Modelling and modifying young heterosexuals' HIV-preventive behaviour; a review of theories, findings and educational implications

Measuring Sexual Motives: A Test of the Psychometric Properties of the Sexual Motivations Scale

Sexual motives refer to functions served by sexual behavior. The Sex Motivations Scale (SMS) has frequently been used to assess sexual motives. At its development, the SMS demonstrated good internal consistency; convergent, divergent, and criterion validity; and configural invariance across sex, age, and Caucasians and African Americans. Yet the metric and scalar invariance of the SMS has not been examined, nor has the measurement invariance of the SMS across Hispanic and Asian Americans, sexual minority status, and relationship status been tested. The criterion validity of the SMS also has yet to be examined for nonintercourse sexual behaviors, such as sexting. The present study aimed to address these gaps in a diverse sample of 2,201 college students (77.60% female; M_age = 22.06; 27.84% Caucasian). Results further affirmed the configural, metric, and scalar invariance of the SMS. The convergent and divergent validity of the SMS was supported in relation to positive and negative affect and attachment patterns; and specific SMS subscales demonstrated associations with sexual intercourse behaviors and sexting, supporting the criterion validity of the SMS. These findings suggest the relevance of the SMS in assessing sexual motives across diverse populations and behaviors.

Reasons People Give for Using (or Not Using) Condoms

Study participants (N = 348) were asked about 46 reasons that have been suggested for why people use or do not use condoms. Participants were asked which of these reasons motivated them when they were deciding whether to use condoms in 503 sexual relationships. Participants were classified into one of three roles based on their HIV status and the status of each sexual partner: HIV+ people with HIV- partners; HIV- people with HIV+ partners; and HIV- people with HIV- partners. Motivations were looked at in the context of each of these roles. Of the 46 reasons, only 15 were selected by at least 1/3 of the participants, and only seven were selected by at least half. Frequently reported reasons primarily concern protecting self and partner from STDs including HIV. Less frequently reported reasons involved social norms, effects of condoms on sex, and concern for the relationship. These findings have implications for clinical interventions.

Reformulating Sexual Script Theory

Sexual script theorists present sexual encounters as learned interactions that follow predictable sequences or `scripts'. Feminist research on heterosexual negotiation uses self-report data to argue that these scripts are gendered such that it is difficult for women to refuse unwanted sex. In this paper, we suggest that, notwithstanding claims made for script theory as a form of social constructionism, it incorporates individualistic and cognitive assumptions that ignore the social context in which self-report data are produced. Illustrating our argument with our own data from young women in focus group discussions talking about refusing unwanted sex, we provide an alternative theoretical perspective on this kind of self-report data, drawn from Edwards' (1995, 1997) concept of `script formulations'. In particular, we show how the `scripted' quality of sexual interaction is actively produced as part of speakers' orientation to issues of accountability. We describe five devices used to construct sexual encounters as scripted: (i) references to predictable stages; (ii) references to common knowledge; (iii) the production of consensus through seamless turn-taking and collaborative talk; (iv) the use of hypothetical and general instances; (v) active voicing. Through the use of script formulations, young women present the difficulty of saying no to unwanted sex as normatively difficult-as a commonplace, ordinary problem-such that they cannot be held accountable for their own specific difficulties, nor can negative dispositional attributes be made on that basis. Finally, we consider the differing implications of `script' and `script formulation' theories in working with young women to prevent unwanted sex.

An Exploration of the Discursive Constructions used in Young Adults' Memories and Accounts of Contraception

The study reported in this article uses discourse analysis to examine the meaning and significance of contraception for young adults and emphasizes the social construction of meaning to better explain what can limit and what can facilitate use of contraception. The study used memory work (Crawford et al., Emotion and Gender: Constructing Meaning from Memories. Sage, 1992) and group discussions to collect accounts of contraception. Analysis of the accounts revealed that constructions of contraception used in the memories all signified sex, which invoked wider gendered discourses surrounding sexuality. Such discourses gave rise to contradictory positionings for the actors within the memories. In contrast, the accounts of contraception from the group discussions were predominantly produced with reference to a health promotion discourse. However, further analysis revealed that the constitution of this discourse was always highly precarious. These findings are discussed in terms of the implications for health promotion efforts.

