African American men; intervention development; HIV/AIDS; condom use; qualitative research


Public Health


Condom Use among Young African American Men: Implications for Planning Interventions

Sexually transmitted diseases, including HIV, continue to present significant public health problems affecting young people in the United States, especially African Americans. While African Americans make up about 12% of the U.S. population, in 2010 they accounted for 44% of new HIV infections in 2010 and 48% of all persons living with AIDS in 2007. The 2010 data shows that of these new cases, 38% occurred among African American males ages 13-24 years old.

Correct condom use remains a challenge in this population and efforts to increase condom use among minority males has been a formidable challenge. This paper reports the results of formative research conducted in order to guide the development of an intervention to increase consistent, effective condom use for young African American males.

Methods: A snowball sampling approach was used to recruit participants. African American males, ages 18-24, who self-reported as sexually active were eligible to participate in one of four focus groups or one of six individual interviews. All study events were conducted at community locations. Each event was audiotaped and notes were taken. Analysis was performed using using NVivo-9. The coding strategy included emic and etic codes and a coding tree was developed which was used to identify themes.

Results: A total of 36 African American males between the ages of 18-24 (mean 20.7 years) took part. In general, participants felt condom use was highly influenced by contextual factors including partner interest, partner communication, length of relationship and trust. Condom use was also influenced by a sense of invincibility and being caught up in the moment. Notably, most sexual activity occurred outside of a relationship, most often within the party scene or as quickly arranged hook-ups.

Analysis: In order to ensure maximum impact on the development of the intervention, the results from this formative phase were viewed through the Transtheoretical Model of Behavior Change (TTM) and most participants would be described as being in the pre-contemplation or contemplation stages of behavioral change. While all participants expressed some understanding of the risks of unprotected sex, many did not connect risks to consequences. While the data did not indicate that condom use behavior was likely to change in the short-term (less than 6 months), several participants were contemplating making a change.

Discussion: The snowball sampling approach allowed us to understand the participants’ social network and allowed us to consider social influences as well as about individual attitudes and beliefs. In the TTM frame, interventions designed for this population need to include contemplators and pre-contemplators and should focus on modification of cognition, affect and behaviors.

Our research also shows that several of the underlying assumptions of TTM are at odds with the framework within which sex often occurs for this population and condom use decisions are highly influenced by the social context. In light of the results, the intervention placed condom use into a health promotion context. It combines group activities and one-on-one interaction. Group activities can impact shared values and beliefs and, thus, the intervention builds social support for behavior changes while addressing individual capacity.

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