Condom Negotiation in Heterosexually Active Men and Women: Development and Validation of a Condom Influence Strategy Questionnaire

Using computer technology for HIV prevention among African-Americans: development of a tailored information program for safer sex (TIPSS)

New prevention options are urgently needed for African-Americans in the United States given the disproportionate impact of HIV/AIDS on this group. This combined with recent evidence supporting the efficacy of computer technology-based interventions in HIV prevention led our research group to pursue the development of a computer-delivered individually tailored intervention for heterosexually active African-Americans--the tailored information program for safer sex (TIPSS). In the current article, we discuss the development of the TIPSS program, including (i) the targeted population and behavior, (ii) theoretical basis for the intervention, (iii) design of the intervention, (iv) formative research, (v) technical development and testing and (vi) intervention delivery and ongoing randomized controlled trial. Given the many advantages of computer-based interventions, including low-cost delivery once developed, they offer much promise for the future of HIV prevention among African-Americans and other at-risk groups.

Reactions of heterosexual African American men to women's condom negotiation strategies

This study describes responses of 172 single heterosexual African American men, ages 18 to 35, to condom negotiation attempts. Strategies used included reward, coercive, legitimate, expert, referent, and informational strategies, based on Raven's (1992) influence model. The purpose was (a) to identify strategies influencing participant acquiescence to request and (b) to identify predictors of participant compliance/refusal to comply with negotiation attempts. Participants viewed six videotape segments showing an actress, portrayed in silhouette, speaking to the viewer as a "steady partner." After each segment, participants completed measures of request compliance, positive and negative affect, and attributions concerning the model and themselves. No significant differences were found in men's ratings across all vignettes. However, differences in response existed across subgroups of individuals, suggesting that, although the strategy used had little impact on participant response, the act of suggesting condom use produced responses that differed across participant subgroups. Subgroups differed on levels of AIDS risk knowledge, sexually transmitted disease history, and experience with sexual coercion. Also, the "least willing to use" subgroup was highest in anger-rejection and least likely to make attributions of caring for partner. Effective negotiation of condom use with a male sexual partner may not be determined as much by specific strategy used as by partner characteristics.

Condom negotiation strategies and actual condom use among Latino youth

PURPOSE

To examine which condom negotiation strategies are effective in obtaining or avoiding condom use among Latino youth.

METHOD

Interviews were conducted with 694 Latino youth, 61% female, aged 16-22. Participants reported on their condom negotiation strategies, perceptions of whether their sexual partner wanted to use condoms, and actual condom use. Three strategies to obtain condom use (risk information, direct verbal/nonverbal communication, insist) and four strategies to avoid condom use (emotional coercion, ignore condom use, dislike condoms, seduction) were examined. Data were analyzed using multiple linear regression, and included youth (n = 574) who reported wanting to use or avoid condoms.

RESULTS

Almost 60% of participants reported wanting to use condoms, and nearly all of these used some strategy to obtain condom use. Young men who wanted to use condoms were more likely to do so, compared with young women. Risk information and direct verbal/nonverbal communication were effective strategies to obtain condom use, even among youth who perceived their sexual partners as not wanting to use condoms. Ignoring condom use was an effective condom avoidance strategy, even when youth thought their partners wanted to use condoms. Unexpectedly, young men who expressed dislike of condoms had higher rates of condom use than young men not using this condom avoidance strategy.

CONCLUSIONS

This research identified condom negotiation strategies that are effective among Latino youth, even when they believe their partners do not want to use condoms. Health care providers could encourage Latino youth to use such condom negotiation strategies.

Meanings and dilemmas of sexual safety and communication for transgender individuals

HIV prevention efforts stress interpersonal communication skills and their protective benefits; however, research on sexual communication has lagged behind interventions that emphasize communication. This project was undertaken to determine how sex talk unfolds in a specific relational and sociocultural context--the transgender community-as well as what constitutes effective or satisfying safer sex talk. Goldsmith's normative theory guided semistructured interviews with 41 transgender individuals. Transgender participants held multiple, often competing goals in safer sex conversations, which resulted in communicative dilemmas. Creative management strategies allowed participants to achieve desired outcomes, like safer sex, without threatening identities and relationships. Implications for communication and health behavior theory and practice are discussed in light of these findings.