Risky Sexual Behavior in American White College Women: The Role of Sex Guilt and Sexual Abuse

Ninety-five sexually active White American female college students participated in a questionnaire study about their sexual behavior in the past 12 months. A path model was tested in order to assess specific hypothesized predictors of risky sexual behavior. As predicted, participants with greater sex guilt reported using condoms more and having had fewer sexual partners. The findings of this study suggest that White American female college students are at some degree of risk due to risky sexual behavior. Taking into account attitudes about sexuality and past sexual abuse along with the requisite training in condom use self-efficacy may enhance the success of interventions designed to reduce risky sexual behavior among White American female college students.

Theoretical Domains: A Heuristic for Teaching Behavioral Theory in HIV/STD Prevention Courses

The HIV/STD epidemics have broadened the need for better behavioral intervention programs and highlighted the importance of providing training in behavioral theory to frontline program practitioners. However, there is a lack of effective methods for teaching theoretical concepts to people who may not have a background in behavioral science. This article presents a solution to this challenge by introducing a new heuristic for teaching theory and for placing individual theories/models in a broader context. Using a broad framework, we identify five domains that influence behavior: risk appraisal, self-perceptions, emotions and arousal, relationships and social influence, and environmental and structural factors. Each domain is described, and a brief overview of supporting literature is provided. Following the presentation of domains, we discuss course structure and activities.

Correlates of self-efficacy for condom use among male clients of female sex workers in Tijuana, Mexico

Male clients of female sex workers (FSWs) in Tijuana, Mexico engage in high levels of unprotected sex. While behavioral change theories posit that self-efficacy predicts condom use, correlates of self-efficacy for condom use remain largely unstudied. We examined these correlates among male clients of FSWs in Tijuana. Eligible male clients were at least 18 years of age, HIV-negative, lived in Tijuana or San Diego, reported unprotected sex with a Tijuana FSW at least once in the past 4 months, and agreed to be treated for sexually transmitted infections (STIs). Participants completed an interviewer-administered questionnaire including demographics, substance use, psychosocial and psychosexual characteristics (e.g., outcome expectancies for negotiation of safer sex, social support, and sexual sensation seeking), and sexual behaviors. Participants also underwent HIV/STI testing. A stepwise hierarchical multiple regression analysis identified correlates of self-efficacy for condom use. Of 393 male clients, median age was 37 years. Participants were mostly Spanish-speaking and employed. Factors independently associated with higher self-efficacy for condom use were higher positive outcome expectancies for negotiation of safer sex, lower sexual sensation seeking scores, and higher social support scores. Both psychosocial and psychosexual factors may influence self-efficacy for condom use among male clients of FSWs. These factors represent central constructs in sociocognitive models that explain behavioral change and could be intervention targets for improving self-efficacy for condom use and, ultimately, safer sex behavior.

Integrating psychological theory into the design of an online intervention for sexual health: the sexunzipped website

Background

The Internet can provide a confidential and convenient medium for sexual health promotion for young people.

Objective

This paper describes the development of an interactive, theory-based website (Sexunzipped) aimed at increasing safe sexual behavior of young people, as well as an outline of the evaluation protocol.

Methods

The website focuses on safer sex, relationships, and sexual pleasure. An overview of the site is provided, including a description of the theoretical constructs which form the basis of the site development. An integrated behavioral model was chosen as the guiding theory for the Sexunzipped intervention. A randomized trial design will be used to evaluate the site quantitatively.

Results

The content of the site is described in detail with examples of the main content types: information pages, quizzes, and decision-making activities. We describe the protocol for quantitative evaluation of the website using a randomized trial design and discuss the principal challenges involved in developing the site, including the challenge of balancing the requirements of theory with young people’s views on website content and design.

Conclusions

Considerations for future interventions are discussed. Developing an online behavior-change intervention is costly and time consuming. Given the large public health potential, the cost involved in developing online interventions, and the need for attractive design, future interventions may benefit from collaborating with established sites that already have a user base, a brand, and a strong Internet presence. It is vital to involve users in decisions about intervention content, design, and features, paying attention to aspects that will attract and retain users’ interest. A central challenge in developing effective Internet-based interventions for young people is to find effective ways to operationalize theory in ways that address the views and perspectives of young people.

Predicting having condoms available among adolescents: the role of personal norm and enjoyment

OBJECTIVES

Having condoms available has been shown to be an important predictor of condom use. We examined whether or not personal norm and goal enjoyment contribute to predicting having condoms available in the context of cognition specified by the theory of planned behaviour (TPB).

DESIGN

Prospective survey study, with a baseline and follow-up measurement (at 3 months).

