Condom Use Predictors for Low-Income African American Women

Sexual risk among African American girls seeking psychiatric care: A social-personal framework

OBJECTIVE

This study examined individual and social factors associated with sexual risk behavior among African American girls seeking outpatient mental health services across 2 years and key developmental transitions.

METHOD

African American females 12-16 years old (M = 14.5; SD = 1.15; n = 266) were recruited from eight outpatient mental health clinics and completed interviewer-administered and computer-assisted measures at baseline, 12, and 24 months. Analyses tested individual attributes (externalizing and internalizing problems) and family context (maternal acceptance-rejection, mother-daughter communication about sex) at baseline, peer influences (peer support of substance use, girlfriend dating behavior) and partner relationship characteristics (rejection sensitivity, partner risk communication frequency and openness) at 12 months, and girls' sexual behavior at 24 months.

RESULTS

At baseline, 32% of girls reported having had vaginal/anal sex compared with 60% at 24 months. Data analyses revealed robust associations between externalizing problems and maternal acceptance-rejection and mother-daughter risk communication during early adolescence, peer support of substance use and girlfriend dating behavior 1 year later, and girls' sexual risk taking 2 years later.

CONCLUSION

Findings support a social-personal framework (SPF) of sexual risk for African American girls seeking mental health care, underscoring the potential benefits of early intervention to reduce externalizing problems while strengthening mother-daughter communication and relationships to prevent subsequent sexual risk and associated negative outcomes. (PsycINFO Database Record

Predictors of Sexual Behavior among out-of-School Adolescents in Nigeria

Purpose:

To examine the influence of specific demographic and socio-cognitive variables on reported condom use among out-of-school adolescents in Nigeria.

Methods:

A cross-sectional study on a community-based sample of 1698 sexually active out-of school adolescents in Oyo state, Nigeria. Data were collected using a non-validated questionnaire administered by an interviewer.

Results:

Nine percent of the sexually-active adolescents reported condom use during sexual intercourse in the past year. Findings of logistic regression showed that adolescents with adequate self-efficacy were seven times more likely to use condom. A two-fold increase in condom use was found in adolescents who value parents' opinion on condom use.

Conclusion:

Results suggest self-efficacy and parents' influence affect condom use among Nigerian adolescents.

Prediction of HIV Sexual Risk Behaviors Among Disadvantaged African American Adults Using a Syndemic Conceptual Framework

The focus of this paper is on HIV sexual risk taking among a community-based sample of disadvantaged African American adults. The objective is to examine multiple factors associated with sexual HIV risk behaviors within a syndemic conceptual framework. Face-to-face, computer-assisted, structured interviews were conducted with 1535 individuals in Atlanta, Georgia. Bivariate analyses indicated a high level of relationships among the HIV sexual risks and other factors. Results from multivariate models indicated that gender, sexual orientation, relationship status, self-esteem, condom use self-efficacy, sex while the respondent was high, and sex while the partner was high were significant predictors of condomless sex. Additionally, a multivariate additive model of risk behaviors indicated that the number of health risks significantly increased the risk of condomless sex. This intersection of HIV sexual risk behaviors and their associations with various other behavioral, socio-demographic, and psychological functioning factors help explain HIV risk-taking among this sample of African American adults and highlights the need for research and practice that accounts for multiple health behaviors and problems.

Predictors of consistent condom use among young African American women

The purpose of this study was to determine the predictive value of selected factors to the consistent use of condoms among high-risk young African American women. A clinic-based, prospective, study of 242 young, African-American women (ages 15-21) was conducted. In multivariate analysis, consistent condom use was predicted by having greater perceptions of condom negotiation self-efficacy, lower fear of negotiating condom use, and having communicated with sex partners (during the recall period) about condom use. Relational variables were predictive of consistent condom use among young African American women. STD/HIV preventive interventions should target these factors, perhaps in dyad-level interventions.

