Feasibility and Use of School-Based Condom Availability Programs in Tijuana, Mexico

Condom availability programs (CAPs) may increase access to condoms and contribute to increased condom use among youth. This study describes the characteristics, degree of satisfaction, and gender differences among users of a CAP implemented in two high schools in Tijuana (Baja California, Mexico). A kiosk distributing free male condoms was set up in two high schools in Tijuana. Kiosk users (N=570) were more likely to be male, young, and/or enrolled in a lower SES school. Most kiosk users were either sexually active or planning to have sex. Females were less likely to request condoms and to continue using the kiosk, but more likely to request information on other contraceptive methods. Results demonstrate the feasibility of implementing CAPs in Mexican schools and suggest that these programs can improve adolescents’ condom access.     

Knowledge, risk perceptions and condom usage in male sex workers from three Australian cities

The study identifies factors associated with knowledge and perception of risk of HIV/AIDS, as well as attitudes to and usage of condoms by a sample of male sex workers (MSW). One hundred and eighty-five male sex workers completed a self-reported questionnaire, including knowledge about HIV transmission, attitudes to condom use and perceptions and personal susceptibility to HIV and sexually transmitted infection (STI) risk, and a two-week diary recording use of condom during commercial sex encounters. The findings reveal that condom use was found in 77.7% of the encounters with clients and the majority of the respondents perceived themselves to be at no risk for HIV because of sex work. Independent sex workers from Melbourne and workers who owned their place of residence used condoms in a significant lower proportion. Generally speaking, knowledge about the risks associated with AIDS was high, with respondents showing lower knowledge about the risks associated with unprotected receptive or active oral sex. Participants held a positive attitude to condom use; most considered the provisions of condoms to be their responsibility rather than clients; and they were more worried about contracting an STI than HIV. Those who scored higher on the knowledge scale had more positive attitudes to condom use and those who had a more positive attitude to condom use recorded a perceived lower risk of contracting STI but not HIV. The study discusses the relevance of these findings for public health risk reduction and sexual health education campaigns.     

Gender differences in sexual behaviors and factors associated with nonuse of condoms among homeless and runaway youths.

Few studies have examined gender-specific factors associated with the nonuse of condoms among homeless and runaway youths (HRYs)-a population at high risk for HIV infection. In this article, we evaluate these factors and explore gender differences in background experiences, psychosocial functioning, and risk behaviors among HRYs from four U.S. metropolitan areas. Of 879 sexually active HRYs sampled, approximately 70% reported unprotected sexual intercourse during a 6-month period, and nearly a quarter reported never using condoms in the same period. Among males and females, having only one sex partner in the previous 6 months had the strongest association with nonuse of condoms. Among males, nonuse was also associated with having ever caused pregnancy, frequent marijuana use, prior physical victimization, and low self-control and sociability. Among females, nonuse was associated with knowledge of HIV status, prior sexual victimization, low social support, and infrequent marijuana use. These findings highlight the ongoing need for HIV prevention services for HRYs. Implications for the scope and content of these services are discussed.     

Gender Differences in the Sexual Risk Practices of HIV+ Heterosexual Men and Women

Although heterosexual transmission of HIV is an important public health concern in the United States, there is a paucity of data on the sexual risk practices of HIV+ heterosexual men and women. This study examined gender differences in rates of unprotected vaginal, oral, and anal sex in a sample of 47 non-IDU heterosexual HIV+ individuals (20 men, 27 women) who reported sexual relations with serodiscordant partners. HIV+ women reported significantly more acts of unprotected vaginal sex as compared to men. Conversely, HIV+ men reported significantly more acts of unprotected receptive oral sex as compared to women. Reasons for not always using condoms varied by gender. HIV+ women were most likely to report partner refusal, whereas HIV+ men were most likely to report that their partner did not ask to use a condom. Our findings suggest the need to develop behavioral interventions that are sensitive to gender issues, and take into account the importance of relationship issues.     

