References - Condoms

Psychological Aspects

Relapse in sexual behavior among homosexual men: A 2-year follow-up from the Chicago MACS/CCS.

Abstract: Studied the prevalence of safer sexual practices among 724 homosexual men assessed over 1-yr (1986-1987) and 2-yr (1986-1988) periods who participated in the Chicago Multicenter AIDS Cohort Study/Coping and Change Study (MACS/CCS). The most consistent finding was the increasing trend toward abstinence of both receptive (RAS) and insertive anal sex (IAS). 52% of the Subjects in 1986 and 68% in 1988 reported avoiding RAS. In 1986, 44% of the Subjects were HIV-seropositive; this varied little over time. In 1986, HIV-seropositive Subjects were twice as likely to engage in unsafe practices than seronegative Subjects. However, the proportion of seropositives practicing safer sex increased, so that differences in practices between this group and seronegatives disappeared by 1987. 53% of the Subjects maintained safer sexual practices in RAS over 1 yr (47% in IAS). Relapse rates were 31% for RAS and 35% for IAS.

Correlates of condom use among Black, Hispanic, and White heterosexuals in San Francisco: The AMEN longitudinal study.

Abstract: Examined correlates of condom use in a longitudinal sample of 716 White, Black, and Hispanic heterosexuals (aged 20-44 yrs) with an HIV risk factor in San Francisco. The AIDS in Multi-Ethnic Neighborhoods (AMEN) survey examined the distribution of HIV infection and HIV risk behaviors across groups defined by race, gender, and sexual orientation. High levels of condom use were associated with labeling one's sexual behavior as risky for HIV infection, high levels of condom enjoyment, and commitment to use condoms, good sexual communication practices, gender (trend), and marital status. Results support the need for wide-ranging intervention programs that stimulate people to make personal risk assessments, teach basic sexual skills, and direct those in need of intensive help to appropriate agencies.

Changes in condom use among Black, Hispanic, and White heterosexuals in San Francisco: The AMEN cohort survey.

Abstract: Examined changes in condom use over a 1-yr period among heterosexual Whites, Blacks, and Hispanics (aged 20-45 yrs) with an HIV related risk factor in a community-based longitudinal sample ( n = 716). Heterosexuals with a risk factor made only marginal gains toward increasing their condom use to highly efficacious levels (100% use) from Wave 1 to 2 (4% net increase). Blacks, people without a primary partner, and the never married were significantly more likely than other social strata to increase condom use from low-moderate use at Wave 1 to always using condoms at Wave 2. Nevertheless, changes across social strata remain modest with iv drug users and Hispanic women showing negative or no change. The young and highly educated were the most likely to maintain moderate to high levels of condom use over time.

Prevalence of AIDS-related risk factors and condom use in the United States.

Abstract: Obtained telephone interview data from 8,263 Subjects (aged 18-75 yrs) on the prevalence of HIV-related risks, on the distribution of the 3 largest risk groups across social strata, and on the prevalence and distribution of condom use among heterosexuals reporting a risk factor. 15-31% of Subjects nationally and 20-41% in cities with a high prevalence of AIDS reported an HIV risk factor. Condom use was relatively low. Results suggest that current HIV prevention programs have, to a limited extent, reached those heterosexuals with multiple sexual partners but have failed to reach many other groups of the heterosexual population at risk for HIV.

Unsafe sex and behavior change. IN: Preventing AIDS in drug users and their sexual partners.

Abstract: (from the introduction) emphasize that drug users and their sexual partners risk transmitting HIV (human immunodeficiency virus) through their sexual behaviors; describe (hetero)sexual behaviors that are risky for transmitting HIV, as well as the difficulties associated with behavioral changes among injection drug users and their sexual partners... in describing AIDS (acquired immune deficiency syndrome) risk behaviors, they critically examine what is known about the risk to sexual partners, the risks of sexual practices, and perceptions of AIDS risk; extend these issues to the difficulties associated with changing risky sexual behaviors; give special attention to the extent of condom use and factors influencing the use of condoms.

Condom use and sexual behaviour in heterosexual prostitution in the Netherlands.

