Delay discounting of protected sex and compulsive sexual behavior in women with borderline personality disorder.

Background and aims: Borderline personality disorder (BPD) is a complex mental health condition characterized by emotional dysregulation, impulsivity, and unstable interpersonal relationships. Some individuals with BPD regularly engage in sexual risk behavior such as unprotected sex and are at higher risk of contracting sexually transmitted infections. This study investigates discounting of condom- or dental dam-protected sex in women with BPD compared with a control group. Methods: Data were collected from 40 women diagnosed with BPD and 40 healthy controls with an average age of 27.28 years (SD = 6.14) using the Sexual Delay Discounting Task (SDT), the Borderline Symptom List-23 (BSL-23), and the Compulsive Sexual Behavior Disorder Scale-19 (CSBD-19). Results: Women with BPD were less likely to use an immediately available condom or dental dam and more likely to discount safer sex than controls. Partner desirability and the perceived STI risk influenced the participants' likelihood of having protected sex. Women with BPD showed more symptoms of compulsive sexual behavior (CSB) than controls. However, sexual delay discounting was not significantly correlated with borderline symptoms or CSB in the BPD group. Discussion and conclusions: These findings contribute to our understanding of sexual impulsivity in women with BPD and highlight the omission and delayed availability of safety measures as important contributors to sexual risk behavior and STI risk in women. Impulsive sexual behavior, as well as the accompanying sexual health concerns, should receive special attention in the treatment of women with BPD.

Inclusion of a Parental Component in a Sports-Based HIV Prevention Program for Dominican Youth.

BACKGROUND: Underprivileged youth in the Dominican Republic (DR) are at high risk of acquiring the human immunodeficiency virus (HIV). Protective parenting practices may inhibit sexual risk-taking. OBJECTIVE: We investigated whether parental involvement in a sports-based HIV prevention program increased self-efficacy to prevent HIV and safe sex behavior among Dominican youth. METHOD: The study had a quasi-experimental design with repeated measures. N = 90 participants between 13 and 24 years of age participated in the program through two different trainings, UNICA and A Ganar, both of which had an experimental (i.e., program with parental component) and a control (i.e., program without parental component) condition. RESULTS: Self-efficacy to prevent HIV significantly increased among participants in the experimental condition of UNICA. Self-efficacy for safe sex increased among sexually active participants in the experimental condition of A Ganar. Implications for Impact: These findings are important to meet the United Nations' Sustainable Development Goal of good health and wellbeing, as they suggest that parental involvement in sports-based HIV prevention programs can enhance their positive effects for increasing youth's self-efficacy to practice HIV-preventive behaviors. Randomized control trials and longitudinal studies are needed.

Explicitness, disgust, and safe sex behavior: A message experiment with U.S. adults.

Sexual health risks are challenging to communicate given the potential negative reactions of target audiences to explicit language. Grounded in research on pathogen avoidance, the current study examined the impact of varying levels of explicit language on message perceptions and safe sex behavioral intentions. U.S. adults (N = 498) were randomly assigned to view messages detailing pandemic safe sexual behavior that contained either low or high levels of explicit language. High explicit language significantly increased perceived disgust which also indirectly linked high explicit language with increased intentions to engage in safe sex behavior. Individual difference variables moderated the impact of message explicitness; dispositional hygiene disgust moderated the impact of high explicit, hygiene-focused messages on safe sex intentions. Those with relatively low levels of dispositional disgust were more positively impacted by explicit language. The results suggest the value of increased message explicitness for sexual health communication and have implications for pathogen avoidance behaviors, the behavioral immune system, and dispositional and affective forms of disgust.

Effect of integrated reproductive health lesson materials in a problem-based pedagogy on soft skills for safe sexual behaviour among adolescents: A school-based randomized controlled trial in Tanzania.

