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The consistently high rate of sexually transmitted infections among people 18–24 years old warrants novel strategies promoting condom use among large segments of this population. Ample opportunity exits to employ such strategies in university settings. This study evaluated a sex-positive, home-practice intervention designed to promote condom use among university undergraduates engaging in penile–vaginal intercourse (PVI). A sample of 29 opposite-sex undergraduate couples, engaging in PVI, was recruited from a large university. After teaching couples about condom use, a health educator helped couples select condoms/lubricants from options comprising various sizes, fits, shapes, textures, and other features. A 30-day ‘homework assignment’ was made to use these products while reducing condom use errors/problems and enhancing sexual pleasure. A repeated measures design, with a six-month observation period, was used to evaluate the program. Over the six-month period, the mean frequency of condomless PVI decreased from 26.4 to 3.9 times ( P

Although emerging evidence suggests that hunger may be a risk factor for engaging in risk behaviors that lead to HIV acquisition, this has rarely been explored for young minority men who have sex with men (YMSM). This study explored a range of sexual risk behaviors for associations with a measure of hunger, assessed among 448 YMSM residing in Los Angeles, CA. Forty-five percent experienced hunger (past 12 months). Hunger was significantly associated with engaging in any condomless anal receptive sex (CARS) (adjusted odds ratio = 1.74; 95% confidence interval = 1.01–3.01; P = .049). Further, hunger was also significantly associated with a greater percentage of CARS (Beta = .12; t = 2.18; P = .03). Parallel effects were not observed relative to condomless anal insertive sex. Findings suggest that the experience of hunger among young minority MSM is generally not associated with a milieu of sexual risk. One important exception is that hunger may lead to having CARS. This suggests a potential ‘trade off’ for receptive partners experiencing hunger and partially supports the idea that at hunger may predispose minority YMSM to partner demands not to use condoms.

Errors and problems associated with male condom use are very prevalent and increase the likelihood of inconsistent and incomplete use, thereby compromising condom effectiveness. The aim of this study was to assess the perceived benefits of a new condom wrapper/integrated applicator designed to reduce barriers to condom use and lessen the likelihood of user errors and problems. After viewing videos depicting features of the wrapper/applicator, participants (N = 547; 62.9% male, M age = 29.2) completed online questionnaires. Most participants reported that the product would make condom application easier and quicker, make them more confident that condoms had been applied correctly and make sex more pleasurable and playful. The majority of participants who had recent experience of condom use errors/problems reported that the use of the product would likely prevent these issues from occurring. Reduced chance of condom damage, the design features of the wrapper and not having to touch the condom itself during application were perceived as particular benefits of the product. The findings suggest that the product might reduce the likelihood of a range of condom user errors and problems and enhance pleasure during condom-protected sex. Future larger-scale studies that involve participants physically testing the condom wrapper/applicator are warranted.

This study assessed the prevalence of self-reported HIV infection among a community sample of transgender women and identified associated contextual, experiential, and behavioral factors. Ninety-two transgender women completed a self-administered interview. Recruitment occurred through an LGBT service organization, a transgender support group, transgender advocates, and informal communications. Eighty-two percent were African American/Black. Of 83 who knew their status, 60% reported being HIV infected. High rates of childhood sexual abuse (52%), rape (53%), intimate partner violence (56%), and incarceration (57%) were reported. Many did not have health insurance (53%), were not employed full-time nor in school (63%) and had been recently homeless (49%). HIV-infected transgender women as compared to HIV-uninfected transgender women were more likely to be African American/Black ( P = 0.04), and older than 34 years ( P = 0.01), unemployed/not in school ( P

This study determined whether a novel (single-item) measure of poverty is associated with elevated sexual risk among young Black men who have sex with men who reside in a US city with high HIV seroprevalence. A convenience sample of 600 Black men who have sex with men (ages 16–29) completed a computer-assisted self-interview. The questionnaire included an item asking men, ‘In the past 12 months have you missed meals because you did not have enough money to eat?’ Selected measures of sexual risk and prevalence of chlamydia, gonorrhea, and HIV were assessed as outcomes of this novel measure of poverty. About 22% had missed meals due to lack of money. In age-adjusted analyses, these men were more likely to report: (1) having concurrent sex partners ( P = .03), (2) having sex with partners who were generally five or more years older ( P = .02), (3) not using condoms the first time they had sex with their most recent new partner ( P = .015), (4) having sex with persons not known by name ( P = .02), (5) depending on sex partners for food, money, and shelter ( P

