Research Article: Exploring Factors Associated with Nonchange in Condom Use Behavior following Participation in an STI/HIV Prevention Intervention for African-American Adolescent Females

Date Published: May 29, 2012

Publisher: Hindawi Publishing Corporation

Author(s): Jessica M. Sales, Jennifer L. Brown, Ralph J. DiClemente, Eve Rose.


To enhance future STI/HIV prevention efforts, this study examined factors associated with adolescents’ failure to improve their condom use behaviors after participating in an STI/HIV prevention intervention. African-American adolescent females (N = 205; M age = 17.9) in an STI/HIV prevention intervention trial completed ACASI interviews and provided self-collected vaginal swabs to assess two prevalent STIs at baseline and 6 months after intervention. Analyses compared those who increased condom use after intervention (change group) to those whose condom use did not increase (nonchange group). 43.4% did not increase their condom use after the intervention and were more likely to have an STI at followup (χ2 = 4.64, P = .03). In a multivariate logistic regression model, the nonchange group was more likely to have (a) higher sensation seeking (AOR = .91, P = .023), (b) a boyfriend (AOR = .32, P = .046), and/or (c) a physical abuse history (AOR = .56, P = .057). There were also differences in the extent to which psychosocial mediators changed between the two groups. Findings highlight the need to tailor STI/HIV interventions to adolescents with a greater degree of sensation seeking and address key relationship characteristics and trauma histories to bolster intervention efficacy.

Partial Text

Adolescents and young adults are disproportionately affected by sexually transmitted infections (STIs) [1]. Among young people, girls have particularly high rates of STIs. Findings from the Centers for Disease Control and Prevention (CDC) indicate that, overall, one in four in the United States has an STI, with nearly half (48%) of African-American girls detected with an STI [2]. To combat the STI epidemic among adolescent females, several STI/HIV prevention interventions have been developed, including interventions designed to be culturally congruent for African-American adolescents and/or young adult females [3–9].

Similar to the limited findings reported in the adult HIV prevention literature on nonchange in preventive behaviors after intervention [13], nearly half of adolescents who participated in a demonstrated efficacious STI/HIV risk-reduction program did not increase their condom use after intervention. Those reporting no increase in recent condom use at the six-month followup assessment were more likely to have higher levels of sensation seeking. In addition, adolescents whose condom use did not improve were more likely to have a current boyfriend and a physical abuse history. Additionally, those who did not increase their recent condom use after intervention reported higher levels of fear of condom negotiation across time and no significant increase in partner communication self-efficacy from baseline levels after intervention participation.

This study is not without limitations. First, the data employed in this study were only from participants who returned for the followup assessment after the intervention workshop. Thus, it is possible that young women who did not return for their followup assessment may differ in meaningful ways from women who did return for followup, but we have no way to formally examine this possibility. However, analyses of baseline sociodemographic characteristics and behaviors indicate no significant differences between those who returned for followup and those who did not. Finally, the findings of this study may not generalize to other young women who have participated in STI/HIV prevention programs, especially if they participated in programs that varied markedly in content from HORIZONS.

Several efficacious STI/HIV prevention programs exist for a variety of populations, including African-American adolescent girls [9, 46]. Despite the demonstrated efficacy of interventions to reduce STI/HIV-associated sexual risk behaviors, not every individual exposed to such a program will positively change their sexual risk behaviors (i.e., increase condom use) following participation in an STI/HIV risk-reduction intervention. The ability to identify barriers and possible causal factors that differentiate those who increased condom use after intervention from those who did not is the first step in refining, adapting, or designing new STI/HIV prevention programs to optimize their appropriateness and efficacy for these especially vulnerable youth.