BACKGROUND: Adolescents are currently becoming sexually active before their 18th birthday during which they have to battle with unsafe sexual behaviours, teenage pregnancies, sexually transmitted infections (STIs), and school dropouts. The trend is linked with low soft skills (self-esteem and assertiveness skills) for them to make informed, reasoned, and responsible decisions over sexual activities. This study designed and tested the effect of integrated reproductive health (RH) lesson materials in a problem-based pedagogy (PBP) to enhance soft skills for safe sexual behaviour among adolescents in Tanzania. METHODS: A double-blinded clustered randomized controlled trial was conducted between September 2019 and September 2020 among 660 randomly selected adolescents. A Sexual-risk Behaviour Beliefs and Self-esteem Scale adopted from previous studies measured soft skills for safe sexual behaviour. A descriptive statistical analysis was performed by using the statistical analysis software programme version 9.4. The effect of the intervention was determined using Linear Mixed Model set at α error probability = 5% significance level (95% confidence interval) and a ß error probability = 0.80. FINDINGS: Adolescents' mean age was 15±1.869 with 57.5% females. The end-line findings indicated that the coefficient of soft skills was significantly higher among adolescents in the hybrid PBP (ß=9.0986, p<0.01; 95%CI: 4.7772, 14.2311) and pure PBP (ß =8.7114, p<0.01; 95%CI: 3.9990, 10.1208) than in the control group. The retention rate of soft skills was still significantly higher at 3-months follow-up (ß=2.0044; p<0.01; 95%CI: 1.0234, 4.1182) and at 6-months follow-up (ß=1.9803; p<0.01; 95%CI: 0.8399, 3.1099) compared to the baseline and immediate post-intervention assessments. CONCLUSION: The intervention substantially enhanced soft skills for safe sexual behaviour among adolescents of both sex. Despite the fact that scores for soft skills varied across the study timelines, adolescents demonstrated significant intentions to abstain from sexual intercourse, delay sexual relationships, negotiate condom use, and withstand sexual coercions. The PBP may need to be incorporated in ordinary level secondary school curricula as a formal guide to teachers and or health workers to optimally prepare adolescents for their healthy adulthood.

An exploratory test of a couples-based condom-use intervention designed to promote pleasurable and safer penile-vaginal sex among university students.

Objective: Dual use of male condoms and female contraceptives is widely advocated for unplanned pregnancy prevention, yet college students often neglect condoms. This feasibility and acceptability study assessed the efficacy of a self-guided home-based condom-promotion intervention among college students in heterosexual relationships. Participants: Fifty-nine couples who had been together at least 30 days and had penile-vaginal sex at least twice weekly. Methods: Assessments were done at baseline and 6 months later. Outcomes were frequency of condom-unprotected penile-vaginal sex and four psychosocial mediators of condom use. Results: Frequency of unprotected penile-vaginal sex decreased over time. Several corresponding psychosocial mediators showed change, particularly among women. Using actor-partner interdependence modeling, men's increase in condom use was associated with an increase in women's sexual pleasure. Conclusion: Findings support implementation of a brief, self-guided, home-based condom-use intervention that could lower incidence of unplanned pregnancy and STIs among heterosexually active college students.

Consistent condom utilization and associated factors among HIV positive clients attending ART clinic at Pawi general hospital, North West Ethiopia.

BACKGROUND: Human immunodeficiency virus (HIV) affects a highly significant number of people and is responsible for the deaths of many people in sub-Saharan African countries alone. The best prevention method for this virus is through consistent condom utilization which can help to prevent drug-resistant HIV infection and acquisition of new infection. Therefore, this study aimed to assess consistent condom utilization and associated factors among HIV-positive individuals attending an antiretroviral therapy clinic at Pawi general hospital, North West Ethiopia in 2020. METHODS: An institutional based cross-sectional study was conducted among 419 HIV-positive individuals who have follow-up in the Pawi general hospital antiretroviral therapy clinics, from January to February 2020. The study subjects were reached using a systematic sampling technique and data were collected using a pretested and structured questionnaire. Data entry and analysis were performed using epi-data version 3.1 and SPSS version 23 respectively. Binary and multivariable analyses with a 95% confidence level were performed. In the final model, variables with P < 0.05 were considered statistically significant. RESULTS: A total of 419 antiretroviral therapy study participants were participated in the study with a response rate of 100%. In this finding, the consistent condom utilization rate was 49.2% [95% CI: 42.2-56.5%]. After controlling for possible confounding factors, the results showed that place of residence [AOR = 2.16, 95% CI: 1.05, 4.45], marital status [AOR = 0.19, 95%CI: 0.05, 0.67], number of partners [AOR = 0.19, 95% CI: 0.07, 0.55] and level of education [AOR = 5.33, 95% CI: 1.57, 18.08] were associated factors of consistent condom utilization. CONCLUSION: Consistent condom utilization among HIV-positive clients attending antiretroviral therapy clinics at Pawi general hospital was low. Residence, marital status, level of education and number of partners were significantly associated factors of consistent condom use. Health education program and counseling services should be started to increase knowledge about way of transmission and appropriate use of condoms, increase self-efficacy towards condom use and reduction in the number of sexual partners.

