Date Published: May 27, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Geoffrey L. Ream, Kate F. Barnhart, Kevin V. Lotz.
Health behavior interventions based on Theory of Planned Behavior address participants’ personally-held beliefs, perceived social norms, and control over the behavior. New data are always needed to “member check” participants’ decision processes and inform interventions. This qualitative study investigates decision processes around condom use among 81 homeless LGBT youth ages 18–26. Findings indicated considerable endorsement of the conventional policy of always using condoms, promulgated in HIV prevention education targeting this population. Although some participants reported risk behavior in contexts of sex work, survival sex, casual encounters, open relationships, and substance use, most were aware of these risks and consistently safe in those situations. Condoms use boundaries became vulnerable in states of emotional need and negative mood. The only effect participants acknowledged of homelessness on condom use was indirect, through negative mood states. The most prevalent context of condom non-use was with long-term primary partners, a potential area of vulnerability because, of 13 participants for HIV or HCV, nine mentioned how they had been infected, and all nine believed they had acquired it from a primary partner. Findings imply programs should emphasize HIV risk potential within long-term romantic partnerships and mental health services to remediate negative mood states.
According to the theory of planned behavior , health behaviors like condom use  are influenced by personally-held beliefs and perceived social norms. In order to appropriately address the target population’s shifting attitudes and values toward the target behavior, new data are always needed. This study concerns homeless lesbian, gay, bisexual, and transgender (LGBT) youth, a population with even higher rates of HIV sexual risk behaviors than heterosexual homeless youth [3–5]. Shelters and other programs serving homeless LGBT youth [6, 7] provide condoms and HIV education tailored to their specific needs. The content of this socialization depends on assumptions about their condom use beliefs and norms, e.g., that their elevated risk comes from greater involvement in survival sex  and substance use . This study is a “member check” of those assumptions, open-endedly inquiring into homeless LGBT youths’ decision processes in hopes of identifying risky beliefs and norms not already addressed.
The purpose of this investigation was to “member check” homeless LGBT youths’ condom-related attitudes and beliefs within the context of homeless LGBT youth services’ tailored safer sex socialization. Findings suggest that the message is getting through: most participants knew that the “correct” answer to our initial question about their decision process about condoms was “always use condoms,” and very few of their responses throughout these interviews reflected misinformation about condoms . However, these participants also employed situational ethics. They were very aware of the risks associated with survival sex, sex work, casual encounters, and substance use. Some acknowledged various degrees of risk behavior, but most reported being strictly safe in those situations. Although open relationships in which partners trust each other not to “bring anything back” are arguably a gray area of safety, most participants who were in open relationships remained safe by insisting on condoms with primary partners as well. The factor that seemed reliably associated with lower vigilance was emotional decision making about condoms, e.g., enhancing pleasure in the moment, avoiding awkwardness around condom negotiation, being in love, or experiencing negative emotional states that weakened boundaries and heightened emotional need. In fact, to the extent that homelessness was acknowledged to have any effect on condom use at all, it was perceived as indirect, through negative emotional states.