Stage of behavior change for condom use: the influence of partner type, relationship and pregnancy factors.

A theoretical model was used to examine the influence of relationship factors, pregnancy intentions, contraceptive behavior and other psychosocial characteristics on stages of behavior change in condom use among heterosexual black women of reproductive age. Data from an inner-city street survey compared women who were not contemplating condom use, women who were attempting to use condoms or had used them consistently for short periods of time, and those who had achieved long-term consistent use. Women's relationship with their main partner appears to be an important factor in understanding their use of condoms both with main partners and with other partners. For condom use with the main partner, factors such as emotional closeness and partner support were significant predictors of the likelihood that women would be attempting to use condoms rather than not contemplating use. Cohabitation and the belief that condom use builds trust were significant predictors of long-term consistent condom use. Having a regular or main partner was strongly associated with intentions to use condoms with other partners. Women who wanted to become pregnant were much less likely to intend to use condoms with their main partner, and women using oral contraceptives were less likely to be long-term consistent condom users.

PIP: This study examines the influence of five groups of factors on the stages of change in condom use among Black women in Baltimore, Maryland, in 1993. The stages of change included: precontemplation, contemplation, ready for action, action, and maintenance. Interviews were obtained from women aged 17-35 years in designated neighborhoods. The sample included 625 women equally divided among age groups 17-20 years, 20-24 years, and 25-35 years. 63% of the 625 women had a main sexual partner and 42% had other partners, of which 33% had a main partner and other partners. Most women with main partners were in the precontemplation stage (50%) and most women with other partners were in the maintenance stage (41%). Women with main and other partners were primarily in the maintenance stage (37%). Few were classified as being in the contemplation or action stages. Changes between the precontemplation stage and the middle stage are viewed as "developing intentions." Changes between the middle stage and maintenance stage are viewed as "using consistently." Condom use with a main partner was associated with all five groups of factors: demographic, social, pregnancy intentions, outcome expectations or HIV risk, and efficacy. Having a regular partner who supported condom use significantly increased the odds of developing intentions to use condoms and of using condoms consistently. Friends support of condom use and condom use among friends raised the odds of becoming a consistent condom user. Having two or more partners and having one or more HIV risk factors was positively associated with the likelihood of consistent condom use. The strongest effects on developing intentions to use condoms with a main partner were emotional closeness, partner support for condom use, and women's potential happiness if pregnancy was an outcome. Consistent condom use with a main partner was predicted best by cohabitation with the main partner, use of the pill at the last intercourse, and the belief in condoms as a means of building trust. Prediction among other partners was more difficult.

Combined use of condoms with other contraceptive methods among inner-city Baltimore women.

Data from a street survey conducted among 717 women aged 17-35 in two inner-city Baltimore communities in 1991-1992 indicate that 17% of the entire sample, 38% of women using the pill and 11% of users of methods other than the pill used a condom in addition to another method the last time they had intercourse. Although adolescents reported the highest rate of combined condom and pill use (22% of 17-19-year-olds), condom use was significantly associated with pill use among adult women (odds ratio of 1.57) but not among adolescents (odds ratio of 1.03). Condom use was negatively associated with use of methods such as the diaphragm, the IUD, the implant and the sponge (odds ratio of 0.21) among both adolescents and adults. Logistic regression analyses show that positive attitudes toward safer sex, ever having refused sex without a condom and believing in condom efficacy all significantly predicted use of the condom with another method. Having ever been tested for HIV was negatively related to combined use, while behavioral risk factors showed no association.

PIP: In 1991 and 1992, in Baltimore, Maryland, interviews were conducted with 717 sexually active women aged 17-35 living in two inner-city neighborhoods to determine the prevalence of combined use of condoms with other contraceptive methods and the demographic, attitudinal, and behavioral correlates of combined use. The typical woman was Black (96%), had never been married (84%), and had at least completed high school (65%). 45% were currently employed. 49% had made changes in their personal behavior since learning about AIDS. More than 80% said that they could do a lot to prevent HIV infection. 24% had at least one personal risk factor for HIV in the last year. 10% had partners who took part in high-risk behaviors in the last six months. Both personal risk factors and partner risk factors were associated with each other (odds ratio [OR] = 5.1). Oral contraceptives (OCs) were the most common method used during last intercourse (40.1%) followed by condoms (33.2%). 38.1% used the condom with OCs. 10.7% used the condom with any other contraceptive method but OCs. Combined use was highest among teenagers (24.1% vs. 7.4-15%) and OC users (41.6% vs. 32.1-36.8%). Condom use had a positive association with OC use among adult women (20-35 years) (OR = 1.57) but not among teenagers. Spermicide use was also associated with condom use (OR = 3.01). Use of diaphragms, sponges, the IUD, and the levonorgestrel implant had a negative relationship with condom use (OR = 0.19, 0.14, 0.32, and 0.35, respectively). Positive attitudes towards safer sex (OR = 1.39), ever having refused sex without a condom (OR = 7.09), and greater belief in condom efficacy (OR = 1.89) predicted combined use. Ever having been tested for HIV predicted non-use (OR = 0.53). Personal and partner behavioral risks for STDs and HIV did not predict combined method use.

Pediatric AIDS in the United States: epidemiological reality versus government policy.

Pediatric AIDS cases constitute approximately 2 percent of total AIDS cases in the United States, but HIV infection and AIDS among children pose a growing concern. Government policies have failed to match the epidemiological reality of the disease. The powerful shapers of public opinion have dedicated their energies to a handful of cases, involving the school attendance of primarily middle-class children. Unfortunately, coverage of school placement issues has overshadowed both the demographically more serious issue of perinatally transmitted AIDS cases and the growing concern over adolescent AIDS. Seventy-five percent of perinatal AIDS sufferers are poor, urban minorities: the disease is clearly related to other indicators of poor child health--urban poverty and oppressive social conditions. School-based prevention efforts for adolescents have been rendered impotent because of moralistic obstacles to explicit education. Prevention of perinatal and adolescent HIV transmission must be both sensitive and relevant to communities in which the greatest threat to survival is poverty, not AIDS. Ultimately, issues surrounding pediatric AIDS only reinforce the long-term position of child health advocates: the best investment a society can make is a sincere commitment of resources to improve the health, education, and welfare of its children.