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Cleaton-Jones, chair of the ethics committee that approved the trial of circumcision for preventing HIV, shares with us the discussions that the committee had ahead of granting approval.

Beyond the monopoly environment of the early 100% Condom Use Program in Cambodia, less is known about how current female entertainment workers negotiate condom use on their own, and what factors impact that negotiation. This study aims to understand the experiences of current female entertainment workers in negotiating condom use with clients in Cambodia. Data collection occurred over a period of 3 weeks (August–September 2017) with concurrent data transcription and translation. A total of 27 focus group discussions (FGDs) were conducted in the following groups: pilot FGD (5), karaoke bar (5), massage parlor (5), beer garden (5), on-call sex workers (3), cross-venue groups exploring parenting issues (2), and street-based sex workers (2). Female entertainment workers experience a range of control over negotiating condom use with clients. Participants reported times when they were able to take direct action and successfully insist on condom use, times when they agreed to participate in condomless sex for money in the face of economic insecurity, and times when male clients sabotaged their attempts to negotiate condom use with tricks, verbal threats or threats of violence. These experiences are influenced by alcohol use, economic shocks, trust between partners, and experiences with side effects. Our findings support the development of policies that re-invigorate the structural-level condom promotion programs while also acknowledging the many individual-level factors that shape condom use such as alcohol consumption, economic insecurity, trust, and side effects.

Increasing numbers of university students in Sudan are at risk of contracting HIV because of their engagement in condomless sex. A comprehensive and culturally accepted condom promotion program could potentially reduce this threat substantially. However, little is known about the sociocognitive determinants of condom use in this population: information that is required to develop such HIV prevention programs. Therefore, in August 2014, we conducted 30 semi-structured individual interviews with male and female students (both currently sexually active and nonactive) to explore determinants of condom use based on the I-Change model. Data were analyzed using Nvivo 10. The results suggest that barriers to condom use among university students include misconceptions about condom use, negative attitudes toward condom use, lack of social support, low self-efficacy to use condoms, and poor action planning. Sexual health promotion should, therefore, address these aspects to successfully promote condom use among sexually active students and subsequently reduce the risk of HIV transmission.

This paper presents data from a recent cross-sectional survey of gay, bisexual and other men who have sex with men (GBMSM) in the US, to understand changes in sexual behavior and access to HIV prevention options (i.e. condoms and pre-exposure prophylaxis (PrEP)) during the COVID-19 lockdown period. The Love and Sex in the Time of COVID-19 survey was conducted online from April to May, 2020. GBMSM were recruited through advertisements featured on social networking platforms, recruiting a sample size of 518 GBMSM. Analysis considers changes three in self-reported measures of sexual behavior: number of sex partners, number of anal sex partners and number of anal sex partners not protected by pre-exposure prophylaxis (PrEP) or condoms. Approximately two-thirds of the sample reported that they believed it was possible to contract COVID-19 through sex, with anal sex reported as the least risky sex act. Men did not generally feel it was important to reduce their number of sex partners during COVID-19, but reported a moderate willingness to have sex during COVID-19. For the period between February and April-May 20,202, participants reported a mean increase of 2.3 sex partners during COVID-19, a mean increase of 2.1 anal sex partners (range - 40 to 70), but a very small increase in the number of unprotected anal sex partners. Increases in sexual behavior during COVID-19 were associated with increases in substance use during the same period. High levels of sexual activity continue to be reported during the COVID-19 lockdown period and these high levels of sexual activity are often paralleled by increases in substance use and binge drinking. There is a clear need to continue to provide comprehensive HIV prevention and care services during COVID-19, and telehealth and other eHealth platforms provide a safe, flexible mechanism for providing services.

Being sexually aroused may be an important risk factor contributing to sexual decision making. Dual-process cognitive models, such as the reflective-impulsive model of Strack and Deutsch (2004), could be used to explain the effect of sexual arousal on intentions to use a condom. In this study, we investigated whether explicit and implicit attitudes toward condom use can predict intentions to use a condom when participants are sexually aroused and not aroused. In a within-subjects experimental design, male participants (N = 27) watched both a neutral and an erotic movie clip in counterbalanced order. After each clip, participants completed a questionnaire assessing their intentions to use a condom and explicit condom attitudes, followed by a wanting Implicit Association Test (IAT; Greenwald et al., 2003) and a liking IAT to assess their implicit attitudes to unsafe sex. In concordance with the reflective-impulsive model, we found that when participants were not sexually aroused, their intentions to use a condom were solely predicted by their explicit attitudes. However, when they were sexually aroused, intentions to use a condom were predicted by both explicit and implicit attitudes toward condom use.