Abstract: Examined the extent to which unsafe sex occurs within the various types of prostitution in the Netherlands and to what extent these types of prostitution are linked sexually. Subjects were 127 adult prostitutes and 91 adult clients. In the previous 12 mo, home, street, and window prostitutes reported having commercial protected intercourse less consistently than escorts or prostitutes at clubs or brothels. 10% of all prostitutes and 12% of all clients engaged in both unsafe commercial and private sex, potentially spreading HIV to the general population.

The effectiveness of condom use among homosexual men.

Abstract: Interviewed 671 homosexual men to investigate the failure rate of condoms in relation to the type of condom and lubricant used, and to examine the extent to which psychosocial and sociodemographic factors influence the occurrence of condom failure. Personal efficacy, with regard to Subjects putting on a condom themselves, was significantly related to the occurrence of condom failure. Subjects who found this difficult experienced a higher failure rate.

Sexual activity, condom use, and HIV-1 seroconversion. IN: AIDS and sex: An integrated biomedical and biobehavioral approach.

Abstract: (from the chapter) report ...the relationship of specific sexual activities and condom use to the HIV-1 (human immunodeficiency virus) seroconversion rate over the first 2 years of follow-up of the ...(homosexual and bisexual) men who are seronegative at first visit to the MACS (Multicenter AIDS (acquired immune deficiency syndrome) Cohort Study).

Psychosocial determinants of condom use among adolescents.

Abstract: (from the preface) focuses on identifying and understanding the role of psychosocial and behavioral factors associated with HIV-preventive sexual behavior (i.e., consistent condom use) (in adolescents). (from the chapter) review studies that evaluated the relative influence of a number of factors to predict condom use among adolescents; each study will be reviewed in turn, and an overarching synthesis of the findings will be described in a summary section; methodological limitations inherent in the design of these studies also will be discussed; presents recommendations for developing more effective HIV-prevention interventions.

Prevention of heterosexual transmission of HIV: Barriers for women.

Abstract: Conducted 11 focus groups with a total of 78 19-45 yr old women (primarily Latinas and Black) from high HIV seroprevalence eighborhoods. Results suggest that HIV interventions for women must consist of sex education, including anatomy and physiology. Sexual negotiation skills must be taught and HIV prevention messages must address many women's desire for pregnancy. Development of new HIV prevention strategies must focus on methods under women's control that are outside of negotiation with a male sex partner.

AIDS and college students: Toward effective prophylactic use of condoms.

Abstract: Argues that information-based approaches to controlling the spread of the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the college student population are not likely to result in sufficient or reliable behavior change. College students must be given the opportunity to develop skills and strategies of behavioral self-management, and they must direct these skills and stategies toward appropriate use of condoms as prophylactics.

Reducing AIDS risks among dually disordered adults.

Abstract: Evaluated a social group work intervention designed to help dually disordered (substance use and mental disorders) adults change sexual behaviors that increase their risk of HIV infection. 30 clients attending a day treatment program for dually disordered adults participated in an AIDS awareness and prevention group. Using a nonequivalent control group evaluation design, Subjects were systematically assigned to either the 1st cycle of the group or to a waiting list. Findings show that, compared with persons on the waiting list, Subjects who received the preventive intervention improved their understanding of correct condom use, used condoms more often, reduced risky sexual practices, and were more assertive in sexual encounters. Behavioral changes were attributable to group involvement and not the clients' pregroup characteristics.

The formulation and implementation of a national policy on condoms in the context of HIV/AIDS: A review.

Abstract: The acquired immune deficiency syndrome (AIDS) pandemic has brought into sharp focus the role of condoms in preventing the transmission of the human immunodeficiency virus (HIV). In the vast majority of countries, the condom prevalence rate is very low and to varying extents socio-cultural, infrastructure and logistics, quality control and incorrect usage problems have made it difficult to promote the use of condoms. It is only by developing a national policy on condoms that countries could mobilize within a short span of time all the resources to ensure that condoms are used by those who are at risk of contracting or transmitting the HIV. The conditions necessary to develop such a policy and the elements of the policy are described.

Why don't young adults protect themselves against sexual transmission of HIV? Possible answers to a complex question.

