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Learn More. Examining attitudes and skills regarding condom use by men and women in substance abuse treatment who engage in high risk sexual behavior may help to explain their inconsistent condom use. Men and women enrolled in two multi-site HIV risk reduction studies were administered the Condom Barriers Scale, Condom Use Skills and an audio computer-assisted structured interview assessing sexual risk behavior.

Men endorsed more barriers to condom use than women, especially in the Effects on Sexual Experience factor. For both men and women, stronger endorsement of barriers to condom use was associated with less use of condoms. However, the difference between condom users and condom non-users in endorsement of condom barriers in general is greater for men than women, especially for Greenfield woman wants sex who report having casual partners.

Individuals struggling with substance abuse problems are particularly vulnerable to contracting Human Immunodeficiency Virus HIV and other sexually transmitted infections STIs. The association between risky sexual behavior e. For example, national survey data show that those engaging in risky drug- or sex-related behaviors were more likely than others to report using condoms. Furthermore, substance abusers may have unique barriers to condom use compared with those in the general population, including loss of inhibition and impaired judgment associated with drug effects.

One oft cited barrier to condom use is lack of motivation to use condoms. Similarly, Song et al. Other studies highlight the importance of using practice-based skills training to increase effective condom use. For example, Calsyn et al. Not only do the Theory of Planned Behavior and Information, Motivation, Behavior Skills Models stand up to empirical scrutiny, they also provide a launching point for developing intervention strategies.

The initial step of identifying barriers to condom use is important because associated behaviors are malleable to intervention. If barriers to condom use can be altered, there is hope that more intractable behaviors, such as sexual practices, can be targeted and changed through intervention as well. That is, condom use behavior can be heavily influenced by ongoing relationship dynamics, as well as the partner interaction before and during the sexual encounter.

Research examining condom use barriers has focused on varied populations. Many studies have used single gendered samples 122223most often women. There is great value in studying women given that they tend to bear an unequal burden when managing the complexities of intimate heterosexual relationships i. Furthermore, comparisons between men and women allow for better understanding of the unique treatment and prevention needs of men and women, better enabling development of appropriate prevention interventions.

Some research on differences between and women has been conducted but with mixed. For example, Brooks et al. In contrast, Absalon et al. Thus, there is a body of literature describing differences between men and women in sexual Greenfield woman wants sex, but less is known about such differences related to condom use barriers. Among rural heterosexual African American stimulant users 27women reported more advantages to condom use on a decisional balance measure.

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These studies reinforce that differences exist between men and women when it comes to condom beliefs and sexual risk behavior. Gender norms and roles would lead one to believe that barriers to condom use would also be different across gender.

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In addition, differences in the populations studied e. An analysis of differences between men and women in a more general, substance use treatment-seeking population, could provide needed clarity for condom use promotion efforts. A recognized need is to measure both barriers to condom use, as well as the correct use of condoms.

Doyle et al. Furthermore, the study samples included men and women enrolled in psychosocial outpatient treatment as well as methadone maintenancea population often overlooked in sexual risk behavior studies in favor of focusing on more narrowly defined groups e. The purpose of this study is to compare treatment-seeking male and female substance abusers in their reported barriers to condom use and their condom use skills, to provide additional information about the unique treatment and prevention needs of men and women.

The study has three objectives: to determine if men and women vary on A baseline assessment condom barriers; B condom use skills; and C their recent condom use among main and casual sex partners. We hypothesize that Greenfield woman wants sex following differences between men and women will be demonstrated: men will identify more barriers associated with the effect on sexual experience and women will identify more partner related barriers.

Eligible participants in these studies were men and women aged 18 and older who were enrolled in a participating substance abuse treatment program, reported engaging in unprotected vaginal or anal intercourse during the prior 6 months, were willing to be randomly ased to one of two interventions and complete study assessments, and able to speak and understand English.

Excluded were participants who showed gross mental status impairment, defined as severe distractibility, incoherence or retardation as measured by the Mini Mental Status Exam 3637 or clinician assessment, men who had a primary sexual partner who was intending to become pregnant, or women who were trying to become pregnant, or participants who had been in methadone maintenance treatment for less than 30 days. The CBS is a self-report instrument consisting of 29 items worded as short statements and rated by participants on a 5-point Likert-type scale from 1 strongly agree to 5 strongly disagree.

