Perceived partner beliefs about condoms and self-efficacy communication within the context of the theory of gender and power

Concept Mapping STI/HIV Prevention and Condom Use among Young African American Adults

Theory-based HIV prevention programs have resulted in increased condom use, which remains the best method for the prevention of sexually transmitted infections (STIs) among sexually active heterosexual individuals. Particularly, the integrative model of behavior prediction theorizes that attitudes, norms, self-efficacy, and socioenvironmental factors influence intention and behavior and has been useful in understanding STI risk among adolescents. However, more research is needed regarding young African American adults. Given the increased freedom and decision-making independence afforded to young adults compared to adolescents, it is important to consider the STI/human immunodeficiency virus (HIV) prevention messages that would resonate with them, particularly regarding condom use. The present study sought to explore how attitudes, subjective norms, self-efficacies, and socioenvironmental factors may influence condom use and STI/HIV prevention, as conceptualized by the participants. We conducted a group-based concept map, a systems-thinking mixed methodology that resulted in a geospatial map reflecting the conceptualizations of the participants. Self-identified young heterosexual African American adults (N = 43) aged 20-26 engaged in an interactive concept mapping procedure in order to "map out" their overarching concepts about STI/HIV risk and condom use. Seven overall conceptual domains emerged: self-efficacy for partner communication, condom use self-efficacy, social media/sociocultural influences, condom use/STI knowledge, condom use cons, condom use pros, and subjective and social norms about condom use. We presented the concept map and discussed the conceptual interpretations and the relationships among the overarching concepts. We also discussed how the social environment, including the social media environment, was conceptualized regarding STI/HIV risk and prevention among young African American adults. Concept mapping can be viewed as a way to determine worthwhile messages for intervention development. The findings may provide information for prevention programs aimed at reducing the incidence of STIs among young adult heterosexual persons within African American communities.

Optimizing Individual HIV Testing and Counseling for Emerging Adult Sexual Minority Men (Aged 18 to 24) in Relationships: A Pilot Randomized Controlled Trial of Adjunct Communication Components

The majority of new HIV infections in the US occur among sexual minority men (SMM) with older adolescent and emerging adult SMM at the highest risk. Those in relationships face unique HIV prevention challenges. Existing sexual HIV transmission risk interventions for male couples often encounter implementation challenges and engaging younger SMM early in relationships may be particularly difficult. This pilot randomized controlled trial evaluated the acceptibility and feasibility of We Test HIV testing - a behavioral health intervention tailored for younger SMM in realtionships - and generated preliminary estimates of effect size. The intervention comprises two adjunct moduls - video-based communication skills training as well as communication goal setting and planning - delivered in conjunction with routine HIV testing and counseling in individual or dyadic formats. A sample of 69 SMM aged 17 to 24 were recruited online. Following baseline assessment, youth were randomized to receive either the experimental, We Test, intervention or routine HIV testing (the control condition). Follow-up assessments were completed 3 and 6 months post-baseline. Results suggested the study was feasible and the individually delivered format was acceptible. We Test HIV testing was associated with significant improvements in communication skills. In addition, youth who remained in a relationship experienced an increase in communal coping to reduce HIV infection risk and relationship power. While groups did not differ with respect to condomless anal sex with casual partners, these psycho-social constructs (communication, communal coping with HIV prevention, and relationship power) may serve as mediators of intervention effects on sexual risk reduction in a larger study.

Acceptance and use of condoms among school-aged young people in Australia

BACKGROUND

Despite availability of vaccines or medical prophylaxis for some sexually transmissible infections (STIs), promoting condom use remains an important public health strategy for the prevention of STIs. Recent research shows that regular condom use among young people in Australia has declined over the past decade, while the rate of common STIs has increased.

METHOD

In this paper, we report findings from a large survey of school-aged young people in Australia (14-18years old) in which we looked at the association between condom use and positive feelings about sex, beliefs about social acceptability of condoms and confidence talking with partners about sex and condoms.

RESULTS

Communication and relational factors supported more consistent condom use. Participants were more likely to regularly use condoms if they discussed condom use with a sexual partner, perceived condom use to be easy (a measure that included perceived ease of discussing condoms with a partner) and perceived condom use to offer social or relational benefits, including perceiving condom use as a demonstration of care for a partner. Young men were more likely to report positive feelings about sex and regular condom use than young women. Young women were less likely than young men or trans and non-binary young people to report regular condom use.

