Predicting increased condom use with main partners: potential approaches to intervention.

Abstract

HIV/AIDS risk reduction interventions have been based on 5 psychological models: Transtheoretical Model of Change, AIDS Risk Reduction Model, Social Cognitive Theory, Theory of Reasoned Action, and Theory of Planned Behavior. This longitudinal study examined changes in condom use as a function of variables from these theories. Risk assessment, "stages of change," and condom use questionnaires were administered to 78 crack smokers or intravenous drug users with a main partner recruited from 2 US towns. Networks of subjects were randomly assigned to a standard intervention (2 educational sessions including basic information about HIV and its prevention as well as demonstrations and practice of correct condom use and cleaning of drug injecting equipment) or an enhanced program (2 additional sessions in which participants set individual risk reduction goals and identified barriers to change). Logistic regression analysis indicated that changes in condom use after 6 months were not predicted by age, gender, ethnicity, type of drug use, perceived HIV risk, or intervention group. Having multiple sex partners significantly predicted increased condom use. The 2 strongest predictors of increased condom use were self-reported assertiveness and the stage of change. High assertiveness at intake (odds ratio, 4.97) and a plan to start using condoms in the next 6 months (odds ratio, 15.49) were significant predictors of an increase in condom use at 6-month follow-up. Proposed is a model that combines Theory of Planned Behavior and Social Cognitive Theory and conceptualizes assertiveness as the mediator between intention and behavior change.