What does PrEP mean for 'safe sex' norms? A qualitative study.

While HIV pre-exposure prophylaxis (PrEP) is highly effective, it has arguably disrupted norms of 'safe sex' that for many years were synonymous with condom use. This qualitative study explored the culture of PrEP adoption and evolving concepts of 'safe sex' in Sydney, Australia, during a period of rapidly escalating access from 2015-2018, drawing on interviews with sexually active gay men (n = 31) and interviews and focus groups with key stakeholders (n = 10). Data were analysed thematically. Our results explored the decreasing centrality of condoms in risk reduction and new patterns of sexual negotiation. With regards to stigma, we found that there was arguably more stigma related to not taking PrEP than to taking PrEP in this sample. We also found that participants remained highly engaged with promoting the wellbeing of their communities through activities as seemingly disparate as regular STI testing, promotion of PrEP in their social circles, and contribution to research. This study has important implications for health promotion. It demonstrates how constructing PrEP as a rigid new standard to which gay men 'should' adhere can alienate some men and potentially create community divisions. Instead, we recommend promoting choice from a range of HIV prevention options that have both high efficacy and high acceptability.

"It really proves to us that we are still valuable": Qualitative research to inform a safer conception intervention for men living with HIV in South Africa.

OBJECTIVE: Many men living with HIV want to have children. Opportunities to reduce periconception HIV transmission include antiretroviral therapy as prevention, pre-exposure prophylaxis, limiting condomless sex to peak fertility, and sperm processing. Whether men have knowledge of or want to adopt these strategies remains unknown. METHODS: We conducted focus group discussions (FGDs) with men accessing HIV care in South Africa in 2014 to inform a safer conception intervention for men. Eligible men were 25-45 years old, living with HIV, not yet accessing treatment, and wanting to have a child with an HIV-negative or unknown serostatus female partner (referred to as the "desired pregnancy partner"). FGDs explored motivations for having a healthy baby, feasibility of a clinic-based safer conception intervention, and acceptability of safer conception strategies. Data were analyzed using thematic analysis. RESULTS: Twelve participants from three FGDs had a median age of 37 (range 23-45) years, reported a median of 2 (range 1-4) sexual partners, and 1 (range 1-3) desired pregnancy partner(s). A third (N = 4) had disclosed HIV-serostatus to the pregnancy partner. Emergent themes included opportunities for and challenges to engaging men in safer conception services. Opportunities included enthusiasm for a clinic-based safer conception intervention and acceptance of some safer conception strategies. Challenges included poor understanding of safer conception strategies, unfamiliarity with risk reduction [versus "safe" (condoms) and "unsafe" (condomless) sex], mixed acceptability of safer conception strategies, and concerns about disclosing HIV-serostatus to a partner. CONCLUSIONS: Men living with HIV expressed interest in safer conception and willingness to attend clinic programs. Imprecise prevention counseling messages make it difficult for men to conceptualize risk reduction. Effective safer conception programs should embrace clear language, e.g. undetectable = untransmittable (U = U), and support multiple approaches to serostatus disclosure to pregnancy partners.

The Interplay between Message Framing and Message Recipients' Regulatory Focus in Promoting HPV Prevention Strategies.

Limited awareness and low uptake rate of Human papillomavirus (HPV) prevention strategies among females require the development of more effective educational interventions. Regulatory focus theory posits the matching of framing valence with the recipients' regulatory focus increases persuasiveness. Following regulatory focus theory, we examined how individual regulatory focus changed the effects of gain- and loss-framed messages on promoting consistent condom use and HPV DNA testing for HPV prevention. We also explored whether this interaction effect impacts the influences of target individuals' initial attitudes about condom use and HPV DNA testing on post attitudes and intentions. Results of Study 1 showed that, in general, the gain-framed message fit with regulatory focus (i.e., promotion focus) promoted more positive attitudes about consistent condom use than the gain-framed message nonfit with their regulatory focus (i.e., prevention focus).Nevertheless, the gain-framed message nonfit with regulatory focus (i.e., prevention focus) strengthened the negative relationship between initial attitudes and intentions, which promoted the intentions to use condom consistently among people who initially held negative attitudes toward consistent condom use. In Study 2, we did not observe a significant interaction effect of message framing and regulatory focus in the HPV DNA testing context. However, we observed that the gain-framed message nonfit with regulatory focus (i.e., prevention focus) led to the changes in the significance of the initial attitudes - post attitudes relationship from significant to non-significant. Thus, the reliance on initial negative attitudes about HPV DNA testing in decision-making decreased. Theoretical and practical implications of our research were discussed.

