Safer Sex Negotiation Research Articles

Can a woman refuse sex if her husband has a sexually transmitted infection? Attitudes toward safer-sex negotiation among married women in Bangladesh

In developing countries, HIV, sexually transmitted infections (STIs) and unintended pregnancy take an enormous toll on women's reproductive health, yet preventive programmes are lacking as married women's risks are frequently underestimated. We examined predictors of married Bangladeshi women's attitudes towards safer-sex negotiation using data on 15,178 currently married women aged 15–49 from the 2011 Bangladesh Demographic Health Survey. Approximately 92% of women believed that a wife's refusal to have sex with her husband is justified if he has an STI. Multilevel logistic regression analysis revealed that the likelihood of a woman holding this belief increased with her autonomy, as measured by the ability to go to a health centre/hospital without another adult, participation in household decision making and rejection of wife beating (p < 0.001). Other significant predictors were knowledge/awareness of STIs (p < 0.05), living in Dhaka division (p < 0.001) and younger age (p < 0.01). Our findings suggest that sexual health education programmes may be more effective if they include strategies to address social norms and cultural practices that limit women's autonomy in society.

Poster Abstracts

Background: HIV prevention for men who have sex with men (MSM) hastypically focused on behaviour change at the individual-level, rather than aspart of a couple. However, recent research has highlighted the role of primarysexual partners in the transmission of HIV among young MSM in the US,estimating that as many as 84% of new transmissions were from men’s mainpartner. This suggests that work with couples could contribute to preventionefforts.Methods: We conducted qualitative in-depth interviews with 30 young MSM(aged 18-29) in Scotland, recruited via a number of strategies; onlineadvertisements, through voluntary sector organisations working with MSM,and snowballing. Thematic data analysis focused on identifying how menunderstand HIV risk management strategies in the context of relationships,specifically the role of ‘safer sex’ practices, HIV testing, and expectationsaround monogamy and/or sexual exclusivity.Results: At the time of interview, nine men reported being in a relationship,and the majority (n=28) discussed their aspirations for sex in long-termrelationships. Participants’ demonstrated varying levels of HIV literacy (i.e.HIV-related knowledge and an individual’s capacity to apply this), andalthough all discussed condom use as part of ‘safer sex’ and their individualmanagement of HIV risk, a recurring theme was desire to discontinue condomuse in the context of a committed relationship. Over a third of the men (n=22)discussed discontinuing condom use in this context. Of those in relationships,six had discontinued condom use, but not all tested for HIV prior to this, norexplicitly discussed expectations for monogamy and/or sexual exclusivity withtheir partners. Agreeing to testing and discussing expectations of fidelity werecomplicated by issues of trust and intimacy.Conclusion: How MSM understand and manage HIV risk in relationships hasimplications for future HIV prevention. Knowledge of their own (and partner’s)HIV status - particularly where serodiscordant relationships are identified -could enable men to make decisions around prevention, and whereappropriate, open up the possibility of accessing biomedical prevention. Ourresearch suggests young MSM in relationships continue to base safer sexdecisions on perceptions of fidelity and trust in their partners. Young MSMaccessing testing in clinical settings could be targeted for interventions toencourage HIV status disclosure and informed safer sex negotiation.

Measurement of Gender Equity: A Clarification

I applaud McCauley et al. for highlighting the important role of gender equity in perpetration of dating violence among US high school athletes.(1) Gender-equitable attitudes are influential in a range of sexual-health outcomes beyond violence, including the negotiation of safer sex and sexually transmitted infections.(2) This is a clearly significant target for intervention. However, I feel clarification is needed regarding the measurement of gender equity. (Am J Public Health. Published online ahead of print January 16, 2014: e1. doi:10.2105/AJPH.2013.301779). Language: en

Situating Risk, Sexual Health and HIV/AIDS: Implications for (Non-) Negotiation of Safer Sex among Young People in North Central Nigeria

This research explores the contexts in which young people identified risks in terms of sexual activity that could result in HIV/AIDS, unwanted pregnancy or other outcomes injurious to their health. This qualitative study draws from 16 in-depth interviews and 10 focus groups through the voices of young women and men (aged 16-25) revealing the dimensions of their perception of sexual risk such as associated with having multiple sexual partners or casual sex and their construction of risk as related to unwanted pregnancy. Beyond this, the young people tended to deploy different discursive frames within moral, gendered and expert discourses to define patterns of sexual practice perceived as ‘safe’ or ‘risky’ in their day-to-day interactions. The study concludes that intervention programmes that emphasize the A and B elements (Abstinence and Being faithful to one partner) as opposed to C (condom use) were unhelpful for young people. Condom use was viewed by a majority of the young people as against their moral upbringing and further reinforced by religious mores and discourses condemning premarital sex for young people. Thus, while most interviewees viewed sexual activity as inevitable, they chose to engage in serial monogamous relations, associating condom use with promiscuity or prostitution.

