Condom Negotiation Strategies Research Articles

“A condom is compulsory”: A qualitative study of condom use and negotiation strategies among female sex workers in Nepal

ABSTRACT The objective of this qualitative study was to understand Nepali female sex workers’ (FSWs) condom negotiation strategies. In 2016, we conducted 30 semi-structured, in-depth interviews with street- and brothel-based FSWs residing in Kathmandu, Nepal. Participants reported that their first entry into sex work typically occurred between the ages of 17–32, and the average duration of women’s involvement with sex work was 8 years. FSWs reported high knowledge and awareness of condoms, and many women had used various sexual and reproductive health services. FSWs used three types of negotiation strategies: withholding or refusing sex, providing risk information, and direct request. While some FSWs believed that these strategies were useful and successful, we found that, for some women, condom negotiation strategies were difficult to implement due to fear of abuse and threats of violence by clients. Condom negotiation was further complicated by poverty and substance abuse, and several narratives revealed the influence of gender and social norms on safe sexual practices. The findings highlight the need for improved sexual health interventions that incorporate a range of negotiation strategies and techniques (e.g., nonverbal communication and reward strategies) and aim to mitigate harm and violence against FSWs.

Condom use: a less travelled route among minibus taxi drivers and their taxi queens in KwaZulu-Natal, South Africa.

Despite significant gains in the HIV epidemic in South Africa, with reduction in mortality and elimination of vertical transmission, national HIV prevalence remains high, with women rather than men continuing to bear higher burden of the disease. Population subgroups, through ignorance, disbelief or recklessness, continue to engage in risky sexual behaviour. A substantial proportion of minibus taxi drivers engage in risky sex, seldom seeing themselves at risk for STIs or HIV/AIDS. These taxi drivers have been linked with so-called taxi queens, with whom they engage in transactional and intergenerational relationships. The study explored condom use and condom negotiation strategies among taxi drivers and taxi queens in Kwa- Zulu-Natal, South Africa. Applying explorative qualitative design, we conducted focus group discussion and individual interviews among participants who were purposively recruited in KwaZulu-Natal. Qualitative data analysis revealed that condom use and negotiation are sources of conflict for the participants. In addition, the strategies employed by participants to ensure condom usage are not always sustainable and are likely to be problematic due to a variety of complex factors. Our study concludes by recommending a nested public health response that takes cognizance of factors that promote sustainable condom use strategies among this population subgroup.

Why non-naked family produce ape baby: To explore the aspect of cheeks pulp

The phenomenon is fairly common, with one in every 80 adults showing cheeks pulp is slot of unprotected sex. As part of a study, young couples revealed no different condom negotiation strategies to cope with unprotected sex. A study has found that non-naked did not recognise that women who collapsed were having an arrest, leading to delays in calling the emergency services and delays in providing resuscitation treatment. A recent study found that adult’s women engaged in unprotected sex even after being aware of the various risks associated with it, when the desire to form lasting romantic relationships arises. According to the researchers from Pune University, this is the first study to directly compare how heterosexual men, heterosexual women and men who have sex with men (MSM) differ in their approach to condom-making decision with a new sexual partner. The study was published in the Journal of Sex Research. The findings may help in explaining why some of the youngsters engage in unsafe sex even though they are aware of the risk of sexually transmitted infections (STIs), HIV, cervical cancer, and unplanned pregnancy

What messages can foster safer sex among young women? Experimental evidence concerning the role of emotions and moral norms

Through a 2 × 2 × 2 quasi experimental design (N = 254), this research investigated if a social campaign eliciting positive emotions and activating moral norms might enhance condom negotiation skills, intended and estimated condom among young women with or without past sexual experience with casual partners. Emotions had a main effect on one of the six condom negotiation strategies we considered; for most of the other variables an interaction effect with moral norms and/or past behaviour emerged. Concerning estimated condom use, positive emotions worked better than negative ones when moral norms were salient. With respect to negotiations skills, positive rather than negative emotions seemed more effective for women with past causal sexual experience. In women without this kind of experience, positive emotions seemed to work better when moral norms were salient. Moral norms had a main effect on negotiation self-efficacy, but not in the predicted direction: when moral norms were more salient women were found to be less confident about their negotiation ability. These results suggest that a message which makes moral norms salient should at the same time elicit positive emotions in order to be effective; moreover, messages should be carefully tailored according to women’s past behaviour.

