studies suggest that unprotected anal sex is resurfacing as an increasing problem. This
suggests that the substantial increase in condom use which occurred after the initial
AIDS prevention efforts may be beginning to reverse.
Condom use is recommended as the main means to prevent the spread of the HIV
virus. These data suggest that many individuals do report using condoms, although
not always on a regular basis. In addition, many individuals say that they do not use
condoms. Therefore, although the health promotion messages may be reaching many
individuals, many others are not complying with their recommendations.
Predicting condom use
Simple models using knowledge only have been used to examine condom use. However,
these models ignore the individual’s beliefs and assume that simply increasing knowledge
about HIV will promote safe sex. In order to incorporate an individual’s cognitive state,
social cognition models have been applied to condom use in the context of HIV and AIDS
(see Chapter 2 for a discussion of these models). These models are similar to those used
to predict other health-related behaviours, including contraceptive use for pregnancy
avoidance, and illustrate varying attempts to understand cognitions in the context of the
relationship and the broader social context.
Social cognition models
The health belief model (HBM)
The HBM was developed by Rosenstock and Becher (e.g. Rosenstock 1966; Becker and
Rosenstock 1987) (see Chapter 2) and has been used to predict condom use. McCusker
et al. (1989) adapted the HBM to predict condom use in homosexual men over a 12-
month period. They reported that the components of the model were not good predictors
and only perceived susceptibility was related to condom use. In addition, they reported
that the best predictor was previous risk behaviour. This suggests that condom use is a
habitual behaviour and that placing current condom use into the context of time and
habits may be the way to assess this behaviour.
The reasons why the HBM fails to predict condom use have been examined by
Abraham and Sheeran (1994). They suggest the following explanations:
Consensus of severity: everyone knows that HIV is a very serious disease. This
presents the problem of a ceiling effect with only small differences in ratings of this
variable.
Failure to acknowledge personal susceptibility: although people appear to know about
HIV, its causes and how it is transmitted, feelings of immunity and low susceptibility
(‘it won’t happen to me’) are extremely common. This presents the problem of a floor
effect with little individual variability. Therefore, these two central components of the
HBM are unlikely to distinguish between condom users and non-users.
Safer sex requires long-term maintenance of behaviour: the HBM may be a good predictor
of short-term changes in behaviour (e.g. taking up an exercise class, stopping
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