Soler H, Quadagno D, Sly D F, Riehman K S, Eberstein I W, Harrison D F
Center for the Study of Population and Department of Sociology, Florida State University, Tallahassee, USA.
Fam Plann Perspect. 2000 Mar-Apr;32(2):82-8, 101.
Women's protection against HIV and sexually transmitted diseases (STDs) depends upon their ability to negotiate safer sex. It is important to know how cultural norms and gender roles, which vary by ethnicity, may either constrain or encourage negotiation of condom use.
Questionnaires were completed by 393 low-income non-Hispanic black, Hispanic and non-Hispanic white women who were sexually active and attending family planning and STD clinics and other public health and social service centers in Miami in 1994 and 1995. Multivariate logit techniques were used to identify ethnic differences in relationship dynamics and to determine couple- and individual-level factors associated with consistent use, occasional use or nonuse of condoms.
Black and Hispanic women reported higher levels of consistent condom use (15-17%) than did white women (4%). Nearly all black and white women (90-95%) said that they were extremely or somewhat comfortable talking about condoms with their partner, whereas 76% of Hispanic women did so. A larger proportion of Hispanic women (55%) reported joint contraceptive decision-making than did black women (26%) or white women (31%). Among women who reported that their partner made contraceptive decisions, 28% used condoms consistently or occasionally, compared with 24% among women who made the decision themselves. When the couple made the decision jointly, 41% of them were condom users. Hispanic women scored the lowest on a scale of condom-related self-efficacy, yet also reported the highest levels of confidence in their condom negotiating skills. Multivariate analysis indicated that, compared with white women, black and Hispanic women were more likely to be consistent condom users than nonusers (odds ratios, 10.2 and 18.9, respectively). Women who shared financial decision-making with their partner were almost 80% less likely to be a consistent condom user, and women who did not participate in financial decisions were more than 90% less likely to do so, than were women who made monetary decisions independently.
HIV prevention and intervention programs should emphasize birth control discussion between partners and the development of condom-related self-efficacy and negotiation skills, and these programs also should customize prevention messages according to ethnicity and social context.
女性预防感染艾滋病毒和性传播疾病取决于她们协商安全性行为的能力。了解因种族而异的文化规范和性别角色如何可能限制或鼓励避孕套使用的协商很重要。
1994年和1995年，393名低收入非西班牙裔黑人、西班牙裔和非西班牙裔白人女性完成了问卷调查，这些女性均有性行为，且前往迈阿密的计划生育和性传播疾病诊所以及其他公共卫生和社会服务中心就诊。采用多变量逻辑技术来识别关系动态中的种族差异，并确定与持续使用、偶尔使用或不使用避孕套相关的伴侣和个人层面因素。
黑人和西班牙裔女性报告的持续使用避孕套比例（15%-17%）高于白人女性（4%）。几乎所有黑人和白人女性（90%-95%）表示，她们与伴侣谈论避孕套时感到非常或有些自在，而76%的西班牙裔女性有此感受。报告共同做出避孕决策的西班牙裔女性比例（55%）高于黑人女性（26%）或白人女性（31%）。在报告由伴侣做出避孕决策的女性中，28%持续或偶尔使用避孕套，而自己做出决策的女性中这一比例为24%。当夫妻共同做出决策时，其中41%是避孕套使用者。西班牙裔女性在与避孕套相关的自我效能感量表上得分最低，但她们对自己的避孕套协商技巧的信心水平也最高。多变量分析表明，与白人女性相比，黑人和西班牙裔女性成为持续避孕套使用者而非非使用者的可能性更大（优势比分别为10.2和18.9）。与伴侣共同做出财务决策的女性成为持续避孕套使用者的可能性比独立做出金钱决策的女性低近80%，不参与财务决策的女性则低90%以上。
艾滋病毒预防和干预项目应强调伴侣之间关于节育的讨论以及与避孕套相关的自我效能感和协商技巧的培养，并且这些项目还应根据种族和社会背景定制预防信息。