'It's Not What You Said, It's How You Said It': Perceptions of Condom Proposers by Gender and Strategy

We examined effects of proposer gender and condom negotiation strategy on perceptions of condom proposers in undergraduates in the southwestern regions of the US. Using a video manipulation (N=150), a female proposer was evaluated no more harshly than a male proposer, and was evaluated more positively in some ways. In a vignette manipulation (N=193) a female proposer using an Eroticization negotiation strategy (compared to Refusal of sex or Explanation of consequences) was seen as more exciting and likely to engage in sex. Surprisingly, women were harsher judges than men of a female condom proposer using an Eroticization strategy. Greater attention should be paid to the nature of condom negotiation within the framework of the sexual script.

Silences, gestures, and words: nonverbal and verbal communication about HIV/AIDS and condom use in black heterosexual relationships

This qualitative study examined how 27 Black men and women, ages 22 to 50 years, in heterosexual relationships communicated verbally and nonverbally about HIV/AIDS and condom use before first time sex. Although most interviewees reported no HIV/AIDS communication, most noted communication about condom use. Verbal condom communication focused typically on requests and declarations, whereas nonverbal communication centered on the presentation of condoms. Women were more likely to communicate about condoms verbally, whereas men were more likely to do so nonverbally. Interviewees who communicated about condom use were more likely than those who did not to report first-time condom use. We discuss these findings and their implications within the context of relationship and sociocultural factors relevant to HIV/AIDS in Black communities.

Examining the Role of Gender in the Relationship Between Use of Condom-Related Protective Behavioral Strategies when Drinking and Alcohol-Related Sexual Behavior

The present research aimed to examine the relationships among gender, condom-related protective behavior strategies (PBS), and condom use during alcohol-related sexual behavior. Heavy drinking, sexually active U.S. undergraduate college students from a large northwest university (N=454; 61.7% female) completed a web-survey that included measures of drinking, sexual behavior, and condom-related PBS. MANOVA findings suggested that males were more likely to use condom-related PBS than females. Negative binomial regression results suggested that use of condom-related PBS by both genders was positively associated with condom use during alcohol-related sexual behavior, but especially for women. These results suggest that condom-related PBS may be useful to incorporate in interventions targeting alcohol-related sexual behavior among heavy drinking college students.

Effects of relationship motivation, partner familiarity, and alcohol on women's risky sexual decision making

This experiment examined the effects of women's relationship motivation, partner familiarity, and alcohol consumption on sexual decision making. Women completed an individual difference measure of relationship motivation and then were randomly assigned to partner familiarity condition (low, high) and to alcohol consumption condition (high dose, low dose, no alcohol, placebo). Then women read and projected themselves into a scenario of a sexual encounter. Relationship motivation and partner familiarity interacted with intoxication to influence primary appraisals of relationship potential. Participants' primary and secondary relationship appraisals mediated the effects of women's relationship motivation, partner familiarity, and intoxication on condom negotiation, sexual decision abdication, and unprotected sex intentions. These findings support a cognitive mediation model of women's sexual decision making and identify how individual and situational factors interact to shape alcohol's influences on cognitive appraisals that lead to risky sexual decisions. This knowledge can inform empirically based risky sex interventions.

Condom Use Self-Efficacy among Young Adult Ecstasy Users

Relying upon a sample of 283 young adult ecstasy users, this research examines three primary research questions: How high/low are young adult ecstasy users' levels of condom use self-efficacy? How does condom use self-efficacy relate to actual condom use in this population? What factors underlie condom efficacy levels in this population? The study entailed face-to-face interviews that were completed with the use of computer-assisted structured interviews (i.e., CASI). Study participants were recruited in the Atlanta, Georgia metropolitan area between August 2002 and August 2004 using a targeted sampling and ethnographic mapping approach. Interviews took approximately two hours to complete. Condom use self-efficacy levels were found to be fairly high in this population. A strong, direct relationship was observed between condom use self-efficacy and actual condom use. Using a multiple regression approach, five factors were found to be predictive of greater condom use self-efficacy in this population. These were educational attainment, amount of communication in one's family of origin, having asked about one's most recent casual sex partner's HIV serostatus, no prior drug treatment, and level of self-esteem.