HIV prevention interventions to reduce racial disparities in the United States: a systematic review

Racial and ethnic minorities are disproportionately affected by HIV/AIDS in the United States despite advances in prevention methodologies. The goal of this study was to systematically review the past 30 years of HIV prevention interventions addressing racial disparities. We conducted electronic searches of Medline, PsycINFO, CINAHL, and Cochrane Review of Clinical Trials databases, supplemented by manual searches and expert review. Studies published before June 5, 2011 were eligible. Prevention interventions that included over 50% racial/ethnic minority participants or sub-analysis by race/ethnicity, measured condom use only or condom use plus incident sexually transmitted infections or HIV as outcomes, and were affiliated with a health clinic were included in the review. We stratified the included articles by target population and intervention modality. Reviewers independently and systematically extracted all studies using the Downs and Black checklist for quality assessment; authors cross-checked 20% of extractions. Seventy-six studies were included in the final analysis. The mean DB score was 22.44--high compared to previously published means. Most of the studies were randomized controlled trials (87%) and included a majority of African-American participants (83%). No interventions were designed specifically to reduce disparities in HIV acquisition between populations. Additionally, few interventions targeted men who have sex with men or utilized HIV as a primary outcome. Interventions that combined skills training and cultural or interactive engagement of participants were superior to those depending on didactic messaging. The scope of this review was limited by the exclusion of non-clinic based interventions and intermediate risk endpoints. Interactive, skills-based sessions may be effective in preventing HIV acquisition in racial and ethnic minorities, but further research into interventions tailored to specific sub-populations, such as men who have sex with men, is warranted.

The moderating effect of sexual pressure on young urban women's condom use

The purpose of this study was to examine whether women's experiences of sexual pressure moderated the relationship between sexual empowerment determinants and condom use in a sample of 100 high-risk women, ages 19-25. Five sexual empowerment determinants of condom use were identified from the literature: HIV knowledge, self-esteem, condom self-efficacy, positive attitudes toward condom use, and condom negotiation skills. Linear and logistic regression analyses revealed that positive attitudes toward condom use and condom negotiation skills were significant predictors of condom use. These relationships, however, were moderated by sexual pressure. Findings indicate that women's experiences with sexual pressure have the potential to decrease the likelihood of condom use, even though other sexually protective behaviors may be exhibited.

Stages of change, decisional balance, and self-efficacy in condom use among rural African-American stimulant users

This pilot study (a) examined the stages of change (SOC) for condom use with primary and casual partners among rural heterosexual African American stimulant users, (b) identified gender differences in variables associated with SOC, and (c) assessed the association of SOC with decisional balance and self-efficacy. A total of 72 participants completed the study. SOC with a primary partner were much lower than with a casual partner, indicating more consistent condom use with casual partners. Significant gender differences existed in decisional balance for condom use for both primary (p = .02) and casual partners (p =.03), with women having higher decisional balance scores than men. Women also reported higher self-efficacy scores for condom use with casual partners than men. In regression models, age, decisional balance, and self-efficacy were significantly associated with SOC for condom use with a primary partner; however, only self-efficacy was significantly associated with SOC with casual partners. The results provide support for the development of interventions that promote the advantages of and increase self-efficacy for condom use.

A little thing called love: condom use in high-risk primary heterosexual relationships

CONTEXT

Condoms are less likely to be used in primary relationships than in other relationship types. An understanding of what women and men expect when entering into these relationships, as well as how they make decisions about condom use and other prevention behaviors, is essential to efforts to curb the spread of HIV.

METHODS

Qualitative in-depth interviews were conducted with 25 high-risk heterosexual couples, including HIV-serodiscordant couples, participating in a trial of the female condom in Hartford in 2004-2007. Data were coded and analyzed in an iterative inductive and deductive process.

RESULTS

Participants described nonuse of condoms as a strategy to fi nd and maintain a primary relationship, establish trust and increase intimacy. Many had unprotected intercourse while recognizing their risk of HIV and other STDs, placing their love for their partner and other emotional needs over concerns about their health. Several couples reduced their STD risk by practicing negotiated safety (i.e., using condoms until their serostatus had been determined) or similar strategies, including sharing sexual or drug use history, disclosing HIV test results and using condoms until they decided that their relationship would be monogamous.

CONCLUSIONS

HIV prevention approaches must recognize the importance of love and the needs that primary relationships satisfy if they are to be considered relevant by those at greatest risk. Negotiated safety and similar strategies may be an important risk reduction tool for heterosexuals, particularly those in HIV-affected relationships, but their potential effectiveness may vary.

The Well Woman Program: a community-based randomized trial to prevent sexually transmitted infections in low-income African American women

In this sexually transmitted infection (STI) prevention study, we compared the efficacy of the Well Woman Program (WWP), a nurse practitioner-directed, culturally specific, intensive intervention, to minimal intervention (MI), brief lecture, and referral to usual care, in a community-based randomized controlled trial. African American women having past STIs and residing in high-risk communities were randomly assigned to the two groups. STI outcome was measured at baseline and three later points. A random effects logistic longitudinal regression model showed that, at baseline, approximately 75% of participants tested positive for an STI, predominantly trichomoniasis. At month 15, the estimated probability of a WWP participant having an STI was 20% less than an MI participant. Better STI outcomes were due to the intensive individualized intervention.

