One love: explicit monogamy agreements among heterosexual young adult couples at increased risk of sexually transmitted infections

HIV prevention strategies among couples include condom use, mutual monogamy, and HIV testing. Research suggests that condom use is more likely with new or casual partners, and tends to decline as relationships become steady over time. Little is known, however, about explicit mutual monogamy agreements and HIV testing within heterosexual couples. This study used data from 434 young heterosexual couples at increased risk of HIV and sexually transmitted infections (STIs) to assess (a) couple concordance on perceptions of a monogamy agreement, sustained monogamy, and HIV testing; and (b) the associations of relationship and demographic factors with monogamy agreement, sustained monogamy, and HIV testing. Results indicated only slight to fair agreement within couples on measures of monogamy agreement and sustained monogamy. Overall, 227 couples (52%) concurred that they had an explicit agreement to be monogamous; of those, 162 (71%) had sustained the agreement. Couples with greater health protective communication and commitment were more likely to have a monogamy agreement. Couples of Latino and Hispanic ethnicity and those with children were less likely to have a monogamy agreement. Only commitment was related to sustained monogamy. Having children, greater health protective communication, and perceived vulnerability to HIV and STIs were associated with HIV testing within the couple.

Characteristics related to effective contraceptive use among a sample of nonurban Latinos

CONTEXT

A better understanding of effective contraceptive use among Latinos is needed to reduce their high rate of unintended pregnancy. Most research has focused on urban Latinas and has overlooked the relationship context of effective contraceptive use.

METHODS

Interviews were conducted among a sample of 450 Latino women and men aged 18-25 in sexual relationships, who were recruited from community sites in four rural Oregon counties in 2006. Bivariate and multinomial logistic regression analyses were used to examine the associations between effective contraceptive use and -individual, cultural and relationship characteristics.

RESULTS

Half of participants reported effective contraceptive use in their primary relationships: Thirty-six percent consistently used a female method, and 15% consistently used condoms. Acculturation and confidence in one's -ability to practice contraception with a primary partner were associated with female method use rather than no effective use (risk ratios, 0.7 and 1.7, respectively). Participation in sexual decision making was positively associated with condom use rather than no effective method use (2.2) or female method use (1.9); partner involvement in birth control was positively associated with condom use rather than female method use (1.8).

CONCLUSIONS

Variations in effective contraceptive use among nonurban Latinos appear related to relationship characteristics and dynamics. Contraceptive counseling and unintended pregnancy prevention programs that are tailored to reflect relationship contexts and to include male partners where appropriate could improve the quality and cultural relevance of services among nonurban Latinos.

Immigrant Latino men in rural communities in the Northwest: social environment and HIV/STI risk

This study explored how migration-related socio-cultural and environmental factors interact to render immigrant Latino men residing in rural Oregon at increased risk for HIV/STI. More specifically, the paper describes the socio-demographic characteristics and sexual risk profile of immigrant Latino men and characterises the physical and socio-cultural contexts in which they reside. In-depth interviews were conducted with 49 men who newly immigrated to the USA and had recently engaged in sexual intercourse with women. Content analysis indicated that job instability and seasonal/industry restrictions resulted in frequent changes in employment and living situations, and one-third of respondents reported having no one to turn to when in need. Over two-fifths had ever had sex with a sex worker, with almost a quarter reporting sex with a sex worker in the past three months. In addition, over half of the men reported that they never, or inconsistently, used condoms. Although respect for wives/girlfriends was valued, loneliness, sexual experimentation and inherent sexual needs were cited as reasons that men have sex outside their primary relationships. Our data support the convergence of risky environments and migration-driven factors in exacerbating STI prevalence and the HIV epidemic among Latino immigrant men residing in the Northwest.

Pregnancy motivations and contraceptive use: hers, his, or theirs?

CONTEXT

Studies increasingly consider the role of pregnancy motivations on contraceptive use. Few studies include measures of men's pregnancy motivations.

