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We examined factors associated with women's perceived advantages (pros), perceived disadvantages (cons), and decisional balance (standardized pros score minus standardized cons score) for condom use with main partner. Data from 1,938 young sexually active women who lived in five U.S. cities where the risk for human immunodeficiency virus is high were analyzed by using logistic, ordinal, and multiple linear regression analysis. For the pros scale of condom use, 27% of the women had low scores, and 33% had moderate scores. For the cons scale, 27% had moderate scores, and 5% had high scores. Of the total, 47% had a negative score on the decisional balance measure. Older age, living with a spouse or partner, or binge drinking was associated with lower pros scores and with a negative score on the decisional balance measure. Income from public assistance was associated with higher pros scores. Income from a spouse or partner or a history of sexually transmitted disease was associated with lower pros scores. Multiple sex partners or being at risk for HIV infection (based on perceptions of the main partner's behaviors) was associated with higher cons scores. Income from a job was associated with a positive score on the decisional balance measure. Our analysis identified the characteristics of women who have low pros scores, high cons scores, and negative decisional balance scores. The regression results can inform our work in HIV prevention on whether to focus on the pros, the cons, or both to obtain positive decisional balance scores and increase condom use in situations that warrant protective behaviors. KEYWORDS. HIV prevention, decisional balance, condom use, at-risk women, heterosexual transmission, sexual behavior change

Many women who are at risk for HIV do not regularly use condoms, particularly with their main partners. In this paper we examine factors related to self-efficacy for condom use with main and other partners and self-efficacy for birth control in 2864 women interviewed in five urban high-risk communities. Limited social and economic resources, dependence on a main partner, and risk factors, including exchanging sex for money or drugs and binge drinking, were found to be negatively related to self-efficacy. Segmentation analysis identified groups of women with low self-efficacy who should be the focus of preventive interventions. KEYWORDS. HIV prevention, self-efficacy, condom use, birth control

This study examined condom use with main partners by surgically sterilized and non-sterilized women at risk for HIV infection. Data were obtained from 379 African American women residing in low-income urban communities. Sterilized women were one-fifth as likely as non-sterilized women to use condoms. Multivariate logistic regression indicated that for both groups of women, higher perceived benefits of condom use for disease prevention were associated with condom use. In addition, younger age, self-efficacy for condom use, peer support for condom use, and whether condoms were ever used for pregnancy prevention were associated with condom use among non-sterilized women. Results of this study indicate the role of fertility status in condom use and the value of developing targeted prevention programs that reach women at high risk for HIV infection. Risk reduction programs need to emphasize the role of condoms in disease prevention and address attitudes towards condom use. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworth.com]

This study presents the results of a needs assessment survey conducted with 66 incarcerated women in a large Philadelphia county jail during the winter of 1993. Results indicated that prior to incarceration, these women engaged in very high risk sexual and drug use behaviors, and had experienced a myriad of other problems that may contribute to their risk for HIV infection. Of the 66 women who participated in the study, over three-fourths had used crack cocaine, nearly one-half had traded sex for drugs or money in the six months prior to incarceration, one-third reported a prior history of injection drug use, and one-half reported sexual contact with a male partner who injected drugs. In addition, one-fourth of the study sample had been homeless during the year prior to incarceration, one-half reported a prior history of sexual abuse, three-fourths had been physically beaten by a boyfriend or spouse, and nearly one-half had a prior history of syphilis. Although limited in scope, the results of the study have important implications for developing relevant jail-based HIV risk reduction programs for women. The results provide strong evidence for the need for interventions that address not only the HIV-related risk behaviors of incarcerated women, but also the underlying social problems that contribute to their risk of HIV infection.