A condom skill scale: assessing condom skills among female drug users

Condom application skills and self-efficacy in youth: A systematic review and meta-analysis

Globally, and in the United States (U.S.) specifically, rates of reported sexually transmitted infections (STIs) have been steadily increasing and are especially high among youth aged 13-25 years. Using condoms correctly and consistently is an effective STI prevention measure for sexually active youth, yet public health endeavors tend to focus only on condom use consistency. Directly measuring condom application is challenging and expensive. Alternative tools evaluate this behaviour, but little evidence exists on the appropriateness of these instruments in measuring application skills. This systematic review and meta-analysis examined the association between condom application skills and self-efficacy. We conducted a search of several databases as well as unpublished works. Studies were included if they were in English, examined youth aged 13-25 years, and were available between 1992 and 2019. The authors screened 630 titles and abstracts for initial inclusion criteria. A full-text review of 30 studies was conducted. The authors included 19 studies in the systematic review and 5 studies were included in the meta-analysis. Both a fixed- and random-effects model (Q = .2321, I2 = 0%) yielded a medium-sized statistically non-significant association (r = 0.217) between skills and self-efficacy. Despite the small sample size, findings suggest that skills and self-efficacy may not be as interchangeable as previously assumed when assessing condom application. Implications for future research are discussed.

Psychopathology Subgroups and HIV Risk Among Women in Psychiatric Treatment

Among individuals with mental illness, the HIV infection rate is generally found to be substantially higher than in the general population. Understanding dimensions or subtypes of psychopathology linked with HIV risk behavior may enable development of targeted interventions to reduce HIV transmission. This study identified subgroups of women (n = 243) receiving outpatient psychiatric treatment based upon cluster analysis of indices of personality disorder and clinical symptom syndromes. High, medium, and low psychiatric severity cluster subgroups were found to differ significantly on key HIV risk variables. The high psychopathology subgroup revealed greater AIDS anxiety, more sexual partners, more sexual trading behaviors, less risk reduction self-efficacy, and less skill in condom usage than was found in one or both cluster subgroups characterized by less psychiatric severity. Results suggest that subgroups differentiated on the basis of levels of personality disorder and clinical symptom severity display differences in types and levels of HIV risk-related attitudes, beliefs, expectancies, skills, and behaviors that might guide development of tailored prevention intervention.

Differences between men and women in condom use, attitudes, and skills in substance abuse treatment seekers

BACKGROUND

For substance abuse treatment-seekers engaging in high risk sexual behavior, their inconsistent condom use may be related to their condom use attitudes and skills.

OBJECTIVE

This study compared treatment-seeking male and female substance abusers in their reported barriers to condom use and condom use skills.

METHODS

Men and women (N = 1,105) enrolled in two multi-site HIV risk reduction studies were administered the Condom Barriers Scale, Condom Use Skills, and an audio computer-assisted structured interview assessing sexual risk behavior.

RESULTS

Men endorsed more barriers to condom use, especially on the Effects on Sexual Experience factor. For both men and women, stronger endorsement of barriers to condom use was associated with less use of condoms. However, the difference between condom users and non-users in endorsement of condom barriers in general is greater for men than women, especially for those who report having casual partners.

CONCLUSIONS

Findings support the need to focus on gender-specific barriers to condom use in HIV/STI prevention interventions, especially risk behavior intervention techniques that address sexual experience with condoms.

SCIENTIFIC SIGNIFICANCE

Results provide additional information about the treatment and prevention needs of treatment-seeking men and women.

Correlates of male condom use skills among high-risk women in South Africa

This exploratory study examined the performance of 295 South African women--who recently traded sex for goods or had unprotected sex--on a male condom use mastery index. Bivariate and multivariate logistic regression analyses were conducted to determine whether age, marital status, highest education obtained, male condom use at first penetrative sex, receiving prior demonstration of male condom use, recent sexually transmitted infection symptoms, and recently trading sex were significantly associated with index scores. Adjusted odds ratios indicated that age and sexually transmitted infection symptoms were negatively associated with condom skills; women who were older and had a higher number of recent sexually transmitted infection symptoms were more likely to have lower scores. Furthermore, participants executed, on average, approximately one third of condom use steps correctly. These findings suggest a need for increased behavioral skills training for women engaging in sexual risk behaviors because many lack the skills required to use a male condom properly.