Percepção de risco e comportamentos de saúde em relação ao sexo casual em universitárias / Risk perception and health behaviors in relation to casual sex in college women / Percepción de riesgo y conductas de salud en relación al sexo casual en estudiantes universitárias

Este estudo buscou explorar e comparar a percepção dos riscos à saúde física e os comportamentos de saúde do sexo casual entre universitárias com (CEX) e sem experiência (SEX) de sexo casual. Participaram 1.133 universitárias brasileiras (média de idade igual a 21,05 anos, DP = 2,05), a maioria nascidas e residentes na região Sul do país, que responderam a um questionário on-line com questões sobre a percepção dos riscos físicos, comportamentos de saúde, comportamento e histórico sexual. Foi encontrada diferença significativa nos comportamentos de saúde e nas percepções de risco entre os grupos. O grupo CEX apresentou mais comportamentos de saúde e cuidados que o grupo SEX. Embora o sexo casual esteja relacionado aos comportamentos de risco, neste estudo, as mulheres CEX apresentaram mais medidas de proteção à saúde que as mulheres SEX. (AU)

This study aimed to explore and compare the perceptions of physical health risks and healthy sex behaviors among female university students with (CEX) and without (SEX) experience in casual sex. With a comparative cross-sectional design, the study included 1,133 Brazilian female university students (mean age 21.05 years, SD=2.05), mostly born and resident in the southern region of the country, who completed an online questionnaire about their perception of physical risks, their health behaviors, and their sexual behavior and history. There was a significant difference in health behaviors and risk perceptions between the two groups, where the CEX group showed higher levels of healthy behaviors and care than the SEX group. Although casual sex is related to risk behaviors, in this study, women in the CEX group reported taking more health protection measures than those in the SEX group. (AU)

La investigación tuvo como objetivo explorar y comparar la percepción de riesgo con la salud física y las conductas de salud relacionadas al sexo casual entre estudiantes universitarias con (CEX) y sin experiencia (SEX) de sexo casual. Participaron 1.133 estudiantes universitarias brasileñas (edad media de 21,05 años, DS=2,054), mayoritariamente nacidas y residentes de la región sur del país, que contestaron a un cuestionario online con preguntas sobre percepción de riesgos físicos, sus conductas de salud e historial sexual. Se pudo observar una diferencia significativa en los comportamientos de salud y en las percepciones de riesgo entre los grupos. El grupo CEX presentó más conductas saludables y de cuidados que el grupo SEX. Aunque el sexo casual esté relacionado con conductas de riesgo, en este estudio las mujeres CEX presentaron más medidas de protección a la salud que las mujeres del grupo SEX. (AU)

The roles of women empowerment on attitude for safer sex negotiation among Indonesian married women.

The situation of low women empowerment in household settings might influence women's attitude and ability to negotiate for protected sex in their marital relationship. This study aimed to investigate the association between women empowerment factors and the attitude for safer sex negotiation among Indonesian married women. The secondary data of 28,934 individual records of married women retrieved from the 2017 Indonesia Demographic and Health Survey (IDHS) was used. The dependent variable was the attitude for safer sex negotiation measured by women's acceptance toward a justification to ask her husband to use a condom if her husband has a sexually transmitted disease. Multivariate logistic regression analysis accounting for the complex survey design was performed. The results showed that women empowerment factors, that include higher level of education and participation in household decision-making had a positive effect on women's attitude for protected sex. Those women with higher levels of HIV knowledge and whoever talked about HIV with their husbands were also more likely to justify for protected sex. Therefore, women empowerment through education, improving socioeconomic conditions, and increasing HIV-related knowledge can help develop a positive attitude and enable women to negotiate for safer sex with their partners.

