Crack smokers' intention to use condoms with loved partners: intervention development using the theory of reasoned action, condom beliefs, and processes of change

Prevalence rates of HIV infection acquired through heterosexual contacts ha ve risen steadily since 1982. Crack cocaine smokers are at particular risk of HIV infection due to heterosexual exposure. HIV risk reduction intervent ions seeking to increase condom use among drug users have met with minimal success, and there is a need for interventions to be strongly grounded in p sychosocial models of behaviour change. This study presents the results of an investigation of Predictors of intention to use condoms and related ther apy processes among heterosexual drug users. Data were analyzed from 586 cr ack smokers recruited in Washington, DC, Miami, Florida, and Collier County , Florida who reported having both primary and casual sex partners. Partici pants responded to items derived from the theory of reasoned action, the th eory of planned behaviour and the transtheoretical model of change. Condom use beliefs and therapy processes used to initiate and maintain condom use were assessed. Outcome expectancies and normative beliefs were the stronges t predictors of intention