Abstract
Studies consistently find that negative condom beliefs or attitudes are significantly associated with less condom use in various populations, including HIV-positive injection drug users (IDUs). As part of efforts to reduce sexual risk among HIV-positive IDUs, one of the goals of HIV interventions should be the promotion of positive condom beliefs. In this paper we sought to identify the correlates of negative condom beliefs and examined whether such correlates varied by gender, using a subsample (those with an opposite-sex main partner; n = 348) of baseline data collected as part of a randomized controlled study of HIV-positive IDUs. In multivariate analyses, we found more significant correlates for women than for men. With men, perception that their sex partner is not supportive of condom use (negative partner norm) was the only significant correlate (Beta = −0.30; p < 0.01; R 2 = 0.18). Among women, negative partner norm (Beta = −0.18; p < 0.05); having less knowledge about HIV, STD, and hepatitis (Beta = −0.16; p < 0.05); lower self-efficacy for using a condom (Beta = −0.40; p < 0.01); and more episodes of partner violence (Beta = 0.15; p < 0.05) were significantly associated with negative condom beliefs (R 2 = 0.36). These findings suggest important gender-specific factors to consider in interventions that seek to promote positive condom beliefs among HIV-positive IDUs.
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References
Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2004, vol. 16. Department of Health and Human Services, Centers for Disease Control and Prevention; 2005. http://www.cdc.gov/hiv/hopics/surveillance/resources/reports/index.htm.
Centers for Disease Control and Prevention. Advancing HIV prevention: New strategies for a changing epidemic—United States, 2003. MMWR Morb Mortal Wkly Rep. 2003;52:329–332.
Centers for Disease Control and Prevention. Incorporating HIV prevention into the medical care of persons living with HIV. Recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2003;52:1–24.
Janssen RS, Valdiserri RO. HIV prevention in the United States: increasing emphasis on working with those living with HIV. J Acquir Immune Defic Syndr. 2004;37(Suppl 2):S119–S121.
Kral AH, Bluthenthal RN, Lorvick J, Gee L, Bacchetti P, Edlin BR. Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: risk-factor analysis. Lancet. 2001;357:1397–1401.
Strathdee SA, Sherman SG. The role of sexual transmission of HIV infection among injection and non-injection drug users. J Urban Health. 2003;80:iii7–iii14.
Avants SK, Warburton LA, Hawkins KA, Margolin A. Continuation of high-risk behavior by HIV-positive drug users: Treatment implications. J Subst Abuse Treat. 2000;19:15–22.
Kwiatkowski CF, Booth R. HIV-seropositive drug users and unprotected sex. AIDS Behav. 1998;2:151–160.
Metsch LR, McCoy CB, Lai S, Miles C. Continuing risk behaviors among HIV-seropositive chronic drug users in Miami, Florida. AIDS Behav. 1998;2:161–169.
Lakta MH, Metsch LR, Mizuno Y, et al. Unprotected sex among HIV-positive injection drug using women and their serodiscordant male partners: Role of personal and partner influences. J Acquir Immune Defic Syndr. 2006;42:222–228.
Purcell DW, Mizuno Y, Metsch LR, et al. Unprotected sexual behavior among heterosexual HIV-positive injection drug using men: associations by partner type and partner serostatus. J Urban Health. 2006;83:656–668.
Boone TL, Lefkowitz ES. Safer sex and the health belief model; considering the contributions of peer norms and socialization factors. J Psychol Hum Sex. 2004;16:51–68.
Crepaz N, Marks G. Towards an understanding of sexual risk behavior in people living with HIV: a review of social, psychological, and medical findings. AIDS. 2000;16:135–149.
DiClemente RJ. Psychological determinants of condom use among adolescents. In: DiClemente RJ, ed. Adolescents and AIDS: A Generation in Jeopardy. Newbury Park, CA: Sage; 1992:34–51.
Fernandez-Esquer ME, Krepcho MA, Freeman AC, Magee E, McAlister AL, Ross MW. Predictors of condom use among African American males at high risk for HIV. J Appl Soc Psychol. 1997;27:58–74.
Ford K, Wirawan DN, Muliawan P. Social influence, AIDS/STD knowledge, and condom use among male clients of female sex workers in Bali. AIDS Educ Prev. 2002;14:496–504.
