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Stage of behavior change for condom use: the influence of partner type, relationship and pregnancy factors.

A theoretical model was used to examine the influence of relationship factors, pregnancy intentions, contraceptive behavior and other psychosocial characteristics on stages of behavior change in condom use among heterosexual black women of reproductive age. Data from an inner-city street survey compared women who were not contemplating condom use, women who were attempting to use condoms or had used them consistently for short periods of time, and those who had achieved long-term consistent use. Women's relationship with their main partner appears to be an important factor in understanding their use of condoms both with main partners and with other partners. For condom use with the main partner, factors such as emotional closeness and partner support were significant predictors of the likelihood that women would be attempting to use condoms rather than not contemplating use. Cohabitation and the belief that condom use builds trust were significant predictors of long-term consistent condom use. Having a regular or main partner was strongly associated with intentions to use condoms with other partners. Women who wanted to become pregnant were much less likely to intend to use condoms with their main partner, and women using oral contraceptives were less likely to be long-term consistent condom users.

Adolescent↗

Individual counseling of patients with sexually transmitted diseases. A way to improve partner notification in a Zambian setting?

BACKGROUND: Sexually transmitted diseases (STD) are a major health problem in Zambia. Partner notification, which is a recommended strategy to decrease STD, must be improved. GOAL: To assess whether individual counseling of patients with STD, combined with contact slip(s), had any impact on the proportion of sex partners traced in an urban setting in Zambia. STUDY DESIGN: A randomized trial comprised of 94 women and 302 men with STD. RESULTS: Women and men in the intervention group informed more partners than did those in the control group. In the intervention group, 1.8 partners per man was treated compared to 1.2 in the control group (P < 0.001). There was no difference between the two groups of women. There was a gradual decline from numbers of partners informed to numbers of partners treated according to the patient to number of contact slips filed. CONCLUSIONS: Individual counseling of men with STD improved partner notification.

Adolescent↗

HIV-related concerns and behaviors among Hispanic women.

Hispanic women whose sexual partners have other sexual partners may be at risk for HIV. A structured interview was administered to 106 Dominican and Puerto Rican women who reported that they knew or suspected that their partner had other partners. A subsample participated in qualitative interviews. The study assessed concern about HIV and predictors of condom use. The majority of women reported that they worried about getting HIV and almost half had been HIV-tested. Most of the women discussed HIV/AIDS concerns with their partners, and one-third reported some condom use. Predictors of condom use were: born in the Dominican Republic/Puerto Rico, having talked with their partner about being tested, and belief that he used condoms with others. Although the women were concerned about HIV, condom use was infrequent. Results suggested methods to address this discrepancy: introducing condoms early in the relationship, developing women-controlled methods, and directly influencing men's behavior.

Adult↗

AIDS-relevant condom use by gay and bisexual men: the role of person variables and the interpersonal situation.

This study examined the relative ability of selected person variables (interpersonal self-efficacy, self-control, attitudes about the effect of condoms on sex, normative beliefs) and interpersonal-situational variables (partner preference, partner serostatus) to explain gay and bisexual males' (N = 267) condom use during insertive and receptive intercourse. Partner preference accounted for a large amount of variance in condom use by itself and when controlling for the effects of the remaining variables. Exploratory hierarchical regression analyses suggested that the receptive partner's preference influenced condom use decisions to a greater extent than did the insertive partner's. Partner serostatus alone explained little variance in condom use. However, partners serostatus interacted with subject serostatus such that dyads with concordance serostatus (i.e., both partners HIV positive or both HIV negative) used condoms the least, and dyads with discordant serostatus used condoms the most. Results suggest that the interpersonal situation plays an important role in condom use decisions.

Acquired Immunodeficiency Syndrome↗

Evaluating an AIDS sexual risk reduction program for young adults in public night schools in São Paulo, Brazil.

