Socio-demographic, marital and psychosocial predictors of safe sex behaviour among Mozambican women at risk for HIV/AIDS

Heterosexual encounters remain the primary route for HIV transmission in Africa. Safer sex behaviour is not adopted by many women due to several social and psychological factors. This paper aims to identify socio-demographic, marital and psychosocial predictors associated with current sexual activity and condom use in Mozambican women at sexual risk for HIV/AIDS. Women (173), patients at a public hospital and at risk for HIV infection, completed measures of condom use negotiation self-efficacy, perceived barriers against safer sex, current sexual activity and condom use. Having more than 6 years of education and being younger and single were significant predictors for current sexual activity and condom use. Regarding psychosocial factors, talking about AIDS with partners, condom use negotiation self-efficacy and fewer perceived barriers to safer sex were significant predictors for current sexual activity (intention to use and buy/get condoms). Condom use negotiation self-efficacy is a significant predictor for condom use. These results should be considered in new HIV prevention intervention design in Mozambique.

Increasing condom use in heterosexual men: development of a theory-based interactive digital intervention

Increasing condom use to prevent sexually transmitted infections is a key public health goal. Interventions are more likely to be effective if they are theory- and evidence-based. The Behaviour Change Wheel (BCW) provides a framework for intervention development. To provide an example of how the BCW was used to develop an intervention to increase condom use in heterosexual men (the MenSS website), the steps of the BCW intervention development process were followed, incorporating evidence from the research literature and views of experts and the target population. Capability (e.g. knowledge) and motivation (e.g. beliefs about pleasure) were identified as important targets of the intervention. We devised ways to address each intervention target, including selecting interactive features and behaviour change techniques. The BCW provides a useful framework for integrating sources of evidence to inform intervention content and deciding which influences on behaviour to target.

Perceptions of Sexual Intent: The Impact of Condom Possession

This study examined whether knowing that a victim of a sexual assault was carrying a condom influenced perceptions of her sexual intention and subsequent judgments of the sexual assault. Participants ( N = 165) read a vignette describing a date that culminated in an alleged sexual assault. Condom possession (carrying a condom, not carrying a condom) of both the female and male target was systematically varied. When the woman was carrying a condom, the woman was perceived as more sexually willing and the sexual assault claim perceived as less valid. In contrast, the male target's condom possession had little impact on judgments.

Defining the Content of an Online Sexual Health Intervention: The MenSS Website

Background

Health promotion and risk reduction are essential components of sexual health care. However, it can be difficult to prioritize these within busy clinical services. Digital interventions may provide a new method for supporting these.

Objective

The MenSS (Men’s Safer Sex) website is an interactive digital intervention developed by a multidisciplinary team, which aims to improve condom use in men who have sex with women (MSW). This paper describes the content of this intervention, and the rationale for it.

Methods

Content was informed by a literature review regarding men’s barriers to condom use, workshops with experts in sexual health and technology (N=16) and interviews with men in sexual health clinics (N=20). Data from these sources were analyzed thematically, and synthesized using the Behavior Change Wheel framework.

Results

The MenSS intervention is a website optimized for delivery via tablet computer within a clinic waiting room setting. Key targets identified were condom use skills, beliefs about pleasure and knowledge about risk. Content was developed using behavior change techniques, and interactive website features provided feedback tailored for individual users.

Conclusions

This paper provides a detailed description of an evidence-based interactive digital intervention for sexual health, including how behavior change techniques were translated into practice within the design of the MenSS website. Triangulation between a targeted literature review, expert workshops, and interviews with men ensured that a range of potential influences on condom use were captured.

Cognitive and contextual variables in sexual partner and relationship perception

This study examined the effects of contextual and cognitive variables for sexual protection on perceived social relationship factors. University students (108 women and 108 men) read script-based narratives on sexual encounters in which six variables were manipulated in two independent analyses. In the first analysis, four variables were evaluated: relational context (stable, casual), condom use (yes, no), script terminus (beginning, middle or end), and the rater's sex. The dependent variables were interpersonal perception of one of the characters of the narrative, and expectations regarding characteristics and future of the relationship. In the second analysis, two other factors were manipulated only in the "yes" condom conditions: communication strategy (verbal, non-verbal) and condom proponent gender. Our findings corroborated other studies where condom use was viewed as unromantic with less positive characteristics for relationships. Condom proponents, especially male, were perceived as less romantic, particularly when proposing a condom non-verbally at the beginning of the encounter. However, the controlled variables enabled us to propose ways of associating condom use with positive expectations towards the proponent and the relationship itself. Romanticism, expectation of sexual intercourse, emotional proximity, and expectations of condom use in encounters where a condom was proposed increased when suggested by a woman, postponed to the end of the encounter, and verbally mentioned. We encourage women to take the lead in suggesting condom use, thus empowering them since they do not have to wait for the male to make the first move.

