The Effects of Alcohol, Relationship Power, and Partner Type on Perceived Difficulty Implementing Condom Use Among African American Adults: An Experimental Study

Abstract

African American adults are disproportionately affected by HIV in the United States, underscoring the need for additional research on barriers to condom use. Guided by the theory of gender and power, this experimental study used a series of vignettes to test causal hypotheses regarding the influence of event-level alcohol use (present and absent), partner type (serious and casual), and relationship power (low and equal) on perceived difficulty implementing condom use. A total of 299 (151 women and 148 men) heterosexual African American adults indicated how “difficult” it would be to use a condom after reading 8 hypothetical sexual encounters, presented in a random order. A 2 x 2 x 2 x 2 repeated measures analysis of covariance (ANCOVA) with one between subjects factor (gender) and one covariate (condom use self-efficacy) was used to estimate the effects of these variables on an index of perceived difficultly. The women in the study reported significantly higher ratings of difficulty implementing condom use in vignettes characterized by low relationship power (p < .001) and presence of alcohol use (p < .001); the manipulated independent variables did not produce any main effects for men. Both men and women’s ratings of perceived difficulty decreased as condom use self-efficacy increased (p < .001). This is the first study to use an experimental methodology to test hypotheses about barriers to condom use among a community-based sample of African American adults. These data can be used to enhance existing HIV prevention interventions.

Monogamy as Public Policy for STD Prevention: In Theory and in Practice

“…Outside of discussions of monogamy, condom use is the other prominent message circulated surrounding STDs. But people generally perceive that condoms are for partners they distrust, and that they can quickly be replaced with monogamy (East et al, 2010; Misovich et al, 1997; Woolf-King & Maisto, 2015). Scant efforts have been made to convince established couples to maintain condom use.…”

African American Women and Sexually Transmitted Infections: The Contextual Influence of Unbalanced Sex Ratios and Individual Risk Behaviors

“…Specifically, African American men may be seen as a commodity in this social context. This disadvantages African American women as they may have less leverage in advocating for monogamous sexual relationships and condom use, which subsequently impacts their sexual health outcomes (Adimora, et al, 2001; Newsome & Airhihenbuwa, 2013; Senn, Scott-Sheldon, Seward, Wright, & Carey, 2011; Woolf-King & Maisto, 2015). …”

“…However, the risk of contracting an STI is not evenly distributed among the U.S. population. African Americans, especially young men and women, are particularly at risk of STIs and of experiencing their negative consequences (Centers for Disease Control and Prevention [CDC], 2014a, 2014b; Morris, Kurth, Hamilton, Moody, & Wakefield, 2009; Woolf-King & Maisto, 2015), and this relationship is more pronounced when drug use is involved (Adimora & Schoenbach, 2005; Aral, Adimora, & Fenton, 2008). Racial disparities in STI prevalence have devastating health consequences and considerable costs.…”

Demographic Predictors of Event-Level Associations between Alcohol Consumption and Sexual Behavior

“…41,42 Samples consisting solely of African American participants indicate associations between alcohol and sexual risk intentions or behaviors. 2,43,44 A smaller body of research has examined race and ethnicity as moderators of the links between alcohol use and sexual behavior, often finding stronger associations between alcohol consumption and sexual behavior among whites. [45][46][47][48] While alcohol consumption increases the likelihood of sexual activity across relationship types, this effect seems to be strongest for sex with casual partners, 10,16,46,[49][50][51][52][53][54] likely owing to the centrality of alcohol consumption in scripts that guide casual sex encounters.…”