Hinkle YA, Johnson EH, Gilbert D, Jackson L, Lollis CM. African-American women who always use condoms: attitudes, knowledge about AIDS, and sexual behavior. J Am Med Womens Assoc. 1992;47:230–237.
O’Leary A, Maibach E, Ambrose TK, Jemmott JB, Celentano DD. Social cognitive predictors of sexual risk behavior change among STD clinic patients. AIDS Behav. 2000;4:309–316.
Reitman D, St. Lawrence JS, Jefferson KW, Alleyne E, Brasfield TL, Shirley A. Predictors of African American adolescents’ condom use and HIV risk behavior. AIDS Educ Prev. 1996;8:499–515.
Sacco WP, Levine B, Reed DJ, Thompson K. Attitudes about condom use as an AIDS-relevant behavior: their factor structure and relation to condom use. Psychol Assess. 1991;3:265–272.
Sonenstein FL, Ku L, Pleck JH. Why young men don’t use condoms: factors related to the consistency of utilization. In: Besharov DJ, Steward FH, Gardiner KN, Parker M, eds. Why Some Men Don’t Use Condoms: Male Attitudes About Condoms and Other Contraceptives. Menlo Park, CA: Henry J. Kaiser Family Foundation; 1997:1–26.
St. Lawrence JS, Reitman D, Jefferson KW, Alleyne E, Brasfield TL, Shirley A. Factor structure and validation of an adolescent version of the Condom Attitudes Scale: an instrument for measuring adolescents’ attitudes toward condoms. Psychol Assess. 1994;6:352–359.
Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;111:455–474.
Ajzen I, Fishbein M. Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, NJ: Prentice Hall; 1980.
Knight KR, Purcell D, Dawson-Rose C, Halkitis PN, Gomez CA, & the Seropositive Urban Injectors Study Team. Sexual risk taking among HIV-positive injection drug users: contexts, characteristics, and implications for prevention. AIDS Educ Prev. 2005;17(Suppl A):76–88.
Parsons JT, Missildine MA, Van Ora J, Purcell DW, Gomez CA, and the Seropositive Urban Injectors Study Team. HIV status disclosure to sexual partners among HIV-positive injection drug users. AIDS Patient Care STDS. 2004;18:457–469.
Gielen AC, McDonnell KA, O’Campo PJ. Intimate partner violence, HIV status, and sexual risk reduction. AIDS Behav. 2002;6:107–116.
Wu E, El-Bassel N, Witte SS, Gilbert L, Chang M. Intimate partner violence and HIV risk among urban minority women in primary health care settings. AIDS Behav. 2003;7:291–301.
Saul J, Moore J, Murphy ST, Miller LC. Relationship violence and women’s reactions to male- and female-controlled HIV prevention methods. AIDS Behav. 2004;8:207–214.
Basuki E, Wolffers I, Deville W, et al. Reasons for not using condoms among female sex workers in Indonesia. AIDS Educ Prev. 2002;14:102–116.
Crossby RA, Graham CA, Yarber WL, Sanders SA. If the condom fits, wear it: a qualitative study of young African-American men. Sex Transm Infect. 2004;80:306–309.
Crosby RA, Sanders SA, Yarber WL, Graham CA. Condom-use errors and problems: a neglected aspect of studies assessing condom effectiveness. Am J Prev Med. 2003;24:367–370.
Thomsen S, Stalker M, Toroitich-Ruto C. Fifty ways to leave your rubber: how men in Mombasa rationalize unsafe sex. Sex Transm Infect. 2004;80:430–434.
Purcell DW, Metsch LR, Latka M, et al. Interventions for seropositive injectors-research and evaluation: an integrated behavioral intervention with HIV-positive injection drug users to address medical care, adherence, and risk reduction. J Acquir Immune Defic Syndr. 2004;37(Suppl 2):S110–S118.
O’Leary A, Hoff CC, Purcell DW, et al. What happened in the SUMIT trial? Mediation and behavior change. AIDS. 2005;19(Suppl 1):S111–S121.
Derogatis LR, Spencer PM. The Brief Symptom Inventory (BSI): Administration, scoring, and procedure manual—1. Baltimore, MD: Wiley; 1982.
Mizuno Y, Kennedy M, Seals B, Myllyluoma J. Predictors of teens’ attitudes toward condoms: gender difference in the effects of norms. J Appl Soc Psychol. 2000;30:1381–1395.
