The Viewpoints of Sexually Active Single Women About Premarital Sexual Relationships: A Qualitative Study in the Iranian Context.

BACKGROUND: Premarital sexual relationships could harm youth's health in terms of sexually transmitted infections or increased risk of unprotected sexual behaviors. Sexual abstinence has been recommended to prevent young adolescents from adverse outcomes of premarital sexual relationships. OBJECTIVES: The aim of this study was to explore the viewpoints of sexually active single women about premarital sexual relationships in the Iranian context. PATIENTS AND METHODS: In this qualitative study, we recruited 41 young women aged 18 to 35 years. Data were collected using focus group discussions and individual interviews. We employed conventional content analysis to analyze the data. Multiple data collection methods, maximum variation sampling, and peer checks were applied to enhance the reliability of the findings. RESULTS: Eight themes emerged from the data analysis: 'acceptance of sexual contact in the context of opposite-sex relationships, 'sexual activity as a guarantee for keeping the boyfriend in the relationship', 'premarital sexual relationship as an undeniable personal right', 'having successful marriage in spite of premarital sexual relationships', 'virginity as an old fashioned phenomenon', 'love as a license for premarital sexual behaviors', 'goal-oriented relationship as a license for premarital sexual behaviors', and 'experiencing premarital sexual relationships in order to gain perfection'. CONCLUSIONS: Results of this study could be applied to designing interventions, such as promotion of preventive beliefs or educational programs regarding premarital sexual relationships in conservative societies. These interventions could start within families and continue at schools and universities.

Premarital Sexual Intercourse-Related Individual Factors Among Iranian Adolescents: A Qualitative Study.

BACKGROUND: Understanding sexual behavior before marriage is relatively rare in the East, especially in Islamic societies, because sexuality is a sensitive subject for many Muslims. OBJECTIVES: The purpose of this study was to identify premarital sexual intercourse-related individual factors among Iranian adolescents. PATIENTS AND METHODS: This qualitative study was performed on 30 students of Payame Noor university of Shiraz city, Iran, in 2014. The study sample includes male and female university students selected using the convenience sampling method. Semistructured interviews were used to collect data. All interviews were conducted by the researcher in a comfortable atmosphere and carried out without the presence of others. Each interview lasted between 30 - 20 minutes. Interviews continued until data saturation occurred. Data were analyzed using the qualitative content analysis method. Participation in the study was voluntary by obtaining an informed consent. RESULTS: The study included 30 participants, 56.6% (n = 17) males and 43.4% (n = 13) females. The age range of study, participants was from 19 to 25 years of age. Data analysis showed that three main categories extracted in shaping premarital sexual intercourse in adolescents: health beliefs, religious-spiritual beliefs, and character. CONCLUSIONS: This study can help find a culturally appropriate intervention to delay sexual initiation and prevent sexual behavior before marriage in adolescents and young adults. The results of the present study have both experimental and theoretical implications for future research. Finally, this study is a form of shared experience that can help similar studies.

Behavioral and sociodemographic risks for frequent visits to commercial sex workers among northern Thai men.

OBJECTIVE: The transmission of HIV-1 in Thailand has recently been attributed to exposure to infected commercial sex workers (CSW). We sought to identify risk factors for patterns of CSW visits among northern Thai men. DESIGN: Retrospective recall of lifetime and recent CSW visits and associated risk factors were obtained by interview. SETTING: Two military bases in northern Thailand. PARTICIPANTS: We enrolled two cohorts (n = 2417) of young men, aged 19-23 years, who were conscripted into the Royal Thai Army and Air Force from six provinces in northern Thailand in May and November 1991. MAIN OUTCOME MEASURES: Frequency of self-reported lifetime and recent sex with CSW. RESULTS: Multivariate results showed that lower socioeconomic status, early first intercourse and substance-use factors (alcohol, marijuana, other drugs, and smoking) associated with lifetime and recent sex with CSW. Sexual intercourse with other female partners, lower price paid at last CSW visit and frequency of condom use with CSW did not differentiate frequent from infrequent CSW visitors. CONCLUSIONS: Limits in the frequency of sex with CSW, improved condom practices and reduction of drinking prior to CSW visits would all appear to provide substantial protection from exposure to HIV-1 in this setting.

PIP: At least 400,000 Thais are believed to be infected with HIV-1 and the principal route of infection is heterosexual intercourse. Given that the transmission of HIV in Thailand has recently been attributed to contact with infected prostitutes, the authors set out to identify the risk factors for patterns of prostitute visits among northern Thai men. 2417 male conscripts to the Royal Thai Army and Air Force aged 19-23 years who enrolled in 2 military bases in northern Thailand in May and November 1991 were recruited for the study. In interviews, 454 reported never having visited a prostitute, 1385 reported at least 1 episode of sexual activity with a prostitute in the preceding year, and 578 reported having had sex with a prostitute in the past. The multivariate analysis found lower socioeconomic status, early first intercourse, and the use of alcohol, marijuana, smoking, and other drugs to be associated with lifetime and recent sex with prostitutes. Sexual intercourse with female partners, lower price paid at last prostitute visit, and frequency of condom use with prostitutes, however, did not differentiate frequent from infrequent prostitute visitors. With the goal of reducing the degree of HIV transmission among these young men, steps should be made to encourage a reduction in the frequency of sex had with prostitutes, to improve condom use, and to reduce drinking before visiting prostitutes.

Change in sexual behaviour and decline in HIV infection among young pregnant women in urban Uganda.

