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Gebru NM, Wongsomboon V. Sexual Arousal-Delay Discounting: When Condoms Delay Arousal. J Sex Res 2024; 61:727-741. [PMID: 37506314 PMCID: PMC10822021 DOI: 10.1080/00224499.2023.2239216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
Sexual arousal plays an important role in condom use decisions. However, combined effects of reduced sexual arousal and delay to achieving arousal on condom use decisions remain understudied. This study used a novel sexual arousal-delay discounting (SADD) task to measure individuals' willingness to use a condom in situations where condom use would (1) delay time to arousal and (2) reduce the level of arousal one could achieve even after the delay (e.g., 5 minutes to reach 50% arousal). In Study 1, U.S. college students (N = 115; Mage = 18.6) reported their willingness to have sex with a condom in hypothetical scenarios where the condom delayed and reduced their partner's sexual arousal. In Study 2, U.S. college students (N = 208; Mage = 19.6; 99% ≤ 24 years old) completed the same task for two partners-partner perceived as most desirable and partner perceived as least likely to have an STI. In this study, a condom would affect either participants' own or partner's arousal. Study 3 replicated Study 2 using a non-college sample in the U.S. (N = 227; Mage = 30.5; 84% ≥ 25 years old). Across studies, willingness to use a condom decreased as the delay to reduced arousal increased. This effect of SADD was stronger when condoms reduced participants' own (vs. partner's) arousal, whereas comparisons between most desirable and least likely-to-have-STI partners provided mixed findings. Men had higher discounting rates than women across conditions. Greater SADD was associated with lower condom use self-efficacy, providing initial evidence for the task's validity. The role of delayed arousal in condom use and implications are discussed.
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Affiliation(s)
- Nioud Mulugeta Gebru
- Center for Alcohol and Addictions Studies; Department of Behavioral and Social Sciences; Brown University School of Public Health, Providence, RI USA
| | - Val Wongsomboon
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL USA
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2
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Rodrigues DL, Carvalho AC, Prada M, Garrido MV, Balzarini RN, de Visser RO, Lopes D. Condom Use Beliefs Differ According to Regulatory Focus: A Mixed-Methods Study in Portugal and Spain. J Sex Res 2024; 61:709-726. [PMID: 36877803 DOI: 10.1080/00224499.2023.2181305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
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.
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Affiliation(s)
- David L Rodrigues
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Lisboa, Portugal
| | | | - Marília Prada
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Lisboa, Portugal
| | | | - Rhonda N Balzarini
- Department of Psychology, Texas State University, San Marcos, TX, USA
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Richard O de Visser
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Diniz Lopes
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Lisboa, Portugal
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3
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Finkenstaedt M, Biedermann D, Schröder J, Mazinan RG, Fuss J, Biedermann SV. Delay discounting of protected sex and compulsive sexual behavior in women with borderline personality disorder. J Behav Addict 2024; 13:250-261. [PMID: 38329531 PMCID: PMC10988410 DOI: 10.1556/2006.2024.00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/23/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024] Open
Abstract
Background and aims Borderline personality disorder (BPD) is a complex mental health condition characterized by emotional dysregulation, impulsivity, and unstable interpersonal relationships. Some individuals with BPD regularly engage in sexual risk behavior such as unprotected sex and are at higher risk of contracting sexually transmitted infections. This study investigates discounting of condom- or dental dam-protected sex in women with BPD compared with a control group. Methods Data were collected from 40 women diagnosed with BPD and 40 healthy controls with an average age of 27.28 years (SD = 6.14) using the Sexual Delay Discounting Task (SDT), the Borderline Symptom List-23 (BSL-23), and the Compulsive Sexual Behavior Disorder Scale-19 (CSBD-19). Results Women with BPD were less likely to use an immediately available condom or dental dam and more likely to discount safer sex than controls. Partner desirability and the perceived STI risk influenced the participants' likelihood of having protected sex. Women with BPD showed more symptoms of compulsive sexual behavior (CSB) than controls. However, sexual delay discounting was not significantly correlated with borderline symptoms or CSB in the BPD group. Discussion and conclusions These findings contribute to our understanding of sexual impulsivity in women with BPD and highlight the omission and delayed availability of safety measures as important contributors to sexual risk behavior and STI risk in women. Impulsive sexual behavior, as well as the accompanying sexual health concerns, should receive special attention in the treatment of women with BPD.
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Affiliation(s)
- Maja Finkenstaedt
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Social and Emotional Neuroscience, Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Biedermann
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Social and Emotional Neuroscience, Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Schröder
- Institute for Clinical Psychology and Psychotherapy, Department for Psychology, Medical School Hamburg, Hamburg, Germany
| | - Rose Gholami Mazinan
- Social and Emotional Neuroscience, Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Fuss
- Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Sarah V. Biedermann
- Social and Emotional Neuroscience, Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Gorissen S, Lillie HM, Chavez-Yenter D, Vega A, John KK, Jensen JD. Explicitness, disgust, and safe sex behavior: A message experiment with U.S. adults. Soc Sci Med 2022; 313:115414. [PMID: 36209520 DOI: 10.1016/j.socscimed.2022.115414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 01/26/2023]
Abstract
Sexual health risks are challenging to communicate given the potential negative reactions of target audiences to explicit language. Grounded in research on pathogen avoidance, the current study examined the impact of varying levels of explicit language on message perceptions and safe sex behavioral intentions. U.S. adults (N = 498) were randomly assigned to view messages detailing pandemic safe sexual behavior that contained either low or high levels of explicit language. High explicit language significantly increased perceived disgust which also indirectly linked high explicit language with increased intentions to engage in safe sex behavior. Individual difference variables moderated the impact of message explicitness; dispositional hygiene disgust moderated the impact of high explicit, hygiene-focused messages on safe sex intentions. Those with relatively low levels of dispositional disgust were more positively impacted by explicit language. The results suggest the value of increased message explicitness for sexual health communication and have implications for pathogen avoidance behaviors, the behavioral immune system, and dispositional and affective forms of disgust.
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Affiliation(s)
- Sebastiaan Gorissen
- Minot State University, Division of Art and Professional Communication, 500 University Avenue West, Minot, ND, 58707, USA.
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Gesselman AN, Ryan R, Yarber WL, Vanterpool KB, Beavers KA, Francis H, Grant BT, Wood K, Graham CA, Milhausen R, Sanders SA, Crosby RA. An exploratory test of a couples-based condom-use intervention designed to promote pleasurable and safer penile-vaginal sex among university students. J Am Coll Health 2022; 70:1665-1672. [PMID: 33151840 DOI: 10.1080/07448481.2020.1818753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/29/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Objective: Dual use of male condoms and female contraceptives is widely advocated for unplanned pregnancy prevention, yet college students often neglect condoms. This feasibility and acceptability study assessed the efficacy of a self-guided home-based condom-promotion intervention among college students in heterosexual relationships. Participants: Fifty-nine couples who had been together at least 30 days and had penile-vaginal sex at least twice weekly. Methods: Assessments were done at baseline and 6 months later. Outcomes were frequency of condom-unprotected penile-vaginal sex and four psychosocial mediators of condom use. Results: Frequency of unprotected penile-vaginal sex decreased over time. Several corresponding psychosocial mediators showed change, particularly among women. Using actor-partner interdependence modeling, men's increase in condom use was associated with an increase in women's sexual pleasure. Conclusion: Findings support implementation of a brief, self-guided, home-based condom-use intervention that could lower incidence of unplanned pregnancy and STIs among heterosexually active college students.
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Affiliation(s)
- Amanda N Gesselman
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
| | - Rebecca Ryan
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - William L Yarber
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
- Department of Gender Studies, Indiana University, Bloomington, Indiana, USA
| | - Karen B Vanterpool
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Karly A Beavers
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Heather Francis
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Brandon T Grant
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Katherine Wood
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- School of Public Health, Indiana University, Bloomington, Indiana, USA
| | - Cynthia A Graham
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- Department of Psychology, University of Southampton, Southampton, UK
| | - Robin Milhausen
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Canada
| | - Stephanie A Sanders
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- Department of Gender Studies, Indiana University, Bloomington, Indiana, USA
| | - Richard A Crosby
- Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
- Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, USA
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
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Millanzi WC, Kibusi SM, Osaki KM. Effect of integrated reproductive health lesson materials in a problem-based pedagogy on soft skills for safe sexual behaviour among adolescents: A school-based randomized controlled trial in Tanzania. PLoS One 2022; 17:e0263431. [PMID: 35192640 PMCID: PMC8863272 DOI: 10.1371/journal.pone.0263431] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/19/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Adolescents are currently becoming sexually active before their 18th birthday during which they have to battle with unsafe sexual behaviours, teenage pregnancies, sexually transmitted infections (STIs), and school dropouts. The trend is linked with low soft skills (self-esteem and assertiveness skills) for them to make informed, reasoned, and responsible decisions over sexual activities. This study designed and tested the effect of integrated reproductive health (RH) lesson materials in a problem-based pedagogy (PBP) to enhance soft skills for safe sexual behaviour among adolescents in Tanzania. METHODS A double-blinded clustered randomized controlled trial was conducted between September 2019 and September 2020 among 660 randomly selected adolescents. A Sexual-risk Behaviour Beliefs and Self-esteem Scale adopted from previous studies measured soft skills for safe sexual behaviour. A descriptive statistical analysis was performed by using the statistical analysis software programme version 9.4. The effect of the intervention was determined using Linear Mixed Model set at α error probability = 5% significance level (95% confidence interval) and a β error probability = 0.80. FINDINGS Adolescents' mean age was 15±1.869 with 57.5% females. The end-line findings indicated that the coefficient of soft skills was significantly higher among adolescents in the hybrid PBP (β=9.0986, p<0.01; 95%CI: 4.7772, 14.2311) and pure PBP (β =8.7114, p<0.01; 95%CI: 3.9990, 10.1208) than in the control group. The retention rate of soft skills was still significantly higher at 3-months follow-up (β=2.0044; p<0.01; 95%CI: 1.0234, 4.1182) and at 6-months follow-up (β=1.9803; p<0.01; 95%CI: 0.8399, 3.1099) compared to the baseline and immediate post-intervention assessments. CONCLUSION The intervention substantially enhanced soft skills for safe sexual behaviour among adolescents of both sex. Despite the fact that scores for soft skills varied across the study timelines, adolescents demonstrated significant intentions to abstain from sexual intercourse, delay sexual relationships, negotiate condom use, and withstand sexual coercions. The PBP may need to be incorporated in ordinary level secondary school curricula as a formal guide to teachers and or health workers to optimally prepare adolescents for their healthy adulthood.
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Affiliation(s)
- Walter C. Millanzi
- Department of Nursing Management and Education, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| | - Stephen M. Kibusi
- Department of Public Health, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| | - Kalafunja M. Osaki
- Centre for Pedagogy, Education, Development, Writing and Editing Documents, St. Augustine University of Tanzania, Mwanza, Tanzania
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Yeshaneh A, Lencha A, Aweke AM, Dessalew Y, Wale T, Mekuriya E, Abdulahi T, Workineh A, Yitayew M, Dinku H, Asfaw G. Consistent condom utilization and associated factors among HIV positive clients attending ART clinic at Pawi general hospital, North West Ethiopia. PLoS One 2021; 16:e0261581. [PMID: 34932611 PMCID: PMC8691638 DOI: 10.1371/journal.pone.0261581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) affects a highly significant number of people and is responsible for the deaths of many people in sub-Saharan African countries alone. The best prevention method for this virus is through consistent condom utilization which can help to prevent drug-resistant HIV infection and acquisition of new infection. Therefore, this study aimed to assess consistent condom utilization and associated factors among HIV-positive individuals attending an antiretroviral therapy clinic at Pawi general hospital, North West Ethiopia in 2020. Methods An institutional based cross-sectional study was conducted among 419 HIV-positive individuals who have follow-up in the Pawi general hospital antiretroviral therapy clinics, from January to February 2020. The study subjects were reached using a systematic sampling technique and data were collected using a pretested and structured questionnaire. Data entry and analysis were performed using epi-data version 3.1 and SPSS version 23 respectively. Binary and multivariable analyses with a 95% confidence level were performed. In the final model, variables with P < 0.05 were considered statistically significant. Results A total of 419 antiretroviral therapy study participants were participated in the study with a response rate of 100%. In this finding, the consistent condom utilization rate was 49.2% [95% CI: 42.2–56.5%]. After controlling for possible confounding factors, the results showed that place of residence [AOR = 2.16, 95% CI: 1.05, 4.45], marital status [AOR = 0.19, 95%CI: 0.05, 0.67], number of partners [AOR = 0.19, 95% CI: 0.07, 0.55] and level of education [AOR = 5.33, 95% CI: 1.57, 18.08] were associated factors of consistent condom utilization. Conclusion Consistent condom utilization among HIV-positive clients attending antiretroviral therapy clinics at Pawi general hospital was low. Residence, marital status, level of education and number of partners were significantly associated factors of consistent condom use. Health education program and counseling services should be started to increase knowledge about way of transmission and appropriate use of condoms, increase self-efficacy towards condom use and reduction in the number of sexual partners.