Items reflect attitudes about condoms, which may act as barriers towards condom use. Lower scores indicate more frequent endorsement of barriers to using condoms. Because the CBS had originally been developed for use with heterosexual women, the wording of 10 items of the original 29 was slightly modified 33 to make the items more gender- or sexual-orientation neutral. Lawrence et al. However, there were a few items that loaded on different factors for men compared to women.

For Greenfield woman wants sex current study, factor scores were calculated by summing the items that occurred on the same factors for men as women. Items are listed in Table 1. If I suggested my partner use a condom, she might be turned off and lose interest in having sex. End of condom is twisted and removed by pulling, with care taken not to spill its contents. All study participants were administered both scales. The items for each scale correspond to steps for correct condom use that were taught in the parent study interventions. In administering the MCUS, 5 types of condoms and 4 types of lubricant were placed on a table in front of the participant along with a plastic penile model.

Participants were asked to choose a condom that would provide protection from HIV and apply and remove the condom from the model, verbalizing what they were doing as they did it. Participants received a point for each activity they demonstrated correctly. A female condom and a pelvic model were placed on the table for administration of the FCUS.

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Scoring proceeded as above. A potential limitation of the scoring method was using an equal weight for each item. Respondents have been shown to disclose more regarding participation in high-risk behaviors with ACASI compared to in-person, face-to-face interviews 42 The SERBAS is a widely used sexual risk behavior assessment with good evidence of reliability and validity among both injection drug users and others at high risk for HIV.

A multivariate analysis of variance MANOVA was utilized to address objective one: to determine if men and women substance abusers differentially endorsed barriers to using condoms as measured by the CBS. The four CBS factor scores served as dependent variables with gender male vs. A MANOVA was also utilized to address objective two: to determine if men and women substance abusers differ in condom use skills. For each CBS and CUS scale for which a subsequent statistically ificant univariate F -value was observed, a series of contingency analyses utilizing the chi-square statistic were conducted with the items for the ificant factors.

CBS and CUS scales served as dependent measures with gender and condom use groups serving Greenfield woman wants sex independent variables. Separate MANOVAs were run for participants who reported having a main partner and participants who reported having a casual partner s. Participants who reported having a main partner and Greenfield woman wants sex partner s were included in both analyses. The sample was Hispanic ethnicity was endorsed by Men Women Men and women did not differ by monogamy status Fewer women reported any condom use with a main partner 9.

However, women and men did not differ in percent reporting frequency of condom use with casual partners none, Men endorsed more barriers to condom use lower scores on the factors of Effects on Sexual Experience, Accessibility, and Motivation. Women demonstrated superior condom application and removal skills for both the male and female condom.

Table 3 shows CBS and CUS differences between men and women as a function of whether they used condoms for any sexual occasion during the prior 90 days with their main sexual partner. There was a ificant multivariate gender by condom use interaction. On the Motivational barriers factor both men and women condom users report fewer barriers than non-condom users, but the difference between users and non-users is greater for women compared to men. Consistent with findings in Table 2women demonstrated superior male and female condom use skills compared to men.

Users of condoms demonstrated greater skills on the use of the male condom than non-users, however, no difference in female condom use skills were observed between condom users and non-users. Differences among the condom frequency groups are larger for men than women. Men who use condoms frequently endorsed fewer barriers than male non-users or sometime-users.

There was a multivariate ificant main effect for gender with women endorsing fewer barriers on the Effects on Sexual Experience factor. There was a multivariate main effect for recent condom use, with condom users endorsing fewer barriers on the Partner, Effects on Sexual Experience, and Motivational Barriers factors. However, no differences between men and women were detected for the MCUS and there was not a main effect for recent condom use frequency. This study elucidates differences between male and female substance abuse treatment seekers on attitudinal barriers towards condom use and condom use skill.

Given the primary role of consistent condom use in the prevention of HIV and other STIs among this population, Greenfield woman wants sex interventions to more closely target important gender-specific condom attitude and skill differences is a critical endeavor. In this study, women and men did not differ greatly in the degree to which they reported engaging in sexual risk behavior.

