Protection styles of prostitutes' clients: intentions,behavior, and considerations in relation to AIDS

The perceived costs and benefits of condom use within the context of commercial sex were examined in interviews with 87 clients of female Dutch prostitutes. 8 types of condom users were identified: convinced (46% of the study group), guilty conscience (11%), anti-ridden (13%), defaulting (6%), maximum selective (8%), minimum selective (3%), indifferent (8%), and recalcitrant (5%). Clients who consistently used condoms take responsibility for both the pleasure and safety of their sexual encounter; their attitude toward prostitution is positive and straightforward. Guilty conscience users are motivated to use condoms by feelings of guilt toward their wife and are ambivalent about their participation in commercial sex. Angst-ridden users are motivated to seek out prostitutes more by loneliness than the pursuit of sexual pleasure; they view their personal risk of acquired immunodeficiency syndrome (AIDS) as higher than that reported by consistent users and thus are motivated by fear to use condoms. Defaulting users perceive themselves as the victims of temptation and express a lack of control over the sexual encounter that places them at risk of unprotected sex. Maximum selective users are consistent in using condoms in sex with prostitutes, except when it involves a prostitute whom they see regularly and frequently. Minimum selective users seek frequent contact with prostitutes and base condom use on a subjective assessment of whether the woman is healthy or not. Indifferent users, often disabled and lonely men with no other source of sexual contact, base their condom use or nonuse solely on the wishes of the prostitute. Finally, recalcitrant users are characterized by a desire for power and protest condom use. In general, consistent condom use was related to a positive evaluation of prostitutes, positive attitudes toward the advantages of condom use, an internal locus of control with regard to health, and a higher level of education.     

The role of cues,self-efficacy,level of worry,and high-risk behaviors in college student condom use

A sample of 879 undergraduate students were recruited from a public university in western New York state during the 1993-94 academic year in order to study condom use among sexually active young people 18-24 years old. A 104-item questionnaire was administered consisting of 5 instruments and single-item measures of sexual behavior and demographics. The instruments were: the Condom Use Self-Efficacy Scale (CUSES), the Perceived Barriers to Condom Use, the Perceived Susceptibility to HIV/AIDS and other STDs, the Cues to Condom Action Scale, and the Perceived Norms scale. 92% of students reported having had sexual intercourse in the past, while 86.75 reported having sexual intercourse in the previous year. About 61% reported having 1 sex partner in the previous 12 months, whereas 35.2% reported having 3 or more partners. 22.4% reported 2 or more 1-night stands. 54.5% reported worrying about HIV/AIDS occasionally, while 23.1% reported doing so frequently. 17.2% (99) of the students were classified as non-users of condoms, 50.2% (289) as sporadic users, and 32.6% (188) as consistent users. 78 (12%) could not be classified. A multiple discriminant function analysis was also conducted to distinguish among the 3 condom user groups totalling 576 cases. The variables were age, gender, frequency of drunkenness during sexual intercourse, number of sex partners, and number of 1-night stands in the past 12 months, perceived barriers, worrying about HIV/AIDS, perceived susceptibility, condom use self-efficacy, and cues to condom action. Two significant functions emerged. Function 1 clearly separated the sporadic users from the consistent users (p 0.001), while Function 2 clearly separated the sporadic users from the non-users (p 0.001). The discriminating variables correctly classified 64.58% of the respondents into the 3 condom user groups. The variables were most effective at correctly classifying non-users (68.7%), consistent users (67.8%), and sporadic users (61.2%). Sporadic users were more diverse with respect to condom use than the other 2 groups.     