Condom Negotiation and Sexual Health in Young Italian Women

In recent years many European studies showed a change in lifestyle and sexual behaviors among young women, like a decreased age of first intercourse, a higher number of sexual partners, a higher consumption of alcohol and a lower use of condom. Aim of this study is to identify the condom negotiation strategies of a representative sample of Italian female university students (IFUS) during sexual intercourse, and evaluate the relation between religiosity, relationship status, alcohol/drugs use and type of negotiation strategy. Nine hundred thirty-seven IFUS, aged 19–26 years, attending the 2nd and 3rd year of humanistic, technical and medical faculties in nine Italian Universities. This is a multicentric study. Two questionnaires were administered to the students: one survey was specifically designed for the study to collect socio-demographic data and sexual and contraceptive habits; the second is the validated Italian version of Condom Influence Strategy Questionnaire (CISQ).

An event-level examination of successful condom negotiation strategies among young women.

This study examines the effect of condom negotiation strategies on condom use and partner type and substance use before sex as moderators of strategy effectiveness. Women reported their daily sexual behavior during the last month. Withholding sex was more strongly associated with condom use when utilized with a non-casual sex partner. Directly requesting condom use was more strongly and using deceptive reasons to influence condom use was less strongly related to condom use during substance use. Results underscore the importance of understanding the contexts in which condom negotiation strategies are successful in order to improve HIV/sexually transmitted infection prevention efforts among women.

Perceptions of Factors Associated with Condom Use to Prevent HIV/AIDS among Persons with Physical Disability in an Urban Town of Cameroon: A Qualitative Study.

Persons with disabilities have been identified as one of the groups vulnerable to HIV, due to several challenges posed by their disabilities. They also suffer external stigma from their able bodied peers. However, they have largely been ignored as part of HIV prevention programs, largely due to the perceptions that they are not at risk, and information is not being accessible. About 5.4% of the Cameroon population lives with a disability. In Cameroon, no official statistics exist on perception of factors associated with condom use to prevent HIV among persons with disabilities, which creates a challenge for understanding the extent of the pandemic in this population. The objective of this study was therefore to investigate perceptions of factors associated with condom use among persons with physical disability in an urban town of Cameroon. The qualitative study from which this paper is based, used semi-structured in-depth interviews, conducted with a purposive sample of ten (5 male and 5 female) persons with physical disability, aged 18 years and above, in April 2015. The findings of this study as interpreted according to the components of the Health Belief Model, indicated that perceived susceptibility to HIV, perceived severity of HIV, perceived benefit of condom use, perceived barriers to condom use and perceived self-efficacy for condom use were the factors perceived by persons with physical disability, to be associated with condom use. It is therefore recommended that there should be educational programs in HIV/AIDS targeted specifically at persons with physical disability. These programs should pertinently promote the understanding and perceptions of persons with physical disability of the real threat of HIV/AIDS, and also equip them with condom negotiation skills and strategies to overcome barriers to condom use.

Minority College Women's Views on Condom Negotiation.

This study utilized quantitative and qualitative methods to (1) investigate the relationship between frequency of condom use and negotiation strategies and (2) evaluate experiences with condom negotiations among sexually active, heterosexual, African American college women. One hundred female students from a Historically Black Colleges and Universities (HBCU) completed a questionnaire that included the Condom Influence Strategies Scale (CIS) and participated in a focus group. An ANOVA was conducted to compare differences between never, inconsistent, and consistent condom users. Consistent condom users scored higher than never users on the “withholding sex” subscale of the CIS (4.88 vs. 3.55; p < 0.001) as well as endorsed items more strongly on the “direct request” subscale of the CIS (4.63 vs. 3.82, p < 0.05) than never users. A thematic analysis of open discussions identified overarching themes. Similarly, refusing sex and/or having direct communications with partner emerged as primary strategies. Threats to negotiation included deciding the “right timing” of discussion and having a previous history of sexual intercourse without a condom with their partner. Other key concepts that contribute to condom negotiation are the views that condoms are a male’s responsibility and stigma of women who carry condoms.