METHODS

Data were gathered using an online survey. In total 282 adolescents (mean age = 15.6, 74% female adolescents) completed both questionnaires. At baseline, demographics, sexual experience, condom use, TPB variables, descriptive norm, personal norm, and enjoyment towards having condoms available were measured. At T2 (3 months later) having condoms available was measured. Direct and moderating effects of personal norm and goal enjoyment were examined by means of hierarchical linear regression analyses.

RESULTS

Regression analyses yielded a direct effect of self-efficacy and personal norm on condom availability. In addition, moderation of the intention-behaviour relation by goal enjoyment added to the variance explained. The final model explained approximately 35% of the variance in condom availability.

CONCLUSIONS

Personal norm and goal enjoyment add to the predictive utility of a TPB model of having condoms available and may be useful intervention targets.

STATEMENT OF CONTRIBUTION

What is already known about this subject? Having condoms available is an important prerequisite for actual condom use. The theory of planned behaviour has successfully been applied to explain condom availability behaviour. The theory of planned behaviour has been criticized for not adequately taking into account affective motivation. What does this study add? Personal norm and goal enjoyment add to the predictive utility of the model. Personal norm explains condom availability directly, enjoyment increases intention enactment. Personal norm and goal enjoyment therefore are useful intervention targets.

Using a combined motivational and volitional intervention to promote exercise and healthy dietary behaviour among undergraduates

AIMS

This study tested the impact of combining a motivational intervention based on protection motivation theory (PMT, Rogers, 1983 [18]) plus a volitional intervention based on action planning and coping planning, as a way to promote the prevention of type 2 diabetes among UK undergraduates.

METHODS

Eighty-four participants were randomly assigned to either a control group or one of three experimental conditions: motivational intervention (PMT), volitional intervention (APCP), or combined motivational and volitional intervention (PMT&APCP). PMT variables, dietary and exercise behaviours were measured at three time-points over a four-week period.

RESULTS

The motivational intervention significantly changed PMT variables. The combined motivational and volitional intervention significantly decreased fat intake and increased the frequency of exercise relative to all other groups, and significantly increased the amount of fruit and vegetables consumed relative to control and volitional intervention groups.

CONCLUSIONS

These results suggest that motivational intervention is effective at changing cognitions but changing behaviour requires an intervention based on both motivation and volition.

Psychosocial risk factors for inconsistent condom use in young people with first episode psychosis

There is evidence of high rates of unprotected sex among young people with first episode psychosis compared to their peers. Little research has explored factors associated with condom use in this population. The current study examined the association between previously identified psychosocial risk factors and condom use in young people with early psychosis and their peers. Sixty-seven sexually active young people with first episode psychosis and 48 sexually active control participants matched on a number of sociodemographic factors completed a self-report survey. Increased probability of inconsistent condom use was associated with clinical status, younger age, unemployment, and the absence of peer support for condom use. Psychological distress, self-esteem, social support, substance use, and impulsivity were not associated with condom use. The results suggest that sexual risk-reduction interventions for young people with psychosis should target peer norms, particularly among those who are younger and unemployed.

Reducing sexually-transmitted infection risk in young people with first-episode psychosis

There is emerging evidence that young people with first-episode psychosis are at greater risk of sexually-transmitted infections (STI) than their peers. Theoretical constructs central to behavioural change theories, broadly defined as sexual health-related knowledge, attitudes, and beliefs, have guided most sexual risk-reduction interventions in other at-risk populations. The role of these constructs in the sexual risk behaviour of young people with early psychosis remains unknown. A convenience sample of 67 young people with first-episode psychosis and 48 healthy controls matched on a number of sociodemographic characteristics was recruited. Participants completed a survey assessing their sexual behaviour and sexual health-related knowledge, attitudes, and beliefs. Group differences and the role of these constructs in the condom-use behaviour of these young people were examined. Although some differences emerged, group similarities were prominent. Inconsistent condom use was predicted by clinical status, unemployment, and the absence of peer support for condom use. These results support previous findings that young people with psychosis have greater needs for STI prevention due to increased rates of unprotected sex. Risk-reduction interventions that target peer influence are important. Inquiry into a broader range of psychosocial factors could further our understanding of STI infection risk in early psychosis.