Safer Sex Negotiation and Its Association With Condom Use Among Clients of Female Sex Workers in Bangladesh

This study examines safer sex negotiation and its association with condom use among clients of female sex workers (FSWs) in Bangladesh. Data were collected from 484 FSWs living in Dhaka city following a convenient sampling procedure. Overall, 47% of the clients were suggested to use condom during last sexual intercourse and 21% did so. Both bivariate and multivariable binary logistic regression analyses yielded significantly increased risk of negotiation for safer sex with clients among FSWs with higher education. The power bargaining significantly (P < .001) increased the risk of condom use by 2.15 times (95% confidence interval = 1.28-3.59). The odds of condom use were significantly higher among the FSWs with higher education, unmarried, hotel-based, and among those with higher level of HIV/AIDS-related knowledge. The Bangladeshi FSWs have little control over their profession. HIV prevention programs should aim to encourage FSWs through information, education, and communication program to insist on condom use among clients.

Correlates of Self-Efficacy for Condom Use Among Male Clients of Female Sex Workers in Tijuana, Mexico

Male clients of female sex workers (FSWs) in Tijuana, Mexico engage in high levels of unprotected sex. While behavioral change theories posit that self-efficacy predicts condom use, correlates of self-efficacy for condom use remain largely unstudied. We examined these correlates among male clients of FSWs in Tijuana. Eligible male clients were at least 18 years of age, HIV-negative, lived in Tijuana or San Diego, reported unprotected sex with a Tijuana FSW at least once in the past 4 months, and agreed to be treated for sexually transmitted infections (STIs). Participants completed an interviewer-administered questionnaire including demographics, substance use, psychosocial and psychosexual characteristics (e.g., outcome expectancies for negotiation of safer sex, social support, and sexual sensation seeking), and sexual behaviors. Participants also underwent HIV/STI testing. A stepwise hierarchical multiple regression analysis identified correlates of self-efficacy for condom use. Of 393 male clients, median age was 37 years. Participants were mostly Spanish-speaking and employed. Factors independently associated with higher self-efficacy for condom use were higher positive outcome expectancies for negotiation of safer sex, lower sexual sensation seeking scores, and higher social support scores. Both psychosocial and psychosexual factors may influence self-efficacy for condom use among male clients of FSWs. These factors represent central constructs in sociocognitive models that explain behavioral change and could be intervention targets for improving self-efficacy for condom use and, ultimately, safer sex behavior.

Hookup Sex Versus Romantic Relationship Sex in College: Why Do We Care and What Do We Do?

Hookup Sex Versus Romantic Relationship Sex in College: Why Do We Care and What Do We Do?

Scenarios in HIV/AIDS prevention research: Insights from literature and research in Botswana

The difficulties in communication about sexuality-related matters in HIV prevention require appropriate research approaches. Scenarios can be useful in qualitative, quantitative research methods and interventions related to sensitive cognitive issues of human sexuality. This paper presents an analysis of the use of scenarios in HIV/AIDS prevention research from the literature and empirical evidence. Examples of scenario-based instrument development research studies in safer sex communication for the prevention of HIV/AID by Kalichman (2000) and Magowe (2006) are provided. A computer-based search of articles addressing the use of case scenarios in research was conducted on Google and Google scholar, using the following search terms: “case scenarios”, “scenarios in research”, case scenarios in safer sex negotiation: “case scenarios in safer sex communication”, “case scenarios in dyadic communication”, “partner communication”, “case research”, “vignettes in HIV/AIDS research”, and, “sexuality related vignettes”. Papers included provided the definition, purpose, components, types of scenarios, use of scenarios in safer sex communication. Examples are drawn from instruments development studies using with case scenarios. Twenty-nine documents were retrieved, and eight of these studies addressed the use of scenarios in research. Five studies were specifically on HIV prevention research, focusing on safer sex communication, negotiation or couple/partner communication. The content of the studies included the definition of scenarios, case scenarios and vignettes; purpose and use of scenarios in research. Studies showed that scenarios are useful in qualitative elicitation of themes and content for instrument development for further quantitative research. Nursing deals with sensitive and complex cognitive issues in human behavior, and therefore scenario-based research can help develop personoriented research and interventions while protecting the individual’s privacy and confidentiality.