BACKGROUND: To determine whether men's reported desire to father a child or their perception that someone wanted to have their child was associated with elevated rates of unprotected vaginal sex, among a sample of young Black men at high risk of sexually transmitted infection acquisition.METHODS: Data were collected in clinics treating sexually transmitted infections in three southern U.S. cities. Men 15-23 years of age who identified as Black/African American and reported recent (past two months) penile-vaginal sex were eligible (N = 578). Logistic regression was used to examine whether desire to conceive a child (self and perception of partners' desire) predicted condom use, adjusting for age and whether they had previously impregnated someone.RESULTS: Their own level of desire to conceive a child was not significantly associated with unprotected vaginal sex or the proportion of times a condom was used. However, those who perceived higher level of someone wanting to conceive their child were 1.73 times more likely to report unprotected vaginal sex (P = .006) and 1.62 times more likely to report a lower proportion of times condoms were used (P = .019).CONCLUSIONS: Young Black men attending sexually transmitted infection clinics in the USA may forego condom use based on a perceived desire of their partners to become pregnant putting themselves at risk for sexually transmitted infection acquisition and unplanned pregnancy. Findings provide initial support for the relevance of the idea that perceptions of women partners' desire to conceive may be a critical determinant of condomless sex.

Despite developmental differences between young adults and adults, studies of condom use have not typically considered young adults as a distinct age group. This study sought to examine how condom use and its correlates differed between high-risk young adults and adults. Sexually transmitted infection (STI) clinic patients ( n = 763) reported STI history, contraception, negative condom attitudes, fear of partner reaction to condom use and risky behaviours. Past 3-month condom use was examined as unprotected vaginal sex (UVS) acts, proportional condom use and consistent condom use. Regression models tested associations of age group and potential correlates with each condom use outcome. Interaction models tested whether associations differed by age group. Proportional condom use was greater in young adults than adults (mean 0.55 vs. 0.47); UVS and consistent condom use were similar between age groups. Young adults with a recent STI reported less condom use, whereas for older adults, a distant STI was associated with less condom use, compared to others in their age groups. Negative condom attitudes were more strongly linked to UVS acts for younger versus older adults. STI prevention efforts for younger adults may be improved by intensifying counselling about condom use immediately following STI diagnosis and targeting negative condom attitudes.

The dramatic racial disparities in the rates of HIV/STIs(sexually transmitted infections) among African Americans make understanding broader structural factors that increase the risk for HIV/STIs crucial. The current study of young 564 African American men attending STI clinics investigated whether those who had ever been incarcerated reported recent sexual behaviors relatively more risky than their counterparts who had never been incarcerated. Participants were recruited from clinics treating STIs in three southern U.S. cities. Males 15 to 23 years of age who identified as Black/African American and reported recent (past 2 months) sexual activity were eligible. Linear mixed-effects models and generalized estimating equation models were used to assess associations between baseline incarceration history and sexual risk behavior over a 6-month follow-up period. Mean age was 19.6 years ( SD = 1.87). At baseline, 240 (42.6%) men reported history of incarceration. Incarceration history predicted several risk behaviors over a 6-month follow-up period. Compared with those with no incarceration history, men previously incarcerated reported a desire to conceive a pregnancy (β = .40, p = .02), were less likely to have used a condom at last sex act (odds ratio = .91, p = .02) and were more likely to have used drugs and alcohol before sex in the past 2 months (β = .69, p < .001; β = .41, p < .001). A history of incarceration may influence the sexual risk behavior of young African American males. Prevention programs and interventions should intensify support for postincarceration African American males to help mitigate this behavior.