The salience and utility of school sex education to young men

This paper focuses on young men's views on the school sex education they have received, the influence of this sex education on their intended or actual behaviour, and the extent to which other sources of information complement or supplement school sex education. Thirty‐five in‐depth interviews and eight group discussions were conducted with male pupils from six schools in the east of Scotland. Most of those interviewed did cite school as a useful source in learning about sex. The most commonly named highlights were learning more about what girls think about sexual matters and learning how to use a condom. Nine described how something they had learned in school sex education had changed the way they had behaved in a sexual encounter. A further eight, who had not experienced sexual intercourse, talked about how they thought sex education would influence their behaviour in a positive way in the future. The most common criticism of sex education was that it was not explicit enough. Although friends and/or television were named by the majority of young men as useful, for most young men school sex education appeared to be the only substantive source of information they had received on sexual matters.     

Contraception and condom use among two samples of university students: 1982 and 1992

8% of all individuals residing in the US have tested positive for infection with HIV. This study reports the use of condoms and others forms of contraception in two samples of students from East Carolina University. 234 students in 1982 taking a course in marriage and family responded to a 32-item questionnaire distributed in five classes on whether they had used contraception during their most recent episode of sexual intercourse and which method they used. 96% of the respondents were never married, 83% white, and 82% middle class. 7% were engaged to be married and 3% were cohabiting. 53.4% were women and in their junior or senior year (52.5%) of undergraduate education. While the sample was not random, it closely approximated the demographic characteristics of the university from which it was drawn. 79.1% reported using some form of contraception, with 61.8% using the pill and 15.3% using the condom. Of those who used a form of contraception, 8.1% reported using withdrawal and 1.5% rhythm. Fifty university students were again sampled in 1992 in a marriage and family class to find 76% reporting use of contraception during their last episode of sexual intercourse. The percentage of students which reported using a condom, however, increased to 39%. These findings add to the body of research literature which suggests that condom use has increased over the past decade. Further research is, however, warranted to determine whether these data reflect an actual increase in condom use or are simply the result of students providing socially desirable answers.     

Correlates of Condom use Among Community College Women: The Role of Victimization,Substance Use,and Mental Health Symptoms

Research is needed to understand intersecting health risks among community college students. Applying a syndemic framework, the present research explored childhood sexual victimization, adolescent sexual victimization, intimate partner violence (IPV), marijuana use, alcohol consumption, and symptoms of depression and post-traumatic stress disorder as additive as well as interactive correlates of women's condom use. Questionnaires were administered to a sample of 212 women between the ages of 18 to 24 attending a community college. A series of logistic regression analyses documented that an increased number of psychosocial risk factors was associated with not using a condom during sexual intercourse. Experiencing both adolescent sexual victimization and lifetime IPV, compared to experiencing one form of victimization, increased the odds of not using a condom. Endorsing both lifetime IPV and past year marijuana use, compared to endorsing only one of these factors, also increased the odds of not using a condom. These findings highlight the importance of targeting intersections between adolescent sexual victimization, IPV, marijuana use, and sexual risk behavior when developing educational programs for community college women.     

Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men's Health Study

OBJECTIVE: The prevalence and characteristics of childhood sexual abuse (CSA) among men who have sex with men (MSM), and links with sexual risk are explored. A model linking CSA and sexual risk among MSM is proposed. METHOD: A telephone probability sample of urban MSM (n = 2881) was recruited and interviewed between November 1996 and February 1998. The interview covered numerous health issues, including history of sexual victimization. RESULTS: One-fifth reported CSA, primarily by non-family perpetrators. Initial CSA experiences are characterized by high levels of force (43% involved physical force/weapons), and penetrative sex (78%; 46% reported attempted or actual anal intercourse). Such men are more likely than nevercoerced men to engage in high risk sex (unprotected anal intercourse with a non-primary partner or with a serodiscordant male). In multivariate analyses, the effect of childhood sexual coercion on sexual risk is mediated by substance use, patterns of sexual contacts, and partner violence, but not by adult sexual revictimization or by depression. CONCLUSIONS: Findings are interpreted within the context of social learning theory and prior research on sexual risk-taking. The high risk for CSA among MSM, which can predispose such men to patterns of HIV sexual risk, warrants new approaches in HIV prevention.     