OBJECTIVE: To describe sexual behaviour that may partly explain a decline in HIV seroprevalence in pregnant women in urban settings in Uganda, East Africa. SETTINGS: Two major urban districts in Uganda. METHODS: Repeated population-based behavioural surveys in 1989 and 1995, and repeated HIV serological surveys in consecutive pregnant women attending antenatal clinics from 1989 to 1995. RESULTS: During the study period, a 2-year delay in the onset of sexual intercourse among youths aged 15-24 years and a 9% decrease in casual sex in the past year in male youths aged 15-24 years were reported. Men and women reported a 40% and 30% increase in experience of condom use, respectively. In the same study area, over the same period, there was an overall 40% decline in the rates of HIV seroprevalence among pregnant women attending antenatal clinics. It can be hypothesized that the observed declining trends in HIV correspond to a change in sexual behaviour and condom use, especially among youths. CONCLUSIONS: This is the first report of a change over a period of 6 years in male and female sexual behaviour, assessed at the population level, that may partly explain the observed decline in HIV seroprevalence in young pregnant women in urban Uganda. This result should encourage AIDS control programmes to pursue their prevention activities.

PIP: Repeated serologic surveys conducted in consecutive pregnant women attending antenatal clinics in three urban sites--Nsambya, Rubaga, and Jinja--in Uganda in 1989-95 documented substantial declines (27-47%) in HIV prevalence. Multiple population-based behavioral surveys conducted in urban Uganda in 1989 and 1995 suggest this decline in HIV prevalence among pregnant women may be a result of three key changes in sexual practices: a 2-year delay in the onset of sexual intercourse among young people 15-24 years of age, a 9% decrease in the practice of casual sex among males 15-24 years old, and increases in the experience of condom use of 40% among males and 30% among females. Proportions of male and female youth reporting they had never had sexual intercourse increased from 31% and 26%, respectively, in 1989 to 56% and 46%, respectively, in 1995. The prevalence among men in the past year of sex outside relationships that had lasted more than 12 months declined from 22.6% in 1989 to 18.1% in 1995. The proportion of men and women who reported exchanging sex for money dropped by almost 50%. Finally, the proportion of sexually active respondents who reported ever-use of condoms increased from 15.4% to 55.2% among men and from 5.8% to 38.7% among women from 1989 to 1995. In two of the three urban areas, the decline in HIV prevalence was sharpest among pregnant women in the youngest age group (15-24 years), suggesting a true decrease. The finding of substantial changes in the sexual behavior of urban Ugandan youth confirms the efficacy of AIDS prevention and control interventions.

Results of a model AIDS prevention program for high school students in the Philippines.

OBJECTIVES: To describe the sexual practices of high school students; to describe the process of development of a school-based AIDS prevention program; and to evaluate the effect of this program on students' AIDS-related knowledge, attitudes and AIDS-preventive behaviors. SUBJECTS AND METHODS: A cluster-randomized, controlled trial with pretest/post-test evaluation was conducted in four demographically similar public high schools in a semi-urban district of Metro Manila, the Philippines. Of 845 high school students who participated in the baseline survey, 804 (95%) completed a postintervention questionnaire. INTERVENTION: An AIDS prevention program was developed by public high school teachers together with local AIDS experts, social scientists and health educators. The teacher-led AIDS program was designed to provide students with accurate information about AIDS, particularly in dispelling misconceptions about casual contagion, to foster positive attitudes towards people with AIDS and to develop skills aimed at clarifying values and assessing intended behavior. RESULTS: At baseline, 11% of students (20% of males and 4% of females) reported ever having had sexual intercourse (mean age 14 years). Among these, condom use was low (24%). After implementation of the AIDS prevention program, statistically significant effects favoring the intervention group were observed in knowledge and attitudes towards people with AIDS. While there was no statistically significant overall effect on intended preventive behavior, the program appeared to delay the students' intended onset of sexual activity. CONCLUSIONS: A sizable number of Filipino high school students are sexually active but condom use is low. School-based AIDS prevention programs can be developed and implemented in developing countries with the assistance of school personnel to address sexual issues. Our program was successful in increasing AIDS-related knowledge and improving attitudes towards people with AIDS. Supplementation with other preventive activities may be needed to achieve lasting changes in students' risk-taking behavior.

PIP: The objectives were to describe the sexual practices of high school students; to describe the process of development of a school-based AIDS prevention program; and to evaluate the effect of this program on students' AIDS-related knowledge, attitudes and AIDS-preventive behaviors by means of self-administered questionnaires. A cluster-randomized, controlled trial with pretest/post-test evaluation was conducted in 4 demographically similar public high schools in a semi-urban district of Metro Manila, the Philippines. Of 845 high school students who participated in the baseline survey, 804 (95%) completed a postintervention questionnaire. An AIDS prevention program was developed by public high school teachers together with local AIDS experts, social scientists, and health educators to provide students with accurate information about AIDS, dispel misconceptions about casual contagion, to foster positive attitudes towards people with AIDS, and to develop skills aimed at assessing intended behavior. At baseline, 80 (11%) of 804 students reported ever having had sexual intercourse (mean age 14 years). 66 were male and 14 were female (p 0.001). Among these, condom use was low (24%). Reasons for failure to use condoms were: use of other method (26%) and loss of sensitivity (25%). After implementation of the AIDS prevention program, the intervention group was more likely to answer correctly that HIV cannot be transmitted by mosquito bites (p 0.01), through a cough or sneeze (p 0.01), or by shaking hands with an infected person (p 0.01). Students who had attended the AIDS education program were less likely to avoid people with AIDS and were more compassionate toward them (p = 0.01). Changes in knowledge about modes of HIV transmission were associated with improvements in preventive knowledge (p 0.001). While there was no statistically significant overall effect on intended preventive behavior, the program appeared to delay the students' intended onset of sexual activity. The program was successful in increasing AIDS-related knowledge and improving attitudes toward people with AIDS.

