Condom-related Attitudes Research Articles

Spanish Translation, Adaptation, and Validation of the Multidimensional Condom Attitudes Scale with Young Colombian Men and Women.

Infection by HIV/AIDS or other STIs and unplanned pregnancies are sexual health problems of considerable impact around the world. Condoms are the only method that prevents all those risks, and attitudes toward the use of condoms are among the best predictors of their consistent use. The purpose of the present study was to translate, adapt, and validate a Spanish-language version of the Multidimensional Condom Attitudes Scale (MCAS) using a sample of young people from Colombia. A total of 1441 young people between the ages of 18 and 26 years responded to a web-based survey conducted between January 2018 and February 2018. The dimensionality of the scale was explored and confirmed to replicate the original five-factor structure (alphas ranged from .65 to .86). Criterion validity was adequate. Women had more positive attitudes toward identity stigma associated with condom use, while men had more positive attitudes toward reliability and effectiveness of condoms and were less embarrassed with condom negotiation and use. The Spanish-language MCAS is suitable for measuring condom-related attitudes among Colombian youth. Future research is needed to validate the Spanish version of the MCAS with other Spanish-speaking populations.

A dyadic approach to understanding safer sex behavior in intimate heterosexual relationships.

This study applied a dyadic approach to condom-use research. Partners from 124 heterosexual couples independently completed a questionnaire assessing condom-related attitudes, subjective norms, perceived behavioral control, and intentions to use condoms. Results demonstrate the superiority of a dyadic approach to understanding couples' condom-use intentions and behavior over traditional, individual-level approaches. The addition of partner effects to the model, via the actor-partner interdependence model, resulted in an increase in the variance accounted for in condom-use intentions and this dyadic model showed better fit compared to the individual-level model. The results suggest that consideration of relationship partners plays an important role in the prediction of safer sex intentions.

A pilot test of a self-guided, home-based intervention to improve condom-related sexual experiences, attitudes, and behaviors among young women

ABSTRACTObjective: To conduct a pilot test of a brief, self-guided, home-based program designed to improve male condom use attitudes and behaviors among young women. Participants: Women aged 18–24 years from a large Midwestern University reporting having had penile–vaginal sex with two or more partners in the past 3 months. Sixty-seven enrolled; 91.0% completed the study. Methods: A repeated measures design was used, with assessments occurring at baseline, immediately post intervention (T2), and 30 days subsequent (T3). Results: Condom use errors and problems decreased, condom-related attitudes and self-efficacy improved, and experiences of condom-protected sex were rated more positively when comparing baseline with T2 and T3 scores. Further, the proportion of condom-protected episodes more than doubled between T1 and T3 for those in the lowest quartile for condom use at baseline. Conclusion: This low-resource, home-based program improved condom-related attitudes and promoted the correct and consistent use of condoms.

Parent-Adolescent Communication About Sex and Condom Use Among Young Men Who Have Sex With Men: An Examination of the Theory of Planned Behavior.

Young men who have sex with men (YMSM) are at disproportionate risk for HIV infection. Parent-adolescent communication about sex, particularly mother-adolescent communication, protects against adolescent sexual risk behavior. However, it is unclear whether these findings generalize to YMSM. The current study used the theory of planned behavior as a framework to examine how YMSM perceptions of parent-adolescent communication about condoms are associated with determinants of condom use and condomless anal sex among YMSM. YMSM ages 14-18 (M = 16.55) completed an online survey (n = 838). Associations between several domains of parent-adolescent communication about condoms (i.e., frequency and specificity, quality, and negative emotionality) and condom-related attitudes, norms, perceived behavioral control, and intentions, as well as instances of condomless anal intercourse (CAI), were examined with structural equation modeling. Multiple facets of mother-adolescent communication were associated with attitudes about condoms, subjective norms for condom use, perceived behavioral control, intentions to use condoms, and indirectly, instances of CAI. Father communication was not associated with determinants of condom use behavior. Parent-adolescent communication about condoms is associated with determinants of condom use behavior among YMSM, and mother communication exerted an indirect influence on HIV-related sexual risk behaviors. Interventions designed to enhance parent- adolescent communication about condoms could prove efficacious in reducing HIV infections among YMSM.

Modelling condom use: Does the theory of planned behaviour explain condom use in a low risk, community sample?

To date, most condom research has focused on young or high-risk groups, with little evidence about influences on condom use amongst lower-risk community samples. These groups are not risk free and may still wish to negotiate safer sex; yet the considerations involved could be different from those in higher-risk groups. Our research addresses this gap: We report a cross-sectional questionnaire study enquiring about recent condom use and future use intentions in community settings. Our sample (n = 311) purposively included couples in established relationships, known to be condom users. Items included demographics, sexual history and social-cognitive variables taken from the theory of planned behaviour. The strongest association with condom use/use intentions amongst our respondents was sexual partner’s perceived willingness to use them. This applied across both univariate and multivariate analyses. Whilst most social-cognitive variables (attitudes; self-efficacy and peer social norms) were significant in univariate analyses, this was not supported in multivariate regression. Of the social-cognitive variables, only “condom-related attitudes” were retained in the model explaining recent condom use, whilst none of them entered the model explaining future use intentions. Further analysis showed that attitudes concerning pleasure, identity stigma and condom effectiveness were most salient for this cohort. Our results suggest that, in community samples, the decision to use a condom involves different considerations from those highlighted in previous research. Explanatory models for established couples should embrace interpersonal perspectives, emphasising couple-factors rather than individual beliefs. Messages to this cohort could usefully focus on negotiation skills, condom advantages (other than disease prevention) and reducing the stigma associated with use.