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Affiliation(s)
- Alex Yeshaneh
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
- * E-mail:
| | - Adugna Lencha
- Department of Midwifery, Institute of health science, Pawi Health Science College, Pawi, Ethiopia
| | - Amlaku Mulat Aweke
- Department of Midwifery, College of Medicine and Health Science, Bahirdar University, Bahirdar, Ethiopia
| | - Yaregal Dessalew
- Department of Midwifery, College of Medicine and Health Science, Assosa University, Assosa, Ethiopia
| | - Tegegne Wale
- Department of Midwifery, College of Medicine and Health Science, Debretabor University, Debretabor, Ethiopia
| | - Esubalew Mekuriya
- Department of Midwifery, College of Medicine and Health Science, Bahirdar University, Bahirdar, Ethiopia
| | - Temkin Abdulahi
- Department of Midwifery, College of Medicine and Health Science, Assosa University, Assosa, Ethiopia
| | - Alemu Workineh
- Department of Reproductive Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Meseret Yitayew
- Department of Nursing, College of Medicine and Health Science, Assosa University, Assosa, Ethiopia
| | - Hirut Dinku
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Genet Asfaw
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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Haire B, Murphy D, Maher L, Zablotska-Manos I, Vaccher S, Kaldor J. What does PrEP mean for 'safe sex' norms? A qualitative study. PLoS One 2021; 16:e0255731. [PMID: 34352034 PMCID: PMC8341650 DOI: 10.1371/journal.pone.0255731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/22/2021] [Indexed: 12/04/2022] Open
Abstract
While HIV pre-exposure prophylaxis (PrEP) is highly effective, it has arguably disrupted norms of ‘safe sex’ that for many years were synonymous with condom use. This qualitative study explored the culture of PrEP adoption and evolving concepts of ‘safe sex’ in Sydney, Australia, during a period of rapidly escalating access from 2015–2018, drawing on interviews with sexually active gay men (n = 31) and interviews and focus groups with key stakeholders (n = 10). Data were analysed thematically. Our results explored the decreasing centrality of condoms in risk reduction and new patterns of sexual negotiation. With regards to stigma, we found that there was arguably more stigma related to not taking PrEP than to taking PrEP in this sample. We also found that participants remained highly engaged with promoting the wellbeing of their communities through activities as seemingly disparate as regular STI testing, promotion of PrEP in their social circles, and contribution to research. This study has important implications for health promotion. It demonstrates how constructing PrEP as a rigid new standard to which gay men ‘should’ adhere can alienate some men and potentially create community divisions. Instead, we recommend promoting choice from a range of HIV prevention options that have both high efficacy and high acceptability.
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Affiliation(s)
- Bridget Haire
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
- * E-mail:
| | - Dean Murphy
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Iryna Zablotska-Manos
- Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
| | - Stephanie Vaccher
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - John Kaldor
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
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Matthews LT, Greener L, Khidir H, Psaros C, Harrison A, Mosery FN, Mathenjwa M, O’Neil K, Milford C, Safren SA, Bangsberg DR, Smit JA. "It really proves to us that we are still valuable": Qualitative research to inform a safer conception intervention for men living with HIV in South Africa. PLoS One 2021; 16:e0240990. [PMID: 33765001 PMCID: PMC7993862 DOI: 10.1371/journal.pone.0240990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 10/06/2020] [Indexed: 11/25/2022] Open
Abstract
Objective Many men living with HIV want to have children. Opportunities to reduce periconception HIV transmission include antiretroviral therapy as prevention, pre-exposure prophylaxis, limiting condomless sex to peak fertility, and sperm processing. Whether men have knowledge of or want to adopt these strategies remains unknown. Methods We conducted focus group discussions (FGDs) with men accessing HIV care in South Africa in 2014 to inform a safer conception intervention for men. Eligible men were 25–45 years old, living with HIV, not yet accessing treatment, and wanting to have a child with an HIV-negative or unknown serostatus female partner (referred to as the “desired pregnancy partner”). FGDs explored motivations for having a healthy baby, feasibility of a clinic-based safer conception intervention, and acceptability of safer conception strategies. Data were analyzed using thematic analysis. Results Twelve participants from three FGDs had a median age of 37 (range 23–45) years, reported a median of 2 (range 1–4) sexual partners, and 1 (range 1–3) desired pregnancy partner(s). A third (N = 4) had disclosed HIV-serostatus to the pregnancy partner. Emergent themes included opportunities for and challenges to engaging men in safer conception services. Opportunities included enthusiasm for a clinic-based safer conception intervention and acceptance of some safer conception strategies. Challenges included poor understanding of safer conception strategies, unfamiliarity with risk reduction [versus “safe” (condoms) and “unsafe” (condomless) sex], mixed acceptability of safer conception strategies, and concerns about disclosing HIV-serostatus to a partner. Conclusions Men living with HIV expressed interest in safer conception and willingness to attend clinic programs. Imprecise prevention counseling messages make it difficult for men to conceptualize risk reduction. Effective safer conception programs should embrace clear language, e.g. undetectable = untransmittable (U = U), and support multiple approaches to serostatus disclosure to pregnancy partners.
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Affiliation(s)
- Lynn T. Matthews
- University of Alabama at Birmingham, Birmingham, AL, United States of America
- Center for Global Health and Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail:
| | - Letitia Greener
- Department of Obstetrics and Gynaecology, MRU (MatCH), University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hazar Khidir
- Harvard Medical School, Massachusetts General Hospital, Brigham and Women’s Hospital, Combined Residency Program in Emergency Medicine, Boston, MA, United States of America
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Behavioral Medicine, Boston, MA, United States of America
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - F. Nzwakie Mosery
- Department of Obstetrics and Gynaecology, MRU (MatCH), University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa
| | - Mxolisi Mathenjwa
- Department of Obstetrics and Gynaecology, MRU (MatCH), University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa
| | - Kasey O’Neil
- Center for Global Health and Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | - Cecilia Milford
- Department of Obstetrics and Gynaecology, MRU (MatCH), University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, FL, United States of America
| | - David R. Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, United States of America
| | - Jennifer A. Smit
- Department of Obstetrics and Gynaecology, MRU (MatCH), University of the Witwatersrand, Faculty of Health Sciences, Durban, South Africa
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Shrader CH, Peters Jefferson K, Kanamori M, Rochat R, Siegler A. "I'd Rather Use a Refuse Bag:" A Qualitative Exploration of a South African Community's Perceptions of Government-Provided Condoms and Participant-Preferred Solutions. Arch Sex Behav 2021; 50:615-627. [PMID: 32367483 PMCID: PMC7609579 DOI: 10.1007/s10508-020-01701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 05/26/2023]
Abstract
Despite South Africa experiencing one of the largest HIV epidemics in the world, condom use has decreased since 2008. However, condoms are the only low-cost HIV prevention technology widely available in South Africa. This study aims to explore a South African community's perceptions of condoms, recent condom use decrease, and suggestions for increasing condom use. In 2014, we conducted seven focus groups (n = 40 men) and 20 in-depth interviews (n = 9 men, n = 11 women) with participants aged ≥ 18 years recruited from four urban settlement health clinics in Cape Town, South Africa. Data were collected, coded, and analysed using a general inductive approach. Participants perceived government-provided condoms negatively, with themes including "disgust" for condom physical properties, concerns with social status associated with free condoms, and performance concerns. There was an intersection of themes surrounding masculinity, condom use, and sexual pleasure. Solutions to increase condom use included improving the quality and variety of free condoms and rebranding free condoms. Participants suggested that condoms are distributed with novel attributes (e.g., more colors, smells/flavors, sizes, and in-demand brands) and that government programs should consider offering all brands of condoms at no or low cost. This study suggests a substantial rethinking of condom branding for government-provided condoms. Our findings suggest that condom dissemination and promotion programs should proactively address public concerns regarding condoms. Existing societal and structural norms such as hegemonic masculinity must also be addressed using gender-transformative interventions. We also strongly suggest the creation of a Male Condom Acceptability Scale to understand condom users' needs.
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Affiliation(s)
- Cho-Hee Shrader
- Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Ste 1006, Miami, FL, 33132, USA.
| | | | - Mariano Kanamori
- Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Ste 1006, Miami, FL, 33132, USA
| | - Roger Rochat
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aaron Siegler
- Department of Epidemiology and Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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11
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Mao B, Kim S, Peng W. The Interplay between Message Framing and Message Recipients' Regulatory Focus in Promoting HPV Prevention Strategies. J Health Commun 2021; 26:92-103. [PMID: 33709870 DOI: 10.1080/10810730.2021.1895918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Limited awareness and low uptake rate of Human papillomavirus (HPV) prevention strategies among females require the development of more effective educational interventions. Regulatory focus theory posits the matching of framing valence with the recipients' regulatory focus increases persuasiveness. Following regulatory focus theory, we examined how individual regulatory focus changed the effects of gain- and loss-framed messages on promoting consistent condom use and HPV DNA testing for HPV prevention. We also explored whether this interaction effect impacts the influences of target individuals' initial attitudes about condom use and HPV DNA testing on post attitudes and intentions. Results of Study 1 showed that, in general, the gain-framed message fit with regulatory focus (i.e., promotion focus) promoted more positive attitudes about consistent condom use than the gain-framed message nonfit with their regulatory focus (i.e., prevention focus).Nevertheless, the gain-framed message nonfit with regulatory focus (i.e., prevention focus) strengthened the negative relationship between initial attitudes and intentions, which promoted the intentions to use condom consistently among people who initially held negative attitudes toward consistent condom use. In Study 2, we did not observe a significant interaction effect of message framing and regulatory focus in the HPV DNA testing context. However, we observed that the gain-framed message nonfit with regulatory focus (i.e., prevention focus) led to the changes in the significance of the initial attitudes - post attitudes relationship from significant to non-significant. Thus, the reliance on initial negative attitudes about HPV DNA testing in decision-making decreased. Theoretical and practical implications of our research were discussed.
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Affiliation(s)
- Bingjing Mao
- Department of Communication Studies, University of Miami, Coral Gables, Florida, USA
| | - Soyoon Kim
- Department of Communication Studies, University of Miami, Coral Gables, Florida, USA
| | - Wei Peng
- Edward R. Murrow College of Communication, Washington State University, Pullman, Washington, USA
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12
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Pan Y, Metsch LR, Gooden LK, Mantero AMA, Feaster DJ. The Disaggregated Repeated Measures Design: A Novel Approach to Assess Sexual Risk Behaviors. Arch Sex Behav 2021; 50:311-322. [PMID: 32458301 PMCID: PMC7688506 DOI: 10.1007/s10508-019-01582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 09/27/2019] [Accepted: 10/31/2019] [Indexed: 06/11/2023]
Abstract
Although numerous studies have examined sexual and substance use behaviors that put people at risk for sexually transmitted infections including HIV, most focus on an overall measure of aggregate risk or a few simple and particular subtypes of sexual acts assessed in separate analyses. In this article, we introduce a more sensitive approach to assess how the relative characteristics of sex acts may determine the level of risk in which an individual chooses to engage. Project AWARE, a randomized clinical trial conducted among 5012 patients in nine STD clinics across the U.S., is used to illustrate the approach. Our study was guided by two aims: (1) describe a new approach to examine the count of sexual acts using a disaggregated repeated measures design and (2) show how this new approach can be used to evaluate interactions among different categories of sexual risk behaviors and other predictors of interest (such as gender/sexual orientation). Profiles of different subtypes of sexual acts in the past 6 months were assessed. Potential interactions of the characteristics associated with each subtype which resulted in up to 48 distinct subtypes of sexual risk behaviors-sex with a primary/non-primary partner; partner's HIV status; vaginal/anal sex; condom use; and substance use before or during sex act-can be examined. Specifically, we chose condom use and primary and non-primary status of partner as an application in this paper to illustrate our method. There were significantly more condomless sex acts (M = 23, SE = 0.9) and sex acts with primary partners (M = 27.1, SE = 0.9) compared to sex acts with condoms (M = 10.9, SE = 0.4, IRR = 2.10, 95% CI 1.91-2.32, p < .001) and sex acts with non-primary partner (M = 10.9, SE = 0.5, IRR = 2.5, 95% CI 2.33-2.78, p < .001). In addition, there were significant differences for the count of sexual risk behaviors among women who have sex with men (WSM), men who have sex with women (MSW) and men who have sex with men (MSM) for sex acts with and without condom use, primary and non-primary partner, and their interaction (ps = .03, < .0001, and .001, respectively). This approach extends our understanding of how people make choices among sexual behaviors and may be useful in future research on disaggregated characteristics of sex acts.
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Affiliation(s)
- Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1034, 1120 N.W. 14th St., Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alejandro Max Antonio Mantero
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1034, 1120 N.W. 14th St., Miami, FL, 33136, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1034, 1120 N.W. 14th St., Miami, FL, 33136, USA
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13
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Berry MS, Sweeney MM, Dolan SB, Johnson PS, Pennybaker SJ, Rosch KS, Johnson MW. Attention-Deficit/Hyperactivity Disorder Symptoms Are Associated with Greater Delay Discounting of Condom-Protected Sex and Money. Arch Sex Behav 2021; 50:191-204. [PMID: 32328913 DOI: 10.1007/s10508-020-01698-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is associated with increased risk of detrimental life outcomes. Recent research also indicates that ADHD is associated with sexual risk behavior, such as unprotected sex. Some risky sexual behaviors may be driven, in part, by preference for immediate rewards, referred to as delay discounting, which is prominent in etiological models of ADHD. Therefore, the present study examined the effect of delay on preference for both monetary and sexual outcomes in adults with many ADHD symptoms (both on and off medication) and with fewer ADHD symptoms. Online participants (N = 275; n = 161 males, n = 114 females) completed a monetary delay discounting task, assessing preference for smaller sooner versus larger delayed hypothetical money, and the Sexual Delay Discounting Task, assessing preference for condom use in hypothetical casual sex scenarios based on delay until condom availability. Those with greater ADHD symptoms discounted delayed monetary outcomes as well as delayed condom-protected sex (i.e., preferred sooner money rewards and immediate unprotected sex) significantly more than those with fewer symptoms; however, no effect of current medication use was found across monetary or sexual delay discounting among those with greater ADHD symptoms. This study is the first to demonstrate the relation between ADHD symptoms and reduced condom-use likelihood. Increased discounting of delayed condom-protected sex might constitute one mechanism of risky sexual behavior among individuals with ADHD symptoms. Interventions geared toward increasing condom use in situations in which condoms may otherwise be unavailable, may mitigate risky sexual behaviors and their associated harms in this population.