“Safe Sex Talk:” Negotiating Safe Sex Practices in Heterosexual Relationships

HIV and AIDS has become a gendered phenomenon, infecting more women than men, in sub-Saharan Africa, where heterosexual sex is the main mode of transmission. The complex interplay between power and gender is crucial for understanding who has control over when, where, and how sex takes place in heterosexual relationships. This study explores research participants’ interpretations of cultural norms of gender, sexuality and power in scripted HIV prevention safe sex practice messages to determine if they shape individual behaviors in safe sex negotiation. Data is from 5 focus group discussions (n= 28) and in-depth interviews (n=7) involving men and women, conducted in Accra, Ghana. Data was transcribed and themes and patterns were identified. The analysis identified contradictions clouded participants’ expectations (intentions) and actual sexual practices. Participants expect male sexual power and female submissiveness, yet present accounts of females actively engaging in sexual negotiations. Participants were more receptive to condom use than abstinence; specifically, the former allows access to male power while the latter controls male sexual pursuit. Yet, participants describe condom use as unpredictable and contradictory. Gendered sexual expectations, intentions and actual experiences described in this study are much more complex and require further attention. HIV interventions in Africa must pay attention to nuances in realistic accounts of heterosexual encounters to decipher complexities in the safe sex negotiation process. DOI: 10.5901/mjss.2013.v4n2p309

Correlates of unprotected sex in a sample of young club drug users

OBJECTIVES:To assess the demographic characteristics, psychiatric symptoms, substance use patterns, and sexual risk behaviors in a sample of club drug users to identify factors associated with unprotected sex during the 12 months prior to the interview.METHODS:This cross-sectional study employed the targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not receiving treatment for alcohol or drug abuse.RESULTS:Of the 240 subjects selected (mean age: 22.9±4.5 years), 57.9% were men; of the male subjects, 52.5% reported having had unprotected sex in the previous 12 months. Of the total sample, 63.33% reported having had unprotected sex. Multivariate regression analysis showed that anal sex (PR = 1.26; 95% confidence interval (CI): 1.044–1.543; p = 0.017) and the use of alcohol/drugs to make sex last longer (PR = 1.430; 95% CI: 1.181–1.732; p<0.001) are associated with unprotected sex.CONCLUSIONS:The implementation of intervention strategies aimed at reducing sexually risky behaviors should take into consideration the specific characteristics of drug users and should include the development of safer sex negotiation skills.

The Impact of PTSD Symptoms on Women's Safer-Sex Negotiation: Influence of Ethnicity.

PTSD has been shown to predict later self reported sexual risk behavior, yet behavioral research is lacking in this area. The present study investigated the impact of PTSD severity on negotiation and interpersonal skills effectiveness in simulated high-risk sexual situations among 368 inner-city women. Participants engaged in role-play scenarios involving 1) refusing sex without a condom, 2) abstaining from drinking prior to sex, and 3) refusing sex until both partners were tested for HIV. Interviews were audio taped and rated along dimensions of negotiation effectiveness by blind raters. Hierarchical linear regression analyses were conducted to investigate the impact of PTSD and ethnicity on 4 theoretically derived skill sets 1) assertiveness, 2) using health and preparedness skills 3) social joining skills and 4) higher order negotiation skills. Generally, results indicated that PTSD severity predicted poorer rated negotiation effectiveness among European Americans, but not African Americans. African Americans' expectations that may prepare them for facing more hardship may help explain ethnic differences.

P2-S1.12 Project prepare Tanzania: engaging multiple stakeholders to develop a school-based sexual health curriculum for adolescents

BackgroundThe objective of this formative research was to engage multiple stakeholders to identify specific factors that may influence program development for Project Prepare Tanzania- an innovative, school-based sexual health curriculum...

Responsibility, risk and negotiation in the discourse of gay men's group sex

Responsibility for the practise of (un)safe sex, for taking or not taking risks in relation to HIV transmission and for the negotiation of (safe) sex have been concerns in HIV-prevention research for a long time. This paper presents the findings of a discourse analysis of interview texts collected as part of the Three or More Study. We examine what, in the discourse examined, constrains and enables ‘response-ability’ – the capacity to respond to others and one's self in light of the complex contingencies that operate to enliven sexual contexts. We identify three key aspects of these sexual contexts that impact on response-ability: that there is an absence of ‘explicit’ (verbally communicated) negotiation and the presence of action-perception links, which are understood as forms of negotiation; that some sexual contexts appear to involve the passivity of participants to the sexual event, interaction or to other men, but that there is agency in and as part of this passivity; and that there exists a social obligation to being individually responsible for sexual decision making, including the taking of risks.