Conversation and Compliance: Role of Interpersonal Discussion and Social Norms in Public Communication Campaigns

This study explores the role of interpersonal discussion and social norms in a public health campaign, the BBC Condom Normalization Campaign, designed to promote conversation and change the public perception of condom use in India. Drawing upon the integrative model of behavioral prediction, attitudes, self-efficacy, subjective norms, and descriptive norms were predicted to relate to behavioral intentions to use condoms. It is important to note that the valence of discussion was hypothesized to relate to each of these more proximal predictors. The authors used structural equation modeling to test the model on 3 separate samples of Indian men between the ages of 15 and 49 years: (a) high-risk men who had sex with nonspouses; (b) low-risk, sexually inactive, unmarried men; and (c) low-risk, monogamous, married men. Results were similar for low- and high-risk audiences, with valence of discussion about condoms predicting condom-related attitudes, self-efficacy, and subjective and descriptive social norms with respect to condom use, which, in turn, predicted behavioral intent to use condoms. These findings underscore the need to take not only the frequency but also the valence of interpersonal discussion into account when assessing the effect of health campaigns. Implications for theory and design of future public communication campaigns are explored.

The Critical Role of Intimacy in the Sexual Risk Behaviors of Gay and Bisexual Men

Research indicates that high numbers of gay and bisexual men report infrequent or inconsistent condom use, placing them at risk for HIV and other STDs. The present study examined positive and negative condom-related attitudes along three dimensions-risk reduction, pleasure reduction, and intimacy interference-and examined their relative predictive power in determining condom use among a sample of sexually risky gay and bisexual men in New York City. In a multivariate model, both risk reduction and intimacy interference attitudes emerged as significant predictors of unprotected sex; however, the variance accounted for by a model including intimacy interference was almost three times that accounted for by a model including risk reduction alone. These data suggest a pivotal role for intimacy in shaping condom attitudes and behavior among gay and bisexual men. HIV prevention interventions should consider incorporating intimacy as a motivating factor for sexual behavior and a potential barrier to condom use.

Depression and HIV Risk Behavior Practices Among “At Risk” Women

ABSTRACT In this study, we examined the relationship between depression and HIV-related risk behavior practices in a sample of 250 “at risk,” predominantly African American women living in the Atlanta, Georgia metropolitan area. Interviews were conducted between August 1997 and August 2000. Street outreach efforts were used to identify potential study participants, with further expansion of the sample via targeted sampling and ethnographic mapping procedures. Our conceptual model hypothesized a relationship between depression and HIV risk in which depression and condom-related attitudes were construed as intervening (or mediating) variables. A multivariate analysis was used to determine the relationship between depression and women's risk behaviors. The results showed that depression was a key-mediating variable, having its primary influence on women's risky practices through its impact upon their attitudes toward using condoms. Factors associated with depression, included religiosity, closeness of family relationships, financial problems, childhood maltreatment experiences, and drug-related problems. The implications of these findings for prevention and intervention efforts are: (1) heightening faith community involvement and religious participation to decrease depression; (2) working with women whose familial bonds are in need of strengthening to combat depression; (3) providing mental health and counseling services to women who were emotionally and/or sexually abused during their formative years seems to help these women to recover from unresolved issues that may be fueling depression; (4) assisting “at risk” women who need training in money management issues to minimize their risk for depression; and (5) helping women drug abusers to receive treatment for their drug problems to combat their depression and lower their HIV risk.

Childhood neglect and adulthood involvement in HIV-related risk behaviors

Objective Much research has been done to examine the long-term effects of being victimized by sexual, physical, and/or emotional abuse in childhood, but much less research has focused on the impact of childhood neglect experiences. This study examines the role that childhood neglect has on adult women's involvement in HIV-related risky behaviors. Methods The data come from a study of 250 “at risk” women living in the Atlanta, GA metropolitan area, most of whom were African American. Data were collected in face-to-face interviews between 1997 and 2000. Multiple regression was used to explore the relationship between childhood neglect experiences, self-esteem, attitudes toward condom use, and involvement in HIV-related risky behaviors. Results Overall, the model tested received strong support by the study data. Childhood neglect led to reduced self-esteem. Neglect was associated with worsened attitudes toward condom use and women who experienced childhood neglect also reported more involvement in HIV risk behaviors. Conclusions HIV intervention programs ought to target women who have experienced childhood neglect, as neglect experiences have adverse impacts upon their self-esteem, condom-related attitudes, and HIV risk behavior practices in adulthood.