Emergency contraception use and non-use in young women: The application of a contextual and dynamic model

There have been many approaches to understanding contraception use including social cognition models which have been criticised for their individualistic approach and their static nature. The present quantitative study developed and refined a contextual and dynamic model of contraception use that was derived using qualitative research. This model conceptualizes the predictors of contraception use in terms of the meaning and importance of a range of social goals, perceptions of vulnerability, and constraints on or facilitators of contraception use each of which changes over time. The present study operationalized this model in relation to emergency contraception and explored differences between users and non-users and between episodes of use and non-use. In terms of users and non-users, the results showed that the users of emergency contraception showed a more positive view of an emergency contraception user, perceived greater support from their partner for emergency contraception use, rated themselves more at risk of pregnancy, and felt more confident about asking for emergency contraception. In terms of use and non-use, use was related to an increased belief about the risk of pregnancy, increased partner support, increased concern about health care professionals and the side-effects of the drug, and a more positive identity of an emergency contraception. The study has helped to develop and refine the model and has identified some key factors that are specifically relevant to emergency contraception use in a sample of women in education in and around London.

How do social norms impact HIV sexual risk behavior in HIV-positive men who have sex with men?: multiple mediator effects

This study examines mediation of the association between social norms and unsafe sexual behavior. Self-report data were collected from 675 HIV-infected men enrolled in a study exploring interventions for HIV risk behavior. Unsafe sex included any unprotected anal sex with HIV-negative or HIV status unknown partners in the last three months. Norms for condom use indirectly influenced unsafe sex through condom self-efficacy and/or safer sex intentions. Additionally, sexual behavior discontrol influenced unsafe sex regardless of other individual or social factors. Our results suggest that interventions consider the combined effects of condom self-efficacy, safer sex intentions and sexual behavior control.

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.

The intent and practice of condom use among HIV-positive men who have sex with men in Japan

To evaluate the intent and practice of condom use among Japanese HIV-positive men who have sex with men (MSM), a survey using anonymous questionnaires was carried out and 117 respondents were investigated. For anal sex and oral sex, respectively, 58.1% and 15.2% intended to use condoms and 47.2% and 12.4% used condoms all of the time. The intent of condom use decisively affected the practice of condom use and was closely related to the perceived risk level of HIV/sexually transmitted (STI) transmission. In anal sex, willingness to protect sexual partners from HIV infection was strongly related not only to the intent but also to the practice. Enhancement of willingness to protect oneself from STI was suggested to enhance willingness to protect his/her sexual partners from HIV infection with secondary enhancement of the intent or the practice of condom use. Specific support of MSM with HIV for improving the intent and practice of condom use is urgently needed.

A qualitative study of the relationship between alcohol consumption and risky sex in adolescents

This study examined how alcohol consumption over a single session can affect the likelihood of risky sex in adolescents. Risky sexual behavior, as defined in this study, included sexual intercourse without the use of contraception or aNY sexual behavior that was subsequently regretted. In-depth interviews were conducted with 64 adolescents (aged 14-17 years). Data were analyzed following the principles of Interpretative Phenomenological Analysis. The impact of alcohol consumption upon risky sexual behavior was found to operate through a "continuum of influence." The 5 effects or explanations within this continuum, possibly determined through the level of inebriation, are summarized as follows: (1) alcohol affecting young people's assessment of a person's sexual attractiveness; (2) alcohol used as an "excuse" for socially unacceptable behavior; (3) increased confidence and lowering of inhibitions; (4) impaired judgment in accurately recognizing and controlling a potentially risky situation; and (5) complete loss of control, memory loss, and "black-out." These explanations were ordered with increasing significance. That is, impaired judgment (Explanation 4) and complete loss of control (Explanation 5) arguably represented the most significant effects of drinking alcohol upon risky sexual behavior. For those participants who reported both risky and non-risky sexual behavior, risky events were more likely to occur when alcohol consumption had increased and when the impaired judgment and complete loss of control explanations were applicable. The implications of understanding this complex relationship are outlined, and they will be of interest to academics, practitioners, and policy-makers in the alcohol and sex fields.

Risky sexual behavior in low-income African American women: the impact of sexual health variables

In a sample of 163 low-income African American women, we used logistic regression analyses to test for associations between (a) 5 operationalized constructs theorized in the Sexual Health Model to impact one's overall sexual health (barriers to healthy sexuality, sexual anatomy and functioning, positive sexuality, sexual health care, and cultural identity) and (b) several measures of risky sexual behavior (consistent condom use, multiple concurrent partnerships, and overall sexual risk). No significant relationship was found between acculturation and risky sexual behaviors. Having sexual difficulties was positively associated with overall sexual risk and multiple concurrent partnerships. Favorable attitudes toward condoms were positively associated with consistent condom use. Desiring or intending pregnancy was positively associated with inconsistent condom use and overall sexual risk behavior This is only the second study linking sexual difficulties and risky sexual behavior The exact nature of this correlational relationship needs to be studied and replicated in different and more heterogeneous populations.

