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Try out PMC Labs and tell us what you think. Learn More. Understanding condom-use patterns and the reasons that women have for choosing not to use condoms with their sexual partners, both steady and non-steady , is important to the development and implementation of targeted, culturally appropriate interventions that can promote condom use in low-income and impoverished women.

Data were collected from August to October Reported levels of condom use were low with both steady and non-steady sexual partners. Reasons given for not using condoms with both partner types included the respondent claiming to know her partner well, a general dislike for condoms, not having condoms available, and perceiving no need for them. These findings provide a foundation on which to build an intervention to promote condom use among impoverished women who live in public housing in Puerto Rico in addition to other disadvantaged or impoverished women.

It is imperative that health practitioners consider the reasons that these women have for not using condoms in order to inform the development and implementation of effective HIV-prevention interventions. The Caribbean remains the only region outside sub-Saharan Africa where women and girls out men and boys among people living with HIV. HIV risks are exacerbated for women by a of social and cultural factors. One of the primary phenomena that contributes to increased risk for women and girls has to do with gender socialization.

Gender refers to the widely shared expectations and norms held by a society with regard to appropriate male and female behavior, characteristics, and roles. It is a social and cultural construct that differentiates women from men and defines the ways in which women and men interact with each other. One socioeconomic phenomenon that contributes to the increased risk of HIV for women is poverty. Many experts believe poverty, unemployment, and a lack of education are helping to drive the growing HIV problem among women.

Women living in inner-city poor neighborhoods are often in poor health and without access to health care for prevention or treatment. While risky behaviors in these communities directly spread HIV, urban poverty is clearly also playing an important role, albeit a somewhat indirect one. research has examined the relationship between socioeconomic status and HIV risk and has identified ificant associations between the two, such as the fact that people who are considered low-income are more likely to be HIV positive than are their higher income peers. Furthermore, the physical, psychological, and social circumstances in which their poverty places them may also increase their risk of HIV exposure.

Given the patterns and inequalities in the roles of women and men, it is not surprising that women are at high risk for HIV transmission, especially those who live in societies that are impoverished and male-dominated, characterized strongly by gender inequality.

The focus on gender relations means that it is important to understand the cultural and social norms that shape behavior. Even in light of the increased vulnerability of women and low-income people, few rigorous HIV-related investigations have been implemented that specifically target low-income-housed women. One large-scale population-based study employing a one-stage probability cluster sample targeted young women ages 18 to 29 years residing in various counties in Northern California where the median household income was below the 10th percentile, as determined by census data.

Face-to-face structured interviews were administered to 2, randomly selected women. revealed that these women displayed high levels of a variety of sexual risk behaviors including low levels of condom use, having multiple sex partners, having high-risk sex partners and ificant levels of intimate partner violence IPV , had an increased incidence of STDs, and tended to be substance abusers specifically referring to non-injecting use.

A study of homeless and low-income-housed women was conducted in Southern California. A total of low-income housed women were interviewed. The study were similar to those found in the Northern California study, with the women interviewed evidencing high levels of risky sexual behaviors, substance abuse, and IPV.

A large-scale study of low-income, housed women in 18 low-income inner-city housing developments in five geographically diverse U. Other studies of small, non-random samples of low-income, housed women have similar . For example, inner-city drug users or women outside health- and social-services offices that are often utilized by low-income women were sampled and subsequently described as being low-income. While there has been much published on the levels and the predictors of condom use among women elsewhere, very few research studies among women have measured the reasons for not using condoms.

One study of heterosexual African American women found through focus groups that approximately one third of the participants stated that a barrier to their practicing safe sex was their belief that there was no risk based on their being in a monogamous relationship and feeling no need to use protection. Another study examined reasons for not using condoms among army women, 23 and found that the reasons included having the same partner, using other contraceptives, irritation or inflammation, breaking of the condoms during use, slip during use, and ruining the moment. A recently published article that presented the of a qualitative study that examined barriers to using condoms among women who live in public housing in Ponce, Puerto Rico.

In , rates of HIV diagnoses among female adults and adolescents ages 13 years and older in Puerto Rico ranked 5th among 40 states and five U. Using these and the population of Puerto Rico, which is approximately 3. The population of females ranging in age from 13 years and older was 1,, If we include them, the rate goes up to almost 11 times the estimated prevalence, or 3.