Protection at First Sexual Intercourse Among Adolescent Girls and Young Women in Kenya.

Adolescent girls and young women (AGYW) are at high risk of HIV and other sexually transmitted infections (STIs), including at first sexual intercourse. The literature is scarce on factors influencing use of protective strategies at this critical time. We conducted 20 in-depth interviews and five focus group discussions with purposively sampled AGYW aged 16-20 years who reported first sex while enrolled in a larger cohort study and willing to participate. All AGYW were counseled on HIV prevention and had access to reproductive health information and services. Data collected were transcribed, translated and analyzed thematically. We identified two approaches to first sex. In one approach, the AGYW facilitated protection use, and those AGYW reported intention and preparation to initiate sexual activity and ability to request condom use, as well as their male partner's willingness to use and provide condoms. In another approach, AGYW experienced first sexual intercourse without agency (the feeling of control over actions and their consequences [Moore, 2016]) and described lack of prior intentions and planning, discomfort with discussions about sex and condom use, and desire to experience sexual pleasure as reported by peers. No AGYW mentioned parents/adults as playing any role as facilitators of protection use at first sex, highlighting the need for further research on the missing gap. The AGYW were trusting of verbal reports by male partners describing themselves as having never engaged in sex, HIV negative, and free of STIs. We found that some AGYW were empowered to plan, discuss, and request protection at first sex, and others did not take agency. First sex is a time of vulnerability where innovative strategies are needed to strengthen AGYW's agency and promote condom use and other HIV/STI prevention methods.

The Disaggregated Repeated Measures Design: A Novel Approach to Assess Sexual Risk Behaviors.

Although numerous studies have examined sexual and substance use behaviors that put people at risk for sexually transmitted infections including HIV, most focus on an overall measure of aggregate risk or a few simple and particular subtypes of sexual acts assessed in separate analyses. In this article, we introduce a more sensitive approach to assess how the relative characteristics of sex acts may determine the level of risk in which an individual chooses to engage. Project AWARE, a randomized clinical trial conducted among 5012 patients in nine STD clinics across the U.S., is used to illustrate the approach. Our study was guided by two aims: (1) describe a new approach to examine the count of sexual acts using a disaggregated repeated measures design and (2) show how this new approach can be used to evaluate interactions among different categories of sexual risk behaviors and other predictors of interest (such as gender/sexual orientation). Profiles of different subtypes of sexual acts in the past 6 months were assessed. Potential interactions of the characteristics associated with each subtype which resulted in up to 48 distinct subtypes of sexual risk behaviors-sex with a primary/non-primary partner; partner's HIV status; vaginal/anal sex; condom use; and substance use before or during sex act-can be examined. Specifically, we chose condom use and primary and non-primary status of partner as an application in this paper to illustrate our method. There were significantly more condomless sex acts (M = 23, SE = 0.9) and sex acts with primary partners (M = 27.1, SE = 0.9) compared to sex acts with condoms (M = 10.9, SE = 0.4, IRR = 2.10, 95% CI 1.91-2.32, p < .001) and sex acts with non-primary partner (M = 10.9, SE = 0.5, IRR = 2.5, 95% CI 2.33-2.78, p < .001). In addition, there were significant differences for the count of sexual risk behaviors among women who have sex with men (WSM), men who have sex with women (MSW) and men who have sex with men (MSM) for sex acts with and without condom use, primary and non-primary partner, and their interaction (ps = .03, < .0001, and .001, respectively). This approach extends our understanding of how people make choices among sexual behaviors and may be useful in future research on disaggregated characteristics of sex acts.

Attention-Deficit/Hyperactivity Disorder Symptoms Are Associated with Greater Delay Discounting of Condom-Protected Sex and Money.