Social class, gender and psychosocial predictors for early sexual debut among 16 year olds in Oslo

BACKGROUND

Variations in early sexual debut among 16 year olds were investigated by social level variables, parental occupation, gender, ethnicity, family structure, family functioning, and individual level variables, future aspirations, academic and social self-perception, and depressed moods.

METHODS

The variations in sexual debut were investigated by examining proportions of 16 year olds reporting their first intercourse before age 16. The data were collected by self-reporting questionnaires administered to in-school-youth, in Oslo. Multivariate logistic regression analyses were used to test for associations. Gender interactions with all variables were tested.

RESULTS

Overall, 25% reported early debut. Independent effect of social class on differences in proportions in early sexual debut were found. Gender interaction with social class, ethnicity and academic self-perception as they associate to proportions having had early sexual debut, were found. For girls the pattern of social class differences was linear and the highest proportions were found among working classes. For boys the pattern was U-shaped and upper managerial and manual working class youth had similar, higher proportions of early debutants. High scores of parental monitoring, future aspirations and academic self-concept and low scores of depressed moods, are protective factors. While high social self-perception is positively associated with early debut for both genders.

CONCLUSION

Early sexual debut varies according to social class, following gender-specific patterns, among 16 year olds in Oslo. The negative association between early debut and academic self-perception are for boys less influenced by other social and individual level factors, than for girls.

Effect of social exclusion on the risk of teenage pregnancy: development of hypotheses using baseline data from a randomised trial of sex education

STUDY OBJECTIVE

The UK government argues that "social exclusion" increases risk of teenage pregnancy and that educational factors may be dimensions of such exclusion. The evidence cited by the government is limited to reporting that socioeconomic disadvantage and educational attainment influence risk. Evidence regarding young people's attitude to school is not cited, and there is a lack of research concerning the UK. This paper develops hypotheses on the relation between socioeconomic and educational dimensions of social exclusion, and risk of teenage pregnancy, by examining whether dislike of school and socioeconomic disadvantage are associated with cognitive/behavioural risk measures among 13/14 year olds in English schools.

DESIGN

Analysis of data from the baseline survey of a study of sex education.

SETTING AND PARTICIPANTS

13/14 year old school students from south east England.

MAIN RESULTS

The results indicate that socioeconomic disadvantage and dislike of school are associated with various risk factors, each with a different pattern. Those disliking school, despite having comparable knowledge to those liking school, were more likely to have sexual intercourse, expect sexual intercourse by age 16, and expect to be parents by the age of 20. For most associations, the crude odds ratios (ORs) and the ORs adjusted for the other exposure were similar, suggesting that inter-confounding between exposures was limited.

CONCLUSIONS

It is hypothesised that in determining risk of teenage pregnancy, the two exposures are independent. Those disliking school might be at greater risk of teenage pregnancy because they are more likely to see teenage pregnancy as inevitable or positive.

Need for intimacy in relationships and motives for sex as determinants of adolescent condom use

PURPOSE

To investigate the extent to which need for intimacy in relationships and motives for sex are capable of distinguishing between adolescents who always have protected sex and adolescents who do not, with reference to both steady and casual relationships.

METHODS

Seven-hundred-and-one adolescents (424 males and 277 females) aged 15 to 23 years filled out a questionnaire assessing determinants of sexual behavior and various outcome behaviors, such as having casual sex and condom use.

RESULTS

Two-thirds of the participants (470) were sexually experienced. Discriminant functions using constructs of the Theory of Planned Behavior (attitude, subjective norm, self-efficacy), as well as the need for intimacy in relationships and motives for sex, were found to distinguish significantly between adolescents who always had protected sexual intercourse and adolescents who did not. This was valid both for sex within steady and within casual relationships. Besides a positive attitude and high perceived subjective norms, protected sex with a steady partner was characterized by low scores on the scale for the motive for sex to express love, and on the scale for the need for intimacy in relationships. Consistent condom use with casual partners was related to high self-efficacy, attitude, and perceived subjective norms, as well as a greater need for intimacy in relationships. Gender differences emerged with respects to determinants of (un)safe sex with casual partner(s), in that for males the variables of the Theory of Planned Behavior were most important in distinguishing those who had unsafe casual sex from those who had safe casual sex. For females, on the other hand, the variables concerning the meaning attached to having sex or to the relationship within which sex occurs seemed to be of more significance in explaining (un)safe sex with casual partner(s). However, owing to small subsamples, caution is warranted when interpreting these differences.