Primacy of Affect Over Cognition in Determining Adult Men's Condom–Use Behavior: A Review1

Prior research suggests that failure to use condoms can be understood within the context of condom‐related attitudes. We reviewed quantitative and qualitative literature on adult men's condom‐use attitudes; condom‐related attitudinal beliefs were classified as cognitive (e.g., effectiveness) or affective (e.g., pleasure‐related), and their relationships to behavior were examined. To determine differences in the effects of cognitive and affective beliefs, we conducted a critical qualitative review, a meta‐analysis, and a “vote‐count.” In support of the primacy of affect hypothesis (Zajonc, 1984), cognitive beliefs were weaker predictors of condom use than were affective beliefs. Results suggest that HIV‐prevention interventions will have greater success by addressing negative affective reactions to condom use in addition to promoting the protective value of condoms.

Communication with Best Friends About Sex-Related Topics During Emerging Adulthood

During emerging adulthood, relationships with close friends may be particularly important and influential, yet most research on communication about sex-related topics focuses on emerging adults' communication with parents. Two hundred and five college students (61% female, mean age = 20.5) completed surveys about the frequency and quality of their sex-related conversations with same-sex best friends, and their sexual attitudes and behaviors. These conversations were more frequent between females, and between less religious youth. Sexually active youth discussed most topics more frequently than abstinent youth, although abstinent youth discussed abstinence more frequently. More frequent and comfortable conversations were generally associated with more liberal sexual attitudes, and more positive condom-related attitudes. Differential associations between the specific topics discussed and attitudes about sexuality, HIV, and condoms highlight the importance of examining multiple dimensions of sex-related communication rather than the unidimensional measures typically employed.

Predictors of condom-related attitudes among at-risk women.

Negative attitudes toward using male condoms tend to be associated with higher rates of sexual risk. Little has been written about the factors that influence women's attitudes toward condom use, and this has implications for HIV intervention efforts. Two hundred fifty adult women considered to be at risk based on demographic and family characteristics and residing in the Atlanta, Georgia, metropolitan area were interviewed between August 1997 and August 2000. Street outreach efforts were used to identify potential study participants, with further expansion of the sample done via targeted sampling and ethnographic mapping procedures. Women held ambivalent to weakly positive attitudes toward condoms. Multivariate analysis revealed that five factors were associated with a greater frequency of engaging in seven specific types of sexual activities known to be associated with HIV transmission: condom-related attitudes (negative condom attitudes), marital status (being married vs. other marital status classification), religiosity (lesser), childhood physical abuse (greater), and the amount of illegal drug use (greater). Four significant predictors of condom attitudes were also identified: age (better condom attitudes among younger women), childhood neglect (more conductive condom attitudes among nonneglected women), self-esteem (more self-esteem = more favorable condom attitudes), and the number of drug problems experienced (more drug problems = more negative condom attitudes). The more negative at-risk women's attitudes were regarding condom use, the more often they tended to engage in risky sex. Specific backgrounds and characteristics of the women were associated with greater/lesser condom use. To increase condom use, programs should consider targeting specific types of women as well as their specific attitudes toward condom use.

Extra-relational sex among Hispanic women and their condom-related behaviours and attitudes

Limited data are available concerning sexual behaviour of Hispanic women. A total of 318 Hispanic women were surveyed concerning extra-relational sex and their condom-related attitudes. Fifteen per cent of the sample had a secondary sex partner (apart from the first partner) during the three months preceding the survey. Of these women, 77 and 53% used condoms with their secondary and primary partners, respectively. Among women in monogamous relationships, condom use was low (17%), and nearly two-thirds (61%) of those with a high-risk partner did not use condoms. The most common concerns about condom use among these Hispanic women were a reduction in pleasurable sensations and embarrassment associated with buying condoms. Women with concurrent partners as compared to those with a single partner felt more at risk for HIV and STDs, were less likely to believe condoms have side effects or are unacceptable to their male partners and were more able to use condoms in long-term relations. In conclusion, extra-relational sex among Hispanic women may be higher than previously reported, although more favourable attitudes to condom use are seen among women with concurrent than those with a single partner. HIV/STD programmes in the Hispanic community should tailor to the sexual behaviour of their participants.

Changes in Adolescent Males' Use of and Attitudes Toward Condoms, 1988-1991

Data from more than 1,000 sexually active young males interviewed in 1988 for the National Survey of Adolescent Males at ages 15-19 and reinterviewed in 1990-1991 at ages 17-22 show that as the respondents grew older, their condom use declined. Although respondents' attitudes about the effects of condoms on pregnancy risk, partner appreciation, sexual pleasure and embarrassment became more favorable toward condom use over time, their degree of worry about AIDS and their perceived likelihood of getting AIDS declined. When data on males aged 17.5-19 in each time period were contrasted, the level of condom use was found to be essentially constant. Several condom-related attitudes among this age-group had become more favorable, although their perceived risk of acquiring AIDS had diminished. Multivariate analyses revealed that decreased worry about AIDS and increased denial of the seriousness of AIDS were modestly associated with a decline in condom use. Change in condom use was also affected by change in perceived reduction in sexual pleasure and by female partner's appreciation of condom use.