Adolescent sexual behavior along the Trans-Africa Highway in Kenya.

OBJECTIVE: To describe the demographic characteristics and HIV-related risk behaviors of adolescents frequenting truck stops along the Trans-Africa Highway in Kenya. METHODS: A cross-sectional study of 200 adolescents (52% female) aged 15-19 years was conducted at the Malaba, Sachangwan and Mashinari truck stops in Kenya. A standardized questionnaire assessing the adolescents' demographic characteristics and sexual behavior was administered. RESULTS: Most (89%) of the adolescents interviewed were out of school. Their median monthly family income was Ksh1000 (US$25). Most felt that their families provided inadequate access to food (72%), clothing (70%) and pocket money (87%). Ninety-three per cent of girls and 87% of boys had ever had sexual intercourse and of these 54% of girls and 38% of boys had ever used a condom. Fifty-two per cent of the girls and 30% of the boys reported ever having had a sexually transmitted disease. Forty-six percent of girls reported usually having sex with truck drivers, 78% of girls reported usually exchanging sex for gifts or money and 59% of boys reported usually giving gifts or money for sex. Subjects engaging in these three risk behaviors were generally less likely to be in school, less likely to live with relatives and less likely to report getting along well with their parents. CONCLUSION: Adolescents at truck stops along the Trans-African Highway in Kenya appear to be at significant risk for HIV infection. In the absence of an immediate and wide-ranging intervention, these conditions are likely to facilitate the spread of HIV from truck drivers and sex workers to adolescents.

Contraception and prevalence of sexually transmitted diseases among adolescents and young adults in Uganda.

The study is aimed at (i) exploring the knowledge and attitudes of adolescents (15-19 years old) and young adults (20-24 years old) towards sex and contraception (condoms) and (ii) determining their level of knowledge and attitudes towards sexually transmitted diseases (STD) as well as the prevalence of the latter among the sexually active adolescents and young adults. A sample of 4510 respondents (1545 males and 2965 females) aged 15-24 years from urban and rural areas were interviewed. The majority of adolescents and young adults surveyed have a negative attitude towards the use of condoms although most of them agreed that they prevent STD. Over 95% of the respondents have heard about STD and their level of knowledge is relatively high; slightly higher for urban residents and for young males. Approximately 21% of the male and 8% of the female respondents admitted having ever contracted STD. The gap between contraceptive knowledge and practice is rather wide. Only a small proportion of the respondents were using condoms at the time of the survey.

PIP: Between 1988 and 1990, researchers conducted the Adolescent Fertility Survey in the districts of Jinja, Kampala, Masaka, Kabale, Hoima, and Mbale in Uganda among 4510 15-24 year old urban and rural youth to examine their knowledge and attitudes toward sex, contraception, and sexually transmitted diseases (STDs). Males were more likely to experience 1st sexual intercourse at an earlier age than females. Many youth experienced their 1st sexual intercourse before age 15 and they had had more sexual partners than females. 83.9% of males and 87% of females used no contraception. Overall knowledge of condoms was high (78.2% for males and 56.6% for females) except among rural females (31.1%), especially among urban males (85.8%). Almost everyone was knowledgeable about STDs (96.1% males, 93.5% females). They tended to agree that condoms prevent STDs (urban males, 80.2%; urban females, 76%; rural males, 89.8%; and rural females 83.7%). Despite these high knowledge levels and positive attitude toward condoms, condom use levels were low, e.g., only 12.7% of males and 0.4% of females who were familiar with condoms used them. 40% of all respondents knew about the 3 most common STDs: gonorrhea, syphilis, and AIDS. Urban males were a bit more knowledgeable about these 3 STDs than were the other groups (48.8% vs. 41.2% for urban females, 41.3% for rural males, and 41.6% for rural females). In addition, STD prevalence was quite high especially among males (21.4% for males vs. 7.8% for females). The unsafe sexual practices revealed in this study indicated the need for sex education earlier than it is presently being offered in the school system and the establishment of health clinics geared toward adolescent needs.

Adolescent pregnancy in the United States: a review and recommendations for clinicians and research needs.

Adolescent pregnancy, often unplanned and unwanted, has a negative impact on the physical, emotional, educational, and economic condition of the pregnant teenager. Forty percent of the one million adolescents who became pregnant in 1986 chose abortion, and, of the remainder, 61% were unmarried. Teenage mothers in greater numbers and at younger ages are opting to keep and raise their children. In 1987 over $19 billion in federal monies were expended on families begun when the mother was a teenager. The preferred approach to this problem is prevention of teenage pregnancy rather than abortion, with emphasis on sex education and access to family planning information and contraceptive devices for both females and males. Sex education in schools is presented in widely varying formats; in fact, prevention of pregnancy may not even be presented. Family planning clinics are subject to the whims and biases of the funding agencies. Clinicians have an important role in providing guidance for teenage patients and their parents, but can also influence school and community leadership to ensure that all teenagers receive sound sex education in school programs and that family planning agencies are permitted to counsel teenagers and provide contraceptive devices.