OBJECTIVES: To describe sexual risk for HIV infection among adult night school students in São Paulo, Brazil, and to evaluate the effect of an HIV/AIDS prevention workshop to reduce sexual risk. SUBJECTS AND METHODS: A longitudinal study was conducted among four demographically similar public night schools in the inner city of São Paulo. Schools were randomized into intervention and control conditions. Of 394 young adults who took part in the baseline survey, 304 (77%) completed a postintervention questionnaire. INTERVENTIONS: In a workshop consisting of four sessions of 3 h each, the students discussed AIDS symbolism, the impact of AIDS on their lives, risk perception, the way in which sexual norms shape knowledge and attitudes, AIDS-related knowledge, reproduction and sexual pleasure, and condom use negotiation. We fostered community-building through AIDS training courses for teachers in the schools, peer support programs and public events. RESULTS: At baseline, 87% had been sexually active at some time and 76% had had sex in the past 6 months. Among those who reported vaginal intercourse and/or anal intercourse, condom use was low. The workshops were positively process-evaluated and supported by the community, the students, their teachers and their parents. We obtained statistically significant effects from the workshops for females only, who reported improved communication with partners about sex and AIDS and less unprotected sex with non-monogamous partners after the intervention. CONCLUSION: These data show that the sexual risk of HIV infection can be lowered when Brazilian disenfranchized communities support AIDS prevention workshops. Even more impressive results may be achieved if the need to address socioeconomic obstacles and gendered sexual roles is emphasized through further long-term community development programs.

Acquired Immunodeficiency Syndrome↗

Young women's degree of control over first intercourse: an exploratory analysis.

CONTEXT: While policymakers and researchers alike often seem to believe that young women's decision to initiate sexual intercourse is conscious and free of ambiguity, the actual degree of control that such young women exert over first intercourse has rarely been explicitly examined. METHODS: The 1995 National Survey of Family Growth asked all women who had experienced intercourse to rate, on a 1-10 scale, the wantedness of their first intercourse; they were then asked whether the experience was voluntary. Logistic regression analysis of data for women aged 15-24 who had experienced first premarital intercourse was performed to test the effect of background factors and wantedness scores on contraceptive use at voluntary first intercourse. RESULTS: Twenty-four percent of women aged 13 or younger at the time of their first premarital intercourse report the experience to have been nonvoluntary, compared with 10% of those aged 19-24 at first premarital intercourse. About one-quarter of respondents who reported their first intercourse as voluntary chose a low value (1-4) on the wantedness scale. Women whose first partner was seven or more years older than themselves were more than twice as likely as those whose first partner was the same age or younger to choose a low value (36% vs. 17%). Women whose partner had been seven or more years older were also less likely than other women to have used contraceptives at first intercourse. After the introduction of controls for demographic and background factors, partner age discrepancy and relationship status, wantedness of voluntary first intercourse was not independently related to the odds of contraceptive use at that intercourse. CONCLUSION: Characterizing women's first intercourse as simply voluntary or nonvoluntary is inadequate. Measures that take into account degrees of wantedness may help elucidate relationships between sexual initiation, contraceptive use and teenage pregnancy. The fact that substantial numbers of young women voluntarily participated in a first sexual experience about which they felt ambivalent or negative deserves the attention of program planners and service providers.

Adolescent↗

Condom use in sexual exchange relationships among young single adults in Ghana.

This article discusses some personal and situational factors which hinder the use of condoms among young single adults ages 18 to 25 years engaged in sexual exchange relationships in a Ghanaian town. Based on focus group discussions and in-depth interviews, this article highlights some key impediments often not adequately discussed in the discourse on condom use but considered vital in any attempt to increase condom use and ultimately reduce HIV transmission. The includes the dilemma facing women who want to use condoms for HIV prevention in premarital sexual exchange relationships (quite different from prostitution) contracted with material gain in mind. Women may face the risk of losing material benefits from sexual exchange relationships if the man is unwilling to use condoms. It is recommended that HIV health educators must increase the involvement of young single adults in exploring these and situational impediments and together design interventions to improve condom use.