Research with impoverished, minority women in the U. As is frequently the case in Latino societies, children born into the Puerto Rican culture find themselves subject to attitudes, mores, and customs that promote very strong gender differences. From birth on, these differences pervade sexual expression and male-female interaction.

Considering these additional cultural and social factors present in Puerto Rico, impoverished Latinas in Puerto Rico may be at a ificantly higher risk for HIV than are their U. The findings from the various, but limited, U. However, in Puerto Rico, this population has largely been ignored. Only one study that specifically targeted women residing in low-income public housing projects in Puerto Rico was identified. An AIDS outreach demonstration and education program for drug-using women, sex workers, and female sex partners of IDUs was implemented in San Juan almost 20 years ago.

While heterosexual risk among Puerto Rican women was the focus of a of studies, the vast majority of the samples was drawn from U. In light of the information presented, it is imperative that HIV research target these at-risk women living in Puerto Rico. As discussed above, there is little or no behavioral research targeting heterosexual, non-injecting drug-using impoverished women residing outside of the San Juan metropolitan area, nor is this population being served by any form of behavioral intervention.

It is critical that these matters be addressed. Although three decades of biomedical and behavioral research have established the causes of HIV and AIDS as well as viable modes of transmission, there is still no cure or vaccine for HIV. Therefore, it is imperative to focus on behavior modification as a way to combat the spread of the disease, especially since the epidemic is rooted in the behaviors that transmit the virus. In order to develop appropriate interventions, it is imperative that the factors associated with condom use or non-condom use be identified.

research with various samples has successfully identified a of factors associated with condom use. However, very few studies have examined personal reasons for not using condoms with sex partners. In addition, no studies were identified that examined reasons for not using condoms by different partner types among low-income, disadvantaged, and impoverished women.

This is an especially important area of research considering the many differences in the dynamics of the relationships that could affect the likelihood of using or the ability to use condoms. As stated earlier, in Puerto Rico, the impoverished population has been largely ignored. The better understanding of high-risk behaviors among disadvantaged women especially with regard to their not using condoms that is provided by this study, can, we hope, be applied to the implementation of HIV-prevention interventions in other male-dominated cultures.

This contribution is critical because it relates to health-literacy interventions, which involve understanding the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Our survey instrument included items addressing sexual history, attitudes toward condoms and safer sex, sexual behaviors by steady and non-steady sex partners, and drug and alcohol use.

Women completed the assessments in the community center room within each housing development. Informed consent was received from every respondent. Due to the nature of the questions and the possible perceived threat of addressing issues of a sexual nature, the instrument was self-administered with no identifiers, providing confidentiality to the respondents.

All surveys were administered in Spanish. Eligibility criteria included being female and a resident of the public housing development PHD. A non-probability sampling approach was employed for the study. Once a public housing development was selected, posters were put up announcing that the project would be coming to the public housing development on a certain date and inviting all women to come to the community center and participate in the study.

All eligible women were invited to participate. Data were gathered from August to October from women in four different public housing developments across the city of Ponce. Since it was a self-selected non-representative sample, we are unable to report any demographic characteristics for the women who refused to participate in the study, nor can we speak to how representative these findings are to other women living in PHDs as well as to women living in PHDs in other regions of Puerto Rico.

Our survey and the study procedures were reviewed and approved by the Institutional Review Board of the Ponce School of Medicine. Responses were categorized as yes or no. Each response was coded as either selecting this particular reason 1 or not selecting this particular reason 0. Women were allowed to select multiple responses. A of variables were used in the analyses.

Some variables were recoded to facilitate the multivariate logistic regression analyses. The following operationalizations were used:. Age was trichotomized into the following : youth aged under 25 years , middle-aged adults aged 25—49 years , and older adults aged 50 years and older. Education was dichotomized into the following : those with less than a high school education and those with at least a high school education.

Women were asked to report marital status by selecting one of the following four response options: legally married, common-law partner, single , or, separated, divorced, or widowed. The responses were then dichotomized into the following : spouse which included legally married and common-law partner and non-spouse which included single, separated, divorced , and widowed. A new variable was computed, one that summed up the responses to the following questions: Have you ever had sexual relations with an aggressor?