PIP: Of the close to 1 million teenagers in the US who became pregnant in 1986, over 470,000 opted to continue the pregnancy. 38% of these births were to females 17 years of age or younger, and 61% of the teen mothers were unmarried. Such untimely childbearing has substantial negative effects on the teenage mother's physical, emotional, educational, and economic condition. In addition, children born to such mothers experience compromised physical and intellectual attainment due to parental immaturity and the related economic and social instability. There are costs to society as well; in 1987, over US$19 billion in federal funds was spent to support families begun when the mother was a teenager. The most effective approach to this problem is prevention of teenage pregnancy through sex education, access to family planning information, and provision of contraception to both males and females. 30% of sexually active unmarried 15-19 year olds reported never-use of contraception in the National Survey of Family Growth, and this rate is higher among black adolescents. Although 60% of 12-17 year olds interviewed in 1986 reported receiving some form of sex education through the public schools, only a third had been exposed to a comprehensive presentation of reproduction, sexual development, and birth control. Use of family planning clinics is consistently associated with a large increase in the number of teenagers using more reliable forms of contraception such as the pill as well as substantial reductions in non-use of birth control. Authoritative guidance on the part of family planning providers has been shown to produce higher rates of contraceptive use than an independent decision-making style. Other pregnancy prevention strategies with documented potential include offering contraceptive information and prescriptions in secondary schools or a combination of sex education and counseling in the schools with services in a nearby free-standing location.

Health beliefs and promotion of HIV-preventive intentions among teenagers: a Scottish perspective.

Beliefs concerning the spread of the human immunodeficiency virus (HIV) and preventive behaviors were examined in a sample of 351 sexually active Scottish teenagers. A postal questionnaire, including measures of variables specified by the health belief model (HBM) and preventive intentions, was employed. The relation between HBM measures and reported endorsement of HIV-preventive intentions was investigated. Results indicated that, in general, respondents intended to use condoms with new sexual partners. The majority also intended to carry condoms if they thought they might have sex with a new partner and to ask potential partners about their previous sexual history. Multiple-regression analyses showed that measures of health beliefs, gender, age, sexual experience, and previous condom use accounted for 17.8% to 24.3% of the variance in reported preventive intentions. Perceived barriers to preventive behaviors were found to be important predictors. However, the overall pattern of results raised questions concerning the adequacy of the HBM as a model of the determinants of HIV-preventive intentions, and the need for an extended model is discussed. Separate analyses were conducted for men and women and for 16- and 18-year-olds, and the implications for modeling intention formation in these subgroups are considered. The relevance of these findings to HIV-preventive campaigns is also discussed.

PIP: Beliefs relating to the spread of HIV and preventive behaviors were explored in a sample of 351 sexually active, 16-18 Scottish teenagers from Dundee, Scotland, who responded to a postal questionnaire. Specifically, the questionnaire investigated the relation between health belief model (HBM) measures and reported endorsement of HIV-preventive intentions. 38% reported 1 previous sex partner, 71% reported 1-3, and 5% reported 10. 70% of respondents reported having used a condom during sexual intercourse. It was found that respondents generally intend to use condoms with new sexual partners, with the majority intending to carry condoms if they thought they might have sex with a new partner and to ask potential partners about their previous sexual history. Measures of health beliefs, gender, age, sexual experience, and previous condom use accounted for 17.8 to 24.3% of variance in reported preventive intentions. Moreover, perceived barriers to preventive behaviors were important predictors. The pattern of results, however, called into question the adequacy of the HBM to HIV-preventive intentions. The authors, therefore, discuss the need for an extended model. The relevance of findings to HIV-preventive campaigns is also considered.

Young women's condom use: the influence of acceptance of sexuality, control over the sexual encounter, and perceived susceptibility to common STDs.

A comprehensive model of the determinants of condom use among young women was developed, tested, and replicated, with longitudinal follow-up to assess predictive utility of the model for condom use over time. Participants in Study 1 and Study 2 were 198 female undergraduates (mean age, 18.6 years) and 238 female undergraduates (mean age, 19.1 years), respectively. Acceptance of sexuality and control over the sexual encounter were related to a multidimensional measure of condom use self-efficacy, which predicted condom use intentions. Perceived susceptibility to STDs was both directly related to intentions and indirectly related through perceived benefits and attitudes about condom use. Intentions predicted subsequent reports of condom use. The model suggests foci for condom use interventions for young women.

PIP: A comprehensive model of the determinants of condom use among young women was developed, tested, and replicated, with longitudinal folow-up to assess the predictive utility of the model for condom use over time. Participants in study 1 and study 2 were 198 female undergraduates of mean age 18.6 years and 238 female undergraduates of mean age 19.1 years, respectively. 74-79% of the women were White and approximately 75% in both groups had ever experienced sexual intercourse. Among those ever having intercourse, the mean age at first intercourse was 16.2-16.3 years and only 15% reported always using condoms. 64-66% reported condom use at first intercourse and 59-60% of all episodes of sexual intercourse overall involved condom use. 66% and 73% of the young women who had had intercourse had had more than one partner and 3-7% of all participants reported ever having a sexually transmitted disease. Acceptance of sexuality and control over the sexual encounter were related to a multidimensional measure of condom use self-efficacy, which predicted condom use intentions. Perceived susceptibility to sexually transmitted diseases was both directly related to intentions and indirectly related through perceived benefits and attitudes about condom use. Intentions predicted subsequent reports of condom use.

Effects of a drinking event on behavioral skills and condom attitudes in men: implications for HIV risk from a controlled experiment.

This study experimentally tested the effects of a drinking event on HIV-related behavioral skills and condom attitudes. Sixty unmarried, heterosexual men were assigned to 1 of 3 conditions (sober, placebo, or alcohol). Participants who consumed alcohol demonstrated lower skill to negotiate for condom use relative to sober controls. More negative condom attitudes were expressed by participants with stronger sex-related alcohol expectancies, especially when these expectancies were triggered by subjective intoxication. Hierarchical regression analyses revealed that the experimental factors accounted for variance in behavioral skills and condom attitudes beyond that explained by known predictors of sexual risk.

