Condom-Protected Sex and Minority Stress: Associations with Condom Negotiation Self-Efficacy, “Passing” Concerns, and Experiences with Misgendering among Transgender Men and Women in Brazil

This cross-sectional exploratory study aims to verify associations between condom-protected sex, condom negotiation self-efficacy, self-esteem, and four minority stressors (experiences with misgendering, “passing” concerns, anticipated prejudice, and perceived prejudice) among transgender men (TM) and transgender women (TW). 260 individuals (192 TW and 68 TM) residing in two Brazilian states participated in the study. Data was collected online and in two hospital programs for transgender people and included sociodemographic data, condom-protected sex, the Trans-Specific Condom/Barrier Negotiation Self-Efficacy (T-Barrier) Scale, the Rosenberg Self-Esteem Scale, and four minority stressors. Measures that were significantly associated with condom-protected sex were tested as independent variables in a linear regression model. The main results suggest that lower condom negotiation self-efficacy, higher “passing” concerns, and higher experiences with misgendering were predictors of lower frequency of condom-protected sex. These negative outcomes were found among both TM and TW, which justifies their inclusion in public health policies. Structural strategies and clinical interventions are suggested to address condom negotiation self-efficacy and “passing” concerns in transgender populations.

Assessing sexting-based condom negotiation among forcibly displaced adolescents in Kampala, Uganda: Validation of the ‘Condom use negotiated experiences through technology’ (CuNET) Scale (Preprint)

BACKGROUND Digital sexual communication strategies (e.g., sexting) may increase adolescents’ confidence to discuss sexual health and negotiate condom use. Because few validated measures for evaluating sexting-based condom negotiation exist, this study created and examined the psychometric properties of a condom use negotiated experiences through technology (CuNET) scale. OBJECTIVE Examining the psychometric properties of a sexting-based condom negotiation scale. METHODS Using peer network sampling, 242 forcibly displaced adolescents (16-19-years) were recruited for participation. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation sub-samples to conduct exploratory and confirmatory factor analyses to establish and validate the scale. CuNET measured participants’ support levels for condom negotiation via sexting by gender and associations with sexual health outcomes RESULTS Approximately 25% of respondents reported substantial support for sexting as a condom negotiation strategy. The one-factor CuNET with the validation sample showed a good fit. Adolescent girls showed significantly lower levels of support for using sexting to negotiate condom use (13.60 vs. 21.48, p=.001). Participants who used a condom in the previous three months were more likely to support condom negotiation via sexting than those who did not use condoms (5.16 vs. 2.70, p=.001). CONCLUSIONS The unidimensional CuNET scale is (1) valid and reliable for forcibly displaced adolescents living in HIV hyper-endemic settlements in Kampala, (2) gender-sensitive, and (3) relevant for predicting condom use among urban displaced and refugee adolescents. Further development of this scale will enable better understandings of how adolescents are using digital tools for condom negotiation.

Love Carefully and Without ‘Over-bearing Fears’: The Persuasive Power of Authenticity in Late 1980s British AIDS Education Material for Adolescents

Summary This article examines the 1987 British AIDS education leaflet Love Carefully: Use a condom, drawing on methodologies from both the history of emotion and literary analysis. The informative leaflet, produced collaboratively by the sexual health charities Brook and the Family Planning Association, was intended to prevent the spread of HIV among heterosexual adolescents, a group increasingly viewed as ‘at risk’ by adult producers of health education globally. Steeped in British teenage popular culture, it deployed an introduction from well-known teenage agony aunt Melanie McFadyean, a cartoon strip, and statements from celebrities. The cartoon offered a representation of the difficulties experienced by heterosexual teenagers negotiating the prospect of penetrative sex with a new partner, offering a successful example of condom negotiation, while sympathetically examining why some found condom use and AIDS difficult subjects to broach. The article argues the leaflet deployed emotions and authenticity to persuade teenagers to practise safer sex.

Sexual coercion and condom use: A moderated mediation model of condom negotiation and sexual orientation in young Chinese women (Preprint)

BACKGROUND Sexual coercion against young women is a global public health problem. Although the relationship between sexual coercion and condom use consistency has been widely demonstrated, the mechanism of this relationship is still unclear. OBJECTIVE To test condom negotiation as a mediator of the relationship between sexual coercion and condom use in young Chinese women and to investigate whether sexual orientation was a moderator. METHODS A total of 402 young Chinese women were included in the analysis using a web-based questionnaire. Moderated mediation analyses were conducted with sexual coercion as the independent variable, condom use consistency as the dependent variable, condom negotiation as the mediator variable, and sexual orientation as a moderator. RESULTS The results of a moderated mediation analysis indicated that this relationship was significantly mediated by condom negotiation and moderated by sexual orientation. The indirect effect of condom negotiation was significant in heterosexual women (indirect effect:-0.80, 95%Boot-confidence interval(CI): -1.67, -0.36) but not in sexual-minority women (indirect effect: -0.33, 95%Boot-CI: -0.86, 0.31). CONCLUSIONS The results showed that sexual orientation meaningfully affects the relationship between sexual coercion and condom negotiation. The difference in the mechanism of the relation between sexual coercion and sexual behaviors in heterosexual and sexual minority women should be considered for future research and interventions aimed at mitigating the adverse effects of sexual coercion.

