Perceiving AIDS-related risk: accuracy as a function of differences in actual risk.

This study investigates the perceived risk of an HIV infection. Cognitive antecedents of biases in risk perception and their effects on behavioral intentions were investigated. The purpose of this study was to determine the relative accuracy of risk assessments for samples that vary in actual risk for AIDS. Subjects were citizens of Amsterdam, heterosexuals with private partners, gay men, and heterosexuals with prostitution partners. Although optimistically biased in all samples, perceptions of risk were related to previous risk behavior in high-risk samples only. Pessimism was more pronounced in samples higher at risk. Optimists had lower levels of previous risk behavior and increased intentions to adopt safe sex practices. Ss in samples higher at risk had, therefore, relatively adequate perceptions of risk.

The importance of ethnicity as a risk factor for STDs and sexual behaviour among heterosexuals.

OBJECTIVES: To study risk factors for sexually transmitted diseases (STDs) and sexual behaviour. Especially to assess whether there is a higher risk of being infected with STDs among ethnic minorities, and if so for what reasons. SETTING: STD-clinic of the Municipal Health Service of Amsterdam, the Netherlands. SUBJECTS: Cross-sectional study of heterosexuals (255 men and 343 women) with multiple sexual partners, who participated between October 1987 and January 1990. RESULTS: Besides STD-related complaints, ethnicity was an important independent predictor of one or more diagnosed genital STDs. STD-prevalence was higher among men born in Turkey (47%, OR = 3.4) and men born in Surinam (36%, OR = 2.1), compared with Dutch men (21%). While Turkish men had mainly riskful sexual behaviour with prostitutes, Surinam men had more often riskful sexual contact with private partners. Among women, STD prevalence was higher among West-European (38%, OR = 2.3) and Latin-American women (30%, OR = 1.6), compared with Dutch women (21%). Latin American women had more often riskful sexual contact with clients; sexual behaviour of West-European women was riskful with both clients and private partners. CONCLUSIONS: Prevention activities should be directed at specific sexual and ethnic groups, sources of information should be carefully selected, and some groups should be addressed differently with regard to language but to content as well.

AIDS-related health behavior: coping, protection motivation, and previous behavior.

The purpose of this study was to examine Rogers' protection motivation theory and aspects of Janis and Mann's conflict theory in the context of AIDS-related health behavior. Subjects were 84 heterosexual men and women and 147 homosexual men with multiple sexual partners; LISREL's path-analysis techniques were used to evaluate the goodness of fit of the structural equation models. Protection motivation theory did fit the data but had considerably more explanatory power for heterosexual than for homosexual subjects (49 vs. 22%, respectively). When coping styles were added, different patterns of findings were found among both groups. Adding variables such as social norms and previous behavior increased the explained variance to 73% for heterosexual subjects and to 44% for homosexual subjects. It was concluded that although protection motivation theory did fit the data fairly adequately, expanding the theory with other variables--especially those related to previous behavior--could improve our understanding of AIDS-related health behavior.

PIP: In this AIDS related health behavior study, the conceptual framework is similar to Rogers' protection motivation theory with elements from Janis and Mann's conflict theory. The purpose of the study is to examine the effects of cognitive mediators on behavioral intentions, to examine the relationship between the mediators and adaptive and maladaptive coping styles, and to test the predictive validity of mediators with additional variables. The adaptive style is included as vigilance, which refers to accurate information searching, and problem solving to reduce and minimize the threat. 2 maladaptive styles are included as defense avoidance (denying threatening information or evading the thread actively) and hypervigilance (panic-like searching for appropriate responses without reaching well balanced decisions). Additional variables included that ordinarily are not found in the general framework of protection motivation and conflict theory are fear, disadvantages of the adaptive response, pleasantness of the maladaptive response, social norms and previous behavior, knowledge about a threatening situation, perceived constraints, and regrets about previous maladaptive behavior. 147 homosexual and 84 heterosexual subjects, who were analyzed separately, aged 18-30 and not HIV positive were recruited in Amsterdam. Self administered questionnaires were given which assessed sexual behavior and intentions, threat and coping appraisal, coping styles, and additional variables. The program, LISREL, was used to provide maximum likelihood estimates and Chi square tests. Differences between groups were pronounced. Homosexuals perceived themselves more at risk and social norms more positive, felt more fear, had lower levels of self response efficacy, and greater tendency for previous adaptive behavior and higher behavioral intentions. There was confirmation of other findings that coping appraisal processes independently affect behavioral intentions to adopt the recommended response. Severity, for example, was significantly related to behavior only when fear as worry was removed from the equation, and risk reduction motivation varied with worry, even when threat appraisal processes are held constant. Hypervigilance had neither adaptive nor maladaptive influences. For planning purposes, it is suggested that information programs need to emphasize how to handle constraining situations. Population specific messages which can be sensitive to severity or experience with the threat need consideration. Immediate positive effects of recommended behavior is suggested. Motivational factors are important at higher fear levels, where anxiety reduction is the focus instead of danger avoidance. Prevention needs to minimize fear arousal. Limitations included the lack of reciprocal models and a limited behavioral intentions scale.

Limited changes in sexual behaviour of heterosexual men and women with multiple partners in The Netherlands.

To study changes in sexual behaviour, heterosexuals with multiple sexual partners were recruited through an STD-clinic and asked to return every 4 months for follow-up. Between October 1987 and June 1989, 512 heterosexuals entered the study and 140 men and 200 women had at least one follow-up visit. No changes were found between 3 visits in the kind of sexual techniques practiced. Condom use during vaginal intercourse with commercial partners (prostitutes or clients) was relatively high and remained high, but was low and remained at that level with private partners. Men and women reduced their number of private sexual partners by 50%, but the decline in the number of commercial partners was nonsignificant. Although more information is needed about the underlying social-psychological aspects of behavioural change, it seems necessary to redesign prevention activities to stress the effectiveness of condoms and to encourage condom use especially among heterosexuals with multiple private partners.

[HIV prevalence among heterosexual subjects with multiple partners in Amsterdam]. / HIV-prevalentie onder heteroseksuelen met veel wisselende partners in Amsterdam.

To study the prevalence of HIV-infection among heterosexuals with multiple partners, participants were recruited from a STD clinic in Amsterdam. In 1988, 785 visitors met the selection criteria, of whom 361 (46%) finally participated. An HIV prevalence of 2/361 (0.6%) was found among participants. To test representativity, participants and refusers were compared on demographic characteristics and prevalence of STDs. Male refusers were on average younger, had on average fewer partners and relatively more often had a foreign nationality. Female refusers had on average fewer partners. No differences were found in the prevalence of STDs between participants and refusers. Because of the high refusal rate and differences between participants and refusers, the HIV prevalence found is not representative of heterosexuals with multiple partners.