Gender Differences in HIV-Related Sexual Behavior among College Students from Spain and Portugal

Condom Use Beliefs Differ According to Regulatory Focus: A Mixed-Methods Study in Portugal and Spain

Reports worldwide have been showing increasing rates of sexually transmitted infections (STIs) and condomless sex in recent years. Research has identified several individual and situational variables that can determine the decision to use condoms or forgo their use. We argue that such a decision can also be shaped by motives related to pleasure and safety (i.e., regulatory focus in sexuality). Using open ended questions, we asked 742 Portuguese and Spanish adults to indicate situations and reasons that could inform the decision making process with casual partners and the functions/attributes related to condoms. Using thematic analyses, we coded the drivers of condomless sex and condom use into themes and subthemes, and computed their frequencies. Using quantitative measures, we also asked participants to indicate their condom use expectancies and perceived barriers. Comparing participants according to regulatory focus revealed some differences. Pleasure promotion participants were more likely to consider that condom use decision making is driven by unexpectedness, pleasure, and intimacy pursuit, attached more pleasure reduction functions to condoms, expected more negative outcomes in condom use, and endorsed more sensation and partner barriers in condom use. In contrast, disease prevention participants were more likely to consider that condom use decision making is driven by adequate sexual education, responsibility, and behavioral control, and attached more health protective functions to condoms. These differences can inform the development of tailored intervention and awareness campaigns aimed at helping people to use condoms more consistently with casual partners and to avoid behaviors that put them at risk of STI transmission.

Factors affecting the safe sexual behaviors of Korean young adults by gender: a structural equation model

PURPOSE

The aim of this study was to determine the factors that influence safe sexual behaviors of Korean young adults and identify differences by gender.

METHODS

This study aimed to determine which factors affected safe sexual behaviors based on the Theory of Planned Behavior. Data from 437 Korean young adults (in their 20s and 30s) were collected via online survey between January 3 and January 28, 2022. The questionnaire included items on sexual body image, sexual role perception, sexual attitudes, sexual socialization, sexual communication, and safe sexual behaviors. Structural equation modeling was performed.

RESULTS

According to the overall model fit of the hypothetical model, the final model was acceptable and explained 49% of safe sexual behaviors. Sexual attitudes (β=-.70, p<.001) and sexual communication (β=.53, p<.001) directly affected safe sexual behaviors, and sexual role perception (β=.42, p<.001) indirectly affected safe sexual behaviors in a combined model. There were gender differences in the path from sexual attitudes (β=-.94, p<.001) and sexual communication (β=.66, p<.001) to safe sexual behaviors and from sexual body image (β=.27, p<.001) to sexual communication.

CONCLUSION

Sexual attitudes and sexual communication were predictors of safe sexual behaviors, which differed by gender. Strategies that consider sexual attitudes, sexual communication, sexual role perception, and differences between men and women should be developed to improve the safe sexual behaviors of young adults.

Knowledge and Risk Behaviors Regarding Human Immunodeficiency Virus Transmission among Portuguese Healthcare Students

BACKGROUND

Human immunodeficiency virus (HIV), the agent responsible for acquired immunodeficiency syndrome, remains a worldwide public health problem. Therefore, this study aimed to assess Portuguese healthcare students' knowledge of HIV, identify risk behaviors for HIV transmission, and assess the frequency of HIV testing and its dissemination by general practitioners.

METHODS

A cross-sectional observational study was conducted using an anonymous questionnaire published online. The questionnaire was administered to Portuguese healthcare students who voluntarily agreed to participate in the study after clarifying its objectives and procedures.

RESULTS

Most students were aware of the three main HIV transmission routes; however, 66.3% were unaware of the level A recommendation for HIV screening in adolescents and adults. In addition, 59.6% of the students were never informed by their general practitioner about HIV screening tests or risk behaviors for HIV transmission. Of the sample, 78.9% had never been tested for HIV infection. Of the 74.6% of sexually active students, 82.0% had or had already had unprotected sex (without a condom). Men showed riskier sexual behaviors than women. None of the inquiries reported intravenous drug use, and most students (69.9%) never shared personal objects.

CONCLUSION

General practitioners and awareness campaigns need to alert and disseminate HIV screening tests. Sexual health and risk behaviors should be addressed more frequently in schools to educate this population because prevention is the best strategy against HIV transmission/contraction.