CONCLUSIONS

In adolescence, the factors which influence the decision to have (un)protected sex depend on the kind of relationship that exists between the partners. In addition, the goals which adolescents pursue with regard to their relationships and with regard to having sex fulfill an important role in the decision-making process whether to use condoms.

Scales measuring psychosocial antecedents of coital initiation among adolescents in a rural southern state

The psychometric properties of psychosexual scales designed to examine intentions toward sexual intercourse were examined. Participants from 22 schools in central Alabama provided data on demographics, knowledge, attitudes, beliefs, and intentions toward sexual intercourse. Theoretical constructs from Theory of Reasoned Action and Social Cognitive Theory guided the development of items assessing psychosocial aspects of sexual intercourse. Findings indicated that approximately half of the conceptual items (13 items) loaded on four factors. The four scales were (a) Coital Intentions, (b) Attitudes toward Negative Sexual Outcomes, (c) Social Norms toward Premature Sex, and (d) Self-efficacy of Sexual Refusal Skills. These factors showed adequate independence and explained 46% of the variance in the data. Cronbach alpha ranged from .69 to .78. Scales show acceptable evidence for evaluation; however, additional research from other geographical districts and other ethnic groups is needed to confirm their generalizability.

Evaluation of a sexual health approach to prevent HIV among low income, urban, primarily African American women: results of a randomized controlled trial

This randomized controlled trial evaluated an innovative culturally specific sexual health intervention-targeting, but not limited to, low-income African American women-in which HIV and sexually transmitted disease prevention strategies were combined with comprehensive sexuality education. The intervention was delivered and evaluated in community-based settings to 218 participants randomly assigned to treatment or a no-treatment control group. Participants were interviewed at pretest and 3 and 9 months after the intervention to assess changes in both sexuality and HIV risk variables. The intervention was effective in improving sexual anatomy knowledge at both 3- and 9-month follow-up. For a subset of women engaging in unprotected sex at pretest, the intervention group reported an increase in positive attitudes toward the female condom at 9-month follow-up. Reasons for the weak treatment effect are discussed in the context of challenges inherent in conducting community-based research with high-risk populations and sensitive topics. Recommendations are provided for improving sample attrition, statistical power, and response bias and for altering the intervention so as to strengthen its impact.

Correlates of HIV risk among Ecuadorian adolescents

The purpose of this study was to examine the relationship of HIV knowledge, demographics, and psychosocial factors with HIV risk behavior among high school students (N = 805) in urban and rural regions of Ecuador. Forty-three percent of the participants reported being sexually experienced. Of the sexually experienced participants, 50% reported never using condoms for intercourse, and 70% did not use condoms at last intercourse. A small minority of the sample felt that they were at risk for contracting HIV (18.5%). Educational aspirations past high school and residence in an urban area were significantly associated with decreased HIV risk (condom use at last intercourse and abstinence). High self-efficacy for condom use and strong refusal skills to unsafe sex were also significantly associated with decreased HIV risk. Consistent with prior research, the participants that reported their peers were sexually experienced were significantly more likely to have had sex. The discussion focuses on the use of interventions and education for promoting safer sexual behavior among Ecuadorian adolescents.

Psychosocial factors associated with self-reported male condom use among women attending public health clinics

BACKGROUND

Previous research has identified factors associated with condom use. However, less information exists on the impact that a history of sexually transmitted disease (STD) has on condom use.

GOAL

To identify factors associated with self-reported male condom use that relate to a history of STD.

STUDY DESIGN

Women attending STD clinics completed a survey that assessed sexual behavior, STD history, and psychosocial characteristics. Binomial regression was used to estimate the association between these factors and condom use.

RESULTS

Of the 12 factors included in the regression model, 11 were significant for all women. When the analysis was stratified by STD history, high condom use self-efficacy, high convenience of condom use, and high frequency of condom use requests were significantly associated with increased condom use among women with or without a history of STD. Factors such as greater perceived condom use norms, higher perceived level of risk, and greater need for condom use in long-term relationships were significantly associated with increased condom use among women with a history of STD. Factors such as shorter duration of a relationship, less violence in the relationship, and lifetime drug use were associated with increased condom use among women with no history of STD.