CONCLUSIONS

The study shows the importance of supporting young people to build confidence expressing sexual needs and wants with partners. Public health approaches to STI prevention need to consider condom promotion in the context of young people's contemporary sexual, gendered and relationships cultures.

Exploring What Influences Heterosexual College Men and the Practice of Safe Sex: The Power of Stigma and Community

The college student population is among the highest risk group for contracting sexually transmitted infections (STIs) such as gonorrhea, chlamydia, and HIV. Safe sex practices, which are intended to mitigate risks associated with sexually transmitted infections, are often negated in the population of heterosexual college students. Historically, research on safe sex practices has shown that the burden of behavior change and the focus on educational efforts historically fall onto the female population. There is little published on how safe sex education for males impacts attitudes and behaviors towards safe sex practices. This community-based participatory research (CBPR) project explored heterosexual college male attitudes and behaviors about safe sex responsibilities with the goal of creating effective health promotion messages to increase safer sex. The research team comprised almost entirely of undergraduate male students, which strengthened the design and translation of results to practice. A mixed methods design was employed utilizing both focus groups and surveys as data collection (n=121). Results showed that young men are still prioritizing pregnancy prevention over disease contraction and/or testing, and relying on female partners to initiate safe sex. Implications for health promotion practice efforts on college campuses include: male-led peer education programming and support and messaging around screening and prevention of STIs.

Condom Use at Last Sex and Sexual Negotiation Among Young African American Women in North Carolina: Context or Personal Agency

African American women are 10.8 times more likely to be diagnosed with HIV compared with White women. This descriptive study fills a gap by examining associations among social and contextual factors and sexual communication, condom use, and safer sex negotiation among African American women. Study participants between 18 and 25 years of age and who reported recent substance use were recruited from three North Carolina counties. A risk behavior survey was administered via audio computer-assisted self-interview, and logistic regression analyses were conducted to assess associations between social and contextual variables and condom use at last sex with a main partner. Education (AOR: 2.078; 95% CI: 1.214, 3.556), sexual communication with a main partner (AOR: 1.079; 95% CI: 1.050, 1.109), and condom use relationship scale (AOR: 1.059; 95% CI: 1.023, 1.098) were positively associated with condom use at last sex, whereas living with a main partner (AOR: 0.447; 95% CI: 0.210, 0.950) and the alcohol and drug problem scale (AOR: 0.971; 95% CI: 0.944, 0.998) were negatively associated with condom use (p < 0.05). The study findings show that among young African American women at risk for HIV, contextual and personal factors may influence condom use. A socio-ecological approach combining personal empowerment, interpersonal, structural, and biobehavioral strategies is necessary in implementing holistic gender-focused HIV prevention programs.

Sexting with benefits? Exploration of sexting behaviours through the lens of protection motivation theory

Sexting is a common form of sexual communication that is often considered normative and beneficial despite some research highlighting its negative social, psychological, and legal repercussions. Using protection motivation theory (PMT), this study examines how young adults weigh the pros and cons of sending consensual sexts, sexting under pressure, and deciding against sending sexts, and whether body image dissatisfaction interacts with any of the decision-making processes. In total, 906 participants (554, 61.14% women), aged 18-25 years (M = 21.65, SD = 2.01), completed an online measure of sexting behaviours, body image, and protection motivation. Overall, 71.41% of respondents ever sent a sext. Of those, 45.07% and 36.32% felt pressure to sext or sent a sext because of pressure. Further, 63.90% participants ever considered and decided not to send a sext. All models predicting various sexting behaviours were significant and provided a partial support for the PMT. Body image was a unique predictor of 'pressured' sexting but its interactions with the PMT subscales for pressured sexting and decisions against sexting were non-significant. Our study illustrates the need for increasing young people's self-efficacy and body image to improve their sexting agency and experience.

Sexual Communication and Sexual Consent Self-Efficacy Among College Students: Implications for Sexually Transmitted Infection Prevention

PURPOSE

Obtaining affirmative consent, a hallmark of sexual violence prevention education on college campuses, may influence sexual communication and behaviors such as condom use. This study examined the relationship between self-efficacy to obtain sexual consent with sexual health communication and behaviors among a sample of U.S. college students.