Condom use behavioural skills mediate the relationship between condom use motivation and condom use behaviour among young adult heterosexual males: An information-motivation-behavioural skills analysis

This study examined the relationship between condom use motivation and condom use behavioural skills, and their direct and mediated influence on condom use consistency from the perspective of the Information-Motivation-Behavioural Skills (IMB) model of health behaviour. Participants were 149 currently sexually active heterosexual males aged 18–24 (M=18.6). The motivation component of the IMB model was operationalized with measures of attitudes toward condoms and perceptions of social norms, while assessing the implementation of negotiation strategies that can be used to obtain or avoid condom use operationalized the behavioural skills component. Results indicated that condom use motivation was positively correlated with specific condom use obtaining strategies, and condom use consistency was negatively correlated with certain condom use avoiding strategies. Moreover, specific condom negotiation strategies partially mediated the relationships between motivational constructs and condom use consistency. These findings confirm the propositions of the IMB model, illustrate the utility of measurement of behavioural skills in relation to implementation of specific actions, and highlight the need for interventions to focus on dyadic negotiation and communication strategies as important influences on condom use consistency. Implications for future research and theoretical refinement are discussed.

Latino youths' sexual values and condom negotiation strategies.

Young Latinos in the United States are at high risk for STDs and are less likely than other youth to use condoms. To our knowledge, no studies have examined the relationship between sexual values and condom negotiation strategies among young Latinos. Cross-sectional data collected in 2003-2006 from 571 Latino women and men aged 16-22 in the San Francisco Bay Area were used to examine associations between sexual values (e.g., considering sexual talk disrespectful or female virginity important) and use of strategies to engender or avoid condom use. Linear regression analyses were used to identify such associations while adjusting for potential covariates and gender interactions. Among women, sexual comfort and comfort with sexual communication were positively associated with frequency of direct communication to foster condom use; the importance of female premarital virginity and levels of sexual self-acceptance were positively associated with expressing dislike of condoms to avoid using them; and levels of sexual self-acceptance were negatively associated with expressing dislike of condoms to avoid using them. Moreover, the degrees to which women considered sexual talk disrespectful and female virginity important were positively associated with the frequency with which they shared risk information as a condom use strategy. Among both sexes, the importance that respondents placed on premarital female virginity was negatively associated with use of direct communication strategies. Researchers designing interventions to influence Latino youths' sexual decision making and behaviors should consider including program components that address sexual values.

Text Messaging for Sexual Communication and Safety Among African American Young Adults

African American young adults are at high risk of HIV infection during their lifetimes, and the male condom remains the best method of prevention. Efforts to increase condom use should address the barrier of condom negotiation. We conducted a thematic analysis of qualitative, semistructured interviews with African American young adults to examine their use of text messaging for requesting human immunodeficiency virus (HIV) or sexually transmitted infection (STI) testing and condom use within the larger context of general sexual communication using text messages. Text messaging gave participants a level of comfort and disinhibition to discuss sexual topics and negotiate sexual safety. Benefits of text messages included ease of communication, privacy, and increased ability to express condom desires. Difficulties reflected the potential relationship implications of suggesting HIV/STI testing and condom use. Condom negotiation strategies using text messages also mirrored those found to be used in face-to-face communication.

Condom Negotiation and Use Among Female Sex Workers in Phnom Penh, Cambodia

We examined condom-use negotiation strategies and condom use among 81 female sex workers (FSWs) in Phnom Penh, Cambodia. Percentages of FSWs who did not negotiate condom use or could not describe a negotiation strategy with native clients, foreign clients, and non-paying partners were 15.0, 29.0 and 67.6 %, respectively. The most common negotiation strategy used was "provision of risk information" for native clients (43.8 %) and non-paying partners (26.5 %), and "direct request" for foreign clients (39.5 %). About half could not describe more than one negotiation strategy. Consistent condom use was high with native clients (98.8 %), yet comparatively lower with foreign clients (86.9 %) and non-paying partners (26.5 %). FSWs who did not negotiate or did not know how to negotiate condom use were less likely to report condom use with non-paying regular partners. Future interventions should enhance condom negotiation strategies between FSWs and all partner types.