Abstract: Examined risk taking regarding HIV infection among young adults by assessing representations of HIV, problems in using condoms and feeling comfortable with safer sex practices, and situational factors associated with at-risk sexual behavior. 272 college students completed a questionnaire developed for the study. Representations of HIV lacked the information necessary to guide sexual behavior. Subjects were aware of the causes of sexual transmission of HIV, but many indicated uncertainty about the effectiveness of preventive strategies. A number of specific problems with using condoms were cited by the Subjects. The majority of Subjects (85.3%) reported at least 1 occurrence of unprotected sexual intercourse. For 60% of them, the stated reason for risk taking was that the intercourse was unplanned or spontaneous; 50% said they "just knew" the partner was safe and not infected with HIV.

Psychological distress, drug and alcohol use as correlates on condom use in HIV-serodiscordant heterosexual couples.

Abstract: Studied the relationship of psychological distress and drug and alcohol habits to condom use in 106 serodiscordant heterosexual couples, using the Brief Symptom Inventory. HIV-positive men who scored higher on Interpersonal Sensitivity items were less likely to use condoms. HIV-positive men who used condoms were younger, had higher educational levels, tended not to receive public assistance, and were not regular drinkers. HIV-negative men who did not use condoms were more likely to be drug users and to combine drugs with sex. HIV-positive women who used condoms tended to be married and to have higher household incomes. They were less likely to be drug users. HIV-positive women who used condoms were more anxious and had lower hostility scores. For HIV-negative women condom use was correlated with being employed. These condom users were not regular drinkers, were less likely to combine drugs and sex, and had fewer drug problems.

Sexual behaviour and use of the condom among Ugandan students.

Abstract: A questionnaire was completed by 661 male and 270 female university undergraduates. More than 60% of the men and 36% of the women reported at least 2 sexual partners in the past year. Over 18% of respondents reported at least one episode of sexually transmitted disease in the past year. Most respondents correctly identified the main routes of human immunodeficiency virus (HIV) transmission but risk was also often incorrectly associated with non-penetrative sex. Only a minority saw the condom as an effective preventive method: most saw it as unsafe or as an encouragement to promiscuity. The condom was approved of by only one quarter of respondents.

Predictive model of college undergraduates' intent to engage in risk reduction behavior regarding AIDS.

Psychosocial factors associated with condom use among African-American drug abusers in treatment.

Abstract: Evaluated the relationship between condom use and various psychological and behavioral factors among 136 heterosexual, African-American, cocaine-dependent men within the context of the AIDS Risk Reduction Model. AIDS prevention knowledge was assessed by the Knowledge of AIDS Risk Test, the AIDS/HIV Prevention Questionnaire, the AIDS Risk Battery, and a behavioral demonstration test. The 52 Subjects who used condoms reported significantly higher levels of self-efficacy, condom use skills, and sexual communication with sexual partners than did the 84 Subjects who did not use condoms. The groups did not differ in perceived susceptibility, anxiety concerning HIV transmission, response efficacy, or knowledge regarding HIV.

Tailoring AIDS prevention: Differences in behavioral strategies among heterosexual and gay bar patrons in San Francisco.

Abstract: Three groups of bar patrons (314 heterosexual men, 437 heterosexual women, and 593 gay men) in San Fransisco were compared on 4 sexual risk reduction strategies for acquired immune deficiency syndrome (AIDS). The strategies were safer sex practices (particularly adoption of the use of condoms), reducing the number of sexual partners, taking the human immunodeficiency virus (HIV) antibody test, and determining the characteristics of a potential sexual partner. Heterosexuals reported fewer sex partners and were more likely than gay men to interview potential partners. Gay men were more likely to use condoms and the HIV antibody test than their heterosexual counterparts.

Thinking about safer sex: The risky business of "know your partner" advice.

Abstract: (from the chapter) illustrate the embedded and dynamic nature of condom use (for HIV prevention) by situating it within a cognitive model based on scripts and plans; the model presumes that the prevailing sexual script warrants against condom use because condoms disrupt the passion of the moment, they signify ghosts of lovers past, and particularly because they symbolize the possibility that one or both partners are infected with the AIDS virus; although the prevailing script does include a "getting to know each other" phase that allows for explicit questions about a potential partner's use of condoms, the pressure to be socially appropriate leads people to assess less relevant features of a target--typically his or her suitability as a rational (rather than sexual) partner... a phenomenological definition of safer sex; a cognitive perspective on sexual communication; plans to use condoms; implications for prevention.

