Motivations for condom use: do pregnancy prevention goals undermine disease prevention among heterosexual young adults?

Pregnancy prevention and condom use practices among HIV-infected women on antiretroviral therapy seeking family planning in Lilongwe, Malawi

Background

Programs for integration of family planning into HIV care must recognize current practices and desires among clients to appropriately target and tailor interventions. We sought to evaluate fertility intentions, unintended pregnancy, contraceptive and condom use among a cohort of HIV-infected women seeking family planning services within an antiretroviral therapy (ART) clinic.

Methods

200 women completed an interviewer-administered questionnaire during enrollment into a prospective contraceptive study at the Lighthouse Clinic, an HIV/ART clinic in Lilongwe, Malawi, between August and December 2010.

Results

Most women (95%) did not desire future pregnancy. Prior reported unintended pregnancy rates were high (69% unplanned and 61% unhappy with timing of last pregnancy). Condom use was inconsistent, even among couples with discordant HIV status, with lack of use often attributed to partner’s refusal. Higher education, older age, lower parity and having an HIV negative partner were factors associated with consistent condom usage.

Discussion

High rates of unintended pregnancy among these women underscore the need for integ rating family planning, sexually transmitted infection (STI) prevention, and HIV services. Contraceptive access and use, including condoms, must be improved with specific efforts to enlist partner support. Messages regarding the importance of condom usage in conjunction with more effective modern contraceptive methods for both infection and pregnancy prevention must continue to be reinforced over the course of ongoing ART treatment.

Are dual-method messages undermining STI/HIV prevention?

Adolescent girls and young women who are at risk for unplanned pregnancy and sexually transmitted infection (STI), including HIV, are frequently counseled to use a hormonal contraceptive to protect against the former and condoms to protect against the latter, for example, American College of Obstetricians and Gynecologists, 2011. The present paper reviews the literature on multiple risk messages, compliance with this dual-use recommendation, predictors of dual use, and interventions developed to encourage dual use. Data indicate that simultaneous use of these two methods is not common, and that efforts to encourage dual use have not yielded promising results. An alternative is to recommend condom use alone, since condoms protect very well against STI and HIV, and quite well against pregnancy when used consistently and correctly. The availability of emergency contraception is relevant here. Research utilizing a randomized controlled trial is recommended.

Alcohol and risky sexual behavior among heavy drinking college students

Multiple event-level methodology was used to examine the relation between risky sexual behavior and alcohol use among sexually active, heavy drinking college students (N = 221). Using a structured timeline follow-back interview, participants reported their sexual, alcohol, and drug use behaviors over a 3-month period. Over 2,700 vaginal or anal sexual events were reported from 177 participants. Overall, condom use was not associated with heavy or non-heavy alcohol consumption among those reporting both sexual events concurrent with heavy drinking and when no alcohol was consumed. Results from multilevel regression analyses revealed a more complex pattern. Among women, but not men, less condom use was associated with steady versus casual sexual partners, but partner type interacted with alcohol consumption such that less condom use occurred when heavy drinking preceded sex with steady partners. At the event-level, alcohol consumption among heavy drinking college students leads to risky sexual behavior but the relation differs by gender and partner type.

Profiles of motivations for alcohol use and sexual behavior among first-year university students

The links between motivations for alcohol use and for sexual behaviors are not well understood. Latent profile analysis was used to identify drinking motivational profiles (based on motivations for: fun/social, relaxation/coping, image, sex; motivations against: physical, behavioral) and sex motivational profiles (motivations for: enhancement, intimacy, coping; motivations against: not ready, health, values) among college students (N=227, 51% male). Latent profiles for drinking were: low for/high against drinking (34%), average drinking motives (53%), and high for/low against drinking (13%). Profiles for sex were: low for/high against sex (35%), high for/low against sex (42%), and high for with coping/moderate against sex (23%). Motivational profiles were related across behaviors. Drinking motivational profiles were associated with alcohol use and psychosocial adjustment; sex motivational profiles were associated with sexual experiences. Distinct profiles of motivations support the need for differentiated intervention programs targeting individuals with different patterns of reasons for engaging in risk behaviors during late adolescence.

Sub-Saharan African university students' beliefs about condoms, condom-use intention, and subsequent condom use: a prospective study

Whether certain behavioral beliefs, normative beliefs, and control beliefs predict the intention to use condoms and subsequent condom use was examined among 320 undergraduates at a university in South Africa who completed confidential questionnaires on two occasions separated by 3 months. Participants' mean age was 23.4 years, 47.8% were women, 48.9% were South Africans, and 51.1% were from other sub-Saharan African countries. Multiple regression revealed that condom-use intention was predicted by hedonistic behavioral beliefs, normative beliefs regarding sexual partners and peers, and control beliefs regarding condom-use technical skill and impulse control. Logistic regression revealed that baseline condom-use intention predicted consistent condom use and condom use during most recent intercourse at 3-month follow-up. HIV/STI risk-reduction interventions for undergraduates in South Africa should target their condom-use hedonistic beliefs, normative beliefs regarding partners and peers, and control beliefs regarding technical skill and impulse control.