Why schools should make condoms available to teenagers

The controversy surrounding sex education and condom availability programs in schools in New York City and throughout the US continues because parents worry that such programs encourage teenagers to engage in sexual behavior. But the reality is that more and more teenagers are engaging in sexual behavior anyway. The Carnegie Council on Adolescent Development found the 17% of girls and 29% of boys engaged in sexual intercourse by the time they were 16 years old. Many parents are ready to blame sex education and condom availability programs for these figures; these parents issue calls for "chastity education." Opponents of sex education also believe that these programs violate the rights of parents to education their children about moral behavior and religious values. But the truth is that these programs do not preclude the right of a parents to teach a child anything. They simply prevent the use of the public schools to impose religious beliefs on students. Those who argue that the mandate of schools is only to teach academic subjects forget that public high schools are the best place for sex education and condom availability programs because the schools are full of teenagers and of adults who are trained and willing to counsel them. Few educators would argue that schools should not teach values, and sex education and condom availability programs provide an excellent way to help teenagers understand not only human sexuality, reproduction, and the spread of disease but also social relationships, the development of cultural norms, and the role of responsible citizens. At the same time that we encourage sexual abstinence among young people, we must also teach about sexual responsibility. Sexual responsibility today means using a condom to prevent pregnancy and disease. If teenagers are embarrassed in their efforts to acquire condoms, pregnancy and diseases will be the result, not abstinence.     

Assessing Student Problem-Solving Skills

This article examines the structure of several HIV risk behaviors in an ethnically and geographically diverse sample of 8,251 clients from 10 innovative demonstration projects intended for adolescents living with, or at risk for, HIV. Exploratory and confirmatory factor analyses identified 2 risk factors for men (sexual intercourse with men and a general risk factor) and 3 factors for women (sexual intercourse with men, substance abuse, and a high risky sex behavior factor). All factors except women engaging in risky sex with men strongly predicted known HIV status of clients for men and women. The findings from this investigation highlight the use of structural equation modeling for applied problems involving overlapping and complex sets of risk behaviors in youth who present at community health programs.     

Level-Specific Evaluation of Model Fit in Multilevel Structural Equation Modeling

This article examines the structure of several HIV risk behaviors in an ethnically and geographically diverse sample of 8,251 clients from 10 innovative demonstration projects intended for adolescents living with, or at risk for, HIV. Exploratory and confirmatory factor analyses identified 2 risk factors for men (sexual intercourse with men and a general risk factor) and 3 factors for women (sexual intercourse with men, substance abuse, and a high risky sex behavior factor). All factors except women engaging in risky sex with men strongly predicted known HIV status of clients for men and women. The findings from this investigation highlight the use of structural equation modeling for applied problems involving overlapping and complex sets of risk behaviors in youth who present at community health programs.     

The attitude towards nature,and incidence of sexual intimacy among students at a South African University

The authors, of the University of Stellenbosch, South Africa, surveyed 60 male university students of mean age 21.37 years and 79 female students of mean age 20.13 years with the goal of gaining insight into their sex behavior and their attitudes toward sexuality. The home language of 83% of the women and 85% of the men was Afrikaans, while the remaining subjects had English as a home language. One student was married, three were engaged to be married, and two lived together with a person of the opposite sex. 51 students were in steady relationships and 82 were single. 82% of the men and 90% of the women choose to have sex with someone of the same race. The study found a relatively low occurrence of sexual intercourse and promiscuity, and a very high percentage of subjects regarded themselves as heterosexual and as morally and religiously conservative. 97% of the men and 99% of the women regarded themselves as being heterosexual, and 3% of men and 1% of women regarded themselves as being bisexual. 6.6% of men and 1.34% of women, however, reported having had sexual contact with someone of the same sex. 37% of the men and 32% of the women reported having ever had sexual intercourse with a person of the opposite sex. These percentages are notably lower than those found by other investigators and the authors believe that a higher proportion of students at the university are actually sexually active than that suggested by this survey's findings. Among those sexually active, 17% of men and 18% of women were involved in sexual relationships with more than one partner. 68% of the sexually active men and women report using condoms often, 14% of men and 8% of women use contraceptives on an irregular basis, and 18% of men and 25% of women never use contraceptives. The birth control pill and condom were the most widely used methods. 85% of men and 86% of women felt that both partners should be responsible for taking precautions against unwanted pregnancy. These findings indicate that the overwhelming majority of subjects in this study are not at high risk for contracting AIDS.     