Determinants of condom use among French heterosexuals with multiple partners.

Abstract: 1,008 French heterosexuals (aged 18-49 yrs) with multiple partners were interviewed about risk perception of HIV transmission, sexual behavior, and condom use. Systematic or occasional use of condoms during the previous 12 mo was reported by 46.9% of Subjects. Among the 473 condom users, 38.7% said they had never used condoms before the last 12 mo. Fear of AIDS rather than contraception was the main motivation of these recent users. Voluntary testing for HIV, average or more than average fear of sexually transmitted diseases, and knowledge of HIV carrier in personal relations were associated with condom use. Nonusers expressed more concern than users about the social and cultural images of condoms.

Controlling HIV in Africa: Effectiveness and cost of an intervention in a high-frequency STD transmitter core group.

Abstract: Demonstrated that a large reduction in human immunodeficiency virus (HIV) transmission can be achieved through an inexpensive intervention program among a cohort of 1,000 female prostitutes in the low-income Pumwani area of Nairobi. Condom use prevented or delayed HIV infection in initially uninfected Subjects, and thus kept them out of the pool of HIV transmitters. Using condoms also reduced genital ulcer (due to other sexually transmitted diseases, which increases the probability of HIV transmission) transmission. Early treatment of ulcers shortened their duration, so that the chances of spreading the infection should have been reduced even at times when condoms were not used. Costs of the program are evaluated by comparing them with the costs of caring for an individual with acquired immune deficiency syndrome (AIDS).

HIV and other sexually transmitted diseases among female prostitutes in Kinshasa.

Abstract: Collected data from 693 hotel prostitutes (HPs), 448 home prostitutes (HMPs), and 85 street prostitutes (SPs) in Zaire. Most Subjects reported taking some preventive measures against sexually transmitted diseases (STDs), but only 11% of HPs, 9% of HMPs, and 31% of SPs mentioned condom use as a way of preventing STDs. Oral and vaginal medication were used frequently to prevent STDs. 99% of the Subjects had heard about acquired immune deficiency syndrome (AIDS), but only 77% knew that sex was the predominant mode of transmission. 75% of the Subjects had at least one STD, and 35% of the Subjects tested positive for human immunodeficiency virus (HIV). Because STDs may enhance transmission of HIV, prostitutes who have a high prevalence of both HIV and other STDs may be at high risk of acquiring and transmitting HIV. Interventions aimed at increasing condom use and lowering levels of STDs should be targeted at this population.

HIV transmission: Men are the solution.

Abstract: Outlines the historical and cultural context of the practices and attitudes that hinder change in male sexuality in Uganda. The data suggest that effective control of HIV transmission depends on men changing their attitudes toward female sexuality. Condoms have been scarce in Uganda because there is no great demand for them by men. Women think the condoms might be their salvation from "the death sentence of AIDS." Effective AIDS education requires transformation in thinking. The double standard, which is conveniently endorsed by men, enables men to have an option in the number of sexual and marriage partners they can enjoy. Women are denied such options.

HIV infection and the meaning of condoms.

Abstract: Describes activities and constructions of meaning associated with condom use among 126 drug-using Black and Latino female methadone patients and their long-term sexual partners. A greater proportion of Subjects did not use condoms with husbands (64%) compared to those who did not use condoms with lovers (38%). HIV positive Subjects were more likely to have informed their spouses of their HIV infection, whereas they were less inclined to have shared their positive serostatus with their lovers. Present day meanings associated with condom use include loss of male protection, violations of constructions of intimacy, fidelity, conjugal bonding, female identity, illness, and death. It is argued that efforts to change condom use patterns must be based on increased vocational, educational, and social opportunities for women and a recontextualization of attitudes, behaviors, and beliefs.

Commentary: Condoms and HIV/STD prevention: Clarifying the message.

Abstract: Argues that correct and consistent use of condoms is highly effective in preventing sexually transmitted HIV infection and other sexually transmitted diseases. Assertions that minimize the potential efficacy of condoms may be self-fulfilling prophecies, because condoms may be used less consistently by those who do not believe them to be effective.

