Condom use self-efficacy among U.S.- and foreign-born Latinos in Texas

Journal of Sex Research, Nov, 2004 by Maria Eugenia Fernandez-Esquer, John Atkinson, Pamela Diamond, Bernardo Useche, Ricardo Mendiola

Latinos are the fastest growing population in the United States, and their rate of growth is having a direct impact on the HIV epidemic. The Centers for Disease Control and Prevention (CDCP, 2000) report that Hispanics represented 13% of the U.S. population (including residents of Puerto Rico), but accounted for 19% of the total number of new U.S. AIDS cases reported in 2000. CDCP data indicate that the proportion of all AIDS cases reported among adult and adolescent women in the U.S., as a group, more than tripled in the interval between 1985 and 1999 (from 7% to 25%). According to the same report, there is also a higher proportion of HIV cases among Latino men born in Mexico compared to those born in the United States, among those who have sex with other men (44% vs. 30%) and those who have sex with women (14% vs. 11%; CDCP, 2000).

The purpose of our research was to explore the influence of condom use self-efficacy on actual condom use for U.S.-born and foreign-born Latinos living in Houston, Texas. Latinos are defined in this study as individuals who were born in or trace their cultural origin to Latin America. In the United States, over 90% of Latinos come from Spanish-speaking Latin American countries, and therefore, we targeted Spanish-speaking Latinos. Given the composition of the Houston population, we expected Latinos to be primarily of Mexican, Mexican American, and Central American origin.

RISK BEHAVIORS

Studies exploring differences among U.S.-born and recently immigrated Latinos indicate that these groups differ on behaviors that put them at risk for HIV. However, place of birth (United States vs. Latin America) may also be a marker for differences that are actually due to socioeconomic status including education, income, employment, and possibly age (Sabogal, Faigeles, & Catania, 1993). Gender also has a strong influence on Latinos' risk behaviors, as men and women enter sexual relationships with different experiences and expectations based on the norms and values learned as part of their cultural heritage. One example of the interplay among these characteristics is multipartnerism. Latino men across the U.S. tend to report multiple sexual partners, particularly if they are unmarried, 18 to 29 years of age, and better educated but with lower income (Sabogal et al., 1993). Foreign-born Latinos differ from their U.S. counterparts in that they are more likely to report sex with prostitutes, and married men report less condom use in these encounters compared to single men (Organista, Balls Organista, Garcia de Alba, Castillo Moran, & Ureta Carrillo, 1997). Contact with prostitutes and having more extramarital partners has been documented more specifically among Mexican immigrant men who are married but who migrate unaccompanied by their wives (Viadro & Earp, 2000). Males have high rates of sexual activity outside of marriage or a primary relationship (Matin & Marin, 1992), perhaps because they are expected to be independent, sexually assertive, and have multiple sex partners (Martinez, Chavez, & Hubbell, 1997). The influence of traditional gender beliefs appears to be stronger among Latino immigrant men, who unfortunately decrease their use of condoms as their number of sexual partners increases (Sabogal et al., 1993).

Concurrent sexual partnerships among U.S. women have been estimated at 12% across all ethnic groups, and Latinas are the group least likely to report multiple partners (Adimora et al., 2002). However, patterns of sexual behavior are not the same for all Latinas: U.S.-born and younger Latina women tend to report more sexual partners compared to recently immigrated and older Latinas (Sabogal, Perez-Stable, & Otero-Sabogal, 1995). Differences in other sexual behaviors have also been associated with Latinas' levels of acculturation and place of birth. For example, recently immigrated Latinas report infrequent sexual activity, a preference for conventional sexual practices, and dissatisfaction with their sexual relationships (Flaskerud, Uman, Lara, Romero, & Taka, 1996). However, even when levels of sexual risk behavior vary across studies, the general trend among Latinas is for AIDS risk to increase as their preference for speaking English increases (Peragallo, 1996).

Substance abuse, and more specifically alcohol consumption, influences participation in sexual risk behaviors. Less acculturated Latino men drink more heavily and are more likely to engage in risky sexual behavior compared to men who are more acculturated. At the same time, while more acculturated Latina women drink more heavily than the less acculturated, those in the latter group engage in riskier sexual behavior (Hines & Caetano, 1998).

CONDOM USE

Spanish monolingualism and strong cultural gender norms regarding sex contribute to the risk for HIV infection, acting as barriers for consistent and effective adoption of HIV-preventive behaviors, particularly among Latina immigrant women (Gomez, Hernandez, & Faigeles, 1999). Latinos generally believe that condoms play a role in preventing HIM but they tend not to use them (Sabogal et al., 1993), although this lack of use has not been consistently reported across studies (Tanrer, Grady, Klepinger, & Billy, 1993). Condom use among Latinos tends to be low perhaps because condoms are associated with prostitution, venereal disease, and extramarital affairs (Flaskerud & Uman, 1993: Ford, King, Nerenberg, & Rojo, 2001: Marin & Marin, 1992).