Combined Impact of Sexual Risk Behaviors for HIV Seroconversion Among Women in Durban, South Africa: Implications for Prevention Policy and Planning

The objective of this study was to estimate the joint impact of demographic and sexual risk behaviors on HIV acquisition. A total of 2,523 HIV seronegative women were recruited through three community based studies in Durban, South Africa. Point and interval estimates of partial population attributable risk (PAR) were used to quantify the proportion of HIV seroconversions which can be prevented if a combination of risk factors is eliminated from a target population. More than 80% of the observed HIV acquisitions were attributed to five risk factors: lack of cohabitation, frequency of sex, sexually transmitted infections (STIs), incidence of pregnancy and not being employed/no income. Structural factors such as minimizing migratory patterns by ensuring cohabitation of partners, access to treatment of STIs, income generation and safe sex negotiation skills are likely to play an important role in future prevention strategies.

Gender relations and sexual communication among female students in the Mekong River Delta of Vietnam

Young women's ability to pursue a safer-sex life in line with their wishes is crucial to their sexual health. Although some previous observations have suggested that young women's lack of ability to negotiate safer sex is due to gender power imbalances in the culture of Vietnam, studies that have tested this hypothesis explicitly and quantitatively are few and far between. The present study aimed to test the association between perceived gender relations and perceived self-efficacy in communicating sexual matters among undergraduate female students in the Mekong River Delta of Vietnam. The analysis involved secondary data from 260 subjects from a larger survey regarding gender equity. Structural equation modeling was used to examine the study's hypothesis. Results showed that adherence to traditional gender roles and norms was significantly associated with female students' reduced self-efficacy to communicate on safer-sex matters, such as refusing unwanted sex or requesting condom use. This association remained invariant in the cross-validation process between partnered and unpartnered groups. Programmes that aim to promote safer-sex negotiation and practices for this population may need to address the influence of gender relations and power.

Drug‐related behaviors independently associated with syphilis infection among female sex workers in two Mexico–US border cities

To identify correlates of active syphilis infection among female sex workers (FSWs) in Tijuana and Ciudad Juarez. Cross-sectional analyses of baseline interview data. Correlates of active syphilis (antibody titers >1 : 8) were identified by logistic regression. Setting Tijuana and Ciudad Juarez, two Mexican cities on the US border that are situated on major drug trafficking routes and where prostitution is quasi-legal. A total of 914 FSWs aged > or =18 years without known human immunodeficiency virus (HIV) infection who had had recent unprotected sex with clients. Baseline interviews and testing for syphilis antibody using Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR) tests. Median age and duration in sex work were 32 and 4 years, respectively. Overall, 18.0% had ever injected drugs, 14.2% often or always used illegal drugs before or during sex in the past month, 31.4% had clients in the last 6 months who injected drugs, and 68.6% reported having clients from the United States. Prevalence of HIV and active syphilis were 5.9% and 10.3%, respectively. Factors independently associated with active syphilis included injecting drugs (AOR: 2.39; 95% CI: 1.40, 4.08), using illegal drugs before or during sex (AOR: 2.06; 95% CI: 1.16, 3.65) and having any US clients (AOR: 2.85; 95% CI: 1.43, 5.70). Among female sex workers in Tijuana and Ciudad Juarez, drug-using behaviors were associated more closely with active syphilis than were sexual behaviors, suggesting the possibility of parenteral transmission of T. pallidum. Syphilis eradication programs should consider distributing sterile syringes to drug injectors and assisting FSWs with safer-sex negotiation in the context of drug use.

