Sharon A. Baker

HIV / STD risk factors for women with violent male partners.

This study compared 167 women, categorized as nonabused, emotionally abused, or physically abused in their primary relationships, on sexual risk factors. Physically abused women differed in several ways: greater STD risk, psychosocial distress, and substance use; more traditional gender role beliefs; lower self-esteem; more likely to have been raped and to engage in sex for pay; and less likely to attend the projects STD/HIV risk reduction groups. Within primary relationships, they differed in amount of decision-making power about safer sex, likelihood of nonmonogamy, use of substances before sex, and self-efficacy about initiating condom use. African American women reported higher rates of emotional abuse than White women, a finding related mainly to their lower socioeconomic status in this sample.

Beliefs about condoms and their association with intentions to use condoms among youths in detention

PURPOSE Youths in detention have been identified as a high-risk group for AIDS. To help inform AIDS-prevention efforts targeted for these youths, we surveyed youths in detention regarding their sexual behaviors, beliefs about condoms, intentions to use condoms, and actual condom use. We examined race and gender differences in these beliefs and behaviors, and we studied the relationship of these beliefs to condom-use intentions. METHODS Questionnaires were administered to a sample of 201 youths in detention who were, on average, 16 years old. The sample was stratified on gender and race (African-American and white), with approximately equal numbers in each group. RESULTS The results indicate that these youths had engaged in behaviors that put them at high risk of acquired immunodeficiency syndrome (AIDS) and other sexually transmitted diseases. Although they used condoms somewhat more consistently with casual partners than with their steady partners, the majority did not use condoms consistently with either partner type. Very few race or gender differences were found with regard to condom use, intentions to use condoms, or beliefs about the consequences of using condoms. Beliefs associated with intentions to use condoms with steady partners included protection against sexually transmitted diseases (STDs), and the beliefs that condoms reduce pleasure, are artificial, unromantic, and interrupt sex. In contrast, only the belief that condoms prevent pregnancy was related to intentions to use condoms with casual partners. CONCLUSION The results suggest that interventions targeted at African-American and white males and females in detention need not differ greatly in content as long as they include the most salient concerns of each group; that interventions include content on the two protective benefits of condom use (pregnancy and STD prevention), as well as on how to minimize the perceived negative aspects of condom use; that they stress the need for condom use with steady as well as casual partners; and that they stress that anal intercourse is especially risky with regard to AIDS transmission.

Sexual risk behavior, knowledge, and condom use among adolescents in juvenile detention.

This paper reports on sexual behavior, knowledge of sexually transmitted diseases (including AIDS) and condoms, and condom use among African-American and white incarcerated adolescents in Seattle, Washington. One hundred nineteen adolescents in a juvenile detention facility completed questionnaires that assessed their lifetime and recent sexual behaviors, an objective test of disease and condom knowledge, attitudes and norms regarding condom use with steady and casual partners, prior condom use, and intentions to use condoms. The results indicate that these adolescents are at high risk by a number of indicators: They have a high average number of partners, have unprotected vaginal and anal sex, and many have sex with known or suspected drug users. Their overall knowledge of condoms and sexual transmitted diseases risks is high, but high knowledge is not correlated with positive attitudes; for one attitude measure, high knowledge is significantly correlated with negative attitudes toward condom use. These findings suggest that programs designed solely to increase knowledge are unlikely to effect behavior change.

Using the Theory of Reasoned Action (TRA) to Understand the Decision to Use Condoms in an STD Clinic Population

The theory of reasoned action (TRA) provides useful information when designing health education interventions. In this study, 703 heterosexual STD clinic clients responded to a TRA-based survey. With steady partners, social norms and attitudes toward condom use were significant predictors of intention for both men and women. The interaction of attitude and norm increased prediction for men (R = .64, p < 0.001) and women (R = .70, p < 0.001). With casual partners, attitude was a predictor for men and social norm was a predictor for women. Prior use of condoms increased prediction for men (R = .38, p < 0.001) and women (R = .47, p < 0.001). Findings suggest that, in addition to traditional TRA model variables, the relationship between sexual partners and the individuals prior experience with condom use should be incorporated into attempts to understand this complex, dyadic behavior. Examining specific outcome and normative beliefs also provides important information for intervention design.

Condom use among high-risk heterosexual teens: A longitudinal analysis using the theory of reasoned action

Abstract This paper describes tests of traditional and augmented versions of Fishbein and Ajzens Theory of Reasoned Action (TRA). applied to condom use among high-risk heterosexually-active teens, drawn from a sexually transmitted disease clinic and a juvenile detention facility. In a longitudinal survey, predictor variables suggested by Ajzen and Fishbein (1980), plus condom use self-efficacy, attitude-norm interaction and gender, were measured at Time l. Condom use at Time 2, 3 months later, was regressed onto these variables. Support was found for the traditional TRA variables, but little support was found for the addition of self-efficacy. Implications for interventions to increase condom use among high-risk teens are discussed.