'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.

Condom inclusion in cognitive representations of sexual encounters

To identify the inclusion of condom use (N = 360 college students), two sexual scripts (stable and casual relationships) were identified by free-generation methods (Study 1) and used to develop open-ended narratives up to the point before sexual intercourse. Participants completed the narratives to verify whether they spontaneously included references to condom use, and these references were related to self-report of sexual protection (Study 2). Finally, a recognition memory test clarified the typicality of condom use actions in the sexual script-based narratives (Study 3). The results indicated that although moderately referred to when free-generation is used, condom use is much less mentioned when participants complete script-based narratives and is considered a script-atypical action. Thus, we conclude that when behavior is guided by script, protective behaviors will not become mentally accessible and will not be used. Both relationships require intervention in order to increase condom use and make it a sexual routine.

Prototypical images in condom scripts among AIDS-bereaved adolescents

Twenty-five HIV-negative late adolescents (13 women and 12 men) who had lost a parent to AIDS generated vignettes in which the characters were deciding whether to use a condom (condom scripts). Two clinically trained judges rated the interpersonal tone of the condom scripts on 17 semantic differential scales. Three other clinically trained raters described script characters' attributes by selecting from a list of 36 terms. Multidimensional scaling (MDS) and individual differences hierarchical classes analyses (INDCLAS) were used to inductively derive a typology of condom scripts. Two dimensions emerged from MDS analysis: incompatibility and inequality. Condom scripts culminating in unprotected sex depicted situations in which partners held unequal influence. INDCLAS results suggested a prototype for equal-influence condom scripts - excited male and assertive, powerful female - and for unequal-influence (unprotected sex) condom scripts - powerful, disengaged male and permissive female. These results inform the development of theoretical models and HIV prevention program materials.

Condom use among South African adolescents: developing and testing theoretical models of intentions and behavior

We developed and tested models of intentions and behavior among adolescents from Cape Town, South Africa. Data from 261 participants who completed an initial measure of attitudes, beliefs, and prior behavior were used to develop a model of intentions to use condoms based on the Theory of Planned Behavior (TPB) and additional constructs found to be important in previous research with adolescents. Of the initial sample, 227 (87%) completed a behavioral follow-up 4 months later, and approximately one-third of those (n=72; 44 boys and 30 girls) reported having had sex in the prior 4 months. Data from this smaller sample were used to develop a model of condom use behavior based on intentions (as per the TPB) and the additional sub-population relevant constructs. Analyses generally supported the validity of the TPB in this context for predicting intentions and behavior. HIV knowledge and positive outlook (self-esteem and future optimism) were significantly related to TPB predictors of intentions. Intentions, acceptance of sexuality, and gender were significant predictors of behavior. Implications for the status of the TPB and the design of interventions for South African adolescents are discussed.

Age, religious beliefs, and sexual attitudes

Age effects on sexual attitudes were examined using the Hendrick and Hendrick (1987a) Sexual Attitude Scale. The study was cross-sectional, including people from various age groups, from young adults to older adults. The religious beliefs variable, which covaries substantially both with age and sexual attitudes, was controlled. Three main questions guided the study: (a) Is the four-factor structure (Permissiveness, Instrumentality, Communion, and Sexual Practices) previously identified in a sample of young students able to accurately account for data gathered over a full range of adult ages, (b) are older adults much less permissive and less instrumentalist than young people, and (c) to what extent are believers less permissive and instrumentalist than young people when age is taken into account? Factor analyses showed that at least five correlated factors were needed to account for the data; the fourth factor, Sexual Practices, divided itself into two distinct factors: Pleasure and Responsibility. Older adults and believers were shown to be less permissive than young people and nonbelievers, and this result held regardless of the participants educational level. As regards to instrumentality, however, the pattern of differences was extremely complex.