METHODS

We used baseline data (from a couples-intervention study) to examine the contribution of women's and men's pregnancy motivations and participation in decision making to contraceptive use by women in relatively stable relationships who were not trying to get pregnant. In addition to conducting multivariate analyses, we assessed agreement between a woman's perceptions of and her partner's reports of his pregnancy motivations.

RESULTS

We observed moderate agreement between men's pregnancy motivations and their partners' perceptions of those motivations. Levels of agreement about participation in decision making were somewhat lower. In bivariate analyses, effective contraceptive use was significantly associated with two measures of pregnancy motivation for men and women. In multivariate analyses, only women not wanting a child in 2 years (adjusted odds ratio [aOR], 1.73), women's (aOR, 1.80) and men's (aOR, 0.78) participation in decision making, women believing their partners favored contraceptive use (aOR, 2.01), relationships lasting 2 or more years (aOR, 1.98), and ethnicity/race (Latina aOR, 0.27; other race aOR , 0.45) were associated with effective contraceptive use.

CONCLUSION

Providers and those developing interventions must recognize that some women who are "not trying to get pregnant" have weak motivations to avoid pregnancy, and so should help women to clarify their motivations and seek support from their partners for contraceptive use. To understand the role of pregnancy motivations, future research may include both qualitative and longitudinal quantitative studies.

Do depression and low self-esteem follow abortion among adolescents? Evidence from a national study

CONTEXT

A 2008 report by the American Psychological Association found no evidence that an induced abortion causes mental health problems in adult women. No conclusions were drawn with respect to adolescents because of a scarcity of evidence.

METHODS

Data from the National Longitudinal Study of Adolescent Health were used to examine whether abortion in adolescence was associated with subsequent depression and low self-esteem. In all, 289 female respondents reported at least one pregnancy between Wave 1 (1994-1995) and Wave 2 (1996) of the survey. Of these, 69 reported an induced abortion. Population-averaged lagged logistic regression models were used to assess associations between abortion and depression and low self-esteem within a year of the pregnancy and approximately five years later, at Wave 3 (2001-2002).

RESULTS

Abortion was not associated with depression or low self-esteem at either time point. Socioeconomic and demographic characteristics did not substantially modify the relationships between abortion and the outcomes.

CONCLUSIONS

Adolescents who have an abortion do not appear to be at elevated risk for depression or low self-esteem in the short term or up to five years after the abortion.

HIV prevention heuristics and condom use among African-Americans at risk for HIV

The goal of this study was to improve understanding of whether incorrect HIV/AIDS heuristics and characteristics-based risk theories are barriers to HIV prevention among young African-Americans at increased risk for HIV. We explored: (1) the beliefs of men and women regarding disease prevention strategies, and (2) the relationship of such beliefs to safer sexual behaviours. In Phase I, semistructured individual interviews were conducted with both members of 22 heterosexual couples at increased risk for HIV/STIs. Subsequently, in Phase II, structured individual interviews were conducted with another 40 women and 40 men (not couples). Participants in Phase I reported use of condoms and monogamy as major strategies for disease prevention. The beliefs that were endorsed by the largest percentage of Phase II participants were related to the 'known partners are safe partners' and 'trusted partners are safe partners' heuristics. Moreover, stronger endorsement of the 'known partners' heuristic was negatively associated with measures of condom use and pregnancy prevention behaviour. Our findings highlight the need for interventions and programmes to encourage intimate partners to consistently use condoms until both members of the dyad are tested and agree to mutual monogamy.

Body mass index and sexual behavior

OBJECTIVE

To characterize the relationship between body mass index and sexual behavior, including sexual orientation, age at first intercourse, ever having had sex with a male partner, number of partners, and frequency of intercourse.

METHODS

This study employed the 2002 National Survey of Family Growth, a cross-sectional, nationally representative database in which women between the ages of 15 years and 44 years were surveyed regarding reproductive health outcomes. Sexual behavior was compared between body mass index groups-normal (less than 25 m/kg2), overweight (25-30 m/kg2), and obese (greater than 30 m/kg2)-using self-reported height and weight. Multiple logistic regression with adjustment for the sampling design was used to measure associations of interest.

