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Costa Rica is among those countries in which no reduction of the annual HIV incidence has been observed in the last 15 years. The country is not among those countries most affected by HIV/AIDS. However, it has shown a reluctant response to the challenges presented by HIV and cannot assure every citizen access to prevention offers. Further, knowledge about HIV protective behaviors among the relevant population (young adults) is limited.
This project thus aimed to establish a basis for prevention by investigating the protective behavior of young adults living in Costa Rica. As partners considered “stable” do not necessarily stay partners for a long time in this age group, there is also an interest in HIV protective behaviors with “stable” partners and its backgrounds.
This research sought to identify the predictors of condom use among women and men aged 18-24 when having sex with stable partners.
The theoretical framework was drawn from an extended version of the Information-Motivation-Behavioral Skills (IMB) Model developed in Europe. Besides the socio-cognitive variables comprised by the original IMB Model, this extended version also includes the personal HIV protection strategy adopted, as well as cultural, social and economic resources. The extended model also considers the inhibitors of condom use related to the sex partner or the situation in which sex was engaged in.
Methods
A stratified random sample of young women and men aged 18–24 living in Costa Rica was drawn. Data were collected using standardized personal interviews. Data were analyzed using descriptive statistics and the model tested by means of structural equation modelling using the scale-free least square method.
Results
The sample of 905 young adults aged 18–24 comprised 484 women und 419 men, of which 446 reported to be in a stable relationship and 25 were married. Of the 391 respondents, 13.8% reported consistent condom use (every time) when having vaginal sex with the stable partner in the last six months, whereas 18.9% reported never using a condom.
Analysis showed that condom use is predicted by behavioral skills (condom self-efficacy), a personal HIV protection strategy implying condom use, and the attitudes toward condom use. Additional predictors were trusting one’s partner, feelings of love and attachment, and the power balance in the couple.
Behavioral skills were determined by the attitudes toward condoms, the perceived severity of an HIV infection, and the perceived susceptibility.
These socio-cognitive variables were determined by cultural and social resources, especially by the educational level and peer incentives.
Conclusions
Condom use with partners considered „stable“ is marginal. The extended IMB model explains condom use. However, some determinants of condom use hypothesized by the extended IMB model were falsified, including the influence of some condom-use inhibitors as well as the construct Information (the latter being central in the traditional IMB model). The strong influence of the peer group shows that discourses among peers serve to filter and amplify the information received. Social work is challenged to develop prevention offers for young adults in Costa Rica considering this factor.