Factors associated with female condom use among HIV-seropositive women

Female condoms are an effective option for preventing sexually transmitted diseases (STDs), including HIV transmission. Little is known, however, about female condom use in women living with HIV/AIDS. Ninety HIV-positive women completed measures of demographic characteristics, exposure and use of female condoms, attitudes toward female and male condoms, sexual behaviours, and substance use. Most women (77%) had been exposed to female condoms, however only 30% reported lifetime use, 16% reported recent use, and only 6% of the sample used female condoms as much or more than they used male condoms. The only factors consistently associated with female condom use were positive attitudes toward female condoms. Women who recently used female condoms were also more likely to have multiple male sex partners and reported fewer unprotected intercourse occasions. Female condoms are therefore used by a small number of HIV-infected women, particularly those with more than one male sex partner. Female condom use may be enhanced by removing barriers to their use, increasing cooperation of male partners, and enhancing proficiency of use.     

Predictors of Day-Level Sexual Risk for Young Gay and Bisexual Men

As HIV infection rates remain high among young gay and bisexual men, investigations into determinants of sexual risk are paramount. This study examined independent and interactive effects of substance use, mental health, perceived benefits of unprotected sex, and type of sex partner on odds of not using condoms. Analyses included 188 high-risk substance using HIV-negative and unknown status young gay and bisexual men (ages 18–29). Substance use and endorsing favorable attitudes towards unprotected sex strongly predicted sexual risk. Mental health moderated the relationship between partner type (main vs. casual) and condom use such that increased anxiety and depression were associated with increased odds of using condoms with main partners and not using condoms with casual partners. Understanding how these determinants of HIV risk converge to predict unprotected anal sex can identify essential risk relationships for prevention, obtain effects sizes of greater magnitude and prolonged sustainability, and build robust couples-based interventions.     

AIDS knowledge, perception of risk, and behaviors among female sex partners of injection drug users.

Interviews were conducted with 137 female sex partners of male injection drug users to provide quantitative and qualitative information regarding their AIDS knowledge, attitudes, and specific risk behaviors. Levels of knowledge regarding HIV transmission and prevention were high, with an average of 81.8% correct on a 16-item test. Most women (87.5%) believed that there was at least some chance they would become HIV infected. Substance abuse was prevalent; 67.2% used non-injection drugs (44.5% used crack cocaine), and 32.1% reported prior use of injection drugs. One fifth had engaged in prostitution. Although AIDS knowledge was high, almost all (94.9%) reported engaging in unprotected vaginal intercourse during the previous 6 months, and 6.6% reported anal intercourse without a condom. Among women who did not report consistent condom use, the most frequently stated reasons for non-use of condoms were dislike by their male partner (26.9%) and/or personal dislike of condoms (23.1%). A disturbing pattern of increased risk was observed among black interviewees, who were more likely than Latinas or whites to have contracted syphilis, have multiple sex partners, engage in prostitution, use crack cocaine, and drink alcohol daily.     

Correlates of HIV risk among Ecuadorian adolescents.

The purpose of this study was to examine the relationship of HIV knowledge, demographics, and psychosocial factors with HIV risk behavior among high school students (N = 805) in urban and rural regions of Ecuador. Forty-three percent of the participants reported being sexually experienced. Of the sexually experienced participants, 50% reported never using condoms for intercourse, and 70% did not use condoms at last intercourse. A small minority of the sample felt that they were at risk for contracting HIV (18.5%). Educational aspirations past high school and residence in an urban area were significantly associated with decreased HIV risk (condom use at last intercourse and abstinence). High self-efficacy for condom use and strong refusal skills to unsafe sex were also significantly associated with decreased HIV risk. Consistent with prior research, the participants that reported their peers were sexually experienced were significantly more likely to have had sex. The discussion focuses on the use of interventions and education for promoting safer sexual behavior among Ecuadorian adolescents.     

Nonsupportive Peer Norms and Incarceration as HIV Risk Correlates for Young Black Men who have Sex with Men

Black men who have sex with men (BMSM) are at considerable risk for HIV infection. A convenience sample of BMSM (n = 252) attending nightclubs in three North Carolina cities was surveyed to investigate factors associated with unprotected anal intercourse (UAI). About 45% reported UAI in the past 2 months. BMSM who strongly agreed that their male friends used condoms for anal sex were significantly less likely to report any UAI. Recently incarcerated men were significantly more likely to report unprotected insertive anal sex. In secondary analyses, men who reported experiencing discrimination based on their race and nongay identified men reported more favorable peer norms for condom use. Men who reported that their family disapproved of their being gay were more likely to have been incarcerated in the past 2 months. HIV prevention for BMSM must promote supportive peer norms for condom use and address incarceration, racial discrimination, and family disapproval.     