RESULTS

Body mass index was not significantly associated with sexual orientation, age at first intercourse, frequency of heterosexual intercourse, and the number of lifetime or current male partners. Overweight women and obese women were more likely to report ever having male sexual intercourse (P<.001). This difference persisted when we adjusted for age as well as type of residence.

CONCLUSION

With the exception of ever engaging in sexual intercourse with a man, sexual behavior differs little between women of different body mass indices.

The influence of nurse home visits, including provision of 3 months of contraceptives and contraceptive counseling, on perceived barriers to contraceptive use and contraceptive use self-efficacy

OBJECTIVE

To identify the influence of a community health nurse (CHN) home visit on perceived barriers to contraceptive access and contraceptive use self-efficacy.

METHODS

We enrolled 103 women into two groups in a randomized trial evaluating the influence of contraceptive dispensing and family planning counseling during home visits on perceived barriers to accessing contraceptives and contraceptive use self-efficacy. Both groups received counseling by a CHN about sexually transmitted disease and pregnancy prevention, and a resource card listing phone numbers of family planning clinics. After randomization, the CHN dispensed three months of hormonal contraception to the intensive intervention group and advised the minimal intervention group to schedule an appointment at a family planning clinic. Data collection at baseline and 12 months included demographic, reproductive and other health-related information as well as quantitative assessments of information on perceived barriers to contraceptive access and contraceptive use self-efficacy.

RESULTS

The mean age of participants was 24.7 years. Three-fourths had household incomes under $25,000. We found significant reductions in three perceived barriers to contraceptive access for both groups, as well as significant increases in two measures of contraceptive use self-efficacy at twelve months compared to baseline.

CONCLUSION

Nurse home visits involving family planning counseling might be effective in reducing perceived barriers to contraceptive access and increasing contraceptive use self-efficacy.

Protecting Against Both Pregnancy and Disease: Predictors of Dual Method Use Among a Sample of Women

Although male condoms are the best form of protection against HIV/STDs, they are not the most effective method for preventing unintended pregnancy. Consequently, use of condoms and a highly effective contraceptive-referred to as dual use-is recommended as the optimal protection against both disease and pregnancy. However, little is known about the factors that promote dual use. This study examined associations of dual method use with women's background characteristics, intrapersonal factors, and relationship characteristics. Data are from a random sample of women selected from a large managed care organization in the Pacific Northwest. The analytic sample contained 371 women who completed a telephone survey and reported use of contraceptives in the past 3 months. Three mutually exclusive method use groups were constructed: effective contraceptive only (hormonal methods, intrauterine device, surgical sterilization) (59%), condom only (24%), and dual use (18%). Variables hypothesized to influence dual use were compared across the three groups in bivariate and multivariate analyses. Findings indicate that women who were younger, reported more than one sexual partner in the past year, and were highly motivated to avoid HIV/STDs--were more likely to use dual methods rather than condoms only or an effective contraceptive method. Women confident about using condoms without feeling embarrassed or breaking the sexual mood were more likely to use dual methods rather than a single effective method. Finally, women with confidence in their ability to use condoms correctly are more likely to rely solely on condoms. Policy and practice implications are discussed.

Effects of a health behavior change model--based HIV/STI prevention intervention on condom use among heterosexual couples: a randomized trial

This study examines an intervention for heterosexual couples to prevent human immunodeficiency virus/sexually transmitted infections. It also evaluates the effect of the intervention, which is based on current models of health behavior change, on intermediate outcomes (individual and relationship factors) and consistency of condom use. Eligible couples were administered a baseline interview and randomized to either a 3-session theory-based intervention or a 1-session standard of care comparison condition. Men and women completed 3-month interviews; only women completed 6-month interviews. No significant intervention effect on condom use was found among couples at 3 months (n = 212) or among women (n = 178) at 6 months. However, condom use increased significantly between baseline and 3 months and baseline and 6 months for participants in both treatment conditions. Intervention effects on condom use self-efficacy were found at 3 months and 6 months and on health-protective communication at 3 months. These findings provide valuable information for the design of future studies to help disentangle the effects of intervening with couples.