PIP: 60 unmarried, heterosexual men of mean age 24.9 years were recruited from the community through newspaper advertisements and flyers to participate in a study to evaluate the effects of drinking-related and dispositional variables on the antecedents of safer sex behavior. 87% of the men were White, 72% drank alcohol 3-4 times per week, 75% had multiple sex partners in the past year (an average of 3.2 partners), 72% did not always use condoms, and all were told that they would be participating in an alcohol and communication study. The men were assigned to 1 of 3 conditions, sober, placebo, or alcohol, to experimentally test the effects of a drinking event upon HIV-related behavioral skills and condom attitudes. Men in the alcohol group received vodka and tonic drinks, men in the placebo group received all tonic drinks with a bit of vodka rubbed on the glass to make the subjects think that the drinks contained vodka, and men in the sober group received only tonic water. 20 men were in each group. All drinks were made in the presence of the subjects, with the tonic being poured from a vodka-labelled bottle in the placebo group. Participants were instructed to finish their drinks in 30 minutes, after which time they participated in role-play scenarios. The men who consumed alcohol demonstrated lower skill in negotiating condom use relative to sober controls and were more likely to consent to sex without a condom. More negative condom attitudes were expressed by participants with stronger sex-related alcohol expectancies, especially when those expectancies were triggered by subjective intoxication. Regression analyses determined that the drinking event, especially beverage content, accounted for variance in behavioral skills and condom attitudes beyond that explained by known predictors of sexual risk.

African-American adolescents' knowledge, health-related attitudes, sexual behavior, and contraceptive decisions: implications for the prevention of adolescent HIV infection.

African-American adolescents (N = 195) completed measures of knowledge related to acquired immunodeficiency syndrome (AIDS), attitudes toward condoms, health locus of control, vulnerability to human immunodeficiency virus (HIV) infection, peer sexual norms, personal sexual behavior for the past 6 months, and contraceptive preferences. Hotelling's T2 tests revealed that girls were more knowledgeable about AIDS, reported fewer sexual partners, held more positive attitudes toward precautionary sexual behavior, and perceived themselves to have greater self-control than boys. Five variables accounted for 44% of the variance in condom use: condom use from the 1st intercourse occasion, earlier grade in school, lower belief in an external locus of control, and higher scores on the Effect on Sexual Experience and Self-Control subscales of the Condom Attitude Scale. Implications for the content, format, and timing of HIV prevention with African-American adolescents are discussed.

PIP: Samples of adolescents in the US which suggest that HIV seroprevalence is climbing affirm the at-risk status of youths for HIV infection. Minority and disadvantaged youths are at even greater overall risk within the general national population of youths. Adolescent HIV infection probably accounts for thousands of current AIDS cases and 75,000 adolescents are estimated to already be infected with HIV. Despite the fact that more than half of all adolescents in the US are sexually active. they accept condoms less than adults. Reported rates of sexual activity among minority adolescents are as high as 80%, with African-American youths being disproportionately represented among AIDS and HIV cases diagnoses in youths. To gain some insight into this community, 195 African-Americans of mean age 15.3 years and average grade in school 9.6 were recruited in the southeast US from a public health service-funded clinic, community-based teen centers and after school programs, and the waiting room of a family service agency to complete measures of knowledge reacted to AIDS, attitudes toward condoms, health locus of control, vulnerability to HIV infection, peer sexual norms, personal sexual behavior over the previous 6 months and contraceptive preferences. 82% of the sample received Medicaid; 70% reported being sexually active and first intercourse occurred at the average ate of 11.7 years. Girls were found to be more knowledgeable about AIDS, reported fewer sexual partners, held more positive attitudes toward precautionary sexual behavior, and perceived themselves to have greater self-control than boys. The following variables accounted for 44% of the variance in condom use: condom use from the first intercourse occasion, earlier grade in school, lower belief in an external locus of control, and higher scores on the Effect on Sexual Experience and Self-Control subscales of the Condom Attitude Scale. Implications for the content, format, and timing of HIV prevention among these adolescents are discussed.

Psychosocial predictors of "safer sex" behaviors in young adults.

This study tested a model of safer sex behavior using variables from social learning theory, the health belief model, the theory of reasoned action, and theories of cognitive coping style. Two types of safer sex behavior were measured: frequency of condom use and the discussion of AIDS and past partners with a sexual partner. The participants--275 undergraduate students--completed an anonymous written questionnaire. The variables (behavioral intention, perceived susceptibility, barriers, self-efficacy, monitoring, blunting, and social support) predicted 35% of the variance in condom use and 13% of the variance in discussion (adjusted R2s). Intention was the strongest predictor of both types of safer sex behavior. Perceived susceptibility and perceived barriers were associated with intention to use a condom; perceived barriers was inversely related to condom use. Self-efficacy was associated with the intention to discuss and reported discussion of AIDS and past partners with a sexual partner; social support was related to the intention to discuss. An information-avoiding coping style was negatively associated with condom use. Implications for future research and intervention efforts in the area of AIDS prevention are discussed.