Condom Negotiation Strategies as a Mediator of the Relationship between Self-Efficacy and Condom Use

College students are a group at high risk of sexually transmitted infections due to inconsistent condom use and engaging in other risky sexual behaviors. This study examined whether condom use self-efficacy predicted the use of condom negotiation strategies (i.e., condom influence strategies) and whether condom influence strategies mediated the relationship between condom use self-efficacy and condom use within this population, as well as whether gender moderated the mediation model. Results showed a strong relationship between condom use self-efficacy and condom influence strategies. Additionally, condom influence strategies completely mediated the relationship between condom use self-efficacy and condom use. Although condom use self-efficacy was related to condom use, the ability to use condom negotiation strategies was the most important factor predicting condom use. The mediation model held across genders, except for the condom influence strategy withholding sex, where it was not significant for men. For women, condom use self-efficacy promoted the use of a very assertive negotiation strategy, withholding sex, and was consequently related to increased condom use. Overall, using assertive condom negotiation strategies (e.g., withholding sex and direct request) were found to be the most important aspects of increasing condom use for both women and men. Implications and suggestions for prevention programming are discussed.

Reactions of Heterosexual African American Men to Women's Condom Negotiation Strategies

This study describes responses of 172 single heterosexual African American men, ages 18 to 35, to condom negotiation attempts. Strategies used included reward, coercive, legitimate, expert, referent, and informational strategies, based on Raven's (1992) influence model. The purpose was (a) to identify strategies influencing participant acquiescence to request and (b) to identify predictors of participant compliance/refusal to comply with negotiation attempts. Participants viewed six videotape segments showing an actress, portrayed in silhouette, speaking to the viewer as a “steady partner.” After each segment, participants completed measures of request compliance, positive and negative affect, and attributions concerning the model and themselves. No significant differences were found in men's ratings across all vignettes. However, differences in response existed across subgroups of individuals, suggesting that, although the strategy used had little impact on participant response, the act of suggesting condom use produced responses that differed across participant subgroups. Subgroups differed on levels of AIDS risk knowledge, sexually transmitted disease history, and experience with sexual coercion. Also, the “least willing to use” subgroup was highest in anger–rejection and least likely to make attributions of caring for partner. Effective negotiation of condom use with a male sexual partner may not be determined as much by specific strategy used as by partner characteristics.

Lowering the Risk of Secondary HIV Transmission: Insights From HIV‐Positive Youth and Health Care Providers

Both perinatally and behaviorally infected HIV-positive youth engage in sexually risky behaviors, and a better understanding of the perceptions of these youth and of health care providers regarding disclosure of HIV status and risk reduction would aid in the development of behavioral interventions for such youth. In spring 2007, some 20 HIV-positive inner-city youth (aged 13-24) and 15 health care providers who work with HIV-infected youth participated in in-depth, semistructured interviews. Youth were recruited at an HIV clinic, AIDS clinics and an AIDS service organization, and had received care from participating providers. Detailed contextual and thematic discourse analysis was performed on interview transcriptions. Eighteen of the 20 youth had disclosed their HIV status to another individual at least once. Eleven reported being sexually active, and three of these had been perinatally infected. Qualitative analysis revealed four subthemes related to disclosure: stigma and emotions, trust issues, reasons for disclosing and strategies for addressing disclosure. Five subthemes were identified related to sexual risk reduction: dating challenges, attitudes toward condom use, self-efficacy for condom use negotiation, pregnancy attitudes and sexual risk reduction strategies. Providers reported that access to more engaging and interactive educational tools within the clinic setting could enhance their risk reduction counseling with HIV-positive youth. HIV-positive youth experience multiple challenges regarding disclosure and sexual risk reduction, and health care providers need innovative tools that can be used in clinic settings to improve adolescents' skills in reducing risky sexual behavior.