Premarital Sex, Social Support, Submissive Behaviors, and Loneliness Among Turkish University Students

The purpose of this study was to investigate whether differences in social support, submissive behaviors, and loneliness existed among Turkish university students who had had premarital sexual intercourse and those who had not. Using self-reported questionnaires, students who had experienced sexual intercourse were contrasted with those who had not. Data were gathered on 420 university students in Ankara, Turkey. MANOVA statistics were used in the data analysis. Results indicated that more than 75?% of the total respondents reported that they had never had sexual intercourse; the frequency of sexual intercourse was higher among males than females. It was found that students who had had sexual intercourse reported less perceived support from family. The two groups were not significantly different, however, in perceived support from friends, submissive behaviors and loneliness. Possible interpretations of these data and implications for future study are suggested.     

Association between receipt of school-based HIV education and contraceptive use among sexually active high school students — United States, 2011–2013

Sexual health education, including HIV prevention information, can help prevent unintended pregnancy and sexually transmitted infections. National Youth Risk Behavior Survey data from 2011 and 2013 were used to determine HIV education prevalence among 9,825 currently sexually active students in grades 9–12. Associations between HIV education and contraceptive methods used at last sexual intercourse were examined for: (1) condom use; (2) any contraceptive method; (3) dual use of a condom and either birth control pills; IUD or implant; or shot, patch, or birth control ring; and (4) primary contraceptive method. Primary contraceptive method options were (1) no method; (2) birth control pills; (3) condoms; (4) IUD or implant; (5) shot, patch, or birth control ring; (6) withdrawal or some other method; and (7) not sure. Logistic regression (prevalence ratios [PRs] and 95% confidence intervals [CIs]) and Chi-squares were used for testing. Students who received HIV education were more likely than students who did not to use a condom (PR:1.09;CI:1.01,1.18) and any contraceptive method (PR:1.08;CI:1.04,1.12); there was no significant association with dual use. Primary contraceptive method varied significantly by receipt of HIV education (p < .001). School-based HIV education may be important for promotion of adolescent condom and contraceptive use.     

Childhood sexual abuse, adolescent sexual coercion and sexually transmitted infection acquisition among homeless female adolescents

OBJECTIVE: To examine the relationship between childhood experiences of sexual abuse, sexual coercion during adolescence, and the acquisition of sexually transmitted infections (STIs) in a population of homeless adolescents. METHOD: Homeless adolescent females (N = 216) from a northwestern United States city were recruited by street outreach workers for a longitudinal study of STI epidemiology. Baseline data on childhood abuse and recent history of sexual coercion were used to predict physiologically confirmed STI acquisition over the subsequent 6 months. RESULTS: About 38% of all girls reported a history of childhood sexual abuse (CSA). Girls with a history of CSA were more likely to report recent sexual coercion. In turn, sexual coercion in the last three months was significantly associated with a higher number of sexual partners (but not with a greater frequency of intercourse or with lower rates of condom use). Number of sexual partners significantly predicted the future acquisition of an STI within 6 months. CONCLUSIONS: Interventions to reduce risky sexual behaviors in homeless adolescent females may need to consider the impact of CSA, particularly on the number of sexual partners during adolescence. However, it also should be noted that engagement in intercourse often results from coercion and is not voluntary in this population.     