PIP: This study of predictors of AIDs risk behavior relies on constructs from the health belief model, social learning theory, the theory of reasoned action, and models of social support and coping among 275 low to moderate risk students from US university undergraduate health and communication classes. The population characteristics were as follows: 65.8% female, 81.4% white, non Hispanics, 8.4% Hispanics, 5.8 blacks, 3.3% Asians, 1.1% Indian and other, 21.6 years average age, 34% with no sexual partners in the past 2 months, 56% with 1 partner, 5% with 2 partners, and 5% with 3 or more partners. The instrument was pretested. The following measures are presented with consistency reliability coefficients, ranges, and sample items: perceived susceptibility based on an Eisen scale, perceived barriers to behavior change also based on Eisen items, self-efficacy, social support based on a French, Marshall, and Gebhardt scale, coping style (monitoring and blunting) using the Miller Behavior Style Scale, safer sex intentions and safer sex behavior. The findings of the univariate correlation analysis were that susceptibility was significantly related to intention to use a condom. Barriers to practicing safer sex, which was significantly affected by self-efficacy, was significantly correlated with intention-discussion and intention condoms, and the reported frequency of condom use. Self-efficacy was also associated with intentions to discuss AIDS and past partners with a sexual partner. Self-efficacy was not correlate with condom use or intention to use. Blunting was significantly and negatively associated with condom use, and positively related to social support, which was related to self-efficacy and barriers. The path analysis used the beta weights of .10 from regression equations. 13% of the variance in discussion and 35% of the variance in both intention discussion and intention condom use were predicted by blunting, monitoring, social support, self-efficacy, susceptibility, barriers, intention discussion, and intention condom use were predicted by the model. Intention variables were the best predictors of safer sex behavior and were not unidimensional. Limitations are that the direction of causation is derived from theory and reflects past behavior. The implications for theory and prevention are indicated. Interventions need to address that denial of risk is a coping style and self efficacy and social support are important influences.

AIDS knowledge and sexual behavior among Mexican gay and bisexual men.

Little knowledge exists about AIDS and Human Immunodeficiency Virus (HIV) infection among Latin American gay males. In Latin America, sexual transmission from man to man is the leading cause of HIV infection. In Mexico, which ranks third in number of AIDS cases in the Americas, more than three-quarters of the cases are due to sexual transmission; among these cases, 35% and 23.7% are due to homosexual and bisexual male practices, respectively. A sample of 200 individuals from Juarez, Mexico, a city on the U.S. border, was interviewed. Information about their AIDS knowledge, sexual behavior, and condom use was obtained. Factory workers and individuals who meet sexual partners in the streets reported more sexual partners than workers in service or professional occupations and those who meet their partners in bars and discos. Number of sexual partners and respondents' age were inversely associated with condom use. Implications for HIV prevention are discussed.

PIP: Two hundred gay and bisexual men of mean age 26.4 years from Juarez, Mexico, were interviewed by the Mexican Federation of PRivate Associations for Community Development (FEMAP) about their AIDS knowledge, sexual behavior, and condom use. 88% were single and never married. 66% self-identified as being gay, 29% as bisexual, and 2% as transvestites; 10% reported having sex for money. 14% had had at least one sexually transmitted disease and 57% were negative about condom use. Having an average 4.46 sex partner/month, most respondents were knowledgeable about HIV transmission routes, AIDS symptoms, and HIV antibody tests. 75% and 77.5%, respectively, reported practicing receptive anal intercourse and insertive anal intercourse. They used condoms an average of 6.47 times in their most recent ten sexual encounters. By profession and social behavior, factory workers and individuals who recruit sex partners from the street reported having more sex partners than service and professional workers and those who meet their partners in bars and discos. Further, the number of sex partners and respondents' age were inversely associated with condom use. These findings clearly highlight the failure of knowledge about HIV to bring about change in sexual behavior among certain subpopulations in the study area. Since homosexuality remains unaccepted in Mexican society, the author suggests targeted peer education and small-group session prevention efforts which do not confront mainstream social structure and values.

The relationship of substance use with sex to the use of condoms among young adults in two urban areas of Scotland.

The relationship of the use of alcohol or drugs in conjunction with sexual activity and the use of condoms and other contraceptives was examined among 1378 respondents in a household survey of two urban areas of Scotland. In bivariate analyses, respondents who reported having had sex under the influence of alcohol or drugs were no less likely than respondents with no such experience to report consistent use of condoms, and having had sex under the influence of substances was positively related to lifetime condom use. Multivariate analyses that included gender and urban area as predictors yielded similar findings. The results suggest that individuals who combine sex with alcohol or drugs are not necessarily more likely to engage in riskier sex.

PIP: A survey conducted among young adults in Scotland failed to provide confirmation for the assumption that sexual intercourse under the influence of drugs or alcohol is associated with a greater likelihood of failure to use condoms. Interviews were conducted in 1990 with 1378 men and women ages 16-30 years located through a random sample of households in Edinburgh's Muirhouse area and Glasgow's Easterhouse area--both economically depressed areas with a high incidence of social problems. 12% of respondents in both areas reported having had sex while using drugs, and 85% of Muirhouse residents and 81% of Easterhouse residents had sex while drinking alcohol. Although 62% of sexually active men and women were not using condoms with their current partner, 66% of men and 48% had used condoms at some point. Experience of sexual intercourse with alcohol or drugs was not significantly associated with reported condom use with current partner or condom use in the past year; however, subjects who had had sex under the influence of one of these substances reported more lifetime condom use than those who had not. Multivariate analysis, controlled for gender and area, produced the same finding.

The efficacy of the health belief model for predicting condom usage and risky sexual practices in university students.

This investigation examined the ability of the health belief model (HBM) to predict condom usage and risky sexual practices in 122 white heterosexual college students (ages 17 to 33 years). The HBM did not significantly explain condom usage in the 58 men and 64 women surveyed; rather it partially explained the variance in sexual risk behaviors. Results were not consistent for men and women. The HBM components significantly explained 18% of the variance in multiple sexual partnerships in men and 22% of the variance in this behavior in women. The HBM constructs also explained 9% of the variance in the likelihood of women being intoxicated or high during sex and 18% of the variance in the number of sexual risk behaviors endorsed by women. These findings suggest that the HBM has differential and limited utility for predicting sexual practices in university students. Future research is needed to examine more comprehensive models of behavior change.