Exploring diaphragm use as a potential HIV prevention strategy among women in the United States at risk

Given the immediate need for physical cervical barrier methods like the diaphragm to protect against HIV/STIs, understanding what factors influence the acceptability of these products and how to overcome obstacles to their use is important. We explored perceptions of the diaphragm and factors that might enhance its acceptability in 25 focus groups with racially/ethnically diverse young women in the U.S. at risk for HIV/STIs (N = 140). Women believed the diaphragm has positive attributes, and most indicated they would be more likely to use the diaphragm if they were confident they could use it correctly and it protected against HIV. They also considered it messy to use and difficult to insert or remove. Findings suggest that the diaphragm could be a desirable option for pregnancy and disease prevention for some women at risk for HIV/STIs. Although disadvantages to diaphragm use were identified, many could be eliminated through changes in product design and provider intervention.

Onset of sexual intercourse among female adolescents: the influence of perceptions, depression, and ecological factors

PURPOSE

This study examined the extent to which perceptions of sex, depression, and other personal and social factors influenced onset of sexual intercourse during maturation among female adolescents.

METHODS

Data from the National Longitudinal Study of Adolescent Health were used. Participants were 3,644 female adolescents 15-19 years of age who completed the wave 1 In-Home Interview. Logistic regression was used to predict onset of sexual intercourse at waves 1, 2, and 3. Variables examined were age, race, depression, self-esteem, sexual intercourse, religiosity, alcohol use, perceptions of sex, mother connectedness, father connectedness, peer connectedness, and school connectedness. Interaction effects among these variables with depression were examined.

RESULTS

Ambivalent perceptions of sex, in addition to closer relationships with one's father, peers, and school environment, were associated with delaying onset of sexual intercourse among non-depressed teens. Perceptions of sex did not influence engagement in sexual intercourse among depressed adolescents. Close maternal relationships delayed onset of sexual intercourse among depressed adolescent females, whereas the interactions between depression and father connectedness, peer connectedness, and school connectedness were associated with having sex.

CONCLUSIONS

Different strategies are needed to address sexual behaviors for non-depressed and depressed female teens. Public health programs concerned with influencing sexual perceptions among non-depressed female adolescents should incorporate parents, peers, and school activities into their planning and implementation. Because depression in combination with connection to the environment was a significant risk factor for sexual intercourse, future research must explore the factors that delay sexual intercourse, particularly for teenage girls with depression.

Intervening with couples: assessing contraceptive outcomes in a randomized pregnancy and HIV/STD risk reduction intervention trial

PURPOSE

This study assessed the contraceptive outcomes of the Partners Against Risk-Taking: A Networking, Evaluation and Research Study (PARTNERS). The PARTNERS project developed and evaluated a 3-session intervention to help young women and their male partners reduce their risk for unintended pregnancies, and HIV and other STDs.

METHODS

Participating couples were randomly assigned to the 3-session intervention or a 1-session information session for couples. Changes in psychosocial factors related to women's motivation to use contraception and relationship factors were assessed using analysis of variance with repeated measures. Changes in contraceptive outcomes were assessed using logistic regression with generalized estimating equations.

RESULTS

Comparison of changes from baseline to 6 months among women who participated in the 3-session intervention with those who participated in the information session showed no significant intervention effect on reports of contraceptive use. Instead, contraceptive use increased in both conditions. Both groups exhibited similar changes in the psychosocial variable measuring the importance of avoiding pregnancy and in the relationship variable measuring women's participation in contraceptive decision making. Members of the intervention group, however, showed greater improvement in the psychosocial variable measuring positive expectations pertaining to partner's support for contraception.

