study suggest that development of an effective, woman-controlled method of pregnancy and disease protection would be welcomed by these women.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Students' knowledge and behavior concerning safer sex: a UK study.

Most students in institutions of further and higher education in the northeast of England who responded to a 1989 survey dealing with sexual behavior and safer sex were heterosexual and had been sexually active or intended to have sexual intercourse. Many students, however, believed that safer sex implied having no sex at all or were unaware of the role of nonpenetrative sex in preventing human immunodeficiency virus (HIV) infection. They did not use condoms, in spite of having positive attitudes about condom use, and they engaged in one or more sexual activities that increased the risk of acquiring HIV infection. In view of the increasing incidence of acquired immunodeficiency syndrome (AIDS), the authors assert, these findings are cause for concern and require concerted action by health educators and society to encourage safer sex practices and to prevent the spread of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Beliefs about condoms in 12/13 and 16/17 year olds.

The present study examined the beliefs and attitudes which surround condoms and their use. Qualitative data in the form of short essays were collected from 12/13 (n = 148) and 16/17 (n = 63) year olds. The results suggest that condoms are conceptualized in terms of a complex set of factual and evaluative factors such as feelings, responsibility and risk and that younger subjects hold more positive beliefs than the older subjects. The results are discussed in terms of models of preventive behaviour and the role of sex education at an early age.

Adolescent↗
PubMed1995

Modelling the impact of alternative HIV intervention strategies in rural Uganda.

OBJECTIVE: To assess the likely impact on HIV incidence of increased condom use, a reduction in casual sexual partners, treatment programmes for other sexually transmitted diseases (STD) and combinations of these in rural Uganda. METHODS: A simulation model for the transmission dynamics of HIV infection and STD was employed, drawing on data from a rural population cohort in South-West Uganda with an HIV prevalence of 9% among adults in 1990. RESULTS: For the scenario most consistent with data from the study population, 39% of all adult HIV infections were averted, in the 10 years from 1990, when condoms were used consistently and effectively by 50% of men in their contacts with one-off sexual partners (such as bar girls and commercial sex workers). Reducing by 50% the frequency of men's sexual contacts with one-off partners averted 68% of infections. Reducing by 50% the duration of all STD episodes averted 43% of infections. Combining these three interventions averted 82% of all adult infections in the 10 years from 1990. CONCLUSION: A substantial proportion of HIV infections may be averted in general populations through interventions targeted only on less regular sexual partnerships.

Adult↗
PubMed2003

HIV/AIDS behavioral surveillance surveys of the cross-border sex-networker population in Hong Kong from 1997 to 2001.

BACKGROUND: Mobility is an important risk factor in the spread of HIV. GOAL: The goal was to conduct behavioral surveillance surveys on Hong Kong males crossing the border to mainland China to have sex with female sex workers (FSW) or nonregular female sex partners who were not FSW (NRP). STUDY DESIGN: Four surveys (1997-2001), using a special data collection method, were conducted at the Hong Kong-mainland China border checkpoint (n=5294). RESULTS: Consistently, a notable proportion of the travelers had patronized FSW or had had sex with NRP in the preceding trip to mainland China. Inconsistent condom use was high (> or =40%) and HIV antibody testing was low (<12%). Self-perceived susceptibility of contracting HIV also was low. CONCLUSION: No remarkable improvement on the level of risk behaviors was observed over the study period. Sustained efforts to promote safer sex and awareness of the risk associated with sex-networking are required.

Adolescent↗
PubMed1993

Correlates of condom use and number of sexual partners among high school adolescents.

Factors associated with condom use and number of sexual partners were examined in a statewide sample of public high school students in grades 9-12 (N = 3,893). Data were collected in spring 1990 using the 70-item, self-report Youth Risk Behavior Survey, developed and piloted by the Centers for Disease Control. Composite scores were constructed to measure aggression, physical recklessness, alcohol use, illegal drug use, cigarette use, lack of exercise, and academic self-image. Since simple polychotomous logistic regression models revealed a significant race by gender interaction, multivariate models were run separately for each race-gender group. Odds ratios and 95% confidence intervals were calculated from polychotomous logistic regression of lifetime sexual activity and condom use with their potential correlates. Risky sexual behavior appears to be correlated with a complex of other behaviors that place students at risk. A pattern of declining condom use with increasing number of partners was evident, especially for White students.