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Affiliation(s)
- Meredith S Berry
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Suite 3000, Baltimore, MD, 21224, USA
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Mary M Sweeney
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Suite 3000, Baltimore, MD, 21224, USA
| | - Sean B Dolan
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Suite 3000, Baltimore, MD, 21224, USA
| | - Patrick S Johnson
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Suite 3000, Baltimore, MD, 21224, USA
- Department of Psychology, California State University, Chico, Chico, CA, USA
| | - Steven J Pennybaker
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Suite 3000, Baltimore, MD, 21224, USA
| | - Keri S Rosch
- Center for Neurodevelopmental and Imaging Research and Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew W Johnson
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Suite 3000, Baltimore, MD, 21224, USA.
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14
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Singh SK, Sharma SK, Vishwakarma D. Covariates of Multiplicity of High-Risk Sexual Behavior Among Men in India: Evidence from the Latest Indian Demographic and Health Survey. Arch Sex Behav 2021; 50:333-346. [PMID: 33063252 DOI: 10.1007/s10508-020-01814-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 06/11/2023]
Abstract
Modern Indian society has witnessed rapid sociocultural transformation where loosening of cultural values is observed at all levels. In the era of transition, traditional norms and values are changing where young male individuals are found to be associated with high-risk multi-partner sexual behavior. Findings are based on a nationally representative sample of 45,231 and 65,704 men aged 15-54 during the period 2005-2006 and 2015-2016, respectively. The burden of high-risk sexual behaviors among men aged 15-54 years in India over the last decade remains disproportionately higher among younger, unmarried, and urban men, who are mainly from economically better-off households. Despite tremendous efforts of the government of India as well as various state governments in condom promotion as part of the HIV/AIDS prevention program, the improvements in condom use over the last decade are not impressive as it has not yet reached the desired threshold level. The disparities in high-risk sexual behavior among men aged 15-54 years, coming from rich and poor households, have narrowed. The findings of the study also underline an apparent paradox in the relationship between knowledge of HIV/AIDS and indulgence in high-risk sexual behavior and adopting safe sexual practices. It is recommended that all the HIV prevention programs in India should promote the concept of men as the responsible sexual partner. This concept may be promoted among young and unmarried men by reinforcing the shift from violence to respect and projecting the condom as a sexual stimulus rather than a means of disease prevention.
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Affiliation(s)
- Shri Kant Singh
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Santosh Kumar Sharma
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India.
| | - Deepanjali Vishwakarma
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
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15
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Casmir E, Daniel AK, Ongolly F, Thuo N, Oluoch L, Kiptinness C, Wald A, Mugo NR, Roxby AC, Ngure K. Protection at First Sexual Intercourse Among Adolescent Girls and Young Women in Kenya. Arch Sex Behav 2021; 50:219-227. [PMID: 32720186 PMCID: PMC8024200 DOI: 10.1007/s10508-020-01785-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/19/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
Adolescent girls and young women (AGYW) are at high risk of HIV and other sexually transmitted infections (STIs), including at first sexual intercourse. The literature is scarce on factors influencing use of protective strategies at this critical time. We conducted 20 in-depth interviews and five focus group discussions with purposively sampled AGYW aged 16-20 years who reported first sex while enrolled in a larger cohort study and willing to participate. All AGYW were counseled on HIV prevention and had access to reproductive health information and services. Data collected were transcribed, translated and analyzed thematically. We identified two approaches to first sex. In one approach, the AGYW facilitated protection use, and those AGYW reported intention and preparation to initiate sexual activity and ability to request condom use, as well as their male partner's willingness to use and provide condoms. In another approach, AGYW experienced first sexual intercourse without agency (the feeling of control over actions and their consequences [Moore, 2016]) and described lack of prior intentions and planning, discomfort with discussions about sex and condom use, and desire to experience sexual pleasure as reported by peers. No AGYW mentioned parents/adults as playing any role as facilitators of protection use at first sex, highlighting the need for further research on the missing gap. The AGYW were trusting of verbal reports by male partners describing themselves as having never engaged in sex, HIV negative, and free of STIs. We found that some AGYW were empowered to plan, discuss, and request protection at first sex, and others did not take agency. First sex is a time of vulnerability where innovative strategies are needed to strengthen AGYW's agency and promote condom use and other HIV/STI prevention methods.
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Affiliation(s)
- Edinah Casmir
- Center for Clinical Research, Kenya Medical Research Institute, KNH, Nairobi, 19865-0020, Kenya.
| | | | - Fernandos Ongolly
- Center for Clinical Research, Kenya Medical Research Institute, KNH, Nairobi, 19865-0020, Kenya
| | - Nicholas Thuo
- Center for Clinical Research, Kenya Medical Research Institute, KNH, Nairobi, 19865-0020, Kenya
| | - Lynda Oluoch
- Center for Clinical Research, Kenya Medical Research Institute, KNH, Nairobi, 19865-0020, Kenya
| | - Catherine Kiptinness
- Center for Clinical Research, Kenya Medical Research Institute, KNH, Nairobi, 19865-0020, Kenya
| | - Anna Wald
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
- Vaccines and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nelly Rwamba Mugo
- Center for Clinical Research, Kenya Medical Research Institute, KNH, Nairobi, 19865-0020, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Alison C Roxby
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
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16
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Giano Z, Kavanaugh KE, Durham AR, Currin JM, Wheeler DL, Croff JM, Hubach RD. Factors Associated with Condom Use among a Sample of Men Who Have Sex with Men (MSM) Residing in Rural Oklahoma. J Homosex 2020; 67:1881-1901. [PMID: 31125299 DOI: 10.1080/00918369.2019.1616430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Public health literature often neglects populations from rural communities, particularly with men who have sex with men (MSM). Although HIV/STI infections are decreasing slightly, there is an increase within rural MSM, thus opening the door for further research on condom use behavior in a rural context. In-depth interviews were conducted with 40 MSM in rural Oklahoma regarding their condom use and sexual behaviors. A qualitative analysis revealed five themes with respect to condom usage: physical discomfort of condoms, relationship trust, usage based on the type of sexual act, substance use, and knowledge of a partner's HIV/STI status. A sixth theme within the context of rural Oklahoma revealed participants' fear of physical/verbal abuse, hesitations seeking medical help due to confidentially issues, and general acknowledgment of the lack of education and resources available. Implications include increasing mobile testing locations and a push for marketing greater confidentially within health service providers.
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Affiliation(s)
- Zachary Giano
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
| | - Katherine E Kavanaugh
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
- Department of Psychology, Texas Tech University , Lubbock, Texas, USA
| | - André R Durham
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
| | - Joseph M Currin
- Department of Psychology, Texas Tech University , Lubbock, Texas, USA
| | - Denna L Wheeler
- Center for Rural Health, Center for Health Sciences, Oklahoma State University , Tulsa, Oklahoma, USA
| | - Julie M Croff
- Center for Rural Health, Center for Health Sciences, Oklahoma State University , Tulsa, Oklahoma, USA
| | - Randolph D Hubach
- Sexual Health Research Lab, Oklahoma State University-Center for Health Sciences , Tulsa, Oklahoma, USA
- Center for Rural Health, Center for Health Sciences, Oklahoma State University , Tulsa, Oklahoma, USA
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17
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Sullivan MC, Cruess DG, Huedo-Medina TB, Kalichman SC. Substance Use, HIV Serostatus Disclosure, and Sexual Risk Behavior in People Living with HIV: An Event-Level Analysis. Arch Sex Behav 2020; 49:2005-2018. [PMID: 31863314 DOI: 10.1007/s10508-019-01531-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/21/2019] [Accepted: 07/31/2019] [Indexed: 05/22/2023]
Abstract
People living with HIV (PLWH) face difficult decisions about disclosing their HIV status to new sexual partners. Alcohol and other drug use could impact these decision-making processes and subsequent sexual risk behavior. We sought to examine the event-level relationships between substance use, HIV disclosure, and condom use in PLWH and their first-time HIV-negative or unknown status sexual partners. Adult PLWH were recruited from care settings in a southeastern U.S. city. Participants reported their sexual behavior for 28 consecutive days via text message prompts. We employed multilevel covariation in a causal system to examine the event-level relations between substance use and condom use. We proposed that this relationship would be mediated by HIV disclosure and moderated by viral suppression status. A total of 243 participants (83% male, 93% Black) reported 509 sexual events with first-time HIV-negative/unknown status sexual partners. Substance use at the time of sex was negatively associated with disclosure in PLWH with suppressed viral load (OR 0.29, β = - 1.22, 95% CI [- 2.42, - 0.03], p = .045), but differentially associated with condom use in PLWH with detectable versus undetectable viral load. In PLWH with viral suppression, participants who always disclosed versus who never disclosed their HIV status were more likely to use condoms (β = 1.84, 95% CI [0.35, 3.53], p = .017), but inconsistent disclosers were less likely to use a condom after disclosing (OR 0.22, 95% CI [0.07, 0.68], p = .008). Event-level analysis offers a more nuanced understanding of the proximal (substance use, HIV disclosure) and person-level (substance use, viral load) determinants of HIV transmission risk behavior in PLWH.
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Affiliation(s)
- Matthew C Sullivan
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA.
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA.
| | - Dean G Cruess
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
| | - Tania B Huedo-Medina
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
- Allied Health Sciences Department, University of Connecticut, Storrs, CT, USA
| | - Seth C Kalichman
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
- Institute for Collaboration for Health, Intervention, and Prevention, University of Connecticut, Storrs, CT, USA
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Inthavong K, Ha LTH, Anh LTK, Sychareun V. Knowledge of safe sex and sexually transmitted infections among high school students, Vientiane Prefecture, Lao PDR. Glob Health Action 2020; 13:1785159. [PMID: 32741352 PMCID: PMC7480502 DOI: 10.1080/16549716.2020.1785159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/29/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Adolescent knowledge of safe sex and sexually transmitted infections (STIs) can reduce the risk of STIs as well as unplanned pregnancies. OBJECTIVE To describe the knowledge of safe sex and STIs and to identify related factors among high school students in Vientiane Prefecture, Lao PDR. METHOD This was an analytical cross-sectional study conducted at one high school from January to February 2019. A self-administered questionnaire was used to collect information from respondents. The questionnaires were completed by 337 respondents who were selected by stratified random sampling. The data collected were entered into and analysed using EpiData and Stata 13.0 software. Descriptive and inferential statistics were applied to determine the factors associated with knowledge of safe sex and STIs. RESULTS The results showed that nearly half of the participants (49.5%) had a good knowledge of safe sex and 51.9% of the respondents had a good knowledge of STIs. Significant positive associations were shown between knowledge of safe sex by students living with other people, those who had studied family planning and had religious beliefs reflecting acceptance to using birth control. Other factors positively associated with knowledge of STIs were students being in Grade 10, and who had studied STIs including HIV/AIDS. CONCLUSION In this study, approximately half of the participants were aware of safe sex and had knowledge of STIs. There is a need to have comprehensive sexual education, particularly emphasising family planning, STIs, and HIV/AIDS for all grades in school.
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Affiliation(s)
- Khonesavanh Inthavong
- Faculty of Public Health, University of Health Sciences, Vientiane, Lao PDR
- Hanoi University of Public Health, Vietnam
| | - Le Thi Hai Ha
- Faculty of Social Sciences, Behavior and Health Education, Ministry of Education and Training, Ministry of Health, Hanoi University of Public Health, Vietnam
| | - Le Thi Kim Anh
- Faculty of Fundamental Sciences, Department of Biostatistics, Ministry of Health, Hanoi University of Public Health, Vietnam
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Nwaozuru U, Blackstone S, Obiezu-Umeh C, Conserve DF, Mason S, Uzoaru F, Gbajabiamila T, Ezechi O, Iwelunmor P, Ehiri JE, Iwelunmor J. Psychosocial correlates of safe sex self-efficacy among in-school adolescent girls in Lagos, Nigeria. PLoS One 2020; 15:e0234788. [PMID: 32574187 PMCID: PMC7310695 DOI: 10.1371/journal.pone.0234788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 06/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adolescent girls in Nigeria are at heightened risk for HIV and other sexually transmitted infections. However, there are limited studies on psychosocial factors that are associated with safe sex intentions among this population. Self-efficacy has been established as an important correlate of behavioral intentions and the actual behavior. The objective of this research was to examine how key psychosocial factors such as social support, parental monitoring, and future orientation influence perceived safe sex self-efficacy among in-school adolescent girls in Nigeria. Furthermore, we assessed the associations between these psychosocial factors and HIV-related knowledge and safe sex self-efficacy. METHODS A self-administered questionnaire was distributed to 426 adolescent girls attending public and private school systems in Lagos, Nigeria. Multiple linear regression was used to evaluate the influence of psychosocial and demographic factors on safe sex self-efficacy. Further, stratified analysis was conducted to compare the estimates between participants attending public schools (n = 272) and those attending private schools (n = 154). FINDINGS Results from the study show that future orientation (β = 0.17; p < 0.05), participants age (β = 0.14; p < 0.05), and HIV knowledge accuracy (β = 0.17; p < 0.05) were associated with safe sex self-efficacy. Future orientation remained statistically significant in the sub-group analysis among participants attending public (β = 0.13; p < 0.05) and private schools (β = 0.24; p < 0.05). Among participants attending public schools, HIV accuracy (β = 0.2; p < 0.05) remained a significant correlate of safe sex self-efficacy while this association dissipated among private school attendees. CONCLUSIONS These findings point to the importance of including future orientation strategies in interventions developed for in-school adolescent girls in Nigeria. School-based interventions that increase positive future orientation outcomes may be beneficial to improve safe sex intentions among adolescent girls in Nigeria.