CONCLUSION

These findings raise questions for further investigation to better understand couples behavior, and whether and how to intervene with couples.

Diaphragm acceptability among young women at risk for HIV

OBJECTIVES

The purpose of this study was to increase understanding of acceptability of the diaphragm among young women at risk for HIV and other sexually transmitted infections (STIs) in the U.S.

METHODS

A total of 140 young (aged 18-25 years) women who had never used the diaphragm and who were at risk for HIV and other STIs completed questionnaires that included questions about the diaphragm and other sexual and reproductive health topics. These women were participants in a focus group study.

RESULTS

The majority of participants perceived that the diaphragm had several characteristics (e.g., is a method they can control, is effective in preventing pregnancy, will not cause side effects, does not decrease sexual pleasure) considered important when selecting a birth control method. However, most were not confident in various aspects of diaphragm use, including their ability to use the method correctly, without breaking the mood, or when sexually excited. In multivariate analyses, intention to use the diaphragm was significantly higher among participants who were less motivated to avoid pregnancy and those with greater perceived self-efficacy to use a diaphragm in different contexts (e.g., when sexually excited).

CONCLUSION

The diaphragm has characteristics that some women consider desirable, suggesting that it could be an acceptable HIV prevention method for some at-risk women.

A conceptual model of women's condom use intentions: Integrating intrapersonal and relationship factors

We developed and tested a multifaceted model of condom use intentions with cross-sectional data from 435 heterosexual women at risk for HIV/STIs. In addition to traditional intrapersonal variables drawn from established models of HIV prevention (e.g. attitudes, norms, self-efficacy), the present study examined the role of relationship factors and dynamics (i.e. relationship commitment, duration, condom use and pregnancy prevention decision-making) in shaping condom use intentions. In some cases, relationship variables were directly associated with condom use intentions. In other cases their effects on condom use intentions were mediated by intrapersonal constructs. The final model accounted for 66% of the variance in condom use intentions and confirmed the importance of integrating intrapersonal variables and relationship characteristics and dynamics in understanding women's intentions to use condoms. These results offer important insights for the design of interventions directed at promoting condom use among young women at risk for HIV/STIs and underscore the need to design prevention programs that address relationship characteristics and dynamics.

Women's acceptance of the diaphragm: the role of relationship factors

The vaginal diaphragm is a candidate for a female-controlled method of reducing risk of HIV/STI acquisition. We examined the association between relationship and partner factors and three measures of diaphragm acceptability: current use, consistency of use, and satisfaction with use. We conducted a telephone survey with 448 female members of a managed care organization, aged 18-49, who currently used contraception (including 140 diaphragm users, 187 pill users, and 121 male condom users). Use of a specific contraceptive was significantly associated with relationship length, condom-use negotiation self-efficacy, importance of covert use, perceived motivation of partner to prevent HIV/STIs, and perceived satisfaction of partner with current method. In addition, among diaphragm users, communication about HIV/STIs and perceived partner motivation to use a diaphragm were related to consistent use. These results suggest that acceptability of contraceptive methods among women is influenced by their perceptions of their male partner and relationship factors.

Recruiting and retaining couples for an HIV prevention intervention: lessons learned from the PARTNERS project

Intervening with both members of a couple has been recommended as an important strategy for human immunodeficiency virus prevention. Analyses of focus groups and in-depth interviews with project personnel involved in recruitment and retention for the Partners Against Risk-Taking: A Networking and Evaluation Research Study project identified, at the termination of the project, barriers and facilitators to recruiting couples. Barriers included logistical problems of coordinating two people's schedules, sensitivity of the topic and challenges related to recruitment efforts focused on one partner only. Strategies to overcome such barriers were to increase availability of project personnel and recruit both partners simultaneously, with recruitment teams consisting of men and women. Challenges related to recruiting and retaining couples remain significant and should be considered before undertaking couples interventions.

