Multilevel Social Influences on Female Condom Use and Adoption Among Women in the Urban United States

Abstract

Heterosexually transmitted HIV remains of critical concern in the United States and around the world, especially among vulnerable and disadvantaged women, complicated by socioeconomic circumstances, gender power, addiction, and experiences of abuse, among other conditions. Effective woman-initiated HIV prevention options, such as the female condom (FC), are needed that women can use in different sexual relationship contexts. We conducted a behavioral and attitudinal survey with 461 primarily African American and Latina (especially Puerto Rican) women in Hartford, Connecticut, to measure factors on the individual, partner relationship, peer, and community levels influencing their initial and continued use of FC (using the prototype FC1) for disease prevention. We used multivariate analyses and structural equation modeling to assess effects of multiple level factors on FC use and unprotected sex with primary, casual, and paying partners. Initial, recent, and continued FC use was associated with factors on the individual level (education, marital status, drug use, child abuse experiences, HIV status), partner level (number of sex partners, paying sex partner, relationship power), and peer level (more or influential peers saying positive things about FC). Community level factors of availability and support were consistently poor across all sectors, which limited overall FC use. Patterns differed between African American and Latina women in stages and contexts of FC use and unprotected sex. FC can make a valuable contribution to reducing heterosexually transmitted HIV among women in many circumstances. The greatest barrier to increased FC use is the lack of a supportive community environment for its promotion and use.

Dimensions of Psychological Well-being Predict Consistent Condom Use among Older Adults Living with HIV

“…Perhaps the most important findings for women are the role of environmental mastery and autonomy in prevention behavior. Because condom use for women necessitates partner negotiation, these findings are consistent with research into the dynamics of condom use among HIVnegative women which demonstrate the significance of gender-roles and powerdynamics in women's sexual behavior (Weeks et al, 2010). Both environmental mastery and autonomy have been observed to show incremental increase with age (Ryff, 1989).…”

A Systematic Review of the Psychometric Properties of the Sexual Relationship Power Scale in HIV/AIDS Research

“…Further, Pulerwitz et al (2000) found no evidence of an association between DMD and physical abuse or forced sex. Weeks et al (2010) and Campbell et al (2012) found that African American women tended to have higher DMD scores compared with White women.…”

“…Higher relationship control (RC subscale) in women was significantly associated with less intimate partner or dating violence (Campbell, Tross, Hu, Pavlicova, & Nunes, 2012; Pulerwitz et al, 2000; Roye, Tolman, & Snowden, 2012; Tietelman et al, 2008; Volpe, Hardie, & Cerulli, 2012), less sex work (Mosack et al, 2010), higher female condom use (Weeks et al, 2010), and less frequent unprotected vaginal sex (Knudsen et al, 2008; Mosack et al, 2010; Pulerwitz et al, 2000; Roye, Krauss, & Silverman, 2010). RC was not associated with preferred contraceptive method (Beckman et al, 2006), diaphragm use satisfaction (Beckman et al, 2006), or childhood sexual abuse (Mosack et al, 2010).…”

“…This may be due to the younger developmental stage of intimate relationships in adolescents, where dyadic decision-making has different focal points. Roye et al (2010) reported poor factorability (KMO=0.56) and the emergence of three separate sub-factors within the DMD, and numerous studies have removed items from the original 8-item subscale due to low factor-item correlation (Kaufman et al, 2008; Kershaw et al, 2006; Magee et al, 2006; Panchanadeswaran et al, 2010; Roye et al, 2012; Shannon et al, 2012; Weeks et al, 2010). The DMD also displays inconsistent construct validity.…”

Female Condom Use and Adoption Among Men and Women in a General Low-Income Urban U.S. Population

“…This model was informed by our prior research on associations in high-risk urban U.S. women among personal (demographic, health status/history, risk behavior and perception, prevention knowledge and attitudes), sex partner-related (relationship number, types and characteristics, abuse history), and peer (perceived influence and norms, network exposure) inputs on FC cognitive factors (knowledge, attitudes) and initial and continued FC use [14]. Though the model was developed and tested with women, we hypothesized the same theoretical relationships among co-factors and first- and second-level outcomes for both men and women in this study.…”