Background Sexual health concerns among young adults worldwide help to motivate preventative practices against sexually transmitted infections. To foster better sexual health, sexual health literacy must be enhanced. Little research has been conducted on the impact of gender power dynamics on sexual health, such as sexual coercion, even though the prevalence of sexual coercion remains high in China. Objective This study describes the development and systematic evaluation of a web-based sexual health literacy intervention called “Smart Girlfriend” for female Chinese university students. Methods A multicenter randomized controlled trial was conducted with 781 female university students at 5 universities with dormitories in Hong Kong. Inclusion criteria were used to select unmarried, female, Chinese university students who were ≥18 years old and had not received a sexual health intervention in the past 12 months. Participants were randomly assigned to 2 groups: one group received an interactive web-based sexual health literacy intervention and the other group received a single webpage of online information about condom use. The intervention content was based on the Health Belief Model and the Continuum of Conflict and Control theory. The primary outcome was self-reported consistency of condom use with every partner at 3-month and 6-month follow-up assessments, analyzed using zero/one inflated beta (ZOIB) regression. The secondary outcome was an appraisal of the knowledge, attitudes, norms, and self-efficacy of condom use using the 25-item Multidimensional Condom Attitudes Scale (MCAS). The intention to treat was applied in analyses. Results Of 1503 individuals that were screened, 781 (52%) were randomized into 2 groups. The retention rates at the 3-month and 6-month follow-ups were 92% and 91%, respectively. Most participants were born locally (536/746, 72%), and 18% (134/746) self-reported as a sexual minority. ZOIB results regarding the consistency of condom use were not significant [model 1: odds ratio (OR) 2.25 with a 95% credible interval (CrI) of 0.84-6.36; model 2: OR 8.03 (95% CrI 0.22-330.31); model 3: OR 1.21 (95% CrI 0.78-1.86)]. Consistency in the intervention group was 5% higher (95% CI −1.90 to 11.63) than the control group at the 3-month follow-up, and 1% higher (95% CI −5.81 to 8·02) at the 6-month follow-up. MCAS scores at the 3-month follow-up were significantly higher in the intervention group (mean 122.51, SD 15.97) than the control group (mean 119.86, SD 15.85; P=.02). Conclusions An interactive web-based sexual health literacy program did not significantly increase the consistency of condom use compared to a single webpage of condom use information; however, it did temporarily improve knowledge, attitudes, norms, and self-efficacy regarding condom use. Future revisions of this intervention should be personalized and delivered with a proactive approach. Trial Registration ClinicalTrials.gov NCT03695679; https://clinicaltrials.gov/ct2/show/NCT03695679

BACKGROUND: Young people aged 16-24 years are disproportionately affected by sexually transmitted infections (STIs). STIs can have serious health consequences for affected individuals and the estimated annual cost of treatment to the National Health Service is £620 million. Accordingly, the UK government has made reducing the rates of STIs among this group a priority. A missed opportunity to intervene to increase condom use is when young people obtain self-sampling kits for STIs via the internet.OBJECTIVE: Our aim was to develop a theory-based tailored intervention to increase condom use for 16-24-years-olds accessing chlamydia self-sampling websites.METHODS: The intervention, Wrapped, was developed using Intervention Mapping and was co-designed with young people. The following steps were performed: (1) identification of important determinants of condom use and evidence of their changeability using computer and digital interventions; (2) setting the intervention goal, performance objectives, and change objectives; (3) identification of Behavior Change Principles (BCPs) and practical strategies to target these determinants; and (4) development of intervention materials able to deliver the BCPs and practical strategies.RESULTS: Users of existing chlamydia self-sampling websites are signposted to Wrapped after placing an order for a sampling kit. Salient barriers to condom use are identified by each user and relevant intervention components are allocated to target these. The components include the following: (1) a sample box of condoms, (2) an online condom distribution service, (3) a product for carrying condoms, (4) a condom demonstration video, (5) a series of videos on communication about condom use, and (6) erotic films of real couples discussing and demonstrating condom use.CONCLUSIONS: This intervention will be directed at young people who may be particularly receptive to messages and support for behavior change due to their testing status.

The use of barrier protections such as condoms has consistently been reported to reduce the acquisition of sexually transmitted infections. However, it has also been reported that the association between condom use intentions and behavior is, at best, often weak. Furthermore, embarrassment associated with purchasing condoms and negotiating their use has been shown to negatively impact the frequency of condom use. Using electroencephalography to analyze P300 event-related potential components known to measure early attention allocation, we examined electrophysiological evidence of early attention disengagement for embarrassing health information. Forty young adults-34 females and six males-participated in an adapted version of Posner's visual cueing paradigm. All were high in intention to use condoms, but half were intention-behavior consistent and half were intention-behavior inconsistent. Compared to intention-behavior consistent participants, those with intention-behavior inconsistency showed a reduced P300 component when attending to a visual target opposite to the field in which embarrassing self-relevant health information was presented, indicating more efficient early attention disengagement from such embarrassing health information. In conclusion, our electrophysiological data suggest that high intention alone may be not sufficient to predict adolescents' condom use behavior.