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Affiliation(s)
- Ucheoma Nwaozuru
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Sarah Blackstone
- Departments of Health Professions and Health Sciences, James Madison University, Harrisonburg, Virginia, United States of America
| | - Chisom Obiezu-Umeh
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Donaldson F. Conserve
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, United States of America
| | - Stacey Mason
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Florida Uzoaru
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | | | - Oliver Ezechi
- Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - Patricia Iwelunmor
- Morning Star Health and Human Development Foundation, Festac Town, Lagos State, Nigeria
| | - John E. Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
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Kolstee J, Holt M, Jin J, Hammoud MA, Degenhardt L, Maher L, Lea T, Prestage G. Characteristics of gay and bisexual men who rarely use HIV risk reduction strategies during condomless anal intercourse: Results from the FLUX national online cohort study. PLoS One 2020; 15:e0233922. [PMID: 32479519 PMCID: PMC7263606 DOI: 10.1371/journal.pone.0233922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/14/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To understand the characteristics of a minority of Australian gay and bisexual men (GBM) who, despite an increase in the number and availability of HIV risk reduction strategies, do not consistently use a strategy to protect themselves from HIV. Methods This analysis is based on data from 2,920 participants in a national, online, prospective observational cohort study. GBM who never or rarely used HIV risk reduction strategies (NRR) were compared with two groups using multivariate logistic regression: i) GBM using pre-exposure prophylaxis (PrEP) and ii) GBM frequently using risk reduction strategies (FRR) other than PrEP. Results Compared to PrEP users, NRR men were younger (p<0.0001), less socially engaged with gay men (p<0.0001) and less likely to have completed a postgraduate (p<0.05) or undergraduate degree (p<0.05). They were also less likely to have recently used amyl nitrite (p<0.05), erectile dysfunction medication (p<0.05) and cocaine (p<0.05) in the previous 6 months. Compared with FRR men, NRR men were less likely to have completed a postgraduate (p<0.0001) or undergraduate degree (p<0.05), scored higher on the sexual sensation-seeking scale (p<0.0001) and were more likely to identify as versatile (p<0.05), a bottom (p<0.05) or very much a bottom (p<0.05) during anal sex. Conclusions NRR men were largely similar to other Australian GBM. However, our analysis suggests it may be appropriate to focus HIV prevention interventions on younger, less socially engaged and less educated GBM, as well as men who prefer receptive anal intercourse to promote the use of effective HIV risk reduction strategies.
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Affiliation(s)
- Johann Kolstee
- Kirby Institute, UNSW Sydney, Kensington, NSW, Australia
- * E-mail:
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Kensington, NSW, Australia
| | - Jeff Jin
- Kirby Institute, UNSW Sydney, Kensington, NSW, Australia
| | | | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Kensington, NSW, Australia
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Kensington, NSW, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Sydney, Kensington, NSW, Australia
- German Institute for Addiction and Prevention Research, Catholic University of Applied Sciences, Cologne, Germany
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Guilamo-Ramos V, Benzekri A, Thimm-Kaiser M, Dittus P, Ruiz Y, Cleland CM, McCoy W. A Triadic Intervention for Adolescent Sexual Health: A Randomized Clinical Trial. Pediatrics 2020; 145:e20192808. [PMID: 32345685 PMCID: PMC7193976 DOI: 10.1542/peds.2019-2808] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES In this study, we evaluate the efficacy of Families Talking Together (FTT), a triadic intervention to reduce adolescent sexual risk behavior. METHODS Adolescents aged 11 to 14 and their female caregivers were recruited from a pediatric clinic; 900 families were enrolled; 84 declined. Families were randomly assigned to FTT or 1 of 2 control conditions. The FTT triadic intervention consisted of a 45-minute face-to-face session for mothers, health care provider endorsement of intervention content, printed materials for families, and a booster call for mothers. The primary outcomes were ever having had vaginal intercourse, sexual debut within the past 12 months, and condom use at last sexual intercourse. Assessments occurred at baseline, 3 months post baseline, and 12 months post baseline. RESULTS Of enrolled families, 73.4% identified as Hispanic, 20.4% as African American, and 6.2% as mixed race. Mean maternal age was 38.8 years, and mean adolescent grade was seventh grade. At the 12-month follow-up, 5.2% of adolescents in the experimental group reported having had sexual intercourse, compared with 18% of adolescents in the control groups (P < .05). In the experimental group, 4.7% of adolescents reported sexual debut within the past 12 months, compared with 14.7% of adolescents in the control group (P < .05). In the experimental group, 74.2% of sexually active adolescents indicated using a condom at last sexual intercourse, compared with 49.1% of adolescents in the control group (P < .05). CONCLUSIONS This research suggests that the FTT triadic intervention is efficacious in delaying sexual debut and reducing sexual risk behavior among adolescents.
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Affiliation(s)
- Vincent Guilamo-Ramos
- Center for Latino Adolescent and Family Health, New York University, New York, New York;
- Adolescent AIDS Program, Children's Hospital at Montefiore Medical Center, Bronx, New York
- Presidential Advisory Council on HIV/AIDS, Washington, District of Columbia
| | - Adam Benzekri
- Center for Latino Adolescent and Family Health, New York University, New York, New York
| | - Marco Thimm-Kaiser
- Center for Latino Adolescent and Family Health, New York University, New York, New York
- Department of Epidemiology and Biostatistics, School of Public Health and Health Policy, The City University of New York, New York, New York
| | - Patricia Dittus
- Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yumary Ruiz
- Center for Latino Adolescent and Family Health, New York University, New York, New York
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
| | | | - Wanda McCoy
- Morris Heights Health Center, Bronx, New York
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Nemoto T, Xie H, Iwamoto M, Sakata M. HIV Risk Behaviors in Relation to Psychosocial Factors and Internet Usage Among Asian and Pacific Islander (API) Men Who Had Sex With Men (MSM) in California. AIDS Educ Prev 2020; 32:117-136. [PMID: 32539477 DOI: 10.1521/aeap.2020.32.2.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Very few studies have been conducted to investigate HIV risk and protective behaviors in relation to psychosocial factors among Asian and Pacific Islander (API) MSM whose HIV/AIDS prevalence is lower than those of other racial/ethnic groups. This study, based on an online survey targeting API MSM in California revealed that API MSM often met sex partners online and that psychosocial factors (e.g., homophobia and identity with API gay community) were correlated with condomless receptive anal sex (RAS) with casual partners. In particular, an Asian cultural construct, interdependency, was correlated with condom use for RAS; that is, those who consider sex partners' health and value harmony tend to engage in safe sex. This finding sheds light on re-thinking the current over-emphasis on assertiveness and self-responsibility to keep free from HIV/STIs during negotiation with partners. Future STI prevention programs for API MSM should incorporate Asian cultural constructs and target specific risk groups.
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Hall WJ, Erausquin JT, Nichols TR, Tanner AE, Brown-Jeffy S. Relationship intentions, race, and gender: Student differences in condom use during hookups involving vaginal sex. J Am Coll Health 2019; 67:733-742. [PMID: 30265847 DOI: 10.1080/07448481.2018.1506788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 06/05/2018] [Accepted: 07/26/2018] [Indexed: 06/08/2023]
Abstract
Objective: To examine the relationship between race, gender, and pre-hookup relationship intentions and college students' participation in condomless vaginal sex. Participants: 3,315 Black and White college students who participated in the Online College Social Life Survey (OCSLS). Methods: Secondary data analysis of the OCSLS using Chi-square and multiple logistic regression analyses. Results: The model revealed that students who did not want a relationship with their hookup partners and students unsure of their relationship intentions were more likely to use condoms during their last vaginal hookup. Further, White and Female students were less likely to have used condoms during their last vaginal hookup.Conclusions: White and female students, as well as students desiring romantic relationships with hookup partners may be at risk for sexually transmitted infections (STIs) due to decreased condom use. However, more research is needed to explore the factors driving STI disparities facing Black students despite higher condom use.
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Affiliation(s)
| | - Jennifer Toller Erausquin
- Department of Public Health Education, The University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Tracy R Nichols
- Department of Public Health Education, The University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Amanda E Tanner
- Department of Public Health Education, The University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - Shelly Brown-Jeffy
- Department of Sociology, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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Butler SM, Mooney K, Janousek K. The Condom Fairy program: A novel mail-order service for condoms and sexual health supplies. J Am Coll Health 2019; 67:772-780. [PMID: 30365911 DOI: 10.1080/07448481.2018.1512500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/27/2018] [Accepted: 08/13/2018] [Indexed: 06/08/2023]
Abstract
Objective: In recent years college health professionals have used a variety of innovative strategies to increase availability and accessibility of condoms and safer sex products. The purpose of this study is to evaluate the efficacy and efficiency of a mail-order delivery program titled the Condom Fairy. Participants: Seven hundred thirty-three students (63.4% women, 86.1% heterosexual, and 59.2% Caucasian) completed a questionnaire assessing their overall experience with the program. Methods: Participants completed a 60 item questionnaire 30 days after receiving condoms and safer sex products. Results: Overall, 46,980 condoms were distributed over a six semester period. Almost all of the participants (97.4%) reported they ordered male condoms while 58.0% ordered sexual lubricant, 11.1% female condoms, and 10.2% latex dams. Nearly than three-quarters (73.9%) of participants reported they used the condoms provided. Conclusions: Findings support the implementation of innovative mail-in condom and safer sex product programs on college campuses.
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Affiliation(s)
- Scott M Butler
- School of Health and Human Performance, Professor of Public Health, Georgia College, Milledgeville, GA, USA
| | - Katharine Mooney
- Wellness and Prevention Services, Wellness and Prevention, Boston University, Boston, MA, USA
| | - Katy Janousek
- University Health Center, The University of Georgia, Athens, GA, USA
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Patel SK, Mukherjee S, Mahapatra B, Battala M, Jayaram M, Kumta S, Atmavilas Y, Saggurti N. Enhancing financial security of female sex workers through a community-led intervention in India: Evidence from a longitudinal survey. PLoS One 2019; 14:e0223961. [PMID: 31639161 PMCID: PMC6804955 DOI: 10.1371/journal.pone.0223961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 10/02/2019] [Indexed: 01/19/2023] Open
Abstract
Introduction Community-led organizations (COs) have been an integral part of HIV prevention programs to address the socio-economic and structural vulnerabilities faced by female sex workers (FSWs). The current study examines whether strengthening of community-led organizations and community collectivization have been instrumental in reducing the financial vulnerability and empowering FSWs in terms of their self-efficacy, confidence, and individual agency in India. Data and methods This study used a panel data of 2085 FSWs selected from 38 COs across five states of India. Two rounds of data (Round 1 in 2015 and Round 2 in 2017) were collected among FSWs. Data were collected both at CO and individual level. CO level data was used to assess the CO strength. Individual level data was used to measure financial security, community collectivization, and individual empowerment. Results There was a significant improvement in CO strength and community collectivization from Round 1 to Round 2. High CO strength has led to improved financial security among FSWs (R2: 85% vs. R1: 51%, AOR: 2.5; 95% CI: 1.5–4.1) from Round 1 to Round 2. High collective efficacy and community ownership have improved the financial security of FSWs during the inter-survey period. Further, the improvement in financial security in the inter-survey period led to increased or sustained individual empowerment (in terms of self-confidence, self-efficacy, and individual agency) among FSWs. Conclusions Institutional strengthening and community mobilization programs are key to address the structural issues and the decrease of financial vulnerability among FSWs. In addition, enhanced financial security is very important to sustain or improve the individual empowerment of FSWs. Further attention is needed to sustain the existing community advocacy and engagement systems to address the vulnerabilities faced by marginalized populations and build their empowerment.
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Affiliation(s)
| | | | | | | | | | - Sameer Kumta
- Bill & Melinda Gates Foundation, New Delhi, India
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26
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Beaulieu-Prévost D, Cormier M, Heller SM, Nelson-Gal D, McRae K. Welcome to Wonderland? A Population Study of Intimate Experiences and Safe Sex at a Transformational Mass Gathering (Burning Man). Arch Sex Behav 2019; 48:2055-2073. [PMID: 31325119 DOI: 10.1007/s10508-019-01509-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 06/10/2023]
Abstract
Transformational festivals are socially immersive artistic mass gatherings that are said to promote a strong feeling of belonging and experiences of personal transformation. The purposes of the present study were (1) to investigate the social and intimate experiences of Burning Man participants and (2) to study the factors predicting safe sex practices in the context of that transformational festival. The study was based on data from two consecutive cycles (2013 and 2014) of the yearly post-event online survey done in collaboration with the Burning Man Project. Participants consisted of people who attended the event (N = 19,512). The results were weighted based on the sociodemographic characteristics of the population. A typology of social and intimate experiences was created using a k-means cluster analysis. Predictors of having had unprotected sex with someone met during the event were identified using a nested logistic regression. Five profiles of social and intimate experiences were identified. Profiles with high levels of emotionally and physically intimate experiences were associated with a strong feeling of belonging and a high proportion of personal transformation. Predictive analyses showed that unprotected sex was mainly predicted by variables associated with one of three factors: (1) a lower lever of preparation and practice in using protection, (2) sex education and/or subcultures, and (3) the perceived costs and benefits associated with protection. The results also indirectly suggest a positive effect of the event on safe sex. Implications in terms of public health intervention are discussed.