Women who reported having experienced any of these types of violence were coded as one, with the remaining women being coded as zero. The values of the four questions were summed, resulting in a range of scores from zero to four. This variable was dichotomized into the following : those who were not exposed to any types of violence and those who were exposed to at least one of the four types of violence listed above.

Women were asked whether they had ever consumed alcohol in their lifetimes; the response were yes and no. Those who reported a history of use for any of the five illicit drugs listed above were coded as one while the remaining women were coded as zero. The values were summed, generating a range of scores going from zero to five. This variable was dichotomized into the following : those who reported no history of using any of the above listed illicit drugs and those who reported a history of using at least one of the drugs listed above.

The response were yes and no. This variable was created based on the responses given to the questions for each partner type and resulted in three : non-steady sex partner only , steady sex partner only , and, both steady and non-steady sex partners.

A new variable was created by combining the type of sexual partner reported by relationship status, and five emerged: Spouse, steady sex partner only; Spouse, steady and non-steady sex partner; Non-spouse, steady sex partner only; Non-spouse, non-steady sex partner only; and Non-spouse, both steady and non-steady sex partner. Both bivariate chi-squared and multivariate logistic regression analyses were employed. Chi-squared analyses were used to examine the differences in proportions between those who used condoms at last sex and those who did not use condoms during their last sexual encounter by partner type.

In addition, in order to understand the relationship among all the model variables with respect to the dependent variables of interest, all model variables were dichotomized or trichotomized to facilitate the logistic regression analyses. Variables that were selected for the regression analyses were based on empirical research and were, as well, theoretically related to condom use. Table 1 displays the sample characteristics, including sociodemographic variables as well as behavioral variables.

A total of women reported having had a sex partner in the 12 months, representing The age of the majority of women ranged from 25 to 49 years The majority had a least a high school education Slightly more than one half reported being married or involved in a common-law relationship The majority of women reported a history of alcohol use The majority of women reported having discussed safer sex with their most recent steady sex partners as well as their most recent non-steady sex partners Slightly more than one third The majority of women reported having had only a steady sex partner in the 12 months Only a very small percentage of women reported having had only a non-steady sex partner during the 12 months 1.

Chi-squared analysis was used to examine the differences in reported levels of condom use by partner type. There was a statistically ificant difference between levels of reported condom use at last sex with most recent steady sex partner and condom use at last sex with most recent non-steady sex partner. Condom use with most recent steady sex partner. Table 2 presents the of reported condom use with most recent steady sex partner by relationship status and partner type.

The total sample of women who reported having had a sex partner ed As is indicated in the table, the vast of majority of women reported no condom use at last sex with this partner. A smaller percentage of women who had only a spouse and a steady sex partner reported lower levels of condom use than did the other three groups of women 5. The reasons for not using a condom were provided by women who reported having had a steady sex partner in the 12 months Women who had a spouse and had only a steady sex partner in the 12 months were more likely than all other groups of women to report that knowing their partner well was their reason for not using condoms No other statistically ificant differences emerged with respect to the reasons for not using a condom at last sex with their most recent steady sex partners.

A ificant percentage of women in the various categorizations by relationship status and partner type ranging from The percentage of women in the various partner type gave the reason of not thinking about not using a condom ranged from 6.

Table 3 presents the of reported condom use with most recent non-steady sex partner by relationship status and partner type. The total sample of women who reported having a non-steady sex partner in the last 12 months ed Of these women who reported having a non-steady sex partner, However, women who reported having had a non-spouse together with both partner types were more likely to report condom use at last sex with this partner that is, the non-spouse than were the other two groups A total of women who reported having had a non-steady sex partner in the 12 months provided at least one reason for not using condoms at last sex with this partner There were two statistically ificant differences among the three groups of women with respect to reasons for not using a condom.

None of the women who were non-spouses who reported having had only a non-steady sex partner reported knowing their partner well as the reason for not using a condom , compared with Women who were non-spouses with only a non-steady partner were less likely to report the lack of availability than were the women in the other two groups 0.

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Condom-Use Patterns among Women Who Live in Public Housing Developments in Ponce, Puerto Rico