Teaching condom use skills: practice is superior to observation

Men exposed to a condom skills practice exercise were hypothesized to perform better on condom skills measures than those exposed only to a demonstration or to no intervention. As part of a larger National Institute on Drug Abuse (NIDA) Clinical Trials Network HIV Prevention protocol, men in substance abuse treatment were administered male and female condom use skills measures (MCUS, FCUS) at preintervention, 2 weeks, 3 months, and 6 months postintervention. The MCUS and FCUS scores were compared for 3 intervention exposure groups (demonstration only [DO, n = 149], demonstration plus practice [D+P; n = 112], attended no sessions [NS, n = 139]) across the 4 assessment time points using a mixed effects linear regression model. There is a statistically significant intervention group-by-time effect (P < .0001) for both the MCUS and FCUS. Post hoc, pairwise linear trends across time indicated that for both the MCUS and the FCUS, the D+P group is significantly superior to the DO group and the NS group.

Predictors of condom use among men enrolled in drug treatment programs

This study identified predictors of condom use and developed a model of condom use in a sample of men (n = 324) enrolled in drug treatment. Utilizing a series of logistic regression analyses reported condom use was predicted by possession of condoms, future intention to use condoms, future intention to increase condom use, having a high-risk partner, low Condom Barriers Scale scores, being unmarried and ethnic minority status. A probit path analysis revealed the following model of condom use among men in drug treatment: Taking condoms from clinic stocks was the best predictor of condom possession, which in turn was the best predictor of condom use. These study findings identify condom availability in treatment programs as an important risk reduction intervention. Treatment programs can apply these predictors of condom use to better identify individuals at risk for HIV and sexually transmitted infections to better target prevention interventions.

A cluster randomized controlled trial of an adolescent HIV prevention program among Bahamian youth: effect at 12 months post-intervention

Behavioral interventions based on the Protection Motivation Theory (PMT) have been demonstrated to reduce HIV risk behavior among mid- and older adolescents in different settings across the globe but have not been evaluated among Caribbean nations and have received limited evaluation among pre-adolescents. To determine (1) the effectiveness among pre-adolescents in The Bahamas of a PMT-based HIV prevention program "Focus on Youth in the Caribbean" (FOYC) and (2) the role of the targeted PMT constructs in intervention effect. 1,360 sixth grade youth (10-11 years of age) from 15 urban schools in New Providence, The Bahamas were randomized by school to receive either FOYC or a control condition. Data collected at baseline, 6 and 12 months post intervention were analyzed. A five-step scheme was used to assess sexual behavior progression, ranging from "1" = "a virgin without intention to have sex" to "5" = "having sex without a condom". Group-based trajectory analysis was utilized in assessing the program effect. Two sexual behavior progression patterns were detected: slow progressors and quick progressors. Receiving FOYC reduced the likelihood for adolescents to become quick progressors (adjusted OR = 0.77, 95% CI: 0.64-1.00). The observed effectiveness was especially impacted by a subset of the targeted PMT constructs. FOYC effectively delays sexual risk among Bahamian pre-adolescents. The group-based trajectory analysis provides an analytical approach for assessing interventions among adolescents with low rates and diverse progression patterns of sexual activity.

Toward errorless condom use: a comparison of two courses to improve condom use skills

Traditionally, researchers have focused HIV/AIDS prevention efforts on increasing condom use, yet few researchers have assessed condom use skills. Because incorrect condom use may lead to condom failure, promoting condom use without ensuring participants have the skills necessary for correct condom use may lead to increased risk of exposure. This study compared the effects of two condom use courses on condom use skills. These courses were administered as part of a HIV/AIDS educational program for college students. Participants in the treatment groups (n=179) attended either a limited, 1-Session, or extensive, 3-Session, condom use course, and an additional 108 participants served as a Control Group. Condom use skills increased among participants in both treatment groups; however, the greatest improvement was among those in the 3-Session Group. This finding supports use of the extensive, 3-Session course as a more effective means for improving condom use skills.