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Affiliation(s)
- Dominic Beaulieu-Prévost
- Département de sexologie, Université du Québec à Montréal, C.P. 8888, succ. Centre-ville, Montréal, QC, H3C 3P8, Canada.
- Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada.
| | - Mélanie Cormier
- Département de sexologie, Université du Québec à Montréal, C.P. 8888, succ. Centre-ville, Montréal, QC, H3C 3P8, Canada
| | - S Megan Heller
- Department of Anthropology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Kateri McRae
- Department of Psychology, University of Denver, Denver, CO, USA
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Hahn H, Kalnitsky S, Haines N, Thamotharan S, Beauchaine TP, Ahn WY. Delay Discounting of Protected Sex: Relationship Type and Sexual Orientation Influence Sexual Risk Behavior. Arch Sex Behav 2019; 48:2089-2102. [PMID: 31414329 DOI: 10.1007/s10508-019-1450-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 05/06/2023]
Abstract
Sexual discounting, which describes delay discounting of later protected sex vs. immediate unprotected sex (e.g., sex now without a condom vs. waiting an hour to have sex with a condom), is consistently linked to sexual risk behavior. Estimates suggest that over two-thirds of HIV transmissions occur between individuals in committed relationships, but current sexual discounting tasks examine sexual discounting only with hypothetical strangers, leaving a gap in our understanding of sexual discounting with committed sexual partners. We used the Sexual Discounting Task (SDT) to compare discounting rates between men who have sex with men (MSM; n = 99) and heterosexual men (n = 144) and tested a new SDT condition evaluating sexual discounting with main partners. MSM in committed relationships discounted protected sex with their main partner at higher rates than heterosexual men, and discounting rates correlated with self-report measures of condom use, impulsivity/sensation seeking, and substance use. These findings suggest that sexual discounting is a critical factor potentially related to increased HIV transmission between MSM in committed relationships and may be an important target for intervention and prevention.
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Affiliation(s)
- Hunter Hahn
- Department of Psychology, The Ohio State University, Columbus, OH, 43210, USA.
| | - Samuel Kalnitsky
- Department of Psychology, The Ohio State University, Columbus, OH, 43210, USA
| | - Nathaniel Haines
- Department of Psychology, The Ohio State University, Columbus, OH, 43210, USA
| | - Sneha Thamotharan
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Child and Adolescent Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | | | - Woo-Young Ahn
- Department of Psychology, The Ohio State University, Columbus, OH, 43210, USA
- Department of Psychology, Seoul National University, Seoul, Korea
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Reisner SL, Moore CS, Asquith A, Pardee DJ, Sarvet A, Mayer G, Mayer KH. High risk and low uptake of pre-exposure prophylaxis to prevent HIV acquisition in a national online sample of transgender men who have sex with men in the United States. J Int AIDS Soc 2019; 22:e25391. [PMID: 31536171 PMCID: PMC6752156 DOI: 10.1002/jia2.25391] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/06/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Trans masculine people who have sex with cisgender ("cis") men ("trans MSM") may be at-risk for HIV infection when they have cis MSM partners or share needles for hormone or recreational drug injection. Limited data are available characterizing indications and uptake of pre-exposure prophylaxis (PrEP) in trans MSM. The aim of this study was to assess PrEP indication and uptake as a means of primary HIV prevention for adult trans MSM in the U.S. METHODS Between November and December 2017, a national convenience sample of trans MSM in the U.S. (n = 857) was recruited using participatory methodologies and completed an online survey of demographics, HIV risk, PrEP, behavioural and psychosocial factors. Self-reported receptive anal sex or frontal/vaginal sex (with or without a condom) with a cis male sex partner in past six months was an eligibility criterion. A multivariable logistic regression procedure was used to model PrEP indications (yes/no) per an interpretation of U.S. Centers of Disease Control and Prevention recommendations among those without HIV (n = 843). RESULTS The diverse sample was 4.9% Black; 22.1% Latinx ethnicity; 28.4% non-binary gender identity; 32.6% gay-identified; 82.7% on testosterone. Overall, 84.1% had heard of PrEP. Of these, 33.3% reported lifetime PrEP use (21.8% current and 11.5% past). Based on HIV behavioural risk profiles in the last six months, 55.2% of respondents had indications for PrEP. In a multivariable model, factors associated with PrEP indication included where met sex partners, not having sex exclusively with cismen, higher perceived HIV risk, greater number of partners and high cis male partner stigma (all p < 0.05). DISCUSSION The majority of trans MSM in this sample had a PrEP indication. Stigma was associated with risk for HIV acquisition and represents a critical target for HIV biobehavioural prevention interventions for trans MSM, who appear to be underutilizing PrEP. CONCLUSIONS Results from this study support the full inclusion of trans MSM in HIV biobehavioural prevention efforts. Public health interventions and programmes are needed to reach trans MSM that attend to general MSM risk factors as well as to vulnerabilities specific to trans MSM, including the context of stigma from cis male sexual partners.
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Affiliation(s)
- Sari L Reisner
- The Fenway InstituteFenway HealthBostonMAUSA
- Department of PediatricsBoston Children's HospitalHarvard Medical SchoolBostonMAUSA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMAUSA
| | | | | | | | - Aaron Sarvet
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Gal Mayer
- Gilead Sciences, Inc.Foster CityCAUSA
| | - Kenneth H Mayer
- The Fenway InstituteFenway HealthBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
- Global Population HealthHarvard T.H. Chan School of Public HealthBostonMAUSA
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Jiang T, Zhou X, Wang H, Luo M, Pan X, Ma Q, Chen L. Psychosocial Factors Associated with Quality of Life in Young Men Who Have Sex with Men Living with HIV/AIDS in Zhejiang, China. Int J Environ Res Public Health 2019; 16:E2667. [PMID: 31349674 PMCID: PMC6696375 DOI: 10.3390/ijerph16152667] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To explore the quality of life (QOL) status and related factors in young human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) aged 16 to 24 years in Zhejiang province. METHODS A cross-sectional study was conducted in 22 counties of Zhejiang province, and 395 subjects took part in our research. A t-test, one-way Analysis of variance (ANOVA), and multivariate stepwise linear regression analysis were used to investigate the factors associated with QOL in young HIV-infected MSM. RESULTS The total score on the QOL was 86.86 ± 14.01. The multivariate stepwise linear regression analysis revealed that self-efficacy and discrimination were associated with all domains on the QOL assessment, monthly income was associated with QOL for all domains except spirituality and consistent condom use during oral sex with men in the past three months was associated with QOL for all domains except the relationship domain. Those individuals within the group of young HIV-infected MSM who have higher self-efficacy, a higher monthly income, greater social support, safer sexual behaviors, a higher level of education, and a higher cluster of differentiation 4 (CD4) count have a better QOL. CONCLUSIONS These findings suggest that to improve the QOL of this population, greater emphasis should be placed on improving social support, self-efficacy, and antiviral therapy adherence and on reducing discrimination, disease progression, and high-risk behaviors.
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Affiliation(s)
- Tingting Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Xin Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Hui Wang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Mingyu Luo
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Xiaohong Pan
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China
| | - Qiaoqin Ma
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China.
| | - Lin Chen
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou 310051, China.
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Reza-Paul S, Lazarus L, Maiya R, Venukumar KT, Lakshmi B, Roy A, Haldar P, Andina M, Lafort Y, Lorway R. Delivering community-led integrated HIV and sexual and reproductive health services for sex workers: A mixed methods evaluation of the DIFFER study in Mysore, South India. PLoS One 2019; 14:e0218654. [PMID: 31226141 PMCID: PMC6588234 DOI: 10.1371/journal.pone.0218654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 06/06/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction Women in developing countries continue to face barriers to accessing sexual and reproductive health (SRH) services, with marginalized women facing increased challenges to accessing care. The Diagonal Interventions to Fast-Forward Enhanced Reproductive Health (DIFFER) project implemented a package of interventions for female sex workers and women from the general population which integrated horizontal health services for the general population with existing vertical targeted interventions aimed at sex workers with an aim to improve SRH and HIV services. We present an outcome evaluation of the DIFFER project in terms of uptake rates for SRH services among sex workers in Mysore, India. Methods Ashodaya Samithi, a sex worker-led organization, implemented the DIFFER strategy through their community-based clinic and a Well Women Clinic (WWC), established at a partner private hospital that provided SRH services for women living with HIV. Mixed methods were used to evaluate the intervention that included a baseline (2012–13) and end of project (2015–16) cross sectional surveys (CSS), focus group discussions (FGDs), key informant interviews, and analysis of service statistics from 2013–2016. Results The CSS found that condom use, STI testing, and treatment were high before, and throughout the intervention; cervical cancer screening and treatment increased significantly, from 11.5% to 56% (aOR 9.85, p<0.001) and HIV testing in the last 3 months increased from 26.3% to 73.3% (aOR 7.25, p<0.001). The proportion of sex workers using any SRH service in the past year doubled from 25.7% to 51.4% (aOR 2.91, p<0.001). Service statistics showed similar trends. The FGDs and key informant interviews showed that women and stakeholders held high levels of satisfaction with the strategy, and affirmed potential for scale up. Conclusion The DIFFER strategy demonstrated that SRH service uptake can occur in conjuction with HIV services offered to sex workers. This model of integrated service delivery has been accepted by policy makers and needs further analysis for scaling up.
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Affiliation(s)
- Sushena Reza-Paul
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- * E-mail:
| | - Lisa Lazarus
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | | | | | - Partha Haldar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Yves Lafort
- Department Uro-Gynaecology, International Centre for Reproductive Health, WHO Collaborating Centre, Ghent University, Ghent, Belgium
| | - Robert Lorway
- Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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Kimemia G, Ngure K, Baeten JM, Celum C, Dew K, Njuguna N, Mugo N, Heffron R. Perceptions of pregnancy occurring among HIV-serodiscordant couples in Kenya. Reprod Health 2019; 16:85. [PMID: 31215447 PMCID: PMC6582525 DOI: 10.1186/s12978-019-0751-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/10/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Among HIV serodiscordant couples, most conception involves condomless sex and may confer a period with increased HIV transmission risk if HIV viral load is not suppressed and other precautions are not used. Safer conception strategies enable HIV serodiscordant couples to attain their pregnancy goals while markedly reducing this risk. We explored the perceptions and beliefs held by HIV serodiscordant couples and health care providers concerning pregnancy among HIV serodiscordant couples in Kenya and gathered their thoughts about how these might influence use of safer conception methods. METHODS We conducted 20 Key Informant Interviews (KIIs) with health care providers offering safer conception counseling and 21 In-Depth Interviews (IDIs) and 4 Focus Group Discussions (FGDs) with members of HIV serodiscordant couples with immediate pregnancy goals in Thika, Kenya. Data were analyzed using an inductive approach that identified two emergent themes: perceptions towards pregnancy among HIV serodiscordant couples and access to safer conception services. RESULTS The perceptions held by the community towards couples in HIV serodiscordant relationships having children were largely negative. The participants were aware of the increased HIV transmission risk to the HIV uninfected partners while trying to become pregnant. In the community, having biological children was cherished yet the majority of the couples shied away from accessing safer conception services offered at health facilities due to stigma and lack of knowledge of the existence of such services. Some providers had limited knowledge on safer conception strategies and services and consequently discouraged HIV serodiscordant couples from natural conception. CONCLUSIONS Negative perceptions towards HIV serodiscordant couples becoming pregnant has hindered access to safer conception services. Therefore, there is need to create a supportive environment for HIV serodiscordant couples with fertility intentions that normalizes their desire to have children and informs the community about the availability of safer conception services.
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Affiliation(s)
- Grace Kimemia
- African Population & Health Research Center, Nairobi, Kenya
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Jared M. Baeten
- Department of Global Health, University of Washington, 325 Ninth Avenue Box 359927, Seattle, WA 98104 USA
- Department of Epidemiology, University of Washington, 325 Ninth Avenue Box 359927, Seattle, WA 98104 USA
- Department of Medicine, University of Washington, Seattle, USA
| | - Connie Celum
- Department of Global Health, University of Washington, 325 Ninth Avenue Box 359927, Seattle, WA 98104 USA
- Department of Epidemiology, University of Washington, 325 Ninth Avenue Box 359927, Seattle, WA 98104 USA
- Department of Medicine, University of Washington, Seattle, USA
| | - Kristin Dew
- Department of Human Centered Design and Engineering, University of Washington, Seattle, USA
| | | | - Nelly Mugo
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Renee Heffron
- Department of Global Health, University of Washington, 325 Ninth Avenue Box 359927, Seattle, WA 98104 USA
- Department of Epidemiology, University of Washington, 325 Ninth Avenue Box 359927, Seattle, WA 98104 USA
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Zhou C, Hsieh E, Rou K, Tillman J, Dong W, Feng XX, Yang YZ, Yang YJ, Sun XG, Zang HJ, Wu YZ, Wu Z. Short-term acceptability of female condom use among low-fee female sex workers in China: a follow-up study. BMC Womens Health 2019; 19:77. [PMID: 31200702 PMCID: PMC6570840 DOI: 10.1186/s12905-019-0773-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low-fee female sex workers (FSW) lack power to effectively negotiate male condom use with clients. Female condoms (FCs) may provide an alternative strategy. This study was conducted to assess the acceptability of FC use among low-fee FSWs, and to identify appropriate candidates for future FC promotion. METHODS A one-month follow-up study was conducted. At entry into the study, eligible participants completed a baseline questionnaire and were given 10 FCs. At the one-month follow up encounter, the number of used FC packages were counted and each participant completed a follow-up questionnaire. Logistic regression was used to identify variables associated with more frequent use of FCs (> 2 times). RESULTS A total of 312 low-fee FSWs were enrolled at baseline and all participants completed the follow-up evaluation. Among them, 123 (39.4%) participants had used more than two FCs. Participants who were illiterate or had completed at most primary school education (OR: 2.4, 95% CI: 1.4-7.2), charged ≤30 RMB per client (≤30 vs. 51-80 RMB, OR: 3.8, 95% CI: 1.9-7.6), or had consistently used condoms with regular clients in the past month (OR: 2.4, 95%CI: 1.4-4.2) were more likely to use FCs. CONCLUSION Low-fee FSWs charging ≤30 RMB per client, and those who are less educated may be appropriate initial candidates for FC promotion in China. Strategies to consider include teaching FSWs tactics for negotiation of FC use that can initially be applied with regular clients, and providing education to maximize ease-of use, and minimize discomfort with FC usage.