Adult↗

Teaching children about health, part II: the effect of an academic-community partnership on medical students' communication skills.

CONTEXT: Partners in Health Education (PHE) is a Dartmouth Medical School elective that pairs first- and second-year medical students with local elementary school classroom teachers to provide health messages to students. The primary aim of the programme is to help medical students improve their communication skills through teaching children about health. Secondary aims are to teach children about health and the prevention of injury and disease and to support community teachers in their health promotion efforts. This report contains the results of the assessment of the programme's impact on the medical students. METHODS: Sixteen first- and second-year medical students comprised the participants for the study. Students were assessed during their first and fourth teaching experiences using a variety of evaluation measures, including student surveys of expectations and perceptions; ratings of performance in the classroom by students, teachers, and classroom observers; coded videotapes of classroom teaching sessions; and performance on a measure of physician-patient communication skills. FINDINGS: Over the course of the teaching experience, medical students' teaching and communication skills increased on a number of measures. DISCUSSION: Programmes such as PHE can provide true service-learning experiences in which all participants benefit. Medical students can learn how to communicate about health, a set of skills they will need to become effective physicians. School children can learn about health, so they are empowered to take charge of their health and to make healthy choices.

Child↗

Family relationships and depressive symptoms preceding induced abortion.

This study examines the association between depressive symptoms preceding induced abortion and dissatisfaction with family relationships. In a cross-sectional survey, 304 women undergoing a first-trimester abortion completed a short version of the Center for Epidemiologic Studies Depression Scale, the Family APGAR, and a researcher-designed questionnaire. Bivariate analyses revealed that depressive symptoms decreased as measures of age, educational attainment, Family APGAR scores, marriage, and subjective health increased. Depressive symptoms increased as measures of denial, difficulties communicating with male partners, pregnancy symptoms, contraceptive use, and dissatisfaction with choosing abortion increased. Controlling for the effects of these significant bivariate associations, increased depressive symptoms were independently predicted by Family APGAR scores, age, communications difficulties, pregnancy symptoms, contraceptive use, and denial. Low Family APGAR scores exhibited the strongest overall effect. Clinicians who encounter women experiencing depressive symptoms preceding abortion may wish to explore family relationships and the possibility of underlying family dysfunction.

Abortion, Induced↗

Determinants of contraceptive use among women of reproductive age in Great Britain and Germany. II: Psychological factors.

Psychological determinants of contraceptive use were investigated in Great Britain and Germany, using national data obtained in 1992. It was hypothesised that current contraceptive use among sexually active, fertile women aged 15-45 was related to their attitude towards the various contraceptive methods, social influences, perceptions of being able to use a method correctly and consistently, a correct estimation of fertility, and communication with their partner. Effects of age and country were also taken into account. The attitude of respondents towards the various contraceptive methods was ambivalent and no method was seen as ideal. On medical methods (OCs, IUDs and sterilisation) many respondents expressed doubts as to their safety for health. Social influences most frequently concerned the use of OCs. Respondents considered themselves able to use oral contraceptives correctly, but expressed general fear about intrauterine devices and sterilisation, and many women believed they were not able to use condoms and periodic abstinence consistently. Multifactorial analyses revealed that current contraceptive use was principally determined by social influences, attitude and self-efficacy with respect to medical methods. Age and country, and, for use of unreliable methods, fertility awareness also played a role. Communication with the partner was less relevant. Contraceptive choice (and the use of non-medical methods) depended greatly on encouragement to use and being in favour of medical methods. A lack of social support for use of medical methods and a negative attitude towards them was related to higher use rates of condoms, periodic abstinence, withdrawal and reliance on 'luck'. In the case of withdrawal and/or no method, underestimation of fertility played an additional role. Contraceptive choice appears to be determined more by a general like or dislike of medical methods rather than on a weighing of the merits of individual available methods.