Factors Associated with Effective Contraceptive Use Among a Sample of Latina Women

Unintended pregnancy disproportionately affects Latina women. One factor contributing to unintended pregnancy among Latinas is the low rate of contraceptive use. This study examined correlates of effective contraceptive use among a sample of Latina women (n=202) at increased risk for HIV. In addition to traditional intrapersonal variables (i.e., perceived risk of pregnancy, motivation to avoid pregnancy), the present study examined the role of the male partner and relationship factors (i.e., relationship commitment, duration, pregnancy prevention decision-making) on contraceptive use. Participants were recruited from clinics and community locations in East Los Angeles and administered a 60-minute in-person interview. Multivariate logistic regression was used to compare women who consistently used effective contraceptives (36%) to women using no method or an ineffective method. Women in relationships of 1 to 2 years were nearly 3 times more likely to use an effective contraceptive compared to women in relationships of less than 1 year (odds ratio (OR)=2.7, 95% CI 1.1, 6.7). Women were more than twice as likely to use an effective method if they reported a high level of involvement in decision-making about whether to use contraception (OR=2.3, 95% CI 1.1, 4.7) or had discussed contraception with their partner (OR=2.4, 95% CI 1.03, 5.6). This study provides additional information about the importance of male partners and relationship factors in contraceptive use among Latina women. Efforts to prevent unintended pregnancy need to address the role of relationship factors in the sexual risk and protective behaviors of Latinas.

Correlates of condom use intentions and behaviors among a community-based sample of Latino men in Los Angeles

HIV/AIDS has disproportionately affected Latino communities. The majority of research addressing HIV risk behaviors within this population has focused on women. However, men who have sex with women (MSW) are a population increasingly becoming infected with HIV and heterosexual contact is the primary source of HIV transmission among Latinos diagnosed with AIDS. It has been assumed that because men are likely to control condom use, relationship factors are less likely to influence safer sex behavior among men. However, because condom use is an interdependent behavior, understanding factors that predict safer sex behavior among MSW is critical. This study examined the influence of multiple factors on condom use behavior in a community-based sample of young Latino men. Data from 191 Latino men who completed baseline interviews for an intervention were analyzed to examine the association of background, intrapersonal and relationship factors with intentions to use condoms and condom use in the past three months. Findings from multivariate analyses indicated that more positive attitudes toward condoms, stronger partner condom norms and greater participation in decision-making about condom use were significantly associated with both condom use and condom use intentions. Additionally, men reporting lower expectations of negative partner reactions to condom requests were more likely to use condoms, and condom use intentions were higher among men reporting more health protective communication in the relationship. Findings suggest that interventions to prevent HIV need to include men as well as women and address the role of relationship factors and dynamics in safer sex practices.

"Are they still having sex?" STI's and unintended pregnancy among mid-life women

Research has shown that women remain sexually active throughout mid-life and into the post-menopausal years. Recent data reveal that significant numbers of STIs (sexually transmitted infections) and unintended pregnancies occur among mid-life women. Data on STI prevalence indicate several STIs have relatively high rates among women over age 30, including HIV and HSV-2. Racial/ethnic disparities in STI prevalence between mid-life African American, Hispanic, and Caucasian women have also been noted. Data from the 1995 National Survey of Family Growth reveal 51% of pregnancies among women 40 and older are unintended. Both STIs and unintended pregnancy can result in serious health consequences for mid-life women. STIs can result in pelvic inflammatory disease and ectopic pregnancy. Unintended pregnancy can result in increased morbidity and mortality to the woman and the fetus. Mid-life women are also highly likely to go through relationship transitions (e.g., separation, divorce) and the subsequent initiation of new sexual relationships. As a result, these women are at elevated risk of STIs and unintended pregnancy. Despite these realities, there is a lack of programs addressing these two health issues among mid-life women and the unique life circumstances of women at this stage of life. The authors assert there is a compelling need for interventions to reduce STIs and unintended pregnancy in this population of women, review the literature regarding STIs and unintended pregnancy in mid-life women, identify gaps in current resources, and make recommendations for health care practice and future research.