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Affiliation(s)
- Chu Zhou
- Division of Prevention and Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 China
| | - Evelyn Hsieh
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut USA
| | - Keming Rou
- Division of Prevention and Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 China
| | - Jonas Tillman
- Division of Prevention and Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 China
| | - Wei Dong
- Division of Prevention and Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 China
| | - Xian-xiang Feng
- Division of HIV Prevention, Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi Zhuang Autonomous Region China
| | - Yan-zhen Yang
- Division of HIV Prevention, Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi Zhuang Autonomous Region China
| | - Yu-jun Yang
- Division of HIV Prevention, Zhangjiajie Center for Disease Control and Prevention, Zhangjiajie, Hunan Province China
| | - Xian-guo Sun
- Division of HIV Prevention, Zhangjiajie Center for Disease Control and Prevention, Zhangjiajie, Hunan Province China
| | - Hai-jian Zang
- Division of HIV Prevention, Pingnan Center for Disease Control and Prevention, Pingnan, Guangxi Zhuang Autonomous Region China
| | - Ying-zhen Wu
- Division of HIV Prevention, Pingnan Center for Disease Control and Prevention, Pingnan, Guangxi Zhuang Autonomous Region China
| | - Zunyou Wu
- Division of Prevention and Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206 China
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Fearon E, Wiggins RD, Pettifor AE, MacPhail C, Kahn K, Selin A, Gómez-Olivé FX, Hargreaves JR. Friendships Among Young South African Women, Sexual Behaviours and Connections to Sexual Partners (HPTN 068). AIDS Behav 2019; 23:1471-1483. [PMID: 30684099 DOI: 10.1007/s10461-019-02406-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Friends could be influential on young women's sexual health via influences on sexual behaviours and as connections to sexual partners, but are understudied in sub-Saharan Africa. We cross-sectionally surveyed 2326 13-20 year-old young women eligible for grades 8-11 in rural South Africa about their sexual behaviour and up to three sexual partners. Participants each described five specific but unidentified friends and the relationships between them in an 'egocentric' network analysis design. We used logistic regression to investigate associations between friendship characteristics and participants' reports of ever having had sex (n = 2326) and recent condom use (n = 457). We used linear regression with random effects by participant to investigate friendship characteristics and age differences with sexual partners (n = 633 participants, 1051 partners). We found that it was common for friends to introduce young women to those who later became sexual partners, and having older friends was associated with having older sexual partners, (increase of 0.37 years per friend at least 1 year older, 95% CI 0.21-0.52, adjusted). Young women were more likely to report ever having had sex when more friends were perceived to be sexually active (adjusted OR 1.85, 95% CI 1.72-2.01 per friend) and when they discussed sex, condoms and HIV with friends. Perception of friends' condom use was not associated with participants' reported condom use. While this study is preliminary and unique in this population and further research should be conducted, social connections between friends and sexual partners and perceptions of friend sexual behaviours could be considered in the design of sexual health interventions for young women in South Africa.
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Affiliation(s)
- Elizabeth Fearon
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9 SH, UK.
| | - Richard D Wiggins
- Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - Audrey E Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
- Wits Reproductive Health Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine MacPhail
- Wits Reproductive Health Institute, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Global Health Research, Umeå University, Umeå, Sweden
- INDEPTH Network, Accra, Ghana
| | - Amanda Selin
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - F Xavier Gómez-Olivé
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - James R Hargreaves
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9 SH, UK
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Gwokyalya V, Beyeza-Kashesya J, Bwanika JB, Matovu JKB, Mugerwa S, Arinaitwe J, Kasozi D, Bukenya J, Kindyomunda R, Wagner GJ, Makumbi FE, Wanyenze RK. Knowledge and correlates of use of safer conception methods among HIV-infected women attending HIV care in Uganda. Reprod Health 2019; 16:64. [PMID: 31138254 PMCID: PMC6538556 DOI: 10.1186/s12978-019-0717-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many people living with HIV would like to have children but family planning (FP) services often focus on only contraception. Availability of safer conception services is still very low in most low income countries. In this study we assessed the knowledge and use of safer conception methods (SCM) among HIV infected women in HIV care in Uganda to inform integration of safer conception in existing FP services. METHODS Data were accrued from a nationally representative cross-sectional survey of 5198 HIV+ women aged 15-49 years from 245 HIV clinics in Uganda. Knowledge and use of safer conception methods and associated factors were determined. The measure of association was prevalence ratio (PR) with corresponding 95% confidence intervals, obtained using a modified Poisson regression via generalized linear models. All the analyses were conducted using STATA version 12.0. RESULTS Overall knowledge of any safer conception method was 74.1% (3852/5198). However only 13.2% knew 3 to 4 methods, 18.9% knew only 2 methods and 42% knew only one method. Knowledge of specific SCM was highest for timed unprotected intercourse (TUI) at 39% (n = 2027) followed by manual self-insemination (MSI) at 34.8% (n = 1809), and pre-exposure prophylaxis (PrEP) at 24.8% (n = 1289). Knowledge of SCM was higher in the Eastern region (84.8%, P < 0.001), among women in HIV-discordant relationships (76.7%, p < 0.017), and those on ART (74.5%, p < 0.034). Overall, 1796 (34.6%) women were pregnant or reported a birth in the past 2 years-overall use of SCM in this group was 11.6% (209/1796). The odds of use of SCM were significantly lower in Kampala [adj. PR = 0.489(0.314, 0.764)] or Eastern region [adj.PR = 0.244; (0.147, 0.405)] compared to Northern region. Higher odds of SCM use were associated with HIV status disclosure to partner [adj.PR = 2.613(1.308, 5.221)] and sero-discordant compared to HIV+ concordant relationship [adj.PR = 1.637(1.236, 2.168)]. Pre-existing knowledge of any one SCM did not influence SCM use. CONCLUSIONS Knowledge and use of SCM among HIV+ women in care is low. Efforts to improve HIV status disclosure, integration of safer conception into FP and HIV services and regional efforts to promote sensitization and access to safer conception can help to increase uptake of safer conception methods.
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Affiliation(s)
| | - Jolly Beyeza-Kashesya
- Department of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda
| | | | | | | | | | - Dickson Kasozi
- Makerere University School of Public Health, Kampala, Uganda
| | - Justine Bukenya
- Makerere University School of Public Health, Kampala, Uganda
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Eleftheriou A, Bullock S, Graham CA, Skakoon-Sparling S, Ingham R. Does attractiveness influence condom use intentions in women who have sex with men? PLoS One 2019; 14:e0217152. [PMID: 31120922 PMCID: PMC6532962 DOI: 10.1371/journal.pone.0217152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 05/06/2019] [Indexed: 12/17/2022] Open
Abstract
Objectives Attractiveness judgements have been shown to affect interpersonal relationships. The present study explored the relationships between perceived attractiveness, perceived sexual health status, condom use intentions and condom use resistance in women. Setting The study data were collected using an online questionnaire. Participants 480 English-speaking women who have sex with men, between 18–32 years old. Outcome measures Women were asked to rate the attractiveness of 20 men on the basis of facial photographs, to estimate the likelihood that each man had a sexually transmitted infection (STI), and to indicate their willingness to have sex with each man without a condom. Condom resistance tactics were also measured and their influence on condom use intentions was assessed. Results The more attractive a man was judged to be, the more likely it was that participants were willing to have sex with him (r (478) = 0.987, p < .001). Further, the more attractive a man was judged to be, the less likely women were to intend to use a condom during sex (r = -0.552, df = 478, p = .007). The average perceived STI likelihood for a man had no significant association with his average perceived attractiveness or with participants’ average willingness to have sex with him. The more attractive a participant judged herself to be, the more she believed that, overall, men are likely to have a STI (r = 0.103, df = 478, p < .05). Conclusions Women’s perceptions of men’s attractiveness influence their condom use intentions; such risk biases should be incorporated into sexual health education programmes and condom use interventions.
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Affiliation(s)
- Anastasia Eleftheriou
- Electronics and Computer Science, University of Southampton, United Kingdom
- Institute for Complex Systems Simulation, University of Southampton, United Kingdom
- * E-mail:
| | - Seth Bullock
- Department of Computer Science, University of Bristol, United Kingdom
| | - Cynthia A. Graham
- Centre for Sexual Health Research, Psychology, University of Southampton, United Kingdom
| | | | - Roger Ingham
- Centre for Sexual Health Research, Psychology, University of Southampton, United Kingdom
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Dawson EL, Mendoza MCB, Gaul Z, Jeffries IV WL, Sutton MY, Wilson PA. Resilience, condom use self-efficacy, internalized homophobia, and condomless anal sex among black men who have sex with men, New York City. PLoS One 2019; 14:e0215455. [PMID: 31017944 PMCID: PMC6481831 DOI: 10.1371/journal.pone.0215455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/02/2019] [Indexed: 11/19/2022] Open
Abstract
Background Black men who have sex with men, who account for less than 1% of the U.S. population, account for approximately 25% of new HIV infections annually. Condomless anal sex contributes to HIV infection among black men who have sex with men. The capacity to recover quickly from difficulties (resilience) may be protective against condomless anal sex, but has been understudied among black men who have sex with men. Psychosocial factors related to resilience, i.e., condom use self-efficacy and internalized homophobia, may also affect condomless anal sex. We assessed the association between resilience, condom use self-efficacy, internalized homophobia and condomless anal sex among black men who have sex with men. Methods Data are from a 2010–2011 study examining condomless anal sex (past 60 days) among black men who have sex with men in New York City. Validated scales assessed resilience (theoretical range = 0–100), condom use self-efficacy (theoretical range = 27–135), and internalized homophobia (theoretical range = 9–36). We described continuous variables using median and interquartile range (IQR). Univariable and multivariable Poisson regression models assuming a robust variance estimator were used to compute unadjusted and adjusted prevalence ratios, respectively, and their corresponding 95% confidence intervals (CI). Adjusted prevalence ratios (aPR) examined the association of resilience, condom use self-efficacy, and internalized homophobia with condomless anal sex, while controlling for potential confounders (e.g., having >1 sex partner). Results The median resilience score within our sample (N = 228) was 75 (IQR = 66–83). Many black men who have sex with men reported condomless anal sex (55.7%) and >1 sex partner (58.8%). Decreased condomless anal sex was associated with increased levels of condom use self-efficacy (aPR: 0.94 per 10-point increase in condom use self-efficacy score; CI: 0.90–0.97; p-value: 0.001). Condomless anal sex was not associated with resilience or internalized homophobia. Conclusions Within this sample of black men who have sex with men, condomless anal sex was prevalent. Greater resilience was not protective against condomless anal sex. Interventions that support condom use are warranted for black men who have sex with men.
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Affiliation(s)
- Erica L. Dawson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Maria C. B. Mendoza
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Zaneta Gaul
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- ICF, Atlanta, Georgia, United States of America
| | - William L. Jeffries IV
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Madeline Y. Sutton
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patrick A. Wilson
- Mailman School of Public Health, Columbia University, New York City, New York, United States of America
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Ramírez-Ortiz D, Rojas P, Sánchez M, Cano MÁ, De La Rosa M. Associations of Self-Silencing and Egalitarian Attitudes with HIV Prevention Behaviors Among Latina Immigrant Farmworkers. J Immigr Minor Health 2019; 21:430-433. [PMID: 30030668 PMCID: PMC6607899 DOI: 10.1007/s10903-018-0773-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Latinas in farmworker communities are at particularly higher risk for human immunodeficiency virus (HIV) due to the vulnerable circumstances they experience. However, little is known about the factors influencing HIV prevention behaviors in this population. The aim of this study was to examine the associations of self-silencing behaviors and egalitarian attitudes toward women in relation to three HIV prevention behaviors: self-efficacy for HIV prevention, intentions to negotiate safe sex, and HIV-related knowledge. This study is a cross-sectional analysis that used hierarchical multiple regression models to examine these previously mentioned associations, among Latina immigrant farmworkers from Miami-Dade County, Florida (n = 232). Findings indicated that self-silencing behaviors were adversely associated with the three HIV preventive behaviors whereas egalitarian attitudes were positively associated. Findings from this study may help to advance the understanding of sociocultural determinants of HIV prevention behaviors among Latina immigrants.
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Affiliation(s)
- Daisy Ramírez-Ortiz
- Department of Epidemiology, Florida International University, Miami, FL, USA
| | - Patria Rojas
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, FL, USA.