Adolescent↗

Health care service use and sexual communication: past experience and future intention of high-risk male adolescents.

High-risk male adolescents were surveyed to collect data to be used to develop strategies to enhance communication with their partners about sexually transmitted diseases (STDs). Participants were concerned about acquiring an STD from their partner, and reported an increased likelihood of communicating about STD-related issues when confidential health care was available.

Adolescent↗

Attitudes, knowledge, and behavior regarding condom use in urban black adolescent males.

This study was conducted to determine male adolescent behavior, attitudes, and knowledge concerning the use of condoms. Subjects were 241 sexually active black adolescent males attending an inner-city adolescent medicine clinic who were surveyed using a structured interview technique. Factors associated with condom use included higher grade level, > or = 2 sexual partners in the past six months, communication about contraception with sexual partner(s), desire for sexually transmitted disease (STD) prevention when contracepting, and parental suggestion to use condoms. Variables not associated with condom use included older age, minimal level of knowledge about condom use, history of having impregnated a partner or of having contracted an STD, desire for pregnancy prevention, suggestion by friends to use condoms, or partner dissatisfaction with condoms. Using multivariate logistic regression analysis, the following variables in combination were able to correctly classify respondents as condom users or nonusers in 74% of cases: higher knowledge score, reported communication about contraception with one's partner(s), > or = 2 partners in the past six months, and higher socioeconomic status. These findings suggest that, for the study population, interventions directed toward improving knowledge about condoms, school achievement, and communication with parents and partners may be effective in increasing condom use.

Adolescent↗

The factors associated with disclosure of intimate partner abuse to clinicians.

OBJECTIVE: Our goal was to identify the prevalence, determinants of, and barriers to clinician-patient communication about intimate partner abuse. STUDY DESIGN: We conducted telephone interviews with a random sample of ethnically diverse abused women. POPULATION: We included a total of 375 African American, Latina, and non-Latina white women aged 18 to 46 years with histories of intimate partner abuse who attended 1 of 3 primary care clinics in San Francisco, California, in 1997. OUTCOMES MEASURED: We measured the relevance and determinants of past communication with clinicians about abuse and barriers to communication. RESULTS: Forty-two percent (159) of the patients reported having communicated with a clinician about abuse. Significant independent predictors of communication were direct clinician questioning about abuse (odds ratio [OR]=4.6; 95% confidence interval [CI] 3.2-6.6), and African American ethnicity (OR=1.8; 95% CI, 1.1-2.9). Factors associated with lack of communication about abuse included immigrant status (OR=0.6; 95% CI, 0.3-1.0) and patient concerns about confidentiality (OR=0.7; 95% CI, 0.5-0.9). Barriers significantly associated with lack of communication were patients' perceptions that clinicians did not ask directly about abuse, beliefs that clinicians lack time and interest in discussing abuse, fears about involving police and courts, and concerns about confidentiality. CONCLUSIONS: Clinician inquiry appears to be one of the strongest determinants of communication with patients about partner abuse. Other factors that need to be addressed include patient perceptions regarding clinicians' time and interest in discussing abuse, fear of police or court involvement, and patient concerns about confidentiality.

Adolescent↗

Cancer-related relationship communication in couples coping with early stage breast cancer.

This longitudinal study examined the association between three types of communication strategies couples may use to handle stressors they experience during and after breast cancer treatment and psychological distress and relationship satisfaction of women with early stage breast cancer and their partners. Mutual constructive communication, mutual avoidance, and demand-withdraw communication strategies as well as psychological distress and marital satisfaction were rated by 147 patients and 127 partners during cancer treatment and 9 months later. Mutual constructive communication was associated with less distress and more relationship satisfaction for both patient and partner. Demand-withdraw communication was associated with higher distress and lower relationship satisfaction for both patient and partner. Mutual avoidance was associated with more distress for patient and partner but was not associated with relationship satisfaction. The negative association between mutual constructive communication and patient distress was stronger for patients with more physical impairment. Patients' perceptions of mutual constructive communication and mutual avoidance were associated with partners' distress, and patients' perceptions of mutual constructive and demand/withdraw communication were associated with partners' marital satisfaction. Clinical implications for couple-focused communication skills training for cancer patients and their partners are discussed.