CONCLUSIONS

The pattern of psychosocial factors determining condom use is modified by a positive history of STD. These findings suggest that a history of STD could be an important factor in targeting condom use interventions.

Behavioural interventions to prevent HIV infection: rapid evolution, increasing rigour, moderate success

Behavioural interventions aim to alter behaviours that make individuals more vulnerable to becoming infected or infecting others with HIV. Research in this field has developed rapidly in recent years. Increased rigour in the design and conduct of evaluations and moderate successes in bringing about behaviour change in target populations are the key achievements so far. This paper reflects on these developments, addresses recent innovations and highlights likely areas for future work. Discussion focuses on maximising the potential effectiveness of new interventions, methodological issues relating to evaluation and implementation of interventions into practice. The paper concludes there is evidence that interventions deemed effective under evaluation conditions can be implemented in HIV prevention services and that this is the next major challenge. The immediate goal should be consolidation of the learning that has occurred, particularly efforts to maintain theoretical and evaluative rigour whilst encouraging increased collaborative partnerships between researchers, service providers and affected communities.

Communication and consistency: AIDS talk and AIDS attitudes

The main hypothesis tested in this study is that the frequency of talk about a particular domain is related to the consistency of attitudes in that domain. This hypothesis was developed by viewing talk as one of the ways in which people express their identities and by exploring the interpersonal processes involved in the construction of consistency. The hypothesis was tested with a questionnaire completed by 73 students at Oxford University. The first part of the questionnaire consisted of items related to attitude, and the second part contained questions about respondents' conversations about AIDS and related topics. Strong support was found for the hypothesis relating frequency of talk with consistency of attitudes. Data about who the respondents talked to about AIDS and the perceived agreement between them and their discussion partners demonstrated the homogeneity of the discussion environment. The implications for understanding attitude formation and change in everyday social contexts are considered.

Hispanic adults' beliefs, attitudes, and intentions regarding the female condom

The present study used the theory of planned behavior (TPB) (Ajzen, 1985) augmented by AIDS knowledge to investigate factors influencing intentions of Hispanic adults to use the female condom. A total of 146 persons (75 women and 71 men; mean age, 27 years) recruited from community-based organizations completed an anonymous survey regarding intentions to use the female condom with their main sex partner. The TPB model had greater predictive utility for women's, than for men's, female condom use intentions. For men, attitudes and norms did not predict female condom use intentions, but greater AIDS knowledge was related to lower intentions to use the female condom, above and beyond the TPB constructs. Perceived behavioral control, operationalized as self-efficacy, significantly increased the predictive utility of the TPB model for women's female condom use intentions but not for men's. Behavior change strategies to increase female condom use are discussed in light of these findings.

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.

Barriers to and Facilitators of HIV–STD Behavior Change: Intrapersonal and Relationship-Based Factors

This article draws on clinical, cognitive, and health psychology literature to explore a range of barriers to sexual risk behavior change. It is divided into 5 sections, each of which presents obstacles and solutions to address them. The first 4 sections are organized around antecedent factors commonly addressed in models of risk behavior. Barriers related to effective information, risk perception, attitudes and intentions, and behavioral skill acquisition are discussed. The 5th section focuses on barriers related to the psychological and social context of sexual encounters, factors relatively underexplored in traditional approaches to risk reduction. It is believed that future intervention programs will be strengthened by incorporating a more integrative and comprehensive approach to intrapersonal and interpersonal aspects of sexual behavior.

Factors associated with gay men's sexual behaviours and risk on holiday

Findings are presented from a questionnaire survey of 562 gay men resident in southern England on their sexual behaviour in the context of holidays. Data were gathered during summer 1996 by means of a self-completion questionnaire; 395 men reported at least one holiday undertaken in 1996 and the analysis focuses on the first or only holiday described. Of 391 men giving details of sexual activity, 187 reported sex with a new partner, 113 men reported penetrative sex and 17 reported penetration without consistent use of condoms. Sexual activity on holiday was predicted by: being on holiday alone or with friends, taking condoms, being motivated by 'gay social life and sex' in planning a holiday, higher expectations of sexual activity/risk and a higher number of new partners at home. Penetrative sex was predicted by: more sexual partners on holiday, taking condoms and higher expectations of sexual activity/risk. Unprotected sex was predicted by: not taking condoms, higher expectations of sexual activity/risk and positive HIV status. Survey findings are discussed in relation to previous research, and implications for travel-related HIV prevention initiatives targeting gay men are explored.