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA.
| | - Mariana Sánchez
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, FL, USA
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
| | - Miguel Ángel Cano
- Department of Epidemiology, Florida International University, Miami, FL, USA
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, FL, USA
| | - Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, FL, USA
- Department of Health Promotion and Disease Prevention, Florida International University, Miami, FL, USA
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Brüll P, Kessels LTE, Repetto L, Dirkson A, Ruiter RAC. ERPs Reveal Disengagement Processes Related to Condom Use Embarrassment in Intention-Behavior Inconsistent Young Adults. Arch Sex Behav 2019; 48:521-532. [PMID: 29696551 PMCID: PMC6373258 DOI: 10.1007/s10508-018-1217-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/23/2018] [Accepted: 04/11/2018] [Indexed: 05/08/2023]
Abstract
The use of barrier protections such as condoms has consistently been reported to reduce the acquisition of sexually transmitted infections. However, it has also been reported that the association between condom use intentions and behavior is, at best, often weak. Furthermore, embarrassment associated with purchasing condoms and negotiating their use has been shown to negatively impact the frequency of condom use. Using electroencephalography to analyze P300 event-related potential components known to measure early attention allocation, we examined electrophysiological evidence of early attention disengagement for embarrassing health information. Forty young adults-34 females and six males-participated in an adapted version of Posner's visual cueing paradigm. All were high in intention to use condoms, but half were intention-behavior consistent and half were intention-behavior inconsistent. Compared to intention-behavior consistent participants, those with intention-behavior inconsistency showed a reduced P300 component when attending to a visual target opposite to the field in which embarrassing self-relevant health information was presented, indicating more efficient early attention disengagement from such embarrassing health information. In conclusion, our electrophysiological data suggest that high intention alone may be not sufficient to predict adolescents' condom use behavior.
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Affiliation(s)
- Phil Brüll
- Department of Work and Social Psychology, Maastricht University, 6200 MD, Maastricht, The Netherlands.
| | - Loes T E Kessels
- Department of Work and Social Psychology, Maastricht University, 6200 MD, Maastricht, The Netherlands
| | - Linda Repetto
- University College Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Anne Dirkson
- University College Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Robert A C Ruiter
- Department of Work and Social Psychology, Maastricht University, 6200 MD, Maastricht, The Netherlands
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Wolfs K, Bos AER, Mevissen FEF, Peters GJY, van Lankveld JJDM. Sexual Arousal and Implicit and Explicit Determinants of Condom Use Intentions. Arch Sex Behav 2019; 48:469-480. [PMID: 30003438 PMCID: PMC6373232 DOI: 10.1007/s10508-018-1257-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 06/08/2018] [Accepted: 06/08/2018] [Indexed: 05/10/2023]
Abstract
Being sexually aroused may be an important risk factor contributing to sexual decision making. Dual-process cognitive models, such as the reflective-impulsive model of Strack and Deutsch (2004), could be used to explain the effect of sexual arousal on intentions to use a condom. In this study, we investigated whether explicit and implicit attitudes toward condom use can predict intentions to use a condom when participants are sexually aroused and not aroused. In a within-subjects experimental design, male participants (N = 27) watched both a neutral and an erotic movie clip in counterbalanced order. After each clip, participants completed a questionnaire assessing their intentions to use a condom and explicit condom attitudes, followed by a wanting Implicit Association Test (IAT; Greenwald et al., 2003) and a liking IAT to assess their implicit attitudes to unsafe sex. In concordance with the reflective-impulsive model, we found that when participants were not sexually aroused, their intentions to use a condom were solely predicted by their explicit attitudes. However, when they were sexually aroused, intentions to use a condom were predicted by both explicit and implicit attitudes toward condom use.
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Affiliation(s)
- Kenny Wolfs
- Department of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands.
- Treatment Center for People with a Mild Intellectual Disability, AltraCura, 6161 DJ, Geleen, The Netherlands.
| | - Arjan E R Bos
- Department of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
| | - Fraukje E F Mevissen
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Gjalt-Jorn Y Peters
- Department of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
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Berry MS, Johnson PS, Collado A, Loya JM, Yi R, Johnson MW. Sexual Probability Discounting: A Mechanism for Sexually Transmitted Infection Among Undergraduate Students. Arch Sex Behav 2019; 48:495-505. [PMID: 29582269 PMCID: PMC6365211 DOI: 10.1007/s10508-018-1155-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 01/02/2018] [Accepted: 01/15/2018] [Indexed: 05/03/2023]
Abstract
Lack of condom use among youth is a major contributor to the spread of sexually transmitted infections (STIs) including HIV/AIDS, which has lifelong deleterious health consequences. College students (N = 262) completed the Sexual Probability Discounting Task in which participants reported their likelihood of condom use under various probabilities of contracting an STI. Each participant completed the task in regard to different STIs including HIV/AIDS and different partners. Results showed that the likelihood of condom-protected sex generally decreased as HIV/AIDS and other STI contraction became less probable. Moreover, condom-protected sex likelihood was related to STI type (e.g., decreased condom-protected sex in chlamydia relative to HIV/AIDS condition) and partner desirability (decreased condom-protected sex with more desirable partners). Results are the first to show that compared to other STIs, HIV/AIDS had the most influence on condom-protected sex. Results showed probability discounting contributed to lack of condom-protected sex and offers a novel framework for examining determinants of within-subject variability in condom use.
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Affiliation(s)
- Meredith S. Berry
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Patrick S. Johnson
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anahí Collado
- Department of Psychology, University of Maryland, College Park, MD
| | - Jennifer M. Loya
- Department of Psychology, University of Maryland, College Park, MD
| | - Richard Yi
- Department of Psychology, University of Maryland, College Park, MD
| | - Matthew W. Johnson
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Lim RBT, Tham DKT, Cheung ON, Adaikan PG, Wong ML. A Public Health Communication Intervention Using Edutainment and Communication Technology to Promote Safer Sex among Heterosexual Men Patronizing Entertainment Establishments. J Health Commun 2019; 24:47-64. [PMID: 30698082 DOI: 10.1080/10810730.2019.1572839] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
It is a challenge to reach out, develop and implement a communication intervention for heterosexual men (HSM) patronizing entertainment establishments (EEs) to promote safer sex. We described the theoretical basis and process from assessment to implementation where edutainment (talk shows) and communication technology (interactive web portal) was implemented. A female comedian hosted the talk shows. The portal contained an HIV risk profile calculator with individually tailored strategies to lower risk; two videos on real-life stories of unsafe sex and exit strategies to avoid casual or paid sex; as well as online support. We integrated edutainment, social cognitive theory (SCT) and the elaboration likelihood model (ELM). Edutainment techniques like humor through jokes, fun through games, and narrative persuasion through real-life accounts were applied. The SCT focused on modifying attitudes and social norm on sexual well-being, increasing self-perceived HIV/STI risk as well as building self-efficacy and skills in condom use. We applied the ELM to guide communication strategies and message development. For peripheral processing, we used cues like comedian delivery and charisma. For central processing, we focused on argument framing, issue involvement, argument quality, and modeling. The intervention was effective in promoting condom use with casual partners among the target group in Singapore.
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Affiliation(s)
- Raymond Boon Tar Lim
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
| | - Dede Kam Tyng Tham
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
| | - Olive Ny Cheung
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
| | - P Ganesan Adaikan
- b Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine , National University of Singapore , Singapore city , Singapore
| | - Mee Lian Wong
- a Health Systems & Behavioural Science, Saw Swee Hock School of Public Health , National University of Singapore , Singapore city , Singapore
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Choi SK, LeGrand S, Dong W, Muessig KE, Hightow-Weidman L. Condom use intentions mediate the relationships between psychosocial constructs and HIV sexual risk behavior in young Black men who have sex with men. AIDS Care 2019; 31:53-60. [PMID: 29950106 PMCID: PMC6301140 DOI: 10.1080/09540121.2018.1492695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
HIV prevention interventions that reduce sexual risk behaviors among young Black men who have sex with men (YBMSM), the most severely affected population in the United States, are critical for reducing disparities in HIV infection. However, there are few theory-based sexual risk reduction interventions designed specifically for YBMSM. This study tested the applicability of the Integrated Behavioral Model (IBM), which theorizes that behavioral intentions mediate the relationship between psychosocial constructs and health behavior on condomless anal intercourse (CAI) among YBMSM. To test key constructs of the IBM, analyses were conducted with baseline data from the HealthMpowerment (HMP) randomized controlled trial. Logistic regression was used to examine the relationships between condom use self-efficacy, norms, attitudes, intentions, and environmental constraints, and CAI. Mediation analysis was conducted to determine if condom use intentions mediated the relationship between psychosocial constructs (i.e., condom use self-efficacy, norms, and attitudes) and CAI. Overall 55.7% reported one or more acts of CAI with a male partner in the past 3 months. Those who reported CAI in the 3 months prior to the baseline survey reported lower self-efficacy for condom use, lower condom use norms, more negative attitudes toward condom use, and lower condom use intentions at baseline than those who reported no CAI. In mediation analysis, the relationships between CAI and self-efficacy for condom use (estimated indirect effect = -0.004 (SE = 0.002)), condom use norms (-0.002 (SE = 0.001)) and attitudes toward condom use (-0.005 (SE = 0.002)) were mediated by condom use intentions. This study applied the IBM to sexual risk behavior among a sample of YBMSM. Results indicate that the relationships between condom use self-efficacy, norms, and attitudes, and CAI were mediated by condom use intentions. Future theory-informed interventions should focus on increasing self-efficacy for condom use, condom use norms, attitudes toward condom use, and condom use intentions to reduce CAI among YBMSM.
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Affiliation(s)
- Seul Ki Choi
- a Department of Health Behavior , University of North Carolina , Chapel Hill , NC , USA
| | - Sara LeGrand
- b Duke Global Health Institute , Duke University , Durham , NC , USA
| | - Willa Dong
- a Department of Health Behavior , University of North Carolina , Chapel Hill , NC , USA
| | - Kathryn E Muessig
- a Department of Health Behavior , University of North Carolina , Chapel Hill , NC , USA
| | - Lisa Hightow-Weidman
- c Division of Global Health and Infectious Diseases , University of North Carolina , Chapel Hill , NC , USA
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Evans W, Kadirov K, Thior I, Ganesan R, Ulasevich A, Deperthes B. Willingness to Pay for Condoms among Men in Sub-Saharan Africa. Int J Environ Res Public Health 2018; 16:ijerph16010034. [PMID: 30586870 PMCID: PMC6339129 DOI: 10.3390/ijerph16010034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 12/22/2022]
Abstract
HIV/AIDS and other sexually transmitted infections (STIs) continue to be among the greatest public health threats worldwide, especially in sub-Saharan Africa (SSA). Condom use remains an essential intervention to eradicate AIDS, and condom use is now higher than ever. However, free and subsidized condom funding is declining. Research on how to create healthy markets based on willingness to pay for condoms is critically important. This research has three primary aims: (1) willingness of free condom users in five African countries to pay for socially marketed condoms; (2) the relationship between specific population variables and condom brand marketing efforts and willingness to pay; and (3) potential opportunities to improve condom uptake. Nationally representative samples of at least 1200 respondents were collected in Kenya, Nigeria, South Africa, Zambia, and Zimbabwe. We collected data on a range of demographic factors, including condom use, sexual behavior, awareness of condom brands, and willingness to pay. We estimated multivariate linear regression models and found that free condom users are overwhelmingly willing to pay for condoms overall (over 90% in Nigeria) with variability by country. Free users were consistently less willing to pay for condoms if they had a positive identification with their free brand in Kenya and Zimbabwe, suggesting that condom branding is a critical strategy. Ability to pay was negatively correlated with willingness, but users who could not obtain free condoms were willing to pay for them in Kenya and Zimbabwe. In a landscape of declining donor funding, this research suggests opportunities to use scarce funds for important efforts such as campaigns to increase demand, branding of condoms, and coordination with commercial condom manufacturers to build a healthy total market approach for the product. Free condoms remain an important HIV/AIDS prevention tool. Building a robust market for paid condoms in SSA is a public health priority.
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Affiliation(s)
- William Evans
- Milken Institute of Public Health, The George Washington University, Washington, DC 20052, USA.
| | - Kuyosh Kadirov
- United States Agency for International Development, Washington, DC 20523, USA.
| | - Ibou Thior
- John Snow Incorporated, Arlington, VA 22209, USA.
| | | | - Alec Ulasevich
- Ulasevich Social Science Research, Silver Spring, MD 20902, USA.
| | - Bidia Deperthes
- United Nations Family Planning Agency, New York, NY 10158, USA.
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Tang W, Liu C, Cao B, Pan SW, Zhang Y, Ong J, Fu H, Ma B, Fu R, Yang B, Ma W, Wei C, Tucker JD. Receiving HIV Serostatus Disclosure from Partners Before Sex: Results from an Online Survey of Chinese Men Who Have Sex with Men. AIDS Behav 2018; 22:3826-3835. [PMID: 29470809 DOI: 10.1007/s10461-018-2062-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
HIV serostatus disclosure before sex can facilitate serosorting, condom use and potentially decrease the risk of HIV acquisition. However, few studies have evaluated HIV serostatus disclosure from partners before sex. We examined the rate and correlates of receiving HIV serostatus disclosure from regular and casual male partners before sex among an online sample of men who have sex with men (MSM) in China. An online cross-sectional study was conducted among MSM in eight Chinese cities in July 2016. Participants completed questions covering sociodemographic information, sexual behaviors, HIV testing (including HIV self-testing) history, self-reported HIV status, and post-test violence. In addition, participants were asked whether they received HIV serostatus disclosure from their most recent partners before sex. Overall, 2105 men completed the survey. Among them, 85.9% were never married, and 35.4% had high school or less education. A minority (20.6%, 346/1678; 17.8%, 287/1608) of men received HIV serostatus disclosure from their most recent regular and casual male partners, respectively. Multivariate analysis indicated that participants who ever self-tested for HIV were more likely to have received HIV status disclosure from regular [adjusted OR (aOR) = 1.92, 95% CI 1.50-2.44] and casual (aOR = 2.34, 95% CI 1.80-3.04) male partners compared to never self-tested participants. Compared to participants who had not received HIV status disclosure from regular partners, participants who received disclosure from regular male partners had higher likelihood in experiencing post-test violence (aOR = 5.18, 95% CI 1.53-17.58). Similar results were also found for receiving HIV serostatus disclosure from casual partners. This study showed that HIV serostatus disclosure from partners was uncommon among Chinese MSM. Interventions and further implementation research to facilitate safe disclosure are urgently needed for MSM.