Addressing the unique needs of African American women in HIV prevention

African American women continue to be disproportionately affected by the HIV/AIDS epidemic, yet there are few effective HIV prevention interventions that are exclusively tailored to their lives and that address their risk factors. Using an ecological framework, we offer a comprehensive overview of the risk factors that are driving the HIV/AIDS epidemic among African American women and explicate the consequences of ignoring these factors in HIV prevention strategies. We also recommend ways to improve HIV prevention programs by taking into consideration the unique life experiences of adult African American women.

Potential markers of female condom use among inner city African-American women

Despite the availability of the female condoms and theoretically based interventions to promote its use, studies have indicated a low level of acceptability of their use among women in most populations. We aimed to determine female condom use prevalence and the potential markers among African-American women. In an intervention trial to test the efficacy of the Information-Motivation-Behavioral Skills model in increasing condom use, we utilized the baseline data of 280 subjects and examined the potential predictors of female condom use. Chi square statistic and unconditional logistic regression were used to test for group independence among users and non-users of the female condom and to assess the potential markers of female condom use respectively. After adjustment for relevant covariates associated independently with female condom use, the significant potential markers for female condom use were age, multiple sexual relationships, knowledge of female condom, and educational status. Women having multiple sexual relationships compared with a monogamous relationship were five times more likely to use the female condom, while women with high school education were three times more likely to use the female condom; prevalence odds ratio, POR=5.32, 95% CI=1.79-15.83 and POR=3.01, 95% CI=1.01-8.93. Women who were not knowledgeable of the female condom, compared to those who were, were 81% less likely to use the female condom, POR=0.19, 95% CI=0.08-0.45. Among African-American women in this sample, knowledge of female condom use, age, educational status, and multiple sexual relationships were significant markers of female condom use. This study is therefore suggestive of the need to educate African-American women on female condom use, given the obstacles in male condom negotiation, especially among the socio-economically challenged.

Communication and Information About "Safer Sex:" Intervention Issues Within Communities of African Migrants Living in Poorer Neighbourhoods in Portugal

The aims of this study are to determine the influence of migrant status on sexual behavior and communication about "safer sex" and to identify ethnic-specific prevention issues. Data were obtained from a special administration of the Health Behavior in School-Aged Children Survey in a special sample of Portuguese schools located in low-income Lisbon neighborhoods with large proportions of African migrants.Survey participants included 919 6th, 8th and 10th graders (52.3% female), of whom 19.2% were migrant foreigners from African Portuguese-speaking countries, including Cape Verde (60.8%), Mozambique (1.6%), Angola (16.8%), S. Tomé (8%), and Guinea-Bissau (14.8%). Subsequently, four focus groups were held with adolescent who had participated in the survey (n = 45), three focus group with health and education professionals (n = 25), and one focus group with parents (n = 6).Compared with Portuguese adolescents, African migrant teens reported initial sexual intercourse at earlier ages, less frequent condom use, and less frequent and less comfortable communications with parents about sexual issues.Implications for selective prevention of STD are discussed and recommendations are made.

Unprotected Sex Among HIV-Positive Injection Drug-Using Women and Their Serodiscordant Male Partners

We investigated the characteristics of human immunodeficiency virus (HIV)-positive injection drug-using women who reported unprotected vaginal and/or anal sex with HIV-negative or unknown serostatus (serodiscordant) male partners. Of 426 female study participants, 370 were sexually active. Of these women, 39% (144/370) and 40% (148/370) reported vaginal and/or anal sex with serodiscordant main and casual partners, respectively. Sixty percent of women inconsistently used condoms with their serodiscordant main partners, whereas 53% did so with casual partners. In multivariate analysis, during sex with main partners, inconsistent condom users were less likely to feel confident about achieving safe sex (self-efficacy), personal responsibility for limiting HIV transmission, and that their partner supported safe sex. Inconsistent condom use was also more likely among women who held negative beliefs about condoms and in couplings without mutual disclosure of HIV status. Regarding sex with casual partners, inconsistent condom users were more likely to experience psychologic distress, engage in sex trading, but they were less likely to feel confident about achieving safe sex. These findings suggest that there are widespread opportunities for the sexual transmission of HIV from drug-using women to HIV-uninfected men, and that reasons vary by type of partnership. Multifaceted interventions that address personal, dyadic, and addiction problems are needed for HIV-positive injection drug-using women.