Attention-deficit/hyperactivity disorder (ADHD) is associated with increased risk of detrimental life outcomes. Recent research also indicates that ADHD is associated with sexual risk behavior, such as unprotected sex. Some risky sexual behaviors may be driven, in part, by preference for immediate rewards, referred to as delay discounting, which is prominent in etiological models of ADHD. Therefore, the present study examined the effect of delay on preference for both monetary and sexual outcomes in adults with many ADHD symptoms (both on and off medication) and with fewer ADHD symptoms. Online participants (N = 275; n = 161 males, n = 114 females) completed a monetary delay discounting task, assessing preference for smaller sooner versus larger delayed hypothetical money, and the Sexual Delay Discounting Task, assessing preference for condom use in hypothetical casual sex scenarios based on delay until condom availability. Those with greater ADHD symptoms discounted delayed monetary outcomes as well as delayed condom-protected sex (i.e., preferred sooner money rewards and immediate unprotected sex) significantly more than those with fewer symptoms; however, no effect of current medication use was found across monetary or sexual delay discounting among those with greater ADHD symptoms. This study is the first to demonstrate the relation between ADHD symptoms and reduced condom-use likelihood. Increased discounting of delayed condom-protected sex might constitute one mechanism of risky sexual behavior among individuals with ADHD symptoms. Interventions geared toward increasing condom use in situations in which condoms may otherwise be unavailable, may mitigate risky sexual behaviors and their associated harms in this population.

The effects of psychological inoculation on condom use tendencies and barriers; a randomized controlled trial.

OBJECTIVE: Condom use prevents the contraction of the HIV. Research shows limited effects of education on increasing condom use. Psychological inoculation (PI) has been found to be more effective in this domain, however, its mechanism is unknown. This study examined effects of PI versus education on condom use barriers and tendencies, and its relations with cognitive dissonance, using a fully automatized online system. DESIGN: The study was a randomized controlled trial (RCT) and included 149 students from a German University randomly assigned to PI or a control condition. MAIN OUTCOME MEASURES: An indirect condom use test (I-CUTE), a condom use barriers questionnaire, self-reported condom use, and cognitive dissonance estimations were all assessed at baseline and one-month post-intervention. RESULTS: PI significantly increased I-CUTE scores when participants had sexual relations. Control participants increased in self-reported condom use and on I-CUTE scores in people without sexual relations. No changes in barriers were seen in either group. The cognitive dissonance tended to be higher in PI participants as compared to control participants. CONCLUSIONS: PI increases I-CUTE scores compared to controls (based on effect sizes), and significantly in those with sexual relations. The role of relationship status and the mechanisms of PI should be further examined.

"I'd Rather Use a Refuse Bag:" A Qualitative Exploration of a South African Community's Perceptions of Government-Provided Condoms and Participant-Preferred Solutions.

Despite South Africa experiencing one of the largest HIV epidemics in the world, condom use has decreased since 2008. However, condoms are the only low-cost HIV prevention technology widely available in South Africa. This study aims to explore a South African community's perceptions of condoms, recent condom use decrease, and suggestions for increasing condom use. In 2014, we conducted seven focus groups (n = 40 men) and 20 in-depth interviews (n = 9 men, n = 11 women) with participants aged ≥ 18 years recruited from four urban settlement health clinics in Cape Town, South Africa. Data were collected, coded, and analysed using a general inductive approach. Participants perceived government-provided condoms negatively, with themes including "disgust" for condom physical properties, concerns with social status associated with free condoms, and performance concerns. There was an intersection of themes surrounding masculinity, condom use, and sexual pleasure. Solutions to increase condom use included improving the quality and variety of free condoms and rebranding free condoms. Participants suggested that condoms are distributed with novel attributes (e.g., more colors, smells/flavors, sizes, and in-demand brands) and that government programs should consider offering all brands of condoms at no or low cost. This study suggests a substantial rethinking of condom branding for government-provided condoms. Our findings suggest that condom dissemination and promotion programs should proactively address public concerns regarding condoms. Existing societal and structural norms such as hegemonic masculinity must also be addressed using gender-transformative interventions. We also strongly suggest the creation of a Male Condom Acceptability Scale to understand condom users' needs.

Covariates of Multiplicity of High-Risk Sexual Behavior Among Men in India: Evidence from the Latest Indian Demographic and Health Survey.