Explicating factors that explain condom use intention among in-school adolescents in Botswana: a structural equation modelling approach

Knowledge with respect to adolescents' intentions to engage in protective sexual behaviours is still deficient in numerous countries around the world, particularly in Sub-Saharan Africa (SSA) where HIV prevalence is the highest. Increasing cross-sectional research suggests that the theory of planned behaviour (TPB) is robust in predicting condom use intentions. This study used secondary, baseline data from a study involving 794 in-school adolescents. A structural equation model was applied to the data. Latent variables were used to validate the applicability of the TPB in HIV/AIDS prevention among adolescents in the Botswana context. The predictors of interest were all derived from the TPB. The results revealed that the TPB predictors, apart from affective and instrumental attitude, were predictive of condom use intention among Batswana adolescents. The independent variables explained 57% of the variance in the model. These results suggest that the TPB is recommended as a framework to establish the predictors of condom use intention among Batswana in-school adolescents. Policy makers working on developing HIV education programmes or interventions targeted at adolescents should improve the intention to use condoms via promotion of positive instrumental attitudes, subjective norms and perceived behavioural control beliefs of condom use.

Applicability of the Theory of Planned Behavior for Predicting Alcohol Use in Spanish Early Adolescents

According to the theory of planned behavior (TPB), intentions to perform a specific behavior are the result of attitudes, norms, and perceived control, and in turn, intentions and perceived control are the main predictors of the behavior. This study aimed to test the applicability of TPB in predicting alcohol use in normative pre-adolescents. The sample was composed of 755 Spanish adolescents aged 11 to 15 (M = 12.24; SD = 0.56), 47.1% females, from 12 state secondary schools in Spain. The results of path analysis indicate that positive attitudes towards alcohol, favorable norms towards alcohol, and offer vulnerability (perceived control) are significantly positively related to intentions to use alcohol as well as negatively related to actual behavioral control (i.e., actual strategies to avoid alcohol use). In turn, intentions to use and actual control predict higher alcohol frequency and heavy drinking. Significant indirect effects of these antecedents were found on alcohol outcomes through the mediation of intentions and actual control. The findings suggest that the validity and applicability of the TPB in normative pre-adolescents depend on the severity of alcohol use and point to a need to consider negative social influence in decision making processes in early adolescence.

Explanatory Psychological Factors of Inconsistently Condom Use among Spanish University Students: Gender Differences

More than 50% of Spanish youth does not use of condoms correctly and consistently. University students are a particular population at high risk of the HIV infection, other STIs and unwanted pregnancies. The influence of psychological variables in using of condom is analyzed by gender and type of sexual relationship. A total of 256 females and 168 males were assessed (Mage= 20.62; SD = 2.16). A regression logistic analysis showed that sexual sensation seeking appears as an explanatory variable of inconsistently condom use in both females and males in vaginal intercourse, steady relationship intercourse and sex under the alcohol and other drugs effects (adjusted odds ratio between 1.095 and 1.124). Moreover, self-esteem appears as a risk factor and extraversion as a protective factor of use of condom in females. On the other hand, neuroticism reveals itself as a protective factor and fear of negative evaluation as a risk factor of use of condom in males. It is necessary to know the psychological mechanisms that underlie sexual risk behaviors for adapting interventions to individual and contextual characteristics.

Factorial Structure and Psychometric Properties of a Brief Scale of the Condom Use Self-Efficacy for Spanish-Speaking People

BACKGROUND

Studies have shown the role played by perceived self-efficacy in explaining condom negotiation and condom use.

AIMS

The factorial structure and the psychometric properties of the Brief Condom Use Self-Efficacy Scale are presented.

METHOD

The study included 368 men and 456 women aged 17 to 55 years ( M_age = 25.01, SD = 6.93).

RESULTS

Exploratory factor analysis yielded three factors: fear of rejection, impulse control, and condom acquisition and negotiation, which together accounted for 68% of the total variance. That structure was confirmed through confirmatory factor analysis. Cronbach's alpha for the Brief Condom Use Self-Efficacy Scale was .71. The scale provided adequate convergent validity, and positive correlations were observed between self-reported condom use and self-efficacy for use of other barrier methods.

DISCUSSION

This brief instrument could be a useful and appropriate measure to assess the types of condom use self-efficacy that occur at the different moments of a sexual relationship.

