Abstract
BackgroundDespite the significance for sexually transmitted diseases (STD) control in East Asia, few studies have examined the relationship between high-risk sexual behavior and condom use. We investigated how three sexually vulnerable groups for STDs show differences in condom use behaviors (CUBs) depending on their STD infection.MethodsThe source of data came from the National Survey for STD Prevalence Rate and Sexual Behavior of the High-Risk Sexual Community. The effects of behavioral determinants on CUBs were estimated by using path analysis models. An 11-item questionnaire assessing subjects’ health risk behaviors, sexual beliefs, sexual risk behaviors, and condom use.ResultsCondom use was higher for men who have sex with men (MSM; n = 108) when they were bisexuals and had high self-efficacy, for Johns (Johns; n = 118) when they had experience of STD infection, and for female sex workers (FSWs; n = 1,083) when they had high self-efficacy, did not engage in drunken sex, and were anxious about infection. Regardless of whether they were infected with STDs, FSWs always used condom when they had high sexual beliefs. On the contrary, Johns exhibited a negative relationship between sexual risk behavior and condom use when they had experience of STD infection. The variable commonly significant to all three groups was the number of sex partners; but it exhibited a positive relationship with MSMs and Johns, and a negative one with FSWs.ConclusionsCUBs were related to sexual beliefs as well as sexual risk behavior. At the same time, the experience of STD infection mediated the relationship between the two. Therefore, we need to draw social attention to promote safer sex among STD-vulnerable groups.
Highlights
Transmitted diseases (STDs) have attracted attention as a major public health issue, and their management remains a daunting challenge [1]
We focused on anxiety about sexually transmitted diseases (STD) as an attitude factor regarding self-efficacy [12,27] and condom use, which are stressed by both the theory of planned behavior (TPB) and the health belief model (HBM), and simplified anxiety about STDs as the factor of sexual beliefs
Sample Description The dominant age group in men who have sex with men (MSM) and female sex workers (FSWs) was people in their 20s: 42.6% and 66.8%, respectively. Those in their 30s were the largest group (43.2%) in Johns (Table 1). When asked if they were inebriated during sexual intercourse, 78.0% Johns responded ‘‘often’’ or ‘‘usually’’, while 74.1% in FSWs replied ‘‘never.’’ On average FSWs had their first sexual experience at a relatively early age; 82.1% experienced it as minors
Summary
Transmitted diseases (STDs) have attracted attention as a major public health issue, and their management remains a daunting challenge [1]. Preventive intervention in the unseen communities is important because such groups are insensitive to condom use despite concurrent sexual partnerships (CSPs) [4,5]. The merit of TPB is its ability to explain human behaviors as a combination of norms, attitudes, and self-efficacy This is based on individual rationality, so that its applicability becomes limited in the case of behaviors such as condom use that requires relational/coordinative decision making and is influenced by social pressure [3]. The health belief model (HBM) illustrates human behaviors with cognitive elements such as the perceived threat of illness, outcome expectation, and perceived self-efficacy [10] It provides a crucial platform for predicting condom use behaviors (CUBs) [11]. We investigated how three sexually vulnerable groups for STDs show differences in condom use behaviors (CUBs) depending on their STD infection
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