Adolescent↗
PubMed1994

A methodological comparison of survey techniques in obtaining self-reports of condom-related behaviors.

To obtain more accurate accounts of sexual attitudes and practices, researchers must explore innovative ways to overcome the reluctance of individuals to disclose sensitive and perhaps incriminating information about themselves. The differences among selected modes of inquiry and survey techniques used to gather self-reports about sensitive contraceptive behaviors among young adults were examined in this study. Comparisons were made between the randomized response versus the direct-inquiry survey techniques and personal interview versus self-administered modes of inquiry relative to the reporting of sensitive condom-related sexual practices of 352 students at a large northeastern university. Findings indicated that the "controlled-choice" randomized-response technique was less effective in obtaining self-reports about condom-related practices than were direct-inquiry techniques. Recommendations for investigations are proposed.

Adolescent↗
PubMed1995

The relational determinants of condom use with commercial sex partners in Thailand.

OBJECTIVE: To analyze the extent and determinants of condom use with commercial sex partners among lower socioeconomic status groups in the Thai population. DESIGN: Respondents were sampled in Udon Thani, Saraburi and Bangkok in 1992. Completed sample size was 678 women in brothels, 330 male truck drivers and 1,075 men aged 17-45 years. Behavioral data and local sexual network information were collected using structured questionnaires (face-to-face interviews), focus groups and in-depth unstructured interviews. METHODS: Data were analyzed using univariate and multivariate logistic regression. RESULTS: Condom use with commercial partners remains inconsistent. Consistent use was reported by 61% of women in brothels, 25% of truck drivers, and 29% of men in the low-income population. The single strongest predictor of consistent condom use for all groups is type of partnership. Consistent use drops significantly with regular (multivisit) commercial sex partners compared with casual (single visit) commercial partners; adjusted odds of consistent use are 0.22 for women and 0.25 for men. Brothel women report that one in five of their commercial partners is a 'regular', and 20% of the young men who report a commercial partner report a 'regular'. DISCUSSION: The strongest determinant of consistent condom use is the nature of the relational bond between the partners, rather than their individual characteristics, knowledge or attitudes. To raise condom use further, programs will have to move beyond the standard knowledge-attitudes-practices paradigm focus on individual attributes to address the contextual determinants of behavior.

Adolescent↗
PubMed1995

Lubrication use in condom promotion among commercial sex workers and their clients in Ratchaburi, Thailand.

Condom promotion has been intensified in Thailand to prevent the spread of HIV. A water soluble lubricant (WSL) could be used to alleviate many unpleasant side effects of frequent condom use experienced by sex workers and their clients. This study was conducted to determine the efficacy of WSL use in preventing the side effects of condom use including condom breakage, and to assess the acceptance of WSLs within the sex-worker population. The results of this study showed that 83 (111) of the 134 sex workers reported use of the WSL provided during the study period and more than 95 per cent (106) expressed interest in employing the WSL regularly, saying that WSLs reduce unpleasant side-effects relating to frequent condom use. Also 70 per cent of them reported that the majority of their clients found using the WSL made condom use more enjoyable. A follow-up study showed that 57 per cent of the respondents were still using a WSL on a regular basis and all of them felt it reduced condom breakage. Therefore, WSL use should be an acceptable and useful method for alleviating problems associated with regular use of condoms within the sex-worker population. In addition, there is evidence that WSLs can reduce the incidence of condom breakage. Thus, WSLs could be valuable tools in condom promotion for AIDS control within this high risk population and their clients.

Adolescent↗
PubMed1996

HIV risk behavior, street outreach, and condom use in eight high-risk populations.

In this paper we examine risk behavior, exposure to street outreach, and condom use in samples of injecting drug users (IDUs) and high-risk youth. We used systematic sampling methods to produce representative samples of injecting drug users IDUs (five sites) and high-risk youth (three sites). The populations surveyed engaged in high levels of sexual risk behavior: 20% to 46% reported two or more sex partners in the last month. The majority (62% to 97%) knew someone infected with HIV. Condom use rates approached national health promotion goals for nonsteady partners but not for steady or main partners. Having a condom at time of interview was the most consistent predictor of condom use at last intercourse. Many of the respondents have been in contact with street outreach programs and many acknowledged some personal risk for HIV infection. However, most of the injecting drug users and high-risk youth interviewed (and their sex partners) were still at risk through unprotected sex.