'Don't know' and 'didn't think of it': condom use at first intercourse by Latino adolescents

We examined the specific reasons Latino adolescents did or did not use condoms at first intercourse and their specific reasons for their perceived risk for contracting HIV. Latino adolescents (n = 618), ages 11-19, completed a face-to-face interview that included information on demographics (sex, age, family-status (lives with both natural parents versus other family structure) and country of birth) and sexual behaviour. The respondents cited 'don't know' (25.9%), 'not available' (25.9%) and 'didn't think of it' (23.5%) as the most frequent reasons for not using condoms at first intercourse. Anyone can get it (41.8%), unknown knowledge of partner's serostatus (24.7%) and unprotected sex (23.8%) were the top three reasons for perceiving oneself as being at risk for contracting HIV. Sexually active adolescents were more likely to perceive themselves at risk for contracting HIV than adolescents that had not had sex. Males were significantly more likely to report using condoms for protection at first intercourse than females. The remaining demographic factors were not significantly related to use of condoms at first intercourse nor to perceived risk for contracting HIV.     

Self-perceived risk of HIV infection and attitudes about preexposure prophylaxis among sexually transmitted disease clinic attendees in South Carolina

Several domestic and international trials of the use of preexposure prophylaxis (PrEP) for HIV prevention are ongoing among groups at high risk for HIV infection. The objective of this cross-sectional study was to assess self-perceived risk of HIV infection and attitudes about PrEP among 405 sexually transmitted disease (STD) clinic attendees in South Carolina. Self-percieved risk of HIV infection and attitudes about PrEP were assessed using three questions from a self-administered survey. Ordinal logistic regression and logistic regression were used to evaluate differences in risk perception for HIV infection and attitudes about the use of PrEP among risk groups. Compared to heterosexual participants, homosexual participants were significantly more likely to have knowledge of PrEP (odds ratio [OR]=6.7, 95% confidence interval [CI]: 1.70-26.1). Compared to those participants who had 1 sexual partner in the past 3 months, individuals who had 2 to 4 sexual partners in the past 3 months were approximately 2.35 times as likely to have a lower level of agreement with the statement "I believe I am at risk of getting HIV" (p=0.0003). Compared to female participants, respondents who were male were approximately 2.8 times as likely to have a lower level of agreement with the statement "If I had to it would be very difficult for me (or my partner) to both use condoms and take daily pills to prevent HIV infection" (p<0.0001). These results suggest the need for the creation of PrEP implementation programs that are tailored to self-perceived risk perception, age, and gender.     

Unprotected Sexual Behavior and HIV Risk in the Context of Primary Partnerships for Transgender Women

Previous research has reported that transgender women are likely to be exposed to HIV through unprotected sex with a male primary partner. We examined prevalence and correlates of unprotected sex with a primary male partner in a sample of n = 174 transgender women. Participants completed surveys on demographic characteristics, relationship dynamics with their male primary partner, sexual behavior, substance use, and psychosocial factors. Overall, 41% reported HIV positive status, 13% had another sexually transmitted infection during the past year, and 34% had unprotected sex with a male primary partner during the past 3 months. Factors associated with unprotected sex with a primary partner included living with the partner, drug use, alcohol use, education level, low self-efficacy to use condoms, and perceived discrimination. Notably, 35% of transgender women in HIV-discordant primary partnerships had unprotected sex with their male primary partner during the past 3 months, and 18% of transgender women in HIV-positive concordant primary partnerships had unprotected sex with an outside partner during the past 3 months. HIV prevention interventions for transgender women must address risk behavior in the context of primary partnerships as well as sex with concurrent partners outside the relationship. Couples-focused interventions involving transgender women and their male primary partners can be particularly promising.     

