Understanding Heterosexual Condom Use among Homeless Men

Abstract

This study uses an event-based approach to examine individual, relationship, and contextual correlates of heterosexual condom use among homeless men. Structured interviews were conducted with a predominantly African American sample of 305 men recruited from meal lines in the Skid Row area of Los Angeles. Men reported on their most recent heterosexual event involving vaginal or anal intercourse. Adjusting for demographic characteristics only, condom use was more likely when men had higher condom use self-efficacy, greater HIV knowledge, or talked to their partner about condoms prior to sex. Condom use was less likely when men held more negative attitudes towards condoms, the partner was considered to be a primary/serious partner, hard drug use preceded sex, or sex occurred in a public setting. Condom attitudes, self-efficacy, partner type, and communication were the strongest predictors of condom use in a multivariate model that included all of the above-mentioned factors. Associations of unprotected sex with hard drug use prior to sex and having sex in public settings could be accounted for by lower condom self-efficacy and/or less positive condom attitudes among men having sex under these conditions. Results suggest that it may be promising to adapt existing, evidence-based IMB interventions for delivery in non-traditional settings that are frequented by men experiencing homelessness to achieve HIV risk reduction and thus reduce a significant point of disparity for the largely African American population of homeless men.

Sex Partner Type, Drug Use and Condom Use Self-Efficacy Among African Americans from Disadvantaged Neighborhoods: Are Associations with Consistent Condom Use Moderated by Gender?

“…Even when one of the steady partners has been identified with a sexually transmitted disease (STD), including HIV, or when one of the partners is known to have had sex with individuals who may have engaged in unsafe sex with others, condom use remains perceived as in violation with the expectations and nature of the steady partnership (Corbett et al, 2009). Perceptions of and commitment to a steady sex partner appear to overwrite potential motives in favor of condom use, especially among women (De Visser & Smith, 2001; Tucker et al, 2012). …”

Knowledge about HIV in a Community Sample of Urban African Americans in the South

“…In the scientific literature, evidence has been accumulating to suggest that various subgroups of African American adults may have lower overall levels of condom use self-efficacy, thereby elevating their risk for contracting HIV and other STIs. This has been found to be true for African Americans who are crack users [20], homeless [21], adolescent females [22], juvenile offenders [23], rural-dwelling women aged 50 or older [24] and HIV-positive men who have sex with men [25]. …”

Housing First and Unprotected Sex: A Structural Intervention

“…This is not surprising as increased odds of unprotected sex (or lower odds of condom use) with a primary or steady partner have been reported in the literature (Grangeiro et al, 2012;Kilbourne et al, 2002;Tucker et al, 2010;Tucker et al, 2013). Moreover, Stein, Nyamathi, Ullman and Bentler (2007) found that marriage and lower condom use were significantly correlated in their confirmatory factor analysis, but not in their predictive model.…”