Women were less likely than men to have used a condom with a main sexual partner, but women and men did not differ in the types of partners they reported or in the degree to which they used condoms with casual partners. Overall, these findings suggest slightly more risk for women by virtue of being somewhat more likely to be sexually active and, similar to the Brooks et al.

Our finding of no gender effect in having casual partners differs from the Absalon et al. For the sample as a whole, men were more likely than women to endorse barriers to using condoms. Related to access, women and men did not differ on items about whether they can get condoms, but men were more likely to be religiously opposed to using condoms. It is also consistent that men reported more condom barriers overall, while women perceived a more positive balance between advantages and disadvantages of condom use Among those who reported having any sex with main partners, a ificant interaction between gender and condom use was ed for largely by motivational barriers.

For both women and men, condom non-users reported more motivational barriers than condom users, but this difference was more pronounced for women. Among those with main partners, gender effects on barriers related to the experience of sex and accessibility were similar to those observed in the full sample; men perceived more barriers.

In addition, men with main partners perceived more partner-related barriers than did women. Compared to women, men who had a steady partner may have felt at greater risk of being suspected by that partner of infidelity if they initiated condom use; infidelity is a theme in several of the partner items. These findings were counter to our pre-study hypothesis based on the literature to date that women would endorse more partner related barriers. Women and men who reported sex with casual partners were similar to each other in their endorsement of condom barriers.

Beliefs that condoms interfere with sexual experience were endorsed less by both female and male frequent condom users than by less frequent and non-users. However, for men with casual partners, the relationship between condom use frequency and these beliefs was stronger than it was for women with casual partners, and women and men who engage in casual sex appear to be more similar than different in their beliefs about condoms.

The one area of difference is effects of condoms on sexual experience, reported most by men and most related to their actual condom use frequency.

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It is consistent with prior qualitative research that sexual experience e. Overall, women performed better on the CUS, measuring information and behavioral skill components, than men in use of both male and female condoms, although this effect of gender did not reach ificance when only those with casual partners were included in the analysis. According to the Theory of Planned Behavior, perceiving fewer negative outcomes associated with condom use i. Although we did not assess condom intentions, the relationship between beliefs and intentions has been confirmed for condom use in prior literature.

An additional interpretation is that women are more likely to seek out health-related help and resources in general, thus increasing access to information about proper condom use.

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Indeed, differences between men and women in help-seeking are well-documented in the literature, in which women are shown to be more likely to seek help than males. Only one other study has reported comparisons between men and women in condom use skills.

That adult women in substance abuse treatment were the most informed and skillful regarding condom use has important implications for interventions with both women and men. Beyond teaching women how to use condoms and how to negotiate condom use with a partner, it may be beneficial to explore with women how to share Greenfield woman wants sex knowledge with a male partner. Likewise, greater attention should be paid on how to better engage men in learning condom use skills. For example, the Real Men Are Safe and Safe Sex for Women interventions specifically included both male and female condom skill education for all participants.

We did not assume that men would be disinterested or lack opportunity to advocate for or apply female condoms. In fact, from the Real Men Are Safe study 34 showed that men in our study did introduce female condoms to partners. Partners are also often a source of information, and ignoring male skill in this area reinforces notions that STI protection is the responsibility of women.

The data are taken from two parallel, but separate, intervention studies that were not deed specifically to compare women and men with each other. Thus, the two samples may differ in characteristics not assessed that are in some way related to the differences identified.

We do know that the two studies differed in one potentially important inclusion criterion: recent participation in penetrative sex. Thus, women who were included had to have had sex with a man, even though they could identify as lesbian or bisexual, whereas men could have had sex exclusively with other men 3. Although the study was conducted in a variety of treatment settings and had few exclusion criteria, the limits on generalizability in terms of patient factors such as self-referral to the study, age, type of substance of abuse, psychiatric and substance abuse diagnosis, and sexual history have not been explored.

In future studies it would be useful to explore the relationship between barriers to condom use and primary drug of abuse, sex under the influence of drugs or alcohol, partner characteristics and type of sexual activity vaginal versus anal intercourse.

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