Is child sexual abuse declining? Evidence from a population-based survey of men and women in Australia

OBJECTIVE: Substantiated cases of child sexual abuse (CSA) in the United States have declined significantly over the past decade. This may, or may not, reflect change in the underlying rate in the general population. This study examines age-cohort differences in the prevalence of self-reported CSA experiences of men and women aged 18-59 years in a community-based sample from a comparable western nation. METHOD: In April 2000, we completed a cross-sectional, telephone-based survey of a randomly selected national sample of men and women in Australia. Volunteers (876 males, 908 females) answered a range of questions about health status and sexuality, including unwanted sexual experiences before the age of 16 years. Of selected adults with publicly-listed telephone numbers, 61% agreed to participate. There were few differences between the volunteers and the Australian population on demographic variables and health indicators. RESULTS: Non-penetrative CSA was twice as common among women (33.6%) than men (15.9%). Approximately 12% of women and 4% of men reported unwanted penetrative experiences. CSA was reported significantly less often by younger males, with a linear decline from the oldest to youngest men. Among all females who had intercourse before age 16, older women were much more likely than younger women to say they were an unwilling partner on the first occasion. If first intercourse occurred at age 16 or later, there were no age-cohort differences in risk of first-time abuse. Self-reported "openness" and "comfort" during the telephone interviews was not systematically related to prevalence of CSA. CONCLUSION: These population-based findings provide evidence of a decline in the underlying rate of CSA in Australia. Although every measure of CSA inevitably is flawed to some extent, these trends in self-report complement official statistics that show substantial decline in recent years.     

Black South African freshmen's experience of first coitus and contraception

The purpose of this study was to investigate Black South African freshmen's experience of first intercourse and contraception. The study found that many students do not use contraception during first intercourse and that peers were reported as the primary first source of learning about sexual intercourse as well as the preferred source. Freshmen who are contemplating, anticipating or deferring the transition from virginity to non-virginity are an important target group for campus safer sex programmes because safer sex behaviours could be encouraged before a high risk sexual behavior pattern develops.     

Childhood maltreatment and adolescent sexual risk behaviors: Unique,cumulative and interactive effects

Child maltreatment has been associated with sexual risk behaviors. Previous investigators have typically studied only one form of maltreatment, preventing them from exploring interrelations between forms of maltreatment and their impact on sexual risk behaviors. Thus, this study aims to examine the unique, cumulative, and interactive effects of four maltreatment forms (sexual abuse, physical abuse, neglect, and witnessing interparental violence) on sexual risk behaviors. The sample comprised 1940 sexually active adolescents (M_age = 15.6; 60.8% girls) attending Quebec (Canada) high schools. Regression results showed that all maltreatment forms were associated with having a higher number of sexual partners, casual sexual behavior, and a younger age at first consensual intercourse. Physical abuse and witnessing interparental violence were associated with inconsistent condom use, and physical abuse was associated with sexually transmitted infections. After controlling for all forms of maltreatment (unique effects), analyses showed that sexual abuse, physical abuse, neglect or witnessing interparental violence remained statistically associated depending on the sexual risk behavior. A greater number of forms of maltreatment was associated with more sexual risk behaviors (cumulative effect). When sexual abuse was not experienced, neglect was associated with a higher number of sexual partners (interactive effects). In general, associations between maltreatment and sexual risk behaviors were similar for both genders. The magnitude of the relationship between a specific form of child maltreatment and sexual risk behaviors may be inaccurately estimated when not controlling for other forms of maltreatment.     

The association between childhood and adolescent sexual abuse and proxies for sexual risk behavior: a random sample of the general population of Sweden