Corby NH, Jamner MS, Wolitski RJ. Using the theory of planned behavior to predict intention to use condoms among male and female injection drug users. J Appl Soc Psychol. 1996;26:52–75.
Straus MA. Measuring intrafamily conflict and violence: the conflict tactics scales. J Marriage Fam. 1979;41:75–88.
Neter J, Wasserman W, Kutner M. Applied Linear Regression Models, 2nd edn. Burr Ridge, IL: Irwin; 1989.
Padian NS, Shiboski SC, Glass SO, Vittinghoff E. Heterosexual transmission of human immunodeficiency virus (HIV) in northern California: results from a ten-year study. Am J Epidemiol. 1997;146:350–357.
Kalichman SC, Carey MP, Johnson BT. Prevention of sexually transmitted HIV infection: a meta-analytic review of the behavioral outcome literature. Ann Behav Med. 1996;18:6–15.
Semaan S, Kay L, Strouse D, et al. A profile of U.S.-based trials of behavioral and social interventions for HIV risk reduction. J Acquir Immune Defic Syndr. 2002;30:S30–S50.
Pronyk PP, Hargreaves JR, Kim JC, et al. Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomized trial. Lancet. 2006;368:1973–1983.
Acknowledgements
The authors wish to acknowledge the study participants in all four communities who made this research possible and the study staff for their outstanding commitment to the success of this project. The authors also wish to thank the members of the community advisory boards and HIV program review panels at each site for providing constructive feedback on the intervention and trial designs.
The INSPIRE Study Group includes the following people: Carl Latkin, Amy Knowlton, Karin Tobin (Baltimore), Lisa Metsch, Eduardo Valverde, James Wilkinson, Martina DeVarona (Miami), Mary Latka, Dave Vlahov, Phillip Coffin, Marc Gourevitch, Julia Arnsten, Robert Gern (New York), Cynthia Gomez, Kelly Knight, Carol Dawson Rose, Starley Shade, Sonja Mackenzie (San Francisco), David Purcell, Yuko Mizuno, Scott Santibanez, Richard Garfein, Ann O’Leary (CDC), Lois Eldred, and Kathleen Handley (Health Resources and Services Administration).
We would also like to acknowledge the following people for their contributions to this research: Susan Sherman, Roeina Marvin, Joanne Jenkins, Donny Gann, Tonya Johnson (Baltimore), Clyde McCoy, Rob Malow, Wei Zhao, Lauren Gooden, Sam Comerford, Virginia Locascio, Curtis Delford, Laurel Hall, Henry Boza, Cheryl Riles (Miami), George Fesser, Victoria Frye, Carol Gerran, Laxmi Modali, Diane Thornton (New York), Caryn Pelegrino, Barbara Garcia, Jeff Moore, Erin Rowley, Debra Allen, Dinah Iglesia-Usog, Gilda Mendez, Paula Lum, Greg Austin (San Francisco), Craig Borkowf, Ying Chen, Gladys Ibanez, Hae-Young Kim, Toni McWhorter, Jan Moore, Lynn Paxton, John Williamson (CDC), Lee Lam, Jeanne Urban, Stephen Soroka, Zilma Rey, Astrid Ortiz, Sheila Bashirian, Marjorie Hubbard, Karen Tao, Bharat Parekh, and Thomas Spira (CDC Laboratory).
This study was supported by the Centers for Disease Control and Prevention and the Health Resources and Services Administration. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
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Mizuno and Purcell are with the Prevention Research Branch, Division of HIV/AIDS Prevention National Center for HIV/STD/TB Prevention, Centers for Disease Control and Prevention, Altanta, GA, USA; at time of the study, Latka was with the Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY, USA; Metsch is with the University of Miami, Miami FL, USA; at time of the study, Gomez was with the University of California - San Francisco, San Francisco, CA, USA; Latkin is with the Johns Hopkins University, Baltimore, MD, USA.
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Mizuno, Y., Purcell, D.W., Latka, M.H. et al. Beliefs that Condoms Reduce Sexual Pleasure—Gender Differences in Correlates Among Heterosexual HIV-Positive Injection Drug Users (IDUs). J Urban Health 84, 523–536 (2007). https://doi.org/10.1007/s11524-007-9162-x
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DOI: https://doi.org/10.1007/s11524-007-9162-x