Sexual behaviors, substance use, and condom use in a sexually transmitted disease clinic sample

In many studies, alcohol and drug use is clearly associated with behaviors that put individuals at risk for sexually transmitted diseases (STDs). However, the nature of the association remains unclear. In this study we examined the relationship of condom use with substance use in adults with other sex partners (N = 508) who were seeking services in an STD clinic, engaged in high levels of risky sexual behaviors, and also engaged in high levels of alcohol and drug use with sex. We also compared the behaviors with steady and casual partners. We hypothesized that condom use would decrease with increasing levels of substance use with both partner types. That hypothesis was not supported: Condom use was not associated with substance use with either partner type. Although respondents reported significantly higher levels of substance use and intoxication with casual than with steady partners, they also reported significantly higher levels of condom use with casual partners. Interventions based on the assumption ...

The influence of psychosocial difficulties on women's attrition in an HIV/STD prevention program

We examined attrition from an HIV/STD group counselling intervention in two ways: quantitative analyses of the entire sample (n=287) and structured interviews of a subset of 30 women with low attendance. In the interviews, the most common reasons for low attendance were time conflicts and enrolling primarily to obtain the monetary incentives given for completing research questionnaires. Latent class statistical analysis of the full sample identified two subgroups that differed from each other in the number of psychosocial problems recently experienced. Relative to the ‘non-distressed’ class, the ‘distressed’ class members had higher probabilities of psychological distress, low incomes, heavy substance use, sex for trade, relationship violence, and unstable housing. This group had higher HIV/STD risk, but lower intervention attendance. Members also had less education and less knowledge about HIV/STD. A higher proportion of the distressed group was African-American. Study findings suggest that in interventions for women at HIV/STD risk, it is not necessarily enough to ensure cultural relevance and to provide food, childcare, and transportation. To increase retention, interventionists should consider (1) the use of strategies to support attendance (such as monetary incentives and attention to group process factors) and (2) intervention formats that are brief, matched to participants’ stage of change, population-specific, and/or maximally accessible.

Heterosexually Active Men's Beliefs About Methods For Preventing Sexually Transmitted Diseases

CONTEXT Most research on heterosexual transmission of HIV and other sexually transmitted diseases (STDs) has focused on women. However, heterosexual transmission of STDs cannot be prevented without a better understanding of mens, as well as womens, sexual beliefs and behaviors. METHODS Heterosexually active mens beliefs about four methods of STD prevention--abstinence, mutual monogamy, use of male condoms and use of female condoms--were elicited through open-ended interviews. A survey based on these responses was administered to a random sample of 486 heterosexually active men, and scores were calculated to examine their beliefs about each behavior. Additional analyses explored how these beliefs were related to mens characteristics and to their actual behavior. RESULTS The men held both positive and negative beliefs about the outcomes of using each method and thought that their partners, close friends, health care providers, family members and, to some extent, friends at church had opinions about whether they should use each method. Multiple regression analyses showed that the mens beliefs were related to their marital status and, to some extent, their race or ethnicity and education. Beliefs about the outcomes of practicing abstinence, practicing mutual monogamy and using male condoms with steady partners were significantly related to these behaviors; beliefs about whether they had support for practicing monogamy or using male condoms with steady partners were significant predictors of doing so. CONCLUSIONS Encouraging safer-sex practices among heterosexually active men will require addressing their beliefs and perceived norms about alternative methods of preventing STDs.

Change trajectories in women's STD/HIV risk behaviors following intervention.

Three 16-month sexual risk-taking trajectories were identified in 287 women in an STD/HIV intervention study. The Risk Eliminator group reported no sex risk following intervention while the Risk Reducer group reported continuous drops over time. The High Risk group reported higher initial risk than the other two and no subsequent changes. The trajectory groups showed no between- or within-group effects of intervention exposure. Trajectory groups were compared on baseline characteristics. No differences were seen in demographics or STD/HIV knowledge. Compared to one or both of the other groups, the High Risk women reported more lifetime partners, recent paying partners, adult rape, and recent substance use. Their steady partners were more likely to be abusive, intoxicated during sex (as were the women themselves), and believed to be non-monogamous. The Risk Eliminator group differed from the other two by being less likely to report a history of childhood sexual abuse.

Interventions to decrease the risk of HIV/AIDS and other sexually transmitted diseases among high-risk heterosexual adolescents☆

Abstract Sexually transmitted diseases (STDs), including HIV/AIDS, have become a major health concern for American adolescents, and professionals need to be knowledgeable about the interventions available to help teenagers decrease their risk of contracting these diseases. This paper provides an overview of the development and implementation of two theoretically and empirically grounded interventions intended for heterosexually active adolescents at high risk of contracting HIV/AIDS and other STDs. The interventions were developed using a process of feedback and revision that allowed for the tailoring of content to the specific target population. The steps in this process are reviewed and the specific content of each intervention is outlined. The interventions provide: basic information about HIV/AIDS and other STDs, information to counter negative beliefs about condom use, models that reinforce positive beliefs, examples of adolescents negotiating condom use with potential sexual partners, and a set of four skills steps for talking to partners about using condoms. The interventions are designed to be culturally sensitive, appropriate for both males and females, and relatively short and simple to administer so they can be delivered in a variety of settings. Preliminary data regarding the usefulness, accessibility, and acceptability of the interventions to the target population are reviewed.