Sexual behaviour, condom use and prediction in attenders at sexually transmitted disease clinics: Implications for counselling.

Abstract: Surveyed 260 attenders at a sexually transmitted disease clinic to examine sexual behavior, condom use, and appraisal and to determine whether situational factors in their last sexual encounters were predictive of condom use. Response to health education campaigns promoting condoms in the light of human immunodeficiency virus (HIV) were also examined. Risk exposure was consistently high. Despite messages about condoms and safe sex, there was consistent evidence of unprotected anal and vagnial intercourse. Difficulties with condoms were widespread and fell into physical and psychological categories. The only predictor of condom use was the desire for unprotected sex. Differences between responses for heterosexual and homosexual men and women were examined. The psychological bases for beliefs underlying high-risk sexual behavior may be a target for counseling interventions.

Inner-city women and AIDS: The psycho-social benefits of unsafe sex.

Abstract: Describes the preliminary findings from an ongoing anthropological exploration of the links between inner-city Black women's ( N = 13) experiences and understandings of heterosexual relationships and condom use rates. The research identified and explored psychosocial barriers to safer sex. HIV/AIDS risk denial was examined, especially as it relates to women's strategic use of unsafe (condomless) sex and "monogamy narratives" to build and to maintain this denial. Research findings suggest that sponsoring group meetings in which women can talk to each other about HIV/AIDS, reducing women's dependence on men, and adjusting HIV/AIDS education curricula to better meet the needs of urban minority women are useful ways to increase safer sex practices in this population.

Condom use in high-risk sexual practices of female prostitutes in Italy.

Abstract: Evaluated the use of condoms and high-risk sexual practices (HSPs) with clients and nonpaying partners in a sample of 53 female prostitutes (47 non-iv drug users and 6 iv drug users) in 7 Italian towns from 1989 to 1991. 52 Subjects reported always using a condom with their clients, while only 2 used condoms with their nonpaying partners. HSPs were reported more for nonpaying partners than for clients.

Sexual behavior, condom use, disclosure of sexuality, and stability of sexual orientation in bisexual men.

Abstract: Studied 105 self-identified bisexual men (aged 19-62 yrs) recruited through a newspaper and interviewed in person concerning social characteristics, sexual behavior, rates of disclosure of sexuality to others, behavioral vs self-labeling definitions of bisexuality, HIV-risk behavior, and stability of sexual orientation. HIV-risk behavior was generally low. Most respondents had not disclosed their same-sex attraction to their social networks, including female sexual partners. Behaviorally bisexual men had higher psychological well-being and lower HIV risk than did men who self-identified as bisexual but did not meet a behavioral criterion. Among respondents recontacted 1 yr after the original interview, 40% had changed toward a more homosexual self-identity.

Assessing AIDS knowledge, attitudes, and risk behaviors among Black and Hispanic homosexual and bisexual men: Results of a feasibility study.

Abstract: Surveyed 91 gay and bisexual men (62.7% Black, 36.1% Hispanic). 72.2% of the Subjects had been tested for humanimmunodeficiency virus (HIV) antibodies. 95.6% knew where to go to be tested. Reasons for not being tested are noted. 34% of the Subjects reported having had sex with someone who has HIV+ or was diagnosed with acquired immune deficiency syndrome (AIDS). 90% of respondents knew that correct use of condoms offers protection from HIV infection. However, knowledge about the effectiveness of various types of condoms varied. Subjects' knowledge about the sexual transmission of HIV is discussed. Oral sex was the most frequently reported sexual behavior. The use of a community-based organization charged to reach Black and Hispanic gay men is recommended.

Changing patterns in reported sexual practices in the population: Multiple partners and condom use.

Abstract: Investigated whether the pattern of change with regard to condom use and number of partners is similar or different by gender and education. Telephone interviews were conducted with 5,149 females and 4,267 males (aged 18-45 yrs) in Scotland. Data were collected 5 days per week from 1987 to 1990. Educational level was assessed by asking at what age Subjects finished full-time education. Condom use increased for both sexes among more educated Subjects. Among less educated, multiple-partner Subjects, there was an increase in condom use (more so among women than men), while a decrease in condom use was observed among less educated, nonmultiple-partner Subjects. Results suggest that a concern with both elements of sexual behavior (condom use and limiting the number of partners) might slow the transmission of HIV.