Condom Negotiation Strategies and Actual Condom Use Among Latino Youth

To examine which condom negotiation strategies are effective in obtaining or avoiding condom use among Latino youth. Interviews were conducted with 694 Latino youth, 61% female, aged 16-22. Participants reported on their condom negotiation strategies, perceptions of whether their sexual partner wanted to use condoms, and actual condom use. Three strategies to obtain condom use (risk information, direct verbal/nonverbal communication, insist) and four strategies to avoid condom use (emotional coercion, ignore condom use, dislike condoms, seduction) were examined. Data were analyzed using multiple linear regression, and included youth (n = 574) who reported wanting to use or avoid condoms. Almost 60% of participants reported wanting to use condoms, and nearly all of these used some strategy to obtain condom use. Young men who wanted to use condoms were more likely to do so, compared with young women. Risk information and direct verbal/nonverbal communication were effective strategies to obtain condom use, even among youth who perceived their sexual partners as not wanting to use condoms. Ignoring condom use was an effective condom avoidance strategy, even when youth thought their partners wanted to use condoms. Unexpectedly, young men who expressed dislike of condoms had higher rates of condom use than young men not using this condom avoidance strategy. This research identified condom negotiation strategies that are effective among Latino youth, even when they believe their partners do not want to use condoms. Health care providers could encourage Latino youth to use such condom negotiation strategies.

Intimate Partner Violence, Condom Use and HIV Risk for Adolescent Girls

ABSTRACT Adolescent girls account for a growing number of new cases of HIV in the United States, primarily transmitted through heterosexual sex. The principal method of HIV prevention for heterosexually-active girls is condom use by their male partners. Most HIV prevention interventions aimed at adolescent girls have focused on promoting the girls' individual behavior change and are most effective in situations that are under girls' control. A growing body of literature indicates the importance of recognizing partner influence on girls' condom use and negotiation strategies, and a beginning recognition of the role that intimate partner violence (IPV) may play in the decision-making control within the dyad. To better understand these linkages, this paper examines the association between IPV and girls' HIV risk through condom non-use with a systematic review of the literature and a theory-informed conceptual background. Six studies with adolescent girls were found that reported an association between intima...

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.

Fixed-Choice and Open-Ended Response Formats: A Comparison from HIV Prevention Research in Zimbabwe

This article examined similarities and differences in responses to open-ended and fixed-choice question formats gathered from Zimbabwean women participating in an HIV intervention study ( n = 227). Specifically, the authors compared the responses of women to two questions (one open-ended and one fixed-choice) about male condom negotiation strategies used with their partners. Comparisons across formats revealed that the definitions of negotiation categories coded from openended responses overlapped only moderately with categories used for the fixed-choice checklist. Fixed-choice reports of negotiation strategies were not statistically associated with reported condom use, but a statistically significant association was obtained with a category derived from open-ended questions. Although these results may be specific to this study and its specific study question, the data suggest that asking key study questions in both open-ended and fixed-choice formats may provide a valuable form of perspective for social and behavioral data.

The acceptability of the female condom: perspectives of family planning providers in New York City, South Africa, and Nigeria.

This article seeks to fill the gap in female condom acceptability research by examining family planning (FP) providers' attitudes and experiences regarding the female condom in three countries (South Africa, the US, and Nigeria) to highlight providers' potential integral role in the introduction of the female condom. The case studies used data drawn from three independent projects, each of which was designed to study or to change FP providers' attitudes and practices in relation to the female condom. The case study for New York City used data from semistructured interviews with providers in one FP consortium in which no special female condom training had been undertaken. The data from South Africa were drawn from transcripts and observations of a female condom training program and from interviews conducted in preparation for the training. The Nigerian study used observations of client visits before and after providers were trained concerning the female condom. In New York City, providers were skeptical about the contraceptive efficacy of the female condom, with only 8 of 22 providers (36%) reporting they would recommend it as a primary contraceptive. In South Africa, providers who had practiced insertion of the female condom as part of their training expressed concern about its physical appearance and effects on sexual pleasure. However, they also saw the female condom as a tool to empower clients to increase their capacity for self-protection. Structured observations of providers' counseling interactions with clients following training indicated that Nigerian providers discussed the female condom with clients in 80% of the visits observed. Despite the lack of a uniform methodology, the three case studies illuminate various dimensions of FP providers' perceptions of the acceptability of the female condom. FP providers must be viewed as a critical factor in female condom acceptability, uptake, and continued use. Designing training programs and other interventions that address sources of provider resistance and enhance providers' skills in teaching female condom negotiation strategies may help to increase clients' use of the female condom.