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Affiliation(s)
- Weiming Tang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China.
- SESH Study Group, Guangzhou, China.
- Dermatology Hospital of Southern Medical University (Guangdong Dermatology Hospital), Guangzhou, China.
- School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Chuncheng Liu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
- SESH Study Group, Guangzhou, China
- Department of Sociology, University of California, San Diego, La Jolla, USA
| | - Bolin Cao
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
- SESH Study Group, Guangzhou, China
- College of Mass Communication, Shenzhen University, Shenzhen, China
| | - Stephen W Pan
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
- SESH Study Group, Guangzhou, China
| | - Ye Zhang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
- SESH Study Group, Guangzhou, China
- Dermatology Hospital of Southern Medical University (Guangdong Dermatology Hospital), Guangzhou, China
| | - Jason Ong
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
| | - Hongyun Fu
- Division of Community Health and Research, Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Rong Fu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
- SESH Study Group, Guangzhou, China
| | - Bin Yang
- Dermatology Hospital of Southern Medical University (Guangdong Dermatology Hospital), Guangzhou, China
| | - Wei Ma
- School of Public Health, Shandong University, Jinan, China
| | - Chongyi Wei
- School of Medicine, University of California, San Francisco, San Francisco, USA
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill Project-China, Guangzhou, 510095, China
- SESH Study Group, Guangzhou, China
- School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, USA
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45
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Wang SC, Lui JHL, Vega G, Waldrop M, Garris J. The moderating effect of alcohol use on protective and risky sex behaviors among college students in the Southeast United States. J Am Coll Health 2018; 66:546-552. [PMID: 29405897 DOI: 10.1080/07448481.2018.1431916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/14/2018] [Indexed: 06/07/2023]
Abstract
Objective: College students are a high-risk population for new human immunodeficiency viruses (HIV) diagnoses. Although condom use self-efficacy and HIV knowledge can protect against risky sexual behavior (RSB), these same protective factors have been shown to exacerbate RSB. The influence of alcohol use can further complicate these protective factors to influence RSB. Participants: 689 African American/Black and non-Hispanic White college students attending a public university in the Southeast United States. Method: This study sought to examine the relations between condom use self-efficacy and HIV knowledge with RSB and the moderating effect of alcohol use. Results: Findings showed positive associations between RSB and HIV knowledge and alcohol use. Unexpectedly, low frequency drinkers with high condom use self-efficacy were at increased risk for RSB compared to high frequency drinking counterparts. Conclusions: Findings point to the need to target prevention services for low-risk drinkers in college settings.
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Affiliation(s)
- Sherry C Wang
- a Department of Counseling Psychology , Santa Clara University Santa Clara , California , USA
| | - Joyce H L Lui
- b Department of Psychology, Washington State University , Pullman , Washington , USA
| | - Geraldo Vega
- c Department of Psychology , University of Southern Mississippi , Hattiesburg , Mississippi , USA
| | - Mindy Waldrop
- c Department of Psychology , University of Southern Mississippi , Hattiesburg , Mississippi , USA
| | - Justin Garris
- c Department of Psychology , University of Southern Mississippi , Hattiesburg , Mississippi , USA
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46
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Young LE, Fujimoto K, Schneider JA. HIV Prevention and Sex Behaviors as Organizing Mechanisms in a Facebook Group Affiliation Network Among Young Black Men Who Have Sex with Men. AIDS Behav 2018. [PMID: 29536285 DOI: 10.1007/s10461-018-2087-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Online social networking sites (SNS)-the Internet-based platforms that enable connection and communication between users-are increasingly salient social environments for young adults and, consequently, offer tremendous opportunity for HIV behavioral research and intervention among vulnerable populations like young men who have sex with men (YMSM). Drawing from a cohort of 525 young Black MSM (YBMSM) living in Chicago, IL, USA April 2014-May 2015, we conducted social network analysis, estimating an exponential random graph model (ERGM) to model YBMSM's group affiliations on Facebook in relation to their sex behaviors and HIV prevention traits. A group's privacy setting-public, closed, or secret-was also modeled as a potential moderator of that relationship. Findings reveal that HIV positive individuals were more likely to affiliate with Facebook groups, while those who engaged in group sex were less likely to do so. When it came to the privacy of groups, we learned that HIV positive individuals tended not to belong to groups with greater privacy (e.g., closed and secret groups), while individuals who engaged in group sex and those who engaged in regular HIV testing were more likely to belong to those groups. Results also showed that individuals who engaged in condomless sex showed significant signs of clustering around the same set of groups. HIV positive individuals, on the other hand, were significantly less likely to demonstrate clustering. Implications for interventions and future research are discussed.
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Affiliation(s)
- Lindsay E Young
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, Chicago, IL, 60637, USA.
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, Chicago, USA.
| | - Kayo Fujimoto
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center, Houston, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, Chicago, IL, 60637, USA
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, Chicago, USA
- Department of Public Health Sciences, University of Chicago, Chicago, USA
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47
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Pellowski JA, Huedo-Medina TB, Kalichman SC. Food Insecurity, Substance Use, and Sexual Transmission Risk Behavior Among People Living with HIV: A Daily Level Analysis. Arch Sex Behav 2018; 47:1899-1907. [PMID: 28429158 PMCID: PMC5650554 DOI: 10.1007/s10508-017-0942-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 06/02/2023]
Abstract
People living with HIV in poverty have limited tangible and mental resources coupled with competing demands for these resources. Competing demands require individuals to make choices that may be beneficial to them in the short term but not in the long term. Past research has shown that food insecurity is related to sexual risk behaviors among people living with HIV. Individuals who are food insecure may sell sex in order to obtain food or lack of food may lead to a depletion of mental resources to negotiate safe sex. Substance use may also create additional constraints on these already limited resources. The current study tested the relation between food insecurity and day-level sexual risk behavior and the possible mediating role that alcohol/substance use may play. Men and women living with HIV were enrolled in a 28-day prospective study between October 2012 and April 2014 in which they completed daily text message surveys regarding their sex behaviors and substance/alcohol use in the context of sex. A total of 796 participants reported sex on 3894 days. On days in which sex occurred, baseline food insecurity was negatively associated with daily condom use. There was also a significant effect of substance use in the context of sex on the rates of change in condom use over time, and this interaction between substance use and time was a partial mediator of the relation between food insecurity and condom use. Gender did not moderate this mediation. Situation-specific alcohol and drug use should be integrated into interventions that target food insecurity and HIV prevention.
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Affiliation(s)
- Jennifer A Pellowski
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, 121 South Main Street, 2nd Floor, Providence, RI, 02903, USA.
| | - Tania B Huedo-Medina
- Department of Allied Health Sciences and Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
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Werner RN, Gaskins M, Ahrens J, Jessen H, Kutscha F, Mosdzen R, Osswald W, Sander D, Schellberg S, Schwabe K, Wünsche T, Dressler C, Sammons M, Nast A. Knowledge and use of HIV pre-exposure prophylaxis among men who have sex with men in Berlin - A multicentre, cross-sectional survey. PLoS One 2018; 13:e0204067. [PMID: 30212547 PMCID: PMC6136827 DOI: 10.1371/journal.pone.0204067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/31/2018] [Indexed: 12/22/2022] Open
Abstract
Background HIV pre-exposure prophylaxis (PrEP) has likely contributed to large decreases in HIV incidence among men who have sex with men (MSM) in several major cities. Berlin has seen a smaller decline, and affordable PrEP has been accessible through formal channels in Germany only since autumn 2017. We aimed to investigate knowledge and use of PrEP among MSM in Berlin, and factors predictive of a desire to use PrEP and history of PrEP use. Methods Multicentre, paper-based, self-administered survey of adult MSM whose HIV status was negative or unknown at time of participation. Data were collected from 1 October 2017 to 2 April 2018. Results 473 of 875 questionnaires were returned (response rate 54.1%; mean age 37.4 years, range 18–79). 90.0% of participants were aware of PrEP and, of these, 48.2% felt well informed about it. Among the 17.2% of participants reporting PrEP use, 59.3% indicated obtaining some or all of it from informal sources. 23.7% of those with no history of PrEP use reported having condomless anal intercourse (CAI) with two or more partners over the past six months. Worries about side effects, cost, not having a doctor who prescribes it, and a lack of information were the most frequently reported barriers to PrEP use. A desire to use PrEP and history of PrEP use were associated in our multivariable model with having multiple CAI partners. A history of PrEP use was associated with having a university degree, one or two parents born outside Germany, or friends living with HIV. Conclusions We found high awareness of PrEP among MSM in Berlin, but also a strong need for more education on its pros, cons and proper use. The frequency of informal PrEP use was also high, raising urgent individual and public health concerns. Policy makers need to consider recent calls to improve access to PrEP and PrEP education through regular health services.
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Affiliation(s)
- Ricardo Niklas Werner
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Department of Dermatology, Venereology and Allergy; Division of Evidence-Based Medicine (dEBM), Berlin, Germany
- * E-mail:
| | - Matthew Gaskins
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Department of Dermatology, Venereology and Allergy; Division of Evidence-Based Medicine (dEBM), Berlin, Germany
| | | | - Heiko Jessen
- Praxis Jessen + Kollegen, SHC–Sexual Health Center Berlin, Berlin, Germany
| | | | | | | | | | | | - Kai Schwabe
- Schwulenberatung Berlin gGmbH, Berlin, Germany
| | | | - Corinna Dressler
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Department of Dermatology, Venereology and Allergy; Division of Evidence-Based Medicine (dEBM), Berlin, Germany
| | - Mary Sammons
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Department of Dermatology, Venereology and Allergy; Division of Evidence-Based Medicine (dEBM), Berlin, Germany
| | - Alexander Nast
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Department of Dermatology, Venereology and Allergy; Division of Evidence-Based Medicine (dEBM), Berlin, Germany
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Abstract
Although there is a growing literature on men's condom use resistance (CUR) tactics (e.g., direct requests, deception), little research exists on women's CUR tactics. This study investigated young women's (ages 18 to 21) self-reported use of CUR tactics since age 14 and related individual difference factors. Participants included 235 sexually active heterosexual women from a nationwide convenience survey sample who completed a newly adapted women's version of the Condom Use Resistance Survey. Consistent with the limited previous research, women were most likely to use risk-level reassurance (37.9%) and seduction (33.2%) tactics. A higher frequency and quantity of alcohol consumption, particularly prior to sex, lower perceived risk of sexually transmitted infections (STIs), and a history of STI diagnosis were associated with having previously used a greater number and variety of CUR tactics. This highlights the need for CUR prevention and intervention programming for women. Future research should specifically examine women's rationale for using CUR tactics and utilize longitudinal and experimental methods to further elucidate directional and causal relationships among individual-level risk factors, CUR, and negative sexual health outcomes.
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Affiliation(s)
- Rhiana Wegner
- a Department of Psychology , University of Massachusetts-Boston
| | - Melissa A Lewis
- b Department of Psychiatry and Behavioral Sciences , University of Washington
| | - Kelly Cue Davis
- c College of Nursing and Health Innovation , Arizona State University
| | | | - Jeanette Norris
- e Alcohol and Drug Abuse Institute , University of Washington
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50
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Ramírez-Correa P, Ramírez-Santana M. Predicting Condom Use among Undergraduate Students Based on the Theory of Planned Behaviour, Coquimbo, Chile, 2016. Int J Environ Res Public Health 2018; 15:ijerph15081689. [PMID: 30096795 PMCID: PMC6121963 DOI: 10.3390/ijerph15081689] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 07/23/2018] [Accepted: 08/02/2018] [Indexed: 11/24/2022]
Abstract
Background: Sexually transmitted infections and pregnancy in adolescents are acknowledged public health problems in many countries. Although it is known that the proper use of condoms allows avoiding these health problems, their use in Chile is still limited, for unknown reasons. Objective: Based on planned behavioural theory, the aim was to validate a behaviour model regarding condom use by measuring the influence of the variables that predict this use among Chilean university students. Methods: A cross-sectional descriptive study was carried out in October 2016 among 151 Chilean university students belonging to the health and engineering areas. The information was collected through a self-administered survey. The sample was divided into two groups: stable and not stable relationships. Partial least squares (PLS) regression was used for the analysis. Results: It was possible to explain the condom use of the students by 57%. The attitude was the main variable related to the intention of using condoms, together with the perceived behavioural control. Additionally, there are statistically significant differences in the variables that predict condom use among students with stable relations compared to those without a stable relationship. Conclusions: The planned behavioural theory is useful for predicting condom use behaviour when students have a stable partner.
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Affiliation(s)
| | - Muriel Ramírez-Santana
- Department of Public Health, Faculty of Medicine, Universidad Católica del Norte, Larrondo 1281, Coquimbo, Chile.
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