Heterosexual behaviour of intravenous drug users in Amsterdam: Implications for the AIDS epidemic.

Abstract: Assessed the possibility of the spread of human immunodeficiency virus (HIV) from iv drug users (IVDUs) to their heterosexual partners by studying the frequency and type of sexual practices and the use of condoms with private steady or casual partners or with commercial partners. The majority of the 243 IVDUs who were interviewed were heterosexually active, and their partners appeared to be at risk for HIV infection only through sexual contact with the IVDUs. Vaginal intercourse was the most popular form of sexual contact in all relationships studied, and reported condom use was infrequent. Sexually transmitted diseases were common in Subjects with or without a history of prostitution. IVDUs may be an important source for heterosexual transmission of acquired immune deficiency syndrome (AIDS).

Determinants of condom use among intravenous drug users.

Abstract: 158 iv drug users were each questioned about their 3 most recent sexual partners, about the circumstances associated with the last time they had sexual intercourse with one of those partners, and about condom use with each partner during the most recent episode of intercourse. Independent variables used to predict condom use were divided into 3 categories: Subject characteristics (including demographics and drug use and related behaviors), a situational characteristic (whether drugs or alcohol were used before intercourse), and partner characteristics (e.g., partner's use of drugs). Condom use during the most recent sexual experience was reported by 34% of Subjects. Being HIV-positive predicted condom use, and condoms were more likely to be used with a casual partner rather than with a steady partner. IV drug use by the partner was not a predictor of condom use.

No connection between alcohol use and unsafe sex among gay and bisexual men.

Abstract: 461 gay and bisexual males were interviewed as part of Project SIGMA (Socio-sexual Investigations of Gay Men and AIDS), a 6-yr study of homosexual men in England and Wales. During the interview, retrospective diary data for the preceding week were collected regarding alcohol use, quantity of alcohol consumed, and sexual behaviors including partner, sequence and type of sexual acts, and condom use. No statistically distinguishable differences were found in HIV risk behaviors between sexual sessions that took place under the influence of alcohol and those that did not. Subjects were no more likely to engage in risky sexual behaviors after consuming alcohol than otherwise and, for those who did have sex while under the influence of alcohol, the quantity of alcohol consumed had no effect on risk behavior.

Sexual issues and condom use among injecting drug users.

Abstract: Assessed the behaviors and attitudes of 141 predominantly heterosexual, injecting drug users to sexual issues, including condom use. Information was gathered using a structured, in-depth interview. The majority of Subjects were polydrug users and were injecting opiates/benzodiazepines. 20 Subjects were reportedly HIV positive. Condom use was low. Obstacles to their use included a desire to conceive, a belief in their infertility, a perceived invulnerability to HIV infection through their sexual behavior patterns, a dislike of condoms, and difficulty in negotiating condom use with partners. The lifestyle of drug users may also have had an influence on condom use: Many drug users funded their habit through illegal activities including prostitution, theft, and fraud. The association between these and other factors and condom use is explored.

A pilot study of sexual communication and negotiation among young African American women: Implications for HIV prevention.

Abstract: Conducted focus groups with 18 low-income African- American women (aged 18-25 yrs) to explore the process of sexual communication and barriers toward sexual negotiation of condom use. Findings suggest that HIV prevention programs tailored to African-American women should emphasize training in sexual negotiation, conflict resolution, and refusal skills.

Health beliefs and HIV prevention: Do they predict monogamy and condom use?

Abstract: Tested 4 health beliefs (perceived susceptibility, severity, benefits, and barrier), as postulated by the health belief model, in terms of their capacity to predict sexual monogamy, condom use, and overall changes in health behavior in the context of HIV prevention. 153 undergraduates who had been sexually active in the previous 6 mo completed surveys. Findings indicate that perceived susceptibility and barriers were significant predictors of the adoption of certain HIV-preventive behaviors among Subjects. In particular, susceptibility was a significant predictor of monogamy, while barrier significantly predicted monogamy and overall changes in health behavior.