Adaptation, Psychological↗

[Impact of HIV counseling and testing during antenal consultation for HIV- women in Abidjan (Côte d'Ivoire): a quantitative and qualitative study (Ditrame Plus 3 project, ANRS 1253)].

This study takes place in Abidjan, Côte d'Ivoire, inside a program of reduction of the mother-to-child HIV transmission, the Ditrame Plus study, ANRS 1201-1202. In this program, HIV test is proposed to women during antenatal consultations. After the test, we have followed during twelve months after childbirth 400 women who were HIV negative. We examine in this paper how these women who have been HIV tested during pregnancy and who are HIV seronegative communicate with their partner about HIV test and about the risk of HIV infection. We analyse also the behaviour of the partners in terms of HIV testing and condom use with their wife. Among the 400 women followed, for 6 upon 10, the HIV test allowed them to reinforced communication with their partner upon STD and AIDS. For 2 upon 10, the HIV test was the occasion to start a dialogue on this subject. On the whole, communication between spouses on these questions became more frequent after HIV test in all socio- demographic classes. They were more frequent when the husband was instructed and they were more easy in monogamous couples. Overall, the spouses discussed about the protection by condoms of the eventual extramarital sexual intercourse of the husband, in order to avoid the risk of infection of the HIV- wife. Ninety per cent of women asked their husband (or regular sexual partner) to use condoms if he would have sexual intercourse "outside". Women used different strategies to tackle this difficult subject of extramarital intercourse with their husband : they approached it as a simple discussion, or as a joke, or when they had a conjugal dispute. Ninety seven per cent of the followed women notified their partner they had been HIV tested. This notification was easy because they were seronegative. Then 94 % of these women told their partner he should be HIV tested also. But, despite this high figure, only a quarter of the partners asked an HIV test and were tested. Many of them were scared by a possible infection and didn't want to know their serostatus. The qualitative study showed also that many men thank that their serostatus was necessary the same than their wife's. They concluded they didn't need to be tested, since their wife was tested and was HIV(-). Instruction level of the husband was the major predictor of the men's probability of being HIV tested : this probability was four time higher among the more instructed partners than among the partners without instruction. Despite the low level of HIV-tested men, only a third of these couples used condoms at the resumption of sexual activity after childbirth. When the woman was instructed, condoms were more frequently used. Generally, women used the contraceptive role of the condom to convince their partner to use it. The ability of HIV negative women to adopt prevention practices in order to avoid a possible HIV infection from their husband (or regular partner) depended strongly on the quality of the conjugal relationship. This conjugal relationship was related to the sociodemographic characteristics of each partners. Behavioral changes were easier when both partners were instructed or when the woman was financially independent. They were more difficult in polygamous marriages or when women were muslims. But the analysis of marginal cases revealed that women with no instruction can also negotiate: this negotiation depends on the quality of the communication existing in the couple. In conclusion, HIV testing allowed some women to strengthen the dialogue pre-existing in their couple upon HIV questions, and it allowed other women to start such a dialogue. This dialogue was centred overall on the use of condoms in case of extramarital intercourse. A complete prevention of HIV transmission in the couple, with HIV testing of both conjugal partners, and use of condoms until this double testing is done, remains seldom. Hence, it seems that the couple should be better taken into account in the HIV counseling and testing programs.

Adolescent↗

Cognitive and behavioral predictors of sexually transmitted disease risk behavior among sexually active adolescents.