Oral contraceptive use may not preclude condom use: a study of non-pregnant African-American adolescent females

OBJECTIVE

To determine the association between oral contraceptive and condom use, and laboratory-confirmed sexually transmitted infection (STI) among African-American adolescent females at a high risk of STI acquisition.

METHODS

A cross-sectional study of 715 African-American adolescent females (15-21 years old) was conducted. Data collection included (a) an audio-computer-assisted self-interview and a self-collected vaginal swab for nucleic acid amplification testing of Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae.

RESULTS

The age-adjusted odds ratio (AOR) indicated a modest protective effect of oral contraceptive use against unprotected vaginal sex (UVS) using a 60-day recall period (AOR = 0.66; 95% CI 0.43 to 0.99). The age-adjusted difference in mean frequency of UVS in the past 60 days was non-significant (p = 0.23) as was condom use at last sex (p = 0.34). The age-AOR relative to STI prevalence also showed a protective effect (AOR = 0.60; 95% CI 0.36 to 0.98) for those using oral contraceptives.

CONCLUSION

The findings suggest that the use of oral contraceptives may not preclude safer sex practices for the prevention of STIs among high-risk African-American adolescent females.

One measure, two motives. Prediction of condom use and interaction between two prevention goals among heterosexual young adults: preventing pregnancy and/or sexually transmitted diseases

Although the dual function of condom use (preventing pregnancy and preventing STDs) is well known, little is known about the determinants of condom use for STD prevention when contraception is not an issue. We compared two intentions to use condoms with a new sex partner: one based on a vignette not mentioning pregnancy risk and one on a vignette explicitly stating there was no risk of pregnancy. We also investigated whether intentions to use condoms change when there is no pregnancy risk, to allow such changes to be predicted from an STD risk-perception perspective. This cross-sectional survey was completed by 151 undergraduate students. The correlation coefficient between the two intentions about condom use approached zero (0.02; p=.783). Logistic regression showed that two STD risk-perception variables distinguished between consistent and non-consistent reporters of their intention to use condoms. Findings are discussed from the perspectives of policy, methodology and theory.

Lack of recent condom use among detained adolescent males: a multilevel investigation

OBJECTIVE

To investigate multiple levels of influence with respect to the lack of recent condom use among a high risk sample of adolescent males recruited from short term detention facilities.

METHODS

A cross sectional survey of 231 adolescent males serving, predominantly, short term detention sentences. Assessments were conducted using audiocomputer assisted self interviewing. Condom use during the most recent sexual event was assessed as well as 20 potential correlates of not using condoms. Correlates were assessed within five levels of causation: personal, relational, peer affiliation, family, and societal.

RESULTS

Nine correlates achieved bivariate significance (p<0.05). Of these, the personal level correlates were particularly important in a multivariate model. The motivation subscale from the Condom Barriers Scale was the strongest multivariate correlate of recent condom use. Adolescents scoring below the median were about 3.4 times more likely to report lack of recent condom use (p=0.0006). Adolescents indicating they had ever caused a pregnancy were about 2.5 times more likely to report lack of condom use (p=0.02). Finally, those reporting their peers did not use condoms were about twice as likely to report lack of use (p=0.048).

CONCLUSION

Upon investigating multiple levels of potential influence on condom use, the multivariate findings suggest that personal level factors may be the most important determinant of non-use among adolescent males in short term detention facilities. Although structural changes may be needed to influence some forms of safer sex behaviour, direct intervention with adolescent males may be justified to favourably alter determinants of condom use.

Methodological challenges in research on sexual risk behavior: I. Item content, scaling, and data analytical options

Investigation of sexual behavior involves many challenges, including how to assess sexual behavior and how to analyze the resulting data. Sexual behavior can be assessed using absolute frequency measures (also known as counts) or with relative frequency measures (e.g., rating scales that range from never to always). We discuss these 2 assessment approaches in the context of research on HIV risk behavior. We conclude that these 2 approaches yield nonredundant information and, more important, that only data yielding information about the absolute frequency of risk behavior have the potential to serve as valid indicators of HIV contraction risk. However, analyses of count data may be challenging because of non-normal distributions with many outliers. Therefore, we identify new and powerful data analytical solutions that have been developed recently to analyze count data and discuss limitations of a commonly applied method (viz., analysis of covariance using baseline scores as covariates).