OBJECTIVE: Several studies with small and "high risk" samples have demonstrated that a history of childhood or adolescent sexual abuse (CASA) is associated with sexual risk behaviors (SRBs). However, few studies with large random samples from the general population have specifically examined the relationship between CASA and SRBs with a comprehensive set of measures. DESIGN: The study was a cross-sectional retrospective survey of past and current sexual health and behavior. METHODS: A random sample of 4781 persons from the Swedish Post Address Register was obtained, which included 6,119,000 Swedish citizens in 1996. Of those persons, 2810 participants agreed to participate in the study. Participants were interviewed as well as administered a questionnaire regarding their sexual health and behavior. RESULTS: Using Mann-Whitney U tests, a history of CASA was found to be associated with younger age at first intercourse; younger age at diagnosis of first sexually transmitted infection (STI); greater frequency of unintended pregnancy; greater likelihood of participation in group sex; higher likelihood of not interrupting sexual intercourse despite the risk of pregnancy or risk of an STI; greater likelihood of exchanging sex for money or other necessities/drugs; more frequent substance use in the last 48 hours; and higher likelihood of adult sexual and physical assault. CONCLUSIONS: The findings of this study confirm previous research, which has reported an association between CASA and SRBs in smaller and high-risk samples. Clinicians working with adults with a history of CASA should be aware of the relationship between CASA and SRBs and be prepared to address such issues during therapy.     

Unzip the Truth: Results from the Fort Peck Men's Sexual Health Intervention and Evaluation Study

American Indian (AI) men experience sexual and reproductive health disparities including sexually transmitted infections, unplanned pregnancy, absent fatherhood, and intimate relationship violence. Using a case-control study within a community-based participatory research framework, we investigated the effectiveness of a sexual and reproductive health peer led education intervention model for AI men, ages 18–24. Intervention results demonstrated the greatest impact on attitudes regarding contraceptives, commitment in relationships, and consistency of condom use. Our study provides insights into how to access education and influence sexual risk behaviors among a diverse group of hard to reach young adult males.     

Childhood neglect and adulthood involvement in HIV-related risk behaviors

OBJECTIVE: Much research has been done to examine the long-term effects of being victimized by sexual, physical, and/or emotional abuse in childhood, but much less research has focused on the impact of childhood neglect experiences. This study examines the role that childhood neglect has on adult women's involvement in HIV-related risky behaviors. METHODS: The data come from a study of 250 "at risk" women living in the Atlanta, GA metropolitan area, most of whom were African American. Data were collected in face-to-face interviews between 1997 and 2000. Multiple regression was used to explore the relationship between childhood neglect experiences, self-esteem, attitudes toward condom use, and involvement in HIV-related risky behaviors. RESULTS: Overall, the model tested received strong support by the study data. Childhood neglect led to reduced self-esteem. Neglect was associated with worsened attitudes toward condom use and women who experienced childhood neglect also reported more involvement in HIV risk behaviors. CONCLUSIONS: HIV intervention programs ought to target women who have experienced childhood neglect, as neglect experiences have adverse impacts upon their self-esteem, condom-related attitudes, and HIV risk behavior practices in adulthood.     

Condom Carnival: feasibility of a novel group intervention for decreasing sexual risk

Young people who engage in unprotected sex are at risk of negative consequences. The current study explored pre-post assessment data from 124, mostly Black, young people (M age = 19.6, SD = 2.8) attending an educational and vocational training programme who participated in the Condom Carnival, a novel, brief, interactive, peer-led, culturally tailored, sexual risk reduction group intervention. Condom Carnival activities provided practice negotiating condom use and using condoms correctly, instruction on safe lubricant use, and opportunities to dispel myths regarding condom size and breakage. We examined the preliminary impact of the Condom Carnival in increasing participants’ condom-related self-efficacy, lubricant safety awareness, and condom-related behavioural intentions and behaviour likelihood. Despite previous exposure to prevention efforts, participants reported significant increases in lubricant safety awareness (p < 0.001) and intentions to carry a condom in the next year (Z = ?2.05, p = 0.04). Although participants reported high condom-related self-efficacy and intentions to use a condom, only three-quarters of young people endorsed intentions to always carry a condom. Findings indicate the need to explore the gap between intentions to use and carry condoms and to develop effective strategies to increase condom carrying among young people. Further assessment of the Condom Carnival as an add-on intervention to enhance sexual risk reduction efforts among youth is warranted.