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

For female crack (cocaine) users, the pattern appeared somewhat different from male users of crack (cocaine). Female users of crack (cocaine) who indicated that "Your partner would feel safer if you used one" (OR=2.81) and "You would feel more responsible using a condom" (OR=3.71) as being important were significantly more likely to use condoms with their main sex partners. Compared to their male counterparts, females had three versus five significant predictor variables of condom use for other sex partners. Female users of crack (cocaine) who indicated importance on the following: "You would feel safer from disease using condom" (OR=6.15), "You would feel more responsible using a condom" (OR=7.74) and "Condoms protect my sex partner as well as myself" (OR=2.69) were more likely to use condoms.

DISCUSSION

The various psychosocial factors that influence condom use can be of great significance in the intervention strategies for reducing HIV transmission. Although the relationship between drug use and HIV risks has been studied in detail, there are a limited number of studies that have investigated the perceived importance of condom use and consistent condom use among African American drug users. This street outreach study attempts to provide additional empirical data to this field. The key points that deserve special attention 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.

PERCEIVED IMPORTANCE

Our literature review has revealed the following key points regarding the perceived importance of condom use. Consistent condom use is more likely to be seen when an individual was aware of ones positive HIV serostatus (Marlowe, 1998), was in short-term relationships (Kalichman, 1999) or less stable relationships and serodiscordant relations, where one partner is positive and the other is not (Kalichman, 1997). The results of our study indicate that the perceived importance of condom use depended on factors such as a feeling of safety from disease transmission for both self as well as for the partner, freedom from contraceptive issues, and a sense of responsibility for protecting one self as well as the partner. As the perceived importance of consistent condom use increased, the actual use increased.

MAIN AND OTHER SEX PARTNERS

The nature of the sexual relationships, as discussed previously, has an impact on sexual practices. Not only is condom use less prevalent in the relationships with main partners, but also the reasons for condom use are significantly different. Condoms, generally perceived primarily for contraception and secondarily for disease prevention, were often replaced by oral contraceptives once a relationship became established, and once partners learn to trust one another, their perceived risk for disease transmission decreases. People in monogamous relationships were also reported to use this as a reason not to use condoms (Critelli, 1998). However, such monogamous relationships are becoming short term as well as more rare with increasing use of drugs and alcohol (Wang, et al, 2000).