Perceived importance of condom use among African Americans using drugs

American Journal of Health Studies, Spring-Summer, 2003 by Joseph Schumacher, Min Qi Wang, Sacia Dear, Sapna Marepally, Foster Cook

Abstract: This study examined the relationship between the perceived importance of using condoms and the condom use among African American users of drugs (marijuana and cocaine) in a street outreach study. Despite the existence of scientific evidence that consistent condom use is a key factor in reducing heterosexual transmission of HIV, the cognitive factors that govern condom use, especially in users of non-injected drugs (crack and marijuana) is not very clear. As such, this study investigated perceived importance of condom use, the type of sex partners, drug use type, and gender of a group of African American users of drugs in a high-risk street outreach study. The key points discussed are: 1) major perceived importance of condom use associated with the actual condom use 2) condom use in main and other partners, 3) gender differences, and 4) differences in drug type related to condom use.

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Human Immunodeficiency Virus (HIV) infection and Acquired Immunodeficiency Syndrome (AIDS) continue to ravage communities of color, and are more closely associated with communities with low social economic levels. It is generally accepted that consistent condom use can prevent the transmission of HIV and sexually transmitted diseases (STD) and is often the key component of HIV prevention efforts. (Davis & Weller, 1999; Friedman, 2001). Consequently, HIV and AIDS prevention programs must target populations at high risk and promote the use of condoms. There are many reasons why people use, or do not use condoms during sex with their partners. In order to effectively promote consistent condom use, it is imperative to identify factors that influence condom use.

COGNITIVE MODELS

Literature has indicated that when people were afraid of being infected with HIV and perceived that condom use could reduce the threat of HIV, STDs and pregnancy, they were more likely to use condoms (Mickler, 1993; Oswalt & Matsen, 1995). In addition, it was also found that a high sense of self-efficacy and self-control, the perceived susceptibility to HIV infection (Goldman, 1993), and high moral reasoning skills (Hubbs-Tait & Garmon, 1995) were associated with consistent condom use. It appears that most of these psychological findings were obtained from non-drug use college populations. These cognitive models emphasize individual-based variables such as knowledge, attitudes, health beliefs, and behavioral intentions (Amaro, 1995; Kelly et al., 1992; Peterson et al., 1991), and appear to de-emphasize the salient dement of sexuality; its non-rational, emotional, counterpart i.e., the relationships between sex partners. It is important to link the perceived importance of condom use with actual condom use in order to identify the most relevant cognitive factors that could be incorporated in behavioral interventions.

PRIMARY AND OTHER SEX PARTNERS

The nature of the sexual relationship has an impact on the sexual practices. Condom use that occurs within steady, ongoing relationships has different implications for prevention than condom use in casual sexual encounters. A consistent finding in both population-based surveys (Kalichman, 1999) and studies of high-risk groups (Kalichman, 1997) has been that condom use is much lower with steady or regular partners than with other types of partners (Carball-Dieguez & Dolezal, 1996). A study by Anderson, Wilson, and Doll (1999) found that 62% of the adults in their study reported using a condom during an intercourse, which did not involve their primary partner. This was in sharp contrast to the 19% that reported using a condom during the last intercourse with their primary partner. Condom use behavioral and cognitive factors should be investigated an individual's main as well as with other sex partners.

TYPE OF DRUG USE

Sexual behaviors are related to individual characteristics such as drug use, which is directly and indirectly linked with increased transmission of HIV. Users of crack cocaine, heroin, and marijuana are more likely to engage in high risk sexual behaviors (Flom PL, Friedman SR, Kottiri BJ, 2001). Drug use and its associated behaviors may reduce the probability of condom use (Friedman, Flom, & Kottiri, 2002). They reported higher incidence of unprotected sex, among other high-risk behaviors. It is important to examine drug and types of drug use on the perception of condom use and reported condom use when conceiving HIV prevention efforts.

GENDER

Between 1985 and 1999, the ratio of HIV infection among men and women showed a reverse trend. Since 1985, the proportion of all AIDS cases reported among adult and adolescent women has increased from 7% in 1985 to 25% in 1999, which is more than three times the proportion seen in 1985 (CDC). More women were being infected than men. This indicated an increase in heterosexual transmission. Unprotected sex is one of the highest-ranking risk factors among these women before contracting HIV (Wilson, Massad, & Riester, 1999). At-risk women are involved in unprotected sex during prostitution for drugs and submissive or abusive relationships with men. Gender, thus, is another important factor in understanding condom use as HIV risk prevention.