Adolescent↗
PubMed2002

Promoting condoms for oral sex: impact on pharyngeal gonorrhea among female brothel-based sex workers.

BACKGROUND: Low condom use for oral sex among female brothel-based sex workers in Singapore has led to a rise in pharyngeal gonorrhea. GOAL: The goal of the study was to evaluate a program promoting the use of condoms for oral sex. STUDY DESIGN: We used the time-series design to compare condom use and pharyngeal gonorrhea trends before and after program intervention in 1996 and the pretest-posttest matched control group design to determine the impact of brothel interventions on sex workers. RESULTS: Consistent oral condom use increased significantly from 42.2% in 1996 to 89.9% in 2000, with a corresponding decline in pharyngeal gonorrhea (in comparison with no significant changes before intervention). Among sex workers in brothels with interventions there was a 10.8% absolute increase in condom use, compared with an 11.7% decrease in condom use in the control group. The gonorrhea incidence rate was also significantly much lower in the intervention group than in the control group (adjusted risk ratio: 0.22; 95% CI: 0.06-0.78). CONCLUSION: The intervention increased oral condom use, with a decline in the incidence of pharyngeal gonorrhea.

Adult↗
PubMedDate not supplied

[Prostitution and AIDS in the city of Mexico].

Since 1987 The National AIDS Council in Mexico (CONASIDA), has conducted research projects among female commercial sex workers (CSW), who are seen at the AIDS Information Centers. Through these studies, we have been able to find out how different issues influence commercial sex work in Mexico City. Since the beginning of our own studies in 1989, HIV prevalence in this particular group has remained low (0.04%-0.2%). Factors found to be associated with condom use were: educational level, not having children, more experience in sex work and younger age. Condom use was reported by 88% of the women; however, qualitative information and high STD prevalence rates suggest a much lower condom use. Mandatory HIV testing is not useful as a preventive measure among sex workers. Persuasive and structural interventions must be implemented in accordance with local and legal situations.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Risk behaviors related with infection by human immunodeficiency virus among adolescent students in Catalonia].

OBJECTIVE: To determine the prevalence of HIV-risk behaviours among high-school adolescents, and the association with HIV-related knowledge, attitudes and risk perception. SUBJECTS AND METHODS: In 1992-93 a questionnaire was administered to the students of a convenience sample of 30 classes, previously to an AIDS education intervention. RESULTS: 1,213 questionnaires corresponding to 12 to 21 years-old respondents were analyzed. The mean age of the sample was 16 years and 61.6% were females. The use of drugs inhibiting the capacity to avoid risk situations was frequent (alcohol: 61.7% and hashish: 11.6%). 18.5% of the respondents were sexually active, of whom 18.1% reported at least one unknown sexual partner during the former year. 3.7% and 9.8% of the sexually active males reported a sexual intercourse with a male or with a prostitute, respectively. Condoms were consistently used by 51.3% of the sexually active students. Knowledge and risk perception were not related to risk behaviours, whereas less positive attitudes towards AIDS information and the HIV-infected were associated with having had intercourse with a high risk partner, and a positive attitude towards condoms was related to consistent use. CONCLUSIONS: Nearly 20% of school teenagers are sexually active and only half of these always use condoms. This places heterosexual activity as the main potential route for HIV-transmission in this group.

Adolescent↗
PubMed1997

How can psychological theory help to promote condom use in sub-Saharan African developing countries?

Condom use for HIV prevention has been very inconsistent in most sub-Saharan African countries. Studies from around the continent report that knowledge about HIV transmission is variable and seems to be related to gender, socioeconomic and educational status. There is a large body of psychological knowledge about HIV prevention which has been applied to condom promotion campaigns in developed countries. These approaches to condom promotion, based on formal theory, have not been used on a wide scale in African countries and this paper explores ways in which psychological theory might be appropriately applied in a situation of high HIV prevalence.

Africa South of the Sahara↗