Modern Indian society has witnessed rapid sociocultural transformation where loosening of cultural values is observed at all levels. In the era of transition, traditional norms and values are changing where young male individuals are found to be associated with high-risk multi-partner sexual behavior. Findings are based on a nationally representative sample of 45,231 and 65,704 men aged 15-54 during the period 2005-2006 and 2015-2016, respectively. The burden of high-risk sexual behaviors among men aged 15-54 years in India over the last decade remains disproportionately higher among younger, unmarried, and urban men, who are mainly from economically better-off households. Despite tremendous efforts of the government of India as well as various state governments in condom promotion as part of the HIV/AIDS prevention program, the improvements in condom use over the last decade are not impressive as it has not yet reached the desired threshold level. The disparities in high-risk sexual behavior among men aged 15-54 years, coming from rich and poor households, have narrowed. The findings of the study also underline an apparent paradox in the relationship between knowledge of HIV/AIDS and indulgence in high-risk sexual behavior and adopting safe sexual practices. It is recommended that all the HIV prevention programs in India should promote the concept of men as the responsible sexual partner. This concept may be promoted among young and unmarried men by reinforcing the shift from violence to respect and projecting the condom as a sexual stimulus rather than a means of disease prevention.

Association between Psychological Factors and Condom Use with Regular and Nonregular Male Sexual Partners among Chinese MSM: A Quantitative Study Based on the Health Belief Model.

OBJECTIVE: The Chinese men who have sex with men (MSM) population is suffering from a high HIV infection rate owing to unprotected anal sex. The Health Belief Model (HBM) has been proven to be an effective frame associated with behavior maintenance. Based on HBM, we analyzed the beliefs associated with consistent condom use behavior with regular and nonregular partners among MSM to better provide targeted interventions and services. METHODS: A study was conducted in Sichuan Province, China, from November 2018 to April 2019, and 801 eligible participants were recruited by snowball sampling. Sociodemographic characteristics, AIDS-related characteristics, sexual behaviors, condom use behavior, and dimensions of HBM were investigated. Univariate, single multivariate, and summary multivariate models were employed to analyze the factors associated with consistent condom use. RESULTS: Of all participants, 39.1% and 53.6% had had anal sex with regular and nonregular partners in the last six months, respectively. Only 56.5% of them had used condoms consistently with regular partners, and only 60% of them had used condoms consistently with nonregular partners. When taking consistent condoms use with regular partners as the dependent variable, the dimensions of perceived threats (ORM = 1.28, 95% CI: 1.10, 1.49), perceived barriers (ORM = 0.70, 95% CI: 0.60, 0.82), self-efficacy (ORM = 1.23, 95% CI: 1.14, 1.32), and cues to action (ORM = 1.21, 95% CI: 1.02, 1.43) showed significant associations with the dependent variable. When taking consistent condoms use with nonregular partners as the dependent variable, the dimensions of perceived barriers (ORM = 0.77, 95% CI: 0.67, 0.89), self-efficacy (ORM = 1.22, 95% CI: 1.13, 1.32), and cues to action (ORM = 1.53, 95% CI: 1.30, 1.80) showed significant associations with the dependent variable. CONCLUSIONS: More attention should be focused on how to decrease the obstructive factors of condom use, how to improve the confidence of condom use, and how to layout more cues to action to promote consistent condom use behavior with regular and nonregular partners during anal sex among Chinese MSM.

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

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

Knowledge of safe sex and sexually transmitted infections among high school students, Vientiane Prefecture, Lao PDR.

BACKGROUND: Adolescent knowledge of safe sex and sexually transmitted infections (STIs) can reduce the risk of STIs as well as unplanned pregnancies. OBJECTIVE: To describe the knowledge of safe sex and STIs and to identify related factors among high school students in Vientiane Prefecture, Lao PDR. METHOD: This was an analytical cross-sectional study conducted at one high school from January to February 2019. A self-administered questionnaire was used to collect information from respondents. The questionnaires were completed by 337 respondents who were selected by stratified random sampling. The data collected were entered into and analysed using EpiData and Stata 13.0 software. Descriptive and inferential statistics were applied to determine the factors associated with knowledge of safe sex and STIs. RESULTS: The results showed that nearly half of the participants (49.5%) had a good knowledge of safe sex and 51.9% of the respondents had a good knowledge of STIs. Significant positive associations were shown between knowledge of safe sex by students living with other people, those who had studied family planning and had religious beliefs reflecting acceptance to using birth control. Other factors positively associated with knowledge of STIs were students being in Grade 10, and who had studied STIs including HIV/AIDS. CONCLUSION: In this study, approximately half of the participants were aware of safe sex and had knowledge of STIs. There is a need to have comprehensive sexual education, particularly emphasising family planning, STIs, and HIV/AIDS for all grades in school.