This study was undertaken in two locations in Trinidad Sea Lots and Point Fortin between November and December 2007. Participants were women aged 16-24. The study uses the PEER (participatory ethnographic evaluation and research) method to generate in-depth narrative data and provide an authentic insider view of the realities of the target group. The FoQus on Segmentation strategy was used to gain programmer input into the study design identify potential determinants of condom use and explore factors that will be used to develop a concept for promoting condom use with outside partners. PSI/Caribbean will use the results to develop interpersonal communication activities and a media campaign directed at the target group. Initially the study set out to understand transactional cross-generational relationships identified as a major risk factor among the target group. The data revealed that within the target population sexual relationships and financial benefits are intimately linked within all relationships. Despite the differences in economic context between Sea Lots and Point Fortin in all interview narratives sex and money are inextricable. An over-riding feature of the interviews is that sex is commoditised as part of the norm of relationships. Sex without financial gain is perceived within the target group as aberrant and certainly not normative. The data made clear that defining some relationships as transactional and some as not is not meaningful in the context of the target group. The study has therefore focussed on understanding how patterns of concurrent relationships are managed and maintained.

This investigation compared circumcised and intact (uncircumcised) men attending sexually transmitted infection (STI) clinics on condom perceptions and frequencies of use. Men ( N = 316) were recruited from public clinics in two US states. Circumcision status was self-reported through the aid of diagrams. Intact men were less likely to report unprotected vaginal sex ( P < 0.001), infrequent condom use ( P = 0.02) or lack of confidence to use condoms ( P = 0.049). The bivariate association between circumcision status and unprotected sex was moderated by age ( P < 0.001), recent STD acquisition ( P < 0.001) and by confidence level for condom use ( P < 0.001). The bivariate association between circumcision status and infrequent condom use was also moderated by age ( P = 0.002), recent STI acquisition ( P = 0.02) and confidence level ( P = 0.01). Multivariate findings supported the conclusion that intact men may use condoms more frequently and that confidence predicts use, suggesting that intervention programmes should focus on building men's confidence to use condoms, especially for circumcised men.

Young Black men (YBM), aged 13 to 24 years, face a disproportionate burden of sexually transmitted infections (STIs). STI acquisition among YBM is due to incorrect and inconsistent condom use and is exacerbated by multiple sexual partners. Sexual and reproductive health is influenced by a complex interaction of biological, psychological, and social determinants that contribute to increased risk for STI acquisition. However, there are key social determinants of sexual health that play a major role in adolescent sexual risk–taking behaviors: gender norms, environment, peers, and families as well as a desire to impregnate a woman. Associations between contextual factors (risky environmental context, desire to impregnate a woman, and peer norms supportive of unsafe sex) and sexual risk behaviors were examined among a sample of YBM attending adolescent health clinics. This study used baseline data from a randomized controlled trial ( N = 702). Parental monitoring was also examined as an effect modifier of those associations. Sexual risk behaviors were the frequency of condomless vaginal sex, number of sexual partners within the previous 2 months, and lifetime number of sexual partners. Mean age was 19.7. In the adjusted model, peer norms was the only significant predictor for all sexual risk outcomes ( p < .05). Parental monitoring was an effect modifier for the perceived peer norms and lifetime sexual partners association ( p = .053) where the effect of peer norms on lifetime sexual partners was lower for participants with higher levels of perceived parental monitoring.

A mathematical model of HIV/sexually transmitted infections (STI) transmission was used to examine how linearity or nonlinearity in the relationship between the number of unprotected sex acts (or the number of sex partners) and the risk of acquiring HIV or a highly infectious STI (such as gonorrhea or chlamydia) affects the utility of sexual behavior change measures as indicators of the effectiveness of HIV/STI risk-reduction interventions. Findings indicate that the risk of acquiring HIV through vaginal intercourse is essentially a linear function of the number of unprotected sex acts and is nearly independent of the number of sex partners. Consequently, the number of unprotected sex acts is an excellent marker for the risk of acquiring HIV through vaginal intercourse, whereas the number of sex partners is largely uninformative. In general, the number of unprotected sex acts is not an adequate marker for the risk of acquiring a highly infectious STI due to the highly nonlinear per act transmission dynamics of these STIs. The number of sex partners is a reasonable indicator of STI risk only under highly circumscribed conditions. A theoretical explanation for this pattern of results is provided. The contrasting extent to which HIV and highly infectious STIs deviate from the linearity assumption that underlies sexual behavior outcome measures has important implications for the use of these measures to assess the effectiveness of HIV/STI risk-reduction interventions.