PIP: The ability of the health belief model (HBM) to predict condom use and high-risk sexual behaviors was investigated in a survey conducted in 1992-93 of 122 US college students 17-35 years of age. The HBM conceptualizes preventive health behavior as a function of perceived severity of illness, perceived susceptibility to illness, perceived benefits for taking a health action, and perceived barriers to engaging in a health action. Students completed the Attitudes Toward Condom Usage Questionnaire, a Perceived AIDS Risk Scale, and a sociodemographic questionnaire. Among the 58 male students, the HBM components did not significantly explain any variance in condom use for vaginal or oral sex after controlling for education and cocaine use. The HBM explained 18% of the variance in men's multiple sexual partnerships in the 6 months preceding the survey. Perceived AIDS risk made a significant contribution to the relationship between HBM components and multiple sexual partnerships. The HBM components were more efficacious in predicting risk behaviors in the 64 female students. Among females, the HBM significantly explained 9% of the variance in the reported likelihood of being high on drugs or intoxicated during sex, 22% of the variance in multiple sexual partnerships, and 18% of that in total number of risk behaviors after controlling for demographic variables and recreational drug use. As with male students, the HBM was not able to predict condom use with oral or vaginal sex, however. Unless the HBM is expanded to include other behavior-specific cognitive factors (e.g., benefits and barriers associated with multiple sexual partnerships), its ability to explain more than a small proportion of the variance in behaviors that prevent AIDS will remain limited.

Evolution of college students' AIDS-related behavioral responses, attitudes, knowledge, and fear.

Data were collected (a) to document extant levels of AIDS-risk behavior, AIDS-preventive behavior, AIDS-knowledge, and attitudes toward prevention among college students, (b) to assess the evolution from 1986 to 1988 of college students' behavioral and attitudinal responses to the AIDS epidemic, and (c) to document changes over time in college students' knowledge about AIDS. Although students' current levels of AIDS-knowledge were found to be relatively high, and their attitudes toward prevention were in the neutral range, actual preventive behavior was low, and unsafe sexual practices were high. Concerning changes in these dimensions across time, data using comparable samples of undergraduates in 1986, 1987, and 1988 indicated that there were substantial increases in knowledge about AIDS, in the favorability of attitudes toward certain "safer-sex" behaviors (e.g., discussing "safer sex"), and in the utilization of relevant informational resources. Students' perceptions of others' vulnerability to AIDS (but not their own vulnerability), had also increased. However, at the same time, students reported a decrease in the safety of their sexual behaviors. Numbers of sexual partners, likelihood of being in an intimate (sexual) relationship, and unsafe sexual practices have all increased since 1986. Finally, evidence suggested that alcohol may play a significant role in students' AIDS-risk behavior.

PIP: A sample of 515 undergraduate college students from the University of Connecticut participated in 1986-88 this study of AIDs related attitudes and behavior. The justifications for collecting AIDs risk behaviors in a selected population were based on the need for an explanation for differences in HIV infection and AIDs incidence among population subgroups, and longitudinal changes in the rates of new infection within and between populations. Future levels of incidence can then be estimated. A wide range of sexual behaviors can be identified in order to generate mathematical modes of the spread of HIV infection, since present estimates are based on data statistics. Data on the incidence of AIDs risk behavior will determine the nature and extent of necessary behavior change interventions. The population sampled was predominately white (92.6%), single (98.8%), 18-19 year olds (77%), Roman Catholic (52%), and from white collar families (71.5%) who lived in dormitories (84%). The annual samples were highly comparable for race, religion, marital and occupational status, or political orientation based on Chi squared analyses. The 35-page questionnaire was given to students taking basic psychology. Questions dealt with types of relationships among students, AIDs risk behavior, preventive behavior, utilization of information services, knowledge, fear of AIDs, and contact with individuals with AIDs. The results indicate that the pattern of relationships has not changes among college students, except to increase sexual behavior and to engage in risk behaviors. More have sought information about AIDs and become more knowledgeable, but have not increased preventive behaviors. There is little contact with AIDs infected persons. The implications for AIDs education if that the focus needs to emphasize risk reduction behavior. More data is needed on what information is lacking, the identification of behavioral skills lacking, and the motivation to practice safer sex. Although condom use has increased somewhat, AIDs risk behavior has also increased. A 1989 American College Health Association survey found a surprising increase in college student HIV prevalence, which coupled with increased sexually risky behavior suggests concern for further HIV spread in the college population.

Sexual behavior and condom use among urban, low-income, African-American and Hispanic youth.

Low income, urban, African-American, and Hispanic youth have been identified as a group for which there is concern about the spread of HIV. Using data from a household probability sample of 1,435 minority youth aged 15 to 24 in Detroit, this paper evaluates levels of sexual activity, condom use, and reasons for condom use and non-use. Comparisons with national samples of minority youth indicated that Detroit low-income youth have similar patterns of sexual behavior to national samples, although males and African-American females began their sexual experiences earlier and were less likely to have used condoms or other protection from pregnancy or sexually transmitted diseases (STDs) at first intercourse. Recent levels of condom use also left many Detroit youth unprotected from STDs. Less than half used a condom at least intercourse in the last year with nonmarital partners that they "knew well." In addition, condom use with partners that they "did not know well" was very low for Hispanic youth: Among those who had at least one casual partner in the last year, only 30% to 33% had ever used a condom with that partner. Analysis of reasons for use indicate that both pregnancy prevention and disease prevention were important motivations for condom use. However, many youth did not use condoms for reasons such as unavailability of condoms or unplanned sex.