Antiretroviral treatment (ART) has been recognized as one of the methods for reducing the risk of HIV transmission, and access to this is being rapidly expanded. However, in a generalized HIV epidemic, ART could increase unprotected sex by people living with HIV/AIDS (PHAs). This paper assessed the rates and predictors of consistent condom-use by sexually-active PHAs after initiating ART. The study used crosssectional data on sexual behaviour of 269 sexually-active ART-experienced individuals (95 males and 174 females) aged 18 years and above. The results revealed that 65% (70% of men and 61% of women) used condom consistently after initiating ART. Consistent use of condom was more likely if PHAs had secondary- or tertiary-level education and had more than one sex partner in the 12 months preceding the study.However, PHAs were less likely to have used condom consistently if they worked in the informal and formal sectors, belonged to the medium- and high-income groups, and were married. PHAs, who were on ART for less than 1 year and 1-2 year(s), had a good self-perception of health, had a sexual partner who was HIV-negative or a partner with unknown HIV status, and desired to bear children, were also less likely to have used condom consistently. The paper concluded that, although the majority of PHAs consistently used condom, there was potential for unprotected sex by PHAs on ART. DOI: http://dx.doi.org/10.3329/jhpn.v30i3.12290 J HEALTH POPUL NUTR 2012 Sep;30(3):270-280

Social norms affect almost every aspect of people’s lives, and can be an obstacle to or support economic development. This paper outlines what social norms are and how they work, providing examples from everyday life and from development case studies. Sometimes not much can be done about changing undesirable social norms. In those cases, development economists need to be aware of how the existence of those norms can impact the effects of the policies they advocate. But of particular importance to development economists is the ways in which social norms can be changed, at least under some circumstances. Understanding of social norm change is still patchy at best, but the paper outlines the theoretical underpinnings of change, with empirical evidence from various policies aimed at changing social norms. However, some of those policies raise ethical concerns that would require attention.

This paper examines the association between alcohol use and sexual risk in two critical migrant populations living within the same geographical areas--migrant men and female sex-workers (FSWs). Data are drawn from two independent surveys of migrant FSWs and male workers in 14 districts of four high HIV prevalent Indian states. In the paper we have examined the independent effects of degree of mobility and alcohol use prior to sex on HIV risk behaviors. Nearly two-thirds of FSWs and a similar proportion of male migrant workers, as well as nine out of ten clients of FSWs consume alcohol. More than half of the FSWs and their clients consumed alcohol prior to sex. The practice of alcohol use prior to sex among both FSWs and their clients has a significant association with inconsistent condom use during paid as well as unpaid sex, and these effects are independent of degree of mobility. The results suggest a need for developing an in-depth understanding of the role of alcohol in accentuating HIV risk particularly among migrant populations who move frequently from one place another.

Gay, bisexual, and other men who have sex with men (MSM) have adapted their sexual practices over the course of the HIV/AIDS epidemic based on available data and knowledge about HIV. This study sought to identify and compare patterns in condom use among gay, bisexual, and other MSM who were tested for HIV at a community-based testing site in Montreal, Canada. Results showed that while study participants use condoms to a certain extent with HIV-positive partners and partners of unknown HIV status, they also make use of various other strategies such as adjusting to a partner's presumed or known HIV status and viral load, avoiding certain types of partners, taking PEP, and getting tested for HIV. These findings suggest that MSM who use condoms less systematically are not necessarily taking fewer precautions but may instead be combining or replacing condom use with other approaches to risk reduction.

Many HIV intervention programs in sub-Saharan Africa have applied social cognitive theories such as the theory of planned behavior. However, a recent sub-Saharan African review was unable to show increased effectiveness for theory-based interventions. This study assessed whether the predictive value of attitudes, subjective norms, self-efficacy, and intention was similar to studies in Europe and the U.S., and whether there were differences between three sub-Saharan sites. Longitudinal multigroup structural equation modeling was used to assess whether attitudes, subjective norms, and self-efficacy predicted condom use intentions and condom use (after 6 months) among adolescents in three sites, namely Cape Town (South Africa; N = 625), Dar es Salaam (Tanzania; N = 271), and Mankweng (South Africa; N = 404). Condom use intentions were predicted by subjective norms and self-efficacy in all three sites. Attitudes were not related to intentions in Dar es Salaam and were moderately related to intentions in Cape Town and Mankweng. The proportions of explained variance in intentions and behavior were decent (37–52 and 9–19 %, respectively). Although significant differences in predictive value were found between sites and in comparison to European and U.S. studies, intentions could adequately be explained by attitudes, subjective norms, and self-efficacy. However, the limited proportions of variance in behavior explained by intentions could signify the importance of contextual and environmental factors. Future studies are recommended to use an integrative approach that takes into account both individual and contextual factors, as well as social and environmental differences. publishedVersion

Community collectivization is an integral part of condom use and HIV risk reduction interventions among key population. This study assesses community collectivization among female sex workers (FSWs), and explores its relationship with sex workers' consistent condom use (CCU) with different partners considering the interaction effect of time and collectivization. Data were drawn from two rounds of cross-sectional surveys collected during 2010 (N1 = 1986) and 2012 (N2 = 1973) among FSWs in Andhra Pradesh, India. Results of the multiple logistic regression analysis show that, CCU with regular and occasional clients increased over the inter-survey period among FSWs with a high collective efficacy (AOR 2.9 and 6.1) and collective agency (AOR 14.4 and 19.0) respectively. The association of high levels of collectivization with CCU and self-efficacy for condom use are central to improve the usefulness and sustainability of HIV prevention programs worldwide.