This study determined whether bisexual male injecting drug users (IDUs) as compared with heterosexual IDUs were more likely to engage in HIV-associated risk behaviours. Respondent-driven sampling was employed to recruit a sample of 382 male IDUs residing in the southeastern USA. Data were collected in face-to-face interviews. Weighted analyses showed that bisexual IDUs in the past 12 months were 4.6 times as likely to share needles and 3.5 times as likely to share a cooker; having multiple female sexual partners and trading money or drugs for sex with women were marginally significant. Bisexual IDUs were 10 times as likely to self-report HIV. Male IDUs, who engage in bisexual behaviour, are also engaging in HIV-associated drug and to some degree sexual-risk behaviours with women more so than heterosexual IDUs. Their higher prevalence of HIV infection coupled with their risk behaviours place themselves and other IDUs at heightened risk of both acquiring and transmitting HIV.

Summary: An exploratory study compared the prevalence of multiple types of condom-associated ‘turn offs’ in men and women. Nearly 2000 people completed a web-based questionnaire. Data were analysed from 464 men and women who reported that condoms had turned them off the last time they were used. Gender differences were not observed for the majority (9) of 15 turn offs. The most common turn offs related to loss of pleasure. For example, more than three-quarters of the men and nearly 40% of the women reported decreased sexual sensation (P = 0.0001). Putting on condoms was reported by 43.2% of the men versus 30.2% of the women (P = 0.02). Smell was a relatively frequent turn off, with about one-third indicating this issue and no significant gender difference (P = 0.32). Turn offs pertaining to arousal and orgasm were also common. Findings suggest that numerous physical and psychological condom turn offs may be experienced by men and women while using male condoms. Although some turn offs differed as a function of gender, there was remarkable similarity between men and women.

This study reports on the validation of a scale to assess adolescent girls' frequency of sexual communication with their parents. The Parent-Adolescent Communication Scale (PACS) was administered to 522 African American female adolescents ranging in age from 14 to 18. The PACS demonstrated satisfactory internal consistency (across multiple administrations) and acceptable test-retest reliability over a 12-month follow-up period. Concurrently, scores on the PACS were correlated with frequency of sexual communication with partner, sexual communication self-efficacy (boyfriend), perceived parental knowledge, family support, depression, and condom use with steady male sex partners. Prospectively, baseline PACS scores were correlated with frequency of sexual communication with partner and condom use. The present investigation indicates that the PACS is a reliable and valid measure of frequency of sexual communication between female adolescents and their parents. Utility of the PACS for researchers and practitioners is discussed.

Theories of health behavior posit that change is accomplished by modifying factors deemed as mediators. A set of mediators from several theoretical models used in sexual risk reduction programs was assessed among a sample of 522 African American female adolescents. The goal was to determine whether self-esteem was associated with sexually transmitted disease (STD), pregnancy, and the set of theoretical mediators controlling for covariates. Bivariate analyses showed no relationship between self-esteem and STD or pregnancy; multivariate regression analysis revealed a significant relation between self-esteem and the set of mediators. Girls higher in self-esteem were more likely to hold positive condom attitudes, felt more efficacious in negotiating condom use, had more frequent communication with sex partners and parents, perceived fewer barriers to using condoms, and were less fearful of negotiating condom use. Self-esteem should be considered when designing and evaluating sexual risk reduction programs for this population.

Our objective was to determine a sociodemographic profile (typology) of men for whom a relatively greater number of sex partners was associated with engaging in unprotected anal sex. A cross-sectional survey of 150 men who have sex with men (MSM) attending a large sex resort was conducted. The sex resort was located in the Southeastern United States. Men from 14 states attended the resort and completed an anonymous, self-administered, questionnaire. The typology that emerged showed that the co-occurring risk behaviours (greater number of partners and having unprotected sex) were reported by older men ( P=0.002), men with incomes of at least US&dollar;50,000 ( P=0.018), men growing up in rural areas ( P=0.005), men who were not knowingly HIV positive ( P=0.004), and men who had received the full series of vaccinations against hepatitis B ( P=0.029). This typology may be useful for more efficient targeting of prevention and counselling programmes designed to reduce sexually transmitted infection incidence among this high-risk (and understudied) population of MSM.