Hearing our voices: assessing HIV prevention needs among Asian and Pacific Islander women

The purpose of this study was to (a) assess the impact of HIV/AIDS on the Asian-Pacific Islander (API) community and changes in their behavior due to AIDS, (b) identify perception of risk, HIV risk behaviors, factors contributing to those behaviors, barriers to HIV prevention, and the types of prevention programs that would benefit their community, and (c) describe culturally appropriate considerations when designing HIV prevention strategies for API women. Thirty API adults participated in three different groups. Focus group interviewing methods were used, guided by the Health Belief Model. The women had numerous concerns about HIV that placed them at risk for infection, such as their inability to talk with their sexual partners about condom use due to the cultural and taboo nature of sexual topics. All groups concluded that for HIV prevention interventions to be successful, they must be tailored to the cultural and specific needs of API women.

Building community partnerships to improve HIV prevention efforts: implications for nurses

Acquired immune deficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV), is a major and complex public health crisis. The Centers for Disease Control and Prevention (CDC) issued effective community-based HIV prevention planning in its 1993 "Supplemental Guidance on HIV Prevention Community Planning" through the formation of community planning groups (CPGs). These guidelines are reviewed along with behavioral and social science theories that are the crux of HIV prevention theory-based research and program development. Nurses' roles in community-based HIV prevention as community advocates, HIV prevention program planners, practitioners, and researchers are discussed. The article concludes with nursing implications for HIV prevention.

The evaluation of motivation for sexual health among women

This study conducted a psychometric evaluation of the construct validity of the Health Self-Determinism Index-Sexual (HSDI-S). The instrument was modified to measure motivation related to sexual health rather than motivation of general health in the Health Self-Determinism Index (HSDI). The HSDI-S was completed by 260 conveniently selected women (between the ages of 18 and 44) attending primary-care clinics in the southeastern United States. Confirmatory factor analysis using LISREL did not validate the four subscales of the original HSDI. Subsequent exploratory and confirmatory factor analysis isolated a single-factor model composed of eight items: four judgment items and four external/internal cues items. This finding is suggestive that changes in wording appear to have shifted the responses from motivation for sexual health to that of women's perception of their role in intimate relationships. The eight extrinsically worded items isolate a single-factor model of social and cultural influences of child-bearing-age women's intimate relationships.

Correlates of condom use in the young adult population in Ontario

OBJECTIVES AND METHODS

Data from the Ontario Health Survey were used to identify sociodemographic, lifestyle and sexual history characteristics associated with the use of condoms for protection against sexually transmitted diseases (STDs) in randomly selected adults between the ages of 16 and 44 years who had had two or more sexual partners in the 12 months before the survey (n = 2,699).

RESULTS

Forty-two percent reported not having used condoms for protection against STDs. Those most likely to use condoms were 16 to 24 years of age, males, students, non-binge-drinkers, urban residents, and those at higher risk for HIV/AIDS. Of those who used condoms, 68% did not use them consistently. Individuals most likely to always use condoms were 16 to 24 years of age, males, students, non-binge-drinkers, and those with secondary school education. Age, gender, occupational activity, and non-binge-drinking were common correlates of both condom use and consistent use.

CONCLUSIONS

Public health messages should be focused on people with multiple sex partners who are not using condoms for STD protection, including rural residents, those with high levels of education, and those over 34 years of age.

Identification of social cognitive variables as predictors of safer sex behavior and intent in heterosexual college students

The purpose of this study was to identify social cognitive factors significantly associated with consistent condom use and safer sex intentions for heterosexual college students. No or new relationship involvement, positive attitudes toward condoms, higher HIV risk perceptions, being male, and being younger were associated with more consistent condom use. Higher HIV risk perceptions, positive attitudes toward condoms, safer sex negotiation, no or newer relationship involvement, lower classification, and higher safer sex perceptions of self-efficacy were associated with increased intent to engage in safer sex. HIV knowledge was not associated with safer sex intent or condom use. HIV intervention must go beyond presenting information. Intervention must incorporate social cognitive factors associated with safer sex intent and practice into their design, targeting groups and building safer sex skills.