METHODS

Data were from 2,291 students enrolled in a cluster-randomized controlled trial conducted on 28 college campuses from 2015 to 2017. Students reported their self-efficacy to obtain sexual consent, communication about sexual health, and sexual health behaviors. Multivariable logistic regression, adjusted for school clustering, history of violence victimization, and sexually transmitted infection history, estimated odds ratios and 95% confidence intervals (CIs) for sexual consent self-efficacy and sexual health communication.

RESULTS

Females (n = 1,150) reported higher self-efficacy to obtain consent than males (b₁ = .32, 95% CI = .23, .41), but lower odds of communication about condom use (adjusted odds ratio [AOR] = .75, 95% CI = .60, .96) and HIV prevention (AOR = .63, 95% CI = .48, .81). Black and other race students reported higher odds of HIV/sexually transmitted infection prevention communication than white students. Odds of consistent condom use were highest among students reporting condom use communication and high self-efficacy to obtain sexual consent (AOR = 1.99, 95% CI = 1.58, 2.51).

CONCLUSIONS

Campus sexual assault prevention education that focuses narrowly on obtaining sexual consent may be missing an opportunity to enhance sexual health communication broadly, including condom and contraceptive use discussion to promote overall sexual health.

Factors Influencing Contraceptive Use Among Sexually Active U.S. Middle and High School Students, 2015 to 2019

Objective The objective of this study is to see whether factors including the age of first sexual intercourse, sexual orientation, age at the time of survey administration, race/ethnicity, and sex affect condom and other types of contraceptive usage among United States middle and high school students. Methods We analyzed data from the Centers for Disease Control's Youth Risk Behavior Surveys from the years 2015 to 2019. Students were asked questions about condom and specific type of contraceptive use (e.g. birth control pills, intrauterine device/implant, shot/patch/ring, withdrawal), age of first sexual intercourse, and sexual orientation, as well as demographic questions. Using a logistic regression model, we tested the linear effects on condom and contraception investigated variables. Results Differing sexual orientations had a significant relationship with both condom and contraceptive usage, with those who identified as lesbian or gay being least likely to use contraception as opposed to those who identified as straight, bisexual, or unsure. Female participants were 31.6% less likely to use contraception overall and 41.7% less likely to use condoms in comparison to male participants. With a one-year increase in the age of first sexual intercourse, contraceptive use overall increased by 23% and condom use specifically increased by 17%. With a one-year increase in a participant's age at the time of survey administration, contraceptive use decreased by 7.4% and condom use decreased by 21%. Between the years 2015 to 2019, there was an average decrease of 5.3% in the usage of condoms. Conclusion We found significant differences in contraceptive and/or condom usage between students of different sexual orientations, sex, age of first sexual intercourse, age at the time of survey administration, and between different years studied. These differences could be attributed to differences in sex education, cultural background, and availability of resources. Further investigations should be conducted to delineate these differences.

The mediating role of partner communication on contraceptive use among adolescent girls and young women participating in a small-group intervention in Malawi: A longitudinal analysis

Though effective reproductive health interventions have been developed for adolescent girls and young women (AGYW) in sub-Saharan Africa, few have explored whether specific components of the interventions are responsible for observed changes in behaviour. Data for this longitudinal mediation analysis come from a quasi-experimental, sexual and reproductive health study conducted among AGYW (age 15-24) in Malawi. We assessed the extent to which the relationship between attending communication-specific small-group sessions and contraceptive use at one-year was mediated by contraceptive communication with partners at six months, using a bootstrapping procedure to estimate indirect effects. Of 358 participants, 44% attended communication-specific small-group sessions, 37% communicated with partners about contraception at six months, and 21% used non-barrier contraception at one-year. Participants who attended communication-specific small-group sessions had increased contraceptive communication with partners at six months (aOR = 1.48, 95% CI: 1.07-2.38) and increased non-barrier contraceptive use at one-year (aOR = 3.53, 95% CI: 1.86-6.69). The relationship between attending communication-specific small-group sessions and non-barrier contraceptive use at one-year was partially mediated by contraceptive communication with partners at six months (indirect effect = 0.04, 95% CI: 0.01-0.07). Our results suggest that contraceptive communication with partners is modifiable through interventions and important for AGYW non-barrier contraceptive uptake.