This study of 522 African American female adolescents, ages 14 to 18, investigated associations between condom use and infrequently communicating with sex partners about sexually transmitted diseases (STDs) and pregnancy prevention. Correlates of infrequent communication were identified. Sexually active adolescents were recruited from schools and adolescent medicine clinics in low-income neighborhoods of Birmingham, Alabama. Adolescents completed a self-administered survey and face-to-face interview. Communication frequency was assessed using a five-item scale. Infrequent communication was significantly associated with lower odds of condom use. Multivariate correlates of infrequent communication were less frequent communication with parents about STD/pregnancy prevention, recent sex with a nonsteady partner, low perceived ability to negotiate condom use and fear of this negotiation, and low motivation to use condoms. Given the importance of partner communication in promoting safer sex behaviors, STD and pregnancy prevention programs may benefit adolescents by addressing the identified psychosocial correlates of infrequent communication with their partners.

The relationship between family and sexual activity-related factors were measured among 522 African American adolescent girls recruited from schools and clinics in Birmingham, Alabama. Girls living with a mother in a supportive family were more likely to use condoms when having sex, less likely to have recent emotional abuse from their sex partners, less fear and higher self-efficacy in negotiating use of a condom, and fewer partner-related barriers to safer sex.

We aimed to determine whether the type of outcome expectation, stemming from HPV vaccination, would have any effect on young men's HPV vaccine intent. We recruited young men (18–24 years of age) from two university campuses ( n = 150). After answering a series of questions they were randomly assigned to one of three information conditions (all delivered by computer): (1) how women may benefit from men's HPV vaccination, (2) preventing genital warts and (3) preventing head and neck cancers. Intent to be vaccinated against HPV in the next 12 months was assessed before and after receiving the informational session corresponding to the assigned condition. A repeated-measures t-test indicated that a significant increase in young men's intent to be vaccinated after they received the assigned information ( t = 9.48, [147], P = 0.0001). However, the increase in intent to be vaccinated did not vary by group assignment as there were no significant differences in mean intent scores between the three groups ( F = 0.59, [2/144], ( P = 0.56). Information that promotes the outcome expectations of protecting women from cervical cancer, preventing genital warts for men and preventing head and neck cancers for men may be equally effective in promoting increased intent for HPV vaccine acceptance among young university men.

Our objective was to assess prospectively the relative contribution of reducing penile–vaginal risk exposure to zero and limiting the number of sex partners to one, on the acquisition of biologically confirmed sexually transmitted disease (STD) among African American women adolescents. Data from a prospective cohort of 522 African American women adolescents enrolled in an HIV prevention trial were used. Baseline STD testing and single-dose directly observable treatment provided an infection-free cohort, who were followed and assessed at six-month intervals. Self-administered vaginal swab specimens were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis at baseline, six, 12, and 18 months. Frequency of having multiple sex partners and unprotected vaginal sex over each six-month assessment interval was measured. Adolescents who reported multiple sex partners, relative to only one partner, were more likely to test positive for an STD (adjusted odds ratio (AOR) = 2.9; P = 0.0001). Adolescents who reported unprotected vaginal sex relative to those reporting protected vaginal sex also had greater odds of testing positive for an STD (AOR = 1.5; P = 0.0001). Prospective findings suggest that having multiple sex partners and engaging in unprotected vaginal sex both remain significant risk factors for STD acquisition among African American adolescent women. STD prevention programmmes need to target both risk factors to achieve optimal risk-reduction effectiveness.

The purpose of this study was to identify the salient issues related to getting a future AIDS vaccine among a high-risk group. In-depth interviews were conducted with 24 White and Black men who have sex with men (MSM). Participants reported that they would need information regarding the vaccine strategy, the clinical trials research, and vaccine attributes. A prerequisite for Black participants was the prior inclusion of Blacks in clinical trials. A high degree of safety and effectiveness, minimal side-effects, high-perceived risk, and affordable cost would promote vaccine acceptance. Barriers were low degree of safety and effectiveness, harsh side-effects, low-perceived risk, perception of a backlash effect, cost, and inconvenience. MSM may not readily get an AIDS vaccine unless they are provided with specific details and the benefits outweigh the costs. Researchers conducting HIV vaccine trials should provide information about the research and insure that samples represent Black men.

This article studies the problems confronting attitude research in a bilingual market. Two experiments were conducted in Canada to develop a clearer understanding of French-English differences, not as they pertain directly to attitudes, but rather as they pertain to differential reactions to the scaling devices themselves.