Male and female rural probationers: HIV risk behaviors and knowledge

Individuals involved in the criminal justice system are at substantial risk for HIV infection and have elevated rates of AIDS. Offenders under community supervision, such as probationers, have substantially more opportunities to engage in high-risk behaviors than prisoners. Furthermore, probationers in rural areas are at risk because rural areas may be slower to adopt HIV risk-reduction approaches. Consequently, the primary goal of this study is to describe the HIV risk behaviors and level of HIV knowledge of 800 rural felony probationers. Bivariate results indicate that males have substantially greater criminal histories and engage in more substance use risk behaviors than females. Overall, there was minimal and inconsistent use of condoms, but there were no significant differences by gender. Gender differences prevailed in perceived HIV knowledge, with females reporting high levels of perceived HIV knowledge. Multivariate models did not support the hypothesis that perceived knowledge would be a more robust correlate of scores on the HIV Risk Behavior Knowledge Test for males than females. Results suggest that rural residents are not protected from engaging in HIV risk behaviors and future studies should examine gender discrepancies between perceived and actual HIV knowledge among offenders under community supervision.     

Sexual risk behaviors of Gay, Lesbian, and bisexual youths in New York City: prevalence and correlates.

The lifetime and recent sexual risk behaviors of 156 Gay, Lesbian, and bisexual youths, recruited from Gay-focused organizations in New York City, were examined. The data indicated seven reasons why the youths are at risk for HIV and other STDs: They initiated sex during early adolescence; their first sexual partners were older than they were; HIV barrier methods (e.g., condoms) were initiated subsequent to sexual debut; many lifetime sexual partners and encounters were reported; some youths exchanged sex for goods; many youths reported having had at least one partner at risk for HIV; and the youths engaged in unprotected sexual behaviors during the past 3 months. Significant gender differences emerged (e.g., the male youths reported more lifetime same-sex partners than the female youths; the female youths reported more lifetime other-sex partners than the male youths). Recent sexual risk behaviors (i.e., numbers of same-sex partners, encounters, and unprotected sex during the past 3 months) were related significantly to the youths' average degree of emotional involvement in or average duration of intimate relationships.     

Prevalence of HIV and factors associated with risk behaviours among Chinese female sex workers in Hong Kong

The study examined the HIV prevalence and factors associated with risk behaviours among Chinese female sex workers (FSW) in Hong Kong. Unlinked anonymous HIV antibody testing and interviews, using structured questionnaires, were conducted for 293 FSW. None was tested HIV positive. In the last 6 months, 13.7% self-reported having contracted STD, 50.7% were not using condoms with their male clients consistently; 73.3% and 22.6% respectively had had unprotected sex with boyfriends and one-night-stand partners. Believing that condom use with a boyfriend is a mistrust and the perception that one did not have full control over condom use decisions, would agree not to use condoms if being paid more, and could not refuse to have unprotected sex with clients were significantly associated with condom use with various types of sex partners (OR =1.95 to 4.83). FSW has low HIV prevalence but high prevalence of risk behaviours. Bridging effects exist. Empowerment of FSW is warranted.     

Health knowledge and beliefs as predictors of intended condom use among Zimbabwean adolescents in probation/remand homes

The association of AIDS knowledge, perceived susceptibility to HIV, efficacy of preventive measures, severity of HIV infection, cues to action, barriers to action and alcohol/drug use with intended condom use was examined among Zimbabwean adolescents (mean age = 16.9) in probation/remand homes. Eighty-six percent of males and 83% of females were reportedly sexually experienced of whom 28% of males and 14% of females reported consistent condom use. Those who knew that babies can be born with AIDS, that there is no vaccine against HIV and that traditional healers cannot cure AIDS were 2.50, 2.32 and 1.97 times as likely to definitely intend to use condoms. Individuals who believed condoms seldom break or leak and are effective against HIV were 4.12 and 4.65 times as likely to definitely intend to use them. Those who believed parents and boyfriend/girlfriends thought condoms should be used were 2.27 and 2.13 times as likely to intend to use them. Respondents who had talked about AIDS with friends, with their boyfriend/girlfriend or a schoolteacher or seen a picture or film of a PWA were, in comparison to those who had not engaged in these actions, 3.70, 2.33, 2.43 and 2.50 times as likely to definitely intend to use condoms. Those who were embarrassed to get condoms from a clinic, thought persons who use condoms are loose and or that the pleasure of unprotected sex was worth the risk of HIV were 3.87, 3.42 and 3.40 times as likely to intend to use condoms. Logistic regression identified belief in efficacy of condoms as the principal predictor of intended condom use.(ABSTRACT TRUNCATED AT 250 WORDS)     