Contextual influences on safer sex negotiation among female sex workers (FSWs) in Hong Kong: the role of non-governmental organizations (NGOs), FSWs' managers, and clients

Despite social-cognitive interventions to increase safer sex awareness, condom use among female sex workers (FSWs) continued to be inconsistent. To account for the possible influences of contextual factors that may hinder or promote FSWs' safer sex negotiation and condom use, the present study examined the effects of non-governmental organizations (NGOs), FSWs' managers, and clients on FSWs' negotiation efficacy and condom-use efficacy, and the effects of efficacy on condom use. One hundred and nineteen FSWs in Hong Kong completed a questionnaire that focused on their perceived influences of NGOs, managers, and clients toward safer sex negotiation and condom use. Hierarchical regression results showed that whereas NGOs' influence and clients' support were positively related to negotiation self-efficacy, managers' pressure, and clients' pressure were negatively related to negotiation self-efficacy. Managers' pressure was negatively related to condom-use self-efficacy. Logistic regression results showed that FSWs with high condom-use self-efficacy was 24 times more likely to use condom in the previous six months than their counterparts. The present study indicated the importance of social contexts in affecting FSWs' safer sex negotiation and condom-use self-efficacy. Implications on preventive programs for FSWs, managers, and clients were discussed.

The Efficacy of HIV/STI Behavioral Interventions for African American Females in the United States: A Meta-Analysis

We evaluated the efficacy of HIV behavioral interventions for African American females in the United States, and we identified factors associated with intervention efficacy. We conducted a comprehensive literature review covering studies published from January 1988 to June 2007, which yielded 37 relevant studies. Data were analyzed using mixed-effects models and meta-regression. Overall, behavioral interventions had a significant impact on reductions in HIV-risk sex behaviors (odds ratio [OR] = 0.63; 95% confidence interval [CI] = 0.54, 0.75; n = 11 239; Cochrane Q(32) = 84.73; P < .001) and sexually transmitted infections (STIs; OR = 0.81; 95% CI = 0.67, 0.98; n = 8760; Cochrane Q(16) = 22.77; P = .12). Greater intervention efficacy was observed in studies that specifically targeted African American females used gender- or culture-specific materials, used female deliverers, addressed empowerment issues, provided skills training in condom use and negotiation of safer sex, and used role-playing to teach negotiation skills. Behavioral interventions are efficacious at preventing HIV and STIs among African American females. More research is needed to examine the potential contribution of prevention strategies that attend to community-level and structural-level factors affecting HIV infection and transmission in this population.

Predictors of Sexual Risk Reduction Among Mexican Female Sex Workers Enrolled in a Behavioral Intervention Study

We recently showed efficacy of an intervention to increase condom use among female sex workers (FSWs) in Tijuana and Ciudad Juarez, situated on the Mexico-United States border. We determined whether increases in condom use were predicted by social cognitive theory and injection drug user status among women randomized to this intervention. Four hundred nine HIV-negative FSWs aged >or=18 years having unprotected sex with clients within the prior 2 months received a brief individual counseling session integrating motivational interviewing and principles of behavior change (ie, HIV knowledge, self-efficacy for using condoms, and outcome expectancies). Increases in self-efficacy scores were associated with increases in percent condom use (P = 0.008), whereas outcome expectancies were not. Female sex workers who inject drugs (FSW-IDUs) increased condom use with clients but not to the same extent as other FSWs (P = 0.09). Change in HIV knowledge was positively associated with change in percent condom use among FSW-IDUs (P = 0.03) but not noninjection drug users. Increases in self-efficacy significantly predicted increased condom use among FSWs, consistent with social cognitive theory. Increased HIV knowledge was also important among FSW-IDUs, but their changes in condom use were modest. Enhanced interventions for FSW-IDUs are needed, taking into account realities of substance use during sexual transactions that can compromise safer sex negotiation.

Negotiating safe sex among women of Afro-Surinamese and Dutch Antillean descent in the Netherlands

Safe sex negotiation and communication about sexual risks with partners is important for women to ensure sexual risk reduction. This paper describes the results of a survey on safer sex and negotiation behavior, and the correlates of negotiation with partners among 128 women from Surinamese and Dutch Antillean descent in the Netherlands. The key findings are that 50% of the participants had negotiated sexual risk reduction with their partner, yet only 40% of the women who negotiated safer sex actually claimed practicing safe sex. Participants defined safe sex with steady partners primarily as negotiated safety and monogamy, and safe sex with casual partners primarily as condom use. Intentions to negotiate safer sex with steady partners were related to positive attitudes and perceived injunctive norms towards safe sex negotiation, and educational background. Intention to discuss safe sex with casual partners were primarily related to attitudes and perceived self-efficacy. STI/HIV prevention interventions targeting these women should incorporate awareness-raising of safety in different types of relationships, deciding on the appropriateness of relation-specific sexual risk reduction strategies, and building negotiation skills to accomplish the realization of these strategies.