OBJECTIVE: To identify important cognitive and behavioral predictors of sexually transmitted disease (STD) risk behavior among a sexually active adolescent cohort. DESIGN: One-year longitudinal study of health beliefs, sexual behaviors, and STD acquisition among 549 adolescents, 14 to 21 years of age. SETTING: School- and community-based health clinics in a large metropolitan area. PARTICIPANTS: Data from 410 sexually active adolescents completing surveys at baseline and 1-year follow-up. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Sexually transmitted disease risk behavior--a composite measure of condom use consistency with most recent sexual partner(s), number of vaginal sex partners, and frequency of intercourse with most recent sexual partner(s). RESULTS: For girls (n = 335), a model including baseline STD risk behavior, condom use self-efficacy, oral contraceptive use, communication with sexual partners about STD prevention, and alcohol use in connection with sexual activity explained 21.1% of the variance in STD risk behavior at 1-year follow-up. For boys (n = 75), the strongest predictors of STD risk behavior at follow-up included baseline STD risk behavior, perceived susceptibility to STD, condom use self-efficacy, negative outcome expectations associated with condom use, and perceived barriers to STD prevention. CONCLUSIONS: Efforts targeting reduction in STD risk behavior must begin before the onset of somewhat stable patterns of sexual risk behavior. Among adolescents who are sexually active, interventions should include components that increase condom use self-efficacy, build skills to communicate with sexual partners about STD prevention, and address behaviors associated with STD risk behavior including oral contraceptive use.

Adolescent↗

Attitudes to sex and sexual behaviour in rural Matabeleland, Zimbabwe.

Though HIV prevention campaigns in Zimbabwe have increased public awareness of HIV, they have not meaningfully changed sexual behaviour. Possibly these campaigns are based on wrong assumptions about sexual behaviour. By means of 111 structured interviews with hospital patients, secondary school students and teachers, and 11 focus group discussions with traditional healers, midwives, village community workers, secondary school students and teachers, and commercial sex workers in a rural district of Matabeleland in Zimbabwe, this low-budget study explores attitudes towards sex and sexual behaviour in order to define more appropriate health education messages. Results indicate that traditional sex education no longer takes place and that communication between sexual partners is limited. The almost ubiquitous expectation of women to get rewards for sex outside marriage motivates mostly single women out of economic necessity to meet the male demand for sexual partners, which is created by large scale migrant labour and men's professed 'biological' need for multiple partners. Types of sexual behaviour other than penetrative vaginal sex are uncommon and considered deviant. Safe sex messages from the West therefore are inappropriate in the Zimbabwean context. Recommendations are given to restore traditional communication about sexual matters across generations and to urge sexual partners to discuss sex. Women who, for economic reasons, engage in casual sex should at least learn to negotiate the use of condoms. Men seriously need to reconsider their attitudes to sex and sexual practices in view of the high HIV sero-prevalence. Faithfulness, rather than multiple sexual contacts, should become a reason to boast.

Adolescent↗

It takes two: the role of partner ethnicity and age characteristics on condom negotiations of heterosexual Chinese and Filipina American college women.

To date, limited attention is paid to how partners influence the condom negotiation process. This study examined whether partner ethnicity and age were associated with condom negotiations (i.e., verbal-direct, verbal-indirect, nonverbal-direct, nonverbal-indirect) in heterosexual Chinese and Filipina American college women. Results from 181 women across four California universities indicated significant effects of partner ethnicity and age on condom negotiation strategies. Asian women with non-Asian partners were more likely to use nonverbal-direct strategies than those with Asian partners. Asian women with older partners were less likely to use verbal strategies (verbal-direct, verbal-indirect) than those with same-age partners. This study suggests that Asian women's safer sex communication varies by partner characteristics. Obtaining information such as partner ethnicity and age can help health educators provide more culturally appropriate sexual communication skills to clients.

Adolescent↗