Differences in HIV Risk Behaviors Among Women Who Exchange Sex for Drugs, Money, or Both Drugs and Money

The purpose of this study was to investigate differences in drug use and HIV risk behaviors among women who exchanged sex for drugs only, for money only, or for both drugs and money. Structured interview responses from 2,042 drug-using women in 23 cities who reported having exchanged sex in the prior 30 days were analyzed. Results indicated that women who exchanged sex for drugs only (n = 117), and for drugs and money (n = 965), were more likely to use alcohol and smoke crack than those who exchanged sex for money only(n = 960). They were also more likely to have had unprotected sex and sex with a drug injector. Those who exchanged sex only for drugs reported having sex half as often as the other two groups and had one fourth the number of partners, but used condoms the least when having sex. Women who exchanged sex for money only were the most likely to inject drugs and the least likely to have had unprotected sex. Promoting condom use and increasing availability of condoms to women who exchange sex, and to their partners, is crucial. Continued research into the relationship between crack use and sex-related HIV risk behaviors is also needed.     

Unprotected Sex of Homeless Women Living in Los Angeles County: An Investigation of the Multiple Levels of Risk

This research uses multi-level modeling to investigate the context of unprotected sex of homeless women. Based on interviews with 429 randomly selected women living in temporary shelter settings in Los Angeles, this project investigates multiple levels of influence on unprotected sex with particular partners. Previous studies have investigated condom use of homeless women primarily at the individual level. This project investigates unprotected sex at the level of the partnership, the individual woman, and her social network. Homeless women who believe in the efficacy of condoms to prevent HIV infection, believe that they have low susceptibility to HIV and have a greater proportion of their non-sex partner social network ties with whom they speak about HIV are less likely to engage in unprotected sex. Women are more likely to engage in risky sexual behavior in relationships in which they have high commitment to their partner and experience physical violence.     

HIV-related risk behaviors among cocaine users.

Risk behaviors related to human immunodeficiency virus (HIV) infection and transmission were studied in a sample of 167 male cocaine users admitted during a 5-month period to an inpatient drug treatment program. Data obtained included drug history and related behaviors, sexual behaviors, knowledge, and attitudes regarding HIV infection and AIDS. Approximately 20% of the sample had used IV drugs in the year prior to the interview and 94% of these reported sharing needles; 20% of the IV drug users (IVDUs) reported always using bleach to clean needles. With regard to sexual practices, 7% of the total sample reported sex with other males in the year prior to the interview; 86% of the total sample reported having sex with females and 80% of these noted they never or rarely used condoms during vaginal sex. Respondents generally did not believe they themselves were at high risk for HIV infection, yet they continued to engage in acknowledged high-risk behaviors. These findings suggest that IVDUs and non-IV cocaine users are likely to contribute to the spread of HIV in several populations.     

Predictors of HIV Sexual Risk Behaviors in a Community Sample of Injection Drug-Using Men and Women

Injection risk practices and unprotected sex between injection drug users (IDUs) and their sexual partners are responsible for a high proportion of AIDS cases and new HIV infections in the United States. The purpose of this study was to investigate the links between drug use behaviors and psychosocial factors with high-risk sexual behaviors among male and female IDUs. Understanding the determinants of sexual risk practices among drug users can lead to the development of more effective programs to prevent sexual HIV and STD transmission. This study enrolled a community sample of 101 IDUs (males = 65, females = 36), primarily African American and unemployed, who injected drugs and had unprotected sex in the past 3 months. The sample was categorized into highest sexual risk (multiple partners and intercourse without condoms) and lower sexual risk subgroups. Univariate analyses showed that IDUs at highest sexual risk had lower sexual risk reduction self-efficacy (p =.01) and were more likely to be African American (p =.02). Drug users at highest sexual risk also used noninjected cocaine and crack more frequently (p =.05), were less likely to inject heroin (p =.04), and tended to more often inject cocaine (p =.05). IDUs at highest sexual risk also tended to more often use crack and methamphetamines. Logistic regression analyses showed that injecting cocaine or crack, sexual risk reduction self-efficacy, and race were independent predictors of sexual risk behavior levels. Sexual risk reduction programs for this population are needed, with HIV prevention programs tailored to specific IDU risk reduction needs.