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One of the challenges facing researchers in the domain of human immunodeficiency virus prevention is the assessment of condom use in an unbiased self-reported manner. The current study presents the development and preliminary validation of an indirect condom use test (I-CUTE), designed to assess condom use tendencies and to overcome self-report biases. Two samples were included using correlational designs. In sample 1, 88 students from European university completed the I-CUTE with questionnaires of condom use barriers, social desirability, and condom use negotiation self-efficacy. In sample 2, 212 students from sub-Saharan universities completed the I-CUTE with questionnaires of condom use barriers and knowledge. The I-CUTE included 17 pictures of human figures in relation to condom use, where participants had to choose one of the four a-priori given sentences reflecting the figures’ thoughts. This represented a semi-projective, yet standardized test. In sample 1, I-CUTE scores were inversely related to barriers, positively correlated with condom use negotiation self-efficacy and unrelated to social desirability. In sample 2, I-CUTE scores were inversely related to barriers and unrelated to knowledge scores. In a multiple regression, condom use barriers had a unique contribution to explaining variance in I-CUTE scores, beyond the contribution of background variables and knowledge. These results support the preliminary reliability and validity of the I-CUTE tool in a variety of cultures, and reveal its lack of bias by social desirability and the importance of condom use barriers in condom use tendencies.

Past studies have shown that in attempts to prevent HIV, health education yields little change in condom use. The reason may be that education fails to target barriers for changing behaviour. The present controlled pilot study tested whether psychological inoculation (PI) reduces such barriers for using male condoms. Twenty-two Nigerian women with HIV were randomly assigned to receive PI or health education (control). In the PI condition, women learned to refute sentences reflecting barriers against condom use, while controls learned how to use condoms and the consequences of their non-use. Barriers for condom use, self-efficacy to negotiate condom use with partners and actual condom use were self-reported before and one week after interventions. Results revealed that only in the PI group were there statistically significant increases in condom use negotiating self-efficacy and reductions in barriers concerning motivation, sexual satisfaction and partners. Controls reported no statistically significant changes. However, actual reported condom use was unchanged in both groups. Thus, it is feasible to conduct PI interventions in an African sample of HIV patients. Furthermore, PI can reduce cognitive barriers for condom use, while health education yields little changes in such outcomes over time. If replicated in larger samples with longer follow-ups, these findings could eventually have implications for HIV prevention in several world regions.