Women's condom use assertiveness and sexual risk-taking: effects of alcohol intoxication and adult victimization

This experiment examined relationships among adulthood victimization, sexual assertiveness, alcohol intoxication, and sexual risk-taking in female social drinkers (N=161). Women completed measures of sexual assault and intimate partner violence history and sexual assertiveness before random assignment to 1 of 4 beverage conditions: control, placebo, low dose (.04%), or high dose (.08%). After drinking, women read a second-person story involving a sexual encounter with a new partner. As protagonist of the story, each woman rated her likelihood of condom insistence and unprotected sex. Victimization history and self-reported sexual assertiveness were negatively related. The less sexually assertive a woman was, the less she intended to insist on condom use, regardless of intoxication. By reducing the perceived health consequences of unprotected sex, intoxication indirectly decreased condom insistence and increased unprotected sex. Findings extend previous work by elucidating possible mechanisms of the relationship between alcohol and unprotected sex - perceived health consequences and situational condom insistence - and support the value of sexual assertiveness training to enhance condom insistence, especially since the latter relationship was robust to intoxication.

Evaluating a two-step approach to sexual risk reduction in a publicly-funded STI clinic: rationale, design, and baseline data from the Health Improvement Project-Rochester (HIP-R)

BACKGROUND

Sexually transmitted infection (STI) clinics provide an opportune setting for HIV prevention efforts. This randomized controlled trial evaluated a unique, two-step approach to sexual risk reduction at a publicly-funded STI clinic.

METHODS

During an initial visit, patients completed an audio-computer assisted self-interview (ACASI), were randomized to and received one of two brief interventions, obtained medical care, and completed a post-assessment. Next, two-thirds of the patients were assigned to attend an intensive sexual risk reduction workshop. At 3, 6, and 12 months, patients completed additional ACASIs and provided urine specimens to assess behavior change and incident STIs.

RESULTS

During a 28-month interval, 5613 patients were screened, 2691 were eligible, and 1483 consented to participate and were randomized; the modal reason for declining was lack of time (82%). Consenting patients included 688 women and 795 men; 64% of participants were African-American. The sample was low-income, with 57% reporting an annual income of less than $15,000; most participants (62%) had a high school education or less, and 51% were unemployed. Sexual risk behavior was common, as indicated by multiple sexual partners (mean=32.8, lifetime; mean=2.8, past 3 months), unprotected sex (mean=17.3 episodes, past 3 months), and prior STIs (mean=3.3, lifetime; 23% at baseline). Bivariate analyses confirmed our prediction that HIV-related motivation and behavioral skills would be related to current sexual risk behavior. All patients received a brief intervention; patient satisfaction ratings were uniformly high for both interventions (all means >or=3.7 on 4-point scales). Fifty-six percent of invited patients attended the intensive workshop, and attendance did not differ as a function of brief intervention. Patient satisfaction ratings were also uniformly positive for the workshop interventions (all means >or=3.6). Return to follow-up assessments exceeded 70%.

CONCLUSIONS

Results demonstrate that implementing an HIV preventive program in a busy, public clinic is feasible and well-accepted by patients. Ongoing evaluation will determine if the interventions reduce sexual risk behavior and lower incident STIs.

An interventionist's guide to AIDS behavioral theories

Although numerous individual-level AIDS behavioral theories (ABTs) exist in the literature, there is currently no consensus as to which theory is most precise in explaining or predicting HIV risk behavior. In the absence of empirical evidence favoring one ABT over another, how should an interventionist go about choosing a theory for one's particular prevention efforts? The current article provides an overview of and conceptually compares 13 ABTs in an attempt to provide guidance regarding this critical decision. A variety of criteria upon which one might judge ABTs are proposed and discussed, including empirical support for variables that make up the theory, whether or not theories are belief-based, AIDS-specific, message-based, intervention-based and behavior or behavioral-change focused. While all of the theories have strengths and weaknesses, the task for an interventionist is to choose the theory of best fit for one's particular prevention efforts. The suggestions provided in the current article may help with such a choice.