Psychometric Properties of the Condom Use Barriers Scale for Adolescents

Inconsistent condom use in young people is related to the perceived barriers to their use. The psychometric properties and factor structure of the new Condom Use Barriers Scale for Adolescents (CUBS-A) are analyzed. Concurrent validity was assessed by the Attitude towards condom use subscale of the validated HIV-AS test and the percentage of condom use variable. A total of 629 Spanish adolescents whose mean age was 15.17 (SD = 1.09; 51.5% boys) participated. Exploratory factor analysis supported a 15–item instrument with four factors: negotiation skills, perceived feelings, negative aspects of condoms, and disruption of the sexual experience, which explained 41.89% of the total variance (KMO = .84; χ2 = 1071.93; p < .001). The results show high internal consistency (α = .86) and a good fit of the data to the model (NNFI = .93; CFI = .95; IFI = .95; RMSEA = .04). Its total score and most of its factors show acceptable correlation with the percentage of condom use, values that support the criterial validity (p ≤ .05). Gender differences were found in most subscales (p ≤ .001). The CUBS-A is a valid and reliable new instrument for assessing perceived barriers in adolescents for using condoms to protect themselves during sexual intercourse.

Factors influencing college women's contraceptive behavior: An application of the integrative model of behavioral prediction

OBJECTIVE

This study investigated variables within the Integrative Model of Behavioral Prediction (IMBP) as well as differences across socioeconomic status (SES) levels within the context of inconsistent contraceptive use among college women.

PARTICIPANTS

A nonprobability sample of 515 female college students completed an Internet-based survey between November 2014 and February 2015.

METHODS

Respondents were asked about their contraception use, knowledge and information sources, demographic information, and IMBP factors, including attitudes, norms, and perceived behavioral control (PBC).

RESULTS

While overall attitudes, norms, PBC, and intentions for contraceptive use were high, only 46.8% of women used contraception consistently. Data also revealed only moderate levels of knowledge about contraception. While there were no differences across SES levels for attitudes, PBC, norms or knowledge, SES levels did differ in sources used to acquire contraceptive information.

CONCLUSIONS

This study highlights the need to consider where college women acquire contraceptive information which is associated with SES.

Indirect and direct perceived behavioral control and the role of intention in the context of birth control behavior

Unintended pregnancies can have negative consequences for both mother and child. The focus of this study was to utilize perceived behavioral control measures (PBC; part of the theory of planned behavior) to identify relevant behavioral determinants of birth control use. This study also tested associations between direct and indirect PBC measures and intention of birth control use and between intention and birth control use. The methods included a randomly selected sample of patients at a health care system in the Upper Midwest who were sent a self-administered survey, with 190 non-pregnant women returning completed surveys. Participants indicated a high level of control over using birth control, and a significant positive correlation was observed between direct and indirect PBC measures. Participants also reported high intentions to use birth control, and a significant positive correlation was observed between intention and PBC. Additionally, both PBC measures and intention were independently and significantly associated with behavior, and PBC remained significantly associated with behavior when intention was added into the model. In conclusion, compared to the previous literature, this study is unique in that it examines indirect PBC measures and also the important role that PBC plays with actual birth control behavior.

Construction and Validation of a Self-Efficacy Scale for Latex Barrier Use

Some studies have concluded there is a relationship between perceived self-efficacy and behaviors that prevent HIV transmission. This paper presents the construction and validation of the latex barrier use self-efficacy scale (LBSS), which 480 participants filled out. Exploratory factor analysis yielded two components: positive expectations of self-efficacy (ES-POS) and negative expectations of self-efficacy (ES-NEG), which together accounted for 65.59% of total variance. That structure was later verified through confirmatory factor analysis. Internal consistency was .80 for the total scale, and .78 for each of the two factors. Moreover, the instrument had adequate convergent validity and was positively related with condom use self-efficacy, attitudes toward condom and latex barrier use, and ability to refuse sex if the partner refuses to use preventive methods. In conclusion, this instrument is a useful measure of self-efficacy in latex barrier use.

Mediation analysis of an effective sexual health promotion intervention for Spanish adolescents

The objective of this study is to determinate the factors that mediate in the self-reported consistent condom use over the 24-months post-intervention period in adolescents who received COMPAS, a sexual health promotion intervention targeted to Spanish adolescents. Twelve high schools located in Spain were randomized to an intervention or a control group with baseline, immediate-post, 12 and 24-month post-intervention assessments. Self-reported consistent condom use by 24 months post-intervention was the primary outcome. Based on the theory of planned behavior, we identified which theory-based variables mediated the intervention's effect on consistent condom use. Serial multiple mediation analysis indicated that attitudes toward condom use, when there are obstacles to use it, and self-efficacy mediated the COMPAS's effect in increasing consistent condom use. This is the first study that identifies the theoretical constructs that mediate the efficacy of a school-based intervention to promote sexual health in adolescents from Spain.