PIP: African-American and Hispanic youth of low income residing in urban settings are at particular risk of contracting and spreading HIV. This paper reports findings from a study evaluating the levels of sexual activity, condom use, and reasons for condom use and non-use among a sample of 1435 minority youth aged 15-24 users of mean age 19.1 in Detroit. Compared against national samples of minority youth, these subjects have similar patterns of sexual behavior, although males and African-American females began their sexual experiences earlier and were less likely to have used condoms or other protection from pregnancy or sexually transmitted diseases at first intercourse. 35-48% used a condom at last intercourse in the last year with nonmarital partners that they knew well. Among Hispanic subjects reporting having at least one casual partner in the last year, only 30-33% had ever used a condom with that partner. Further, prevention against both pregnancy and disease were found to be important motivators for using condoms, but many did not use them because they were unavailable or the sexual encounter was unplanned.

Gender differences in AIDS-relevant condom attitudes and condom use.

Two studies, conducted approximately one year apart, examined gender differences in AIDS-relevant condom attitudes, condom use behaviors, and relationships among attitudes and condom use behaviors. Subjects (N = 248, N = 528) were undergraduates, primarily heterosexual. Females reported more favorable attitudes, with the exception of greater inhibition about buying and possessing condoms. Men engaged in preliminary condom use behaviors (carrying and keeping condoms at home) substantially more often than did women. Preliminary condom use behaviors predicted past and intended condom use more consistently for men than for women. Relationships between condom attitudes and condom use behaviors were generally similar for both sexes, with poorer self-control explaining the most variance in past and intended condom use. These results, interpreted from the perspective of Eagly's (1987) gender role theory, suggest that although females may indirectly influence condom use decisions, providing condoms is the expected role of males, infusing them with greater control over the interpersonal process.

PIP: 2 studies were conducted 1 year apart exploring gender differences in AIDS-relevant condom attitudes, condom use behaviors, and relationships among attitudes and condom use behaviors. 248 self-reported heterosexual undergraduates were studied in the 1st study. Participants were 65% female, 96% self-reported heterosexuals, 87% white, and of average age 22.77 years. 71% reported having sexual intercourse at least once in the preceding 2 years and 64% reported using a condom at least once during sex in the preceding 2 years. The 2nd group of 528 individuals sampled in the 2nd study had characteristics which were highly similar to those of the 1st study, except that 74% of the participant were female. Females generally had more favorable attitudes than men about condoms, but were more inhibited than men about buying and possessing them. Men carried and kept condoms at home far more often than did women. This behavior predicted past and intended condom use more consistently for men than for women. Generally similar relationships were found for both sexes between condom attitudes and condom use behaviors; poorer self-control explained the most variance in past and intended condom use. The results suggest that while females may indirectly influence condom use decisions, providing condoms is the expected role of males. Interventions with the objective of increasing the use of condoms during sexual intercourse should be designed accordingly.

Learning from Norwegian experience: attempts to mobilize the youth culture to fight the AIDS epidemic.

This study describes to what extent Norwegian adolescents were aware of a campaign to combat the spread of AIDS, and their participation in the various components. The material comprised a nationwide representative sample of 3000 adolescents aged 17 through 19 years. Data were collected by means of self-administered, anonymous questionnaires. The response rate was 62.8%. The intention of the campaign was to mobilize the youth culture in the fight against AIDS with a view to internalizing existing knowledge about HIV and AIDS in the hope of improving consistency between knowledge and sexual behavior. The campaign included five elements connected to the use of media and activities in the adolescents' social environment. The campaign slogan--Talk about sex, about being in love and about love--was referred to AIDS only indirectly. The medium used to communicate the message was rock music. Over one quarter of the adolescents reported a general awareness of the campaign. Awareness of the different elements varied between 2.4% and 24.0%. Use of condoms was apparently no higher among adolescents who were generally aware of the campaign than among adolescents with no knowledge of it. The adolescents had not grasped any specific message from the campaign. The campaign would probably have been more successful if the message had been more direct and more specific to the context.

PIP: Data on 1855 17-19 year olds in Norway were analyzed to determine how aware they were of a national AIDS prevention campaign and their participation in its activities. Only 27.5% knew about the campaign. The message indirectly referred to AIDS. 56.8% of them did not realize that AIDS was the key message. The most familiar element of the campaign was the rock concert on TV (24%) followed by hearing the campaign song (14.9%), seeing the campaign song's video (8%), and reading the campaign novel (6.6%). Younger teenagers were more likely to have been aware of the concert and the campaign video than older teenagers. Teenagers with high educational aspirations and those living in a rural setting had a higher general awareness of the campaign than did those with lower aspirations and living in larger cities. Adolescents with much knowledge about sexuality were more aware of the campaign than those who did not. Those teenagers who often spoke to parents and friends about sex and to friends about their risk of HIV infection had a higher general awareness of the campaign than their less communicative counterparts. Rural adolescents were more likely to be aware of campaign activities in their area than the urban adolescents. Most teenagers (63.4%) learned about activities by reading the newspaper. Condom use was basically the same among teenagers who were familiar with the campaign as it was with those who were not familiar with it. The campaign primarily affected teenagers who already had been motivated to use protection during intercourse. These results indicated that the campaign did not improve consistency between knowledge and behavior among adolescents. The project designers did not study media habits of adolescents before the campaign. The campaign probably would have been more successful if they had done so and if the message had been more direct and specific.