Condom use measurement in 56 studies of sexual risk behavior: review and recommendations

Despite numerous studies that measure self-reported condom use, there is currently no agreed upon "gold standard" in terms of the best way to assess condom use. The purpose of the current study was to review measures of self-reported condom use within correlational studies of sexual risk behavior, and to evaluate such measures on the basis of suggestions from the methodological literature. An additional purpose was to examine specifically whether measures published in the correlational literature have improved over time. A systematic review of studies was undertaken and specific review criteria were used to guide the inclusion of studies. A final set of 56 studies that contained 72 measures of self-reported condom use were included in the review. These measures were coded and evaluated on 12 dimensions, including measure type, number of response categories, recall period, sex partner specificity, and sex act specificity. Results indicated a great amount of diversity in terms of how condom use has been measured in the literature. Although results indicated that measures published between 1996 and 2003 were of higher quality on a number of dimensions as compared to 1989-1995, a number of these gains were minimal and in some cases measures have decreased in quality. The overall conclusion is that the sexual risk behavior literature should implement more of the recommendations made by methodological scholars in this area. Specific recommendations are summarized and presented in a way that may be helpful in guiding the development of future measures of self-reported condom use.

Why communication is crucial: meta-analysis of the relationship between safer sexual communication and condom use

The purpose of this study was to quantitatively synthesize the growing literature on the relationship between safer sexual communication (SSC) among sexual partners and condom use, and to systematically examine a number of conceptual and methodological moderators of this relationship. Data from 53 articles published in 27 journals met criteria for the study. Fifty-five independent effect sizes coded from samples totaling N=18,529 were meta-analyzed. Results indicate that the mean sample-size weighted effect size of the SSC-condom use relation was r=.22, and a number of conceptual variables were found to moderate this relationship. Specifically, communication about condom use (r=.25) and sexual history (r=.23) had significantly (p<.05) larger effect sizes than communication about safer sex (r=.18). In addition, SSC measures operationalized differently had significantly (p<.05) different effect sizes. From largest to smallest, these were behavioral format (r=.29), intentional format (r=.18), and self-efficacy format (r=.13). Measures that tried to assess persuasion attempts as compared with informational exchanges were not found to have significantly different effect sizes (p>.05). Further, methodological moderators tended to be unrelated to effect size. Implications for the future study of safer sexual communication as well as the importance of emphasizing communication skills in HIV preventive interventions are discussed.

Interpersonal issues surrounding HIV counseling and testing, and the phenomenon of "testing by proxy"

This multimethod study explored challenges faced by women in close heterosexual relationships who decided to test for HIV, and their experiences with instituting safer sexual practices and partner testing. Eighty-one women who sought HIV counseling and testing and had a regular male sexual partner were interviewed on five occasions, and 18 of these women and 15 men later took part in one of four focus groups (women only, men only, or couples). Findings identified difficulty understanding the unpredictability of HIV transmission, gender differences in how partners interpret their susceptibility to HIV, and male resistance to safer sex and testing. We also identified a pervasive phenomenon of "testing by proxy"--the belief that if one partner tests negative for HIV after having unprotected intercourse, the untested partner's serostatus is deemed to be negative. This dangerous practice must be addressed in public health prevention efforts. Programs aiming to reduce heterosexual HIV risk for women must include their male partners and incorporate effective interpersonal communication skills.

Integrating personality and psychosocial theoretical approaches to understanding safer sexual behavior: implications for message design

The purpose of this study was to propose and conduct tests of a multivariate model of condom use utilizing data from 2 independent samples of young adults (City 1, N=746; City 2, N=743). The model examined the relations between personality characteristics, including sexual sensation seeking and sexual impulsive decision making; psychosocial variables, including condom attitudes, norms, and self-efficacy; and condom use behaviors, including carrying, communicating about, and using condoms. Structural equation modeling analyses indicated a good fit for both models (Confirmatory Fit Index=.93; Average Absolute Standardized Residuals=.05 for both), with each explaining 25% of the variance ( R (2)=.25) in condom use behaviors. Results support the fusion of personality and psychosocial approaches to gain a broader theoretical understanding of condom use in young adults. In addition, those developing and implementing health communication campaigns may find sexual sensation seeking and sexual impulsive decision making to be fruitful variables on which to target messages aimed at increasing safer sexual behavior.