Condom negotiation self-efficacy and preparatory behaviors among Mozambican women at sexual risk

Background Preparatory behaviors (intention to use and buy/get condoms) are extremely important for sexual protection among African women, because the intentions to use and get condoms are the best predictors of effective condom use in some African contexts. However, these preventive behaviors are not as successful as desired, because they are often associated with negative meanings in the context of the sexual relationship. This study aims to identify whether condom negotiation self-efficacy is associated with sexual preparatory behaviors among Mozambican women at risk for HIV/AIDS infection. Methods Women (173), patients at a public Hospital and at risk for HIV infection, completed measures of sociodemographic and marital characteristics, condom negotiation self-efficacy, and sexual preparatory behaviors. Results Socio-demographic variables (age and education) explained 16.1% of variance (ΔF(2, 170)=16.30, p <.001), and marital variables, “marital status” and “talking about AIDS with partner” explained 22.3% of additional variance (ΔF(2, 168)=30.36, p <.001) in preparatory behaviors. The final model with condom negotiation self-efficacy explained 11.7% of additional variance (ΔF(1, 167)= 39.14, p <.001), this being the most important correlate in the model (β = .48). We observed that higher condom negotiation self-efficacy is associated with higher levels of preparatory behaviors. The overall model explained 48.6% of variance in sexual preparatory behaviors. Conclusions These results seem to support an exploratory predictive model of sexual preparatory behaviors that can inform interventions directed at behavioral change among Mozambican women at sexual risk. Key messages Women who were younger, had a higher level of education, were single, and talked about AIDS, had higher levels of preparatory behaviors. Women who had a higher level of condom negotiation self-efficacy, had higher levels of preparatory behaviors.

Barriers against safer sex as predictors of condom negotiation self-efficacy among Mozambican Women

Background Negotiation self-efficacy is one of the main predictors of effective condom use. Therefore, it is essential to identify the factors that influence condom use negotiation self-efficacy in vulnerable women. The aim of this paper is to examine whether socio-demographic and marital factors, and perceived barriers against safer sex are associated with condom use negotiation self-efficacy among Mozambican women at sexual risk. Methods 173 women, patients at a Mozambican public Hospital and at risk for HIV infection, completed measures of sociodemographic and marital characteristics, perceived barriers against safer sex, and condom use negotiation self-efficacy. Measures included the Mozambican version of the “Women's Health Study Questionnaire”, which presented good psychometric properties in this sample. Results Demographic variables (age and education) explained 20% of the variance (ΔF(2, 170)=20.92, p<.001) in condom use negotiation self-efficacy, and the marital variables, “marital status” and “talking about AIDS with partner”, explained 30% of the variance in the outcome (ΔF(2, 168)=50.06, p<.001). Barriers against safer sex explained 6.5% of unique variance in condom use negotiation self-efficacy (ΔF(1, 167)= 24.68, p<.001). The overall model explained 55% of the variance in condom use negotiation self-efficacy. Conclusions These results support an exploratory predictive model of condom use negotiation self-efficacy that can inform interventions directed at behavioral change among Mozambican women at sexual risk. Key messages Women who were younger, had a higher level of education, were single, and talked about AIDS, had higher levels of condom use negotiation self-efficacy. Women who had lower levels of perceived barriers, had higher levels of condom use negotiation self-efficacy.

Care Support Education: Optimization Model of Communication Change Behavior in Female Sex Workers

Female Sex Workers (FSW) are a group of populations at high risk of transmitting HIV/AIDS. In Indonesia, it is predicted that more than 50% of FSW suffer from sexually transmitted diseases (STDs), as well as in the district of Batang, Central Java, the most cases of HIV/AIDS in FSW. The main causes are weak sexual negotiation skills and economic reasons. The model of behavior change is the main key in decreasing cases of HIV/AIDS transmission. The Care Support Education (CSE) model is an innovative community-based behavior change communication. This research is pre experimental research with one group pretest posttest design. The population is FSW in Batang district localization totaling 123 people. Samples were taken by purposive sampling of 57 people. Test the effect of applying the CSE model on behavior change was analyzed using the Mc Nemar test. Condom use in risky sexual behavior among FSWs was still low (15.8%). Factors that influence it are knowledge, attitudes, perceptions of vulnerability, seriousness, benefits, negotiation capabilities and customer support. The application of the CSE model can significantly increase knowledge (p value 0.00006), attitude (0.0001), condom negotiation skills (0.000001) and practise of using condoms (0.000005).

Condom use: a less travelled route among minibus taxi drivers and their taxi queens in KwaZulu-Natal, South Africa

Background: Despite significant gains in the HIV epidemic in South Africa, with reduction in mortality and elimination of vertical transmission, national HIV prevalence remains high, with women rather than men continuing to bear higher bur- den of the disease. Population subgroups, through ignorance, disbelief or recklessness, continue to engage in risky sexual behaviour. A substantial proportion of minibus taxi drivers engage in risky sex, seldom seeing themselves at risk for STIs or HIV/AIDS. These taxi drivers have been linked with so-called taxi queens, with whom they engage in transactional and intergenerational relationships. Objectives: The study explored condom use and condom negotiation strategies among taxi drivers and taxi queens in Kwa- Zulu-Natal, South Africa. Methods: Applying explorative qualitative design, we conducted focus group discussion and individual interviews among participants who were purposively recruited in KwaZulu-Natal. Results: Qualitative data analysis revealed that condom use and negotiation are sources of conflict for the participants. In addition, the strategies employed by participants to ensure condom usage are not always sustainable and are likely to be problematic due to a variety of complex factors. Conclusion: Our study concludes by recommending a nested public health response that takes cognizance of factors that promote sustainable condom use strategies among this population subgroup. Keywords: Condom use; minibus taxi drivers; KwaZulu-Natal; South Africa.