Sexual risk behaviors increasing among adolescents over time: comparison of two cohorts in Spain

Despite advances in treatment and prevention, HIV/AIDS remains a serious health and social problem. This study's objective is to examine sexual behavior, levels of knowledge, and attitudes toward HIV/AIDS between two cohorts in Spanish adolescents, and to analyze gender differences in these cohorts. Participants were 2132 adolescents between 15 and 18 years of age: 1222 in 2006 (43.2% boys) and 910 in 2012 (54.1% boys). The results indicate lower HIV knowledge and less favorable attitudes about HIV/AIDS in the 2012 cohort. In addition, adolescents from the 2012 cohort had their first sexual intercourse at an earlier age and have more sexual partners than those from the 2006 cohort. Compared to boys, girls engage in fewer risky behaviors, although they did not use condoms with their stable partner; girls tended to use condom less when they were in a stable relationship than boys. This study confirms the insufficiency of prevention campaigns as well as the need to improve the impact from programs that promote healthy sexual habits. Assuming comparability of cohorts, this study suggests increased risk of HIV/AIDS over time.

Sexual and reproductive health of Portuguese adolescents

BACKGROUND

As adolescent pregnancy and sexually transmitted infections (STIs) are major sources of morbidity, preventing them is an important health goal for Portuguese society.

OBJECTIVE

To review data on the knowledge, attitudes and statistics on sexual and reproductive health.

METHODS

A systematic review was conducted including peer-reviewed articles addressing issues influencing the sexuality of Portuguese adolescents (aged 13 to 19), published up to 2011 and conducted in any type of setting. After crossing-cleaning the reference list, 33 articles were included.

RESULTS

The rate of sexual activity by Portuguese adolescents is high (44%-95%), but there has been an increase in the age of intercourse debut (currently 15.6 years). Early commencement of sexual intercourse is associated with smoking and regular alcohol consumption. Condoms are the most frequently chosen contraceptive method for first (76%-96%) and subsequent (52%-69%) sexual encounters. The perception of a double standard in sex still exists in teenage culture for both genders and influence behavior. There are significant differences between migrant and native adolescents: African adolescents initiate sexual intercourse at earlier ages and are more likely to have unprotected sex. Only one-third of Portuguese teenagers have ever visited a health facility to seek counseling concerning contraception or STIs, and less than half have ever attended classes on reproductive health. Very few (12%) have knowledge about Chlamydia trachomatis infection. The prevalence of STIs in Portuguese youth is unknown. The adolescent fertility rate is still high (14.7 births per 1000 females aged 15-19 years), but it, as well as the rate of abortion, is steadily decreasing.

CONCLUSIONS

There is still a long way to go towards promoting a resourceful young population. Citizens and institutions must focus on increasing both the competence of youths and external supports. Information must be provided systematically and health services must have greater accessibility. Studies addressing cultural and environmental determinants that contribute to the molding of the sexual conduct of Portuguese adolescents must be held to produce new and effective culturally sensitive health interventions.

Differences in psychosocial risk variables for HIV as a function of sexual experience

The aim of this study was to analyze the differences in psychosocial risk variables for HIV as a function of sexual experience in an adolescent population. The study sample consisted of 846 adolescents of both sexes aged between 14 and 19 years. Participants responded to several questionnaires that assessed four psychosocial variables related to risk sexual behavior for HIV infection: 1) perception of peer group norms, 2) condom use self-efficacy, 3) attitudes towards condom use and 4) parental communication about sexuality, STIs, HIV and pregnancy. Participants in both groups with sexual experience (with and without penetration) reported better communication with their mothers on sexuality and scored higher in positive attitudes towards condom use than those in the group without sexual experience. The sexual experience with penetration group perceived more negative peer group norms related to safe sexual behavior than the group without sexual experience; the group without sexual experience had a higher perception of condom use self-efficacy than the sexual experience with penetration group.

Psychosocial Correlates of Condom Use and their Relationship with Worry about STI and HIV in Native and Immigrant Adolescents in Spain

The goal of this study was to analyze how worry about sexually-transmitted infections (STI) and HIV influences attitudes and self-efficacy towards condom use, HIV-related knowledge, HIV-perceived susceptibility and HIV-misconceptions in a multicultural sample in Spain. The sample was composed of 3,051 adolescents aged between 14 and 19 years old who lived in Spain. Of these, 67.7% were native Spaniards and the remaining 32.3% were Latin American immigrants. Results showed that worry about STI and HIV has a direct influence on condom use self-efficacy and HIV-knowledge and HIV-perceived susceptibility. Native Spanish adolescents showed higher positive attitudes towards condom use, greater HIV-knowledge and HIV-perceived susceptibility, and lower negative attitudes towards condoms use and HIV-misconceptions than Latin American adolescents. In the discussion, the importance of worry about STI and HIV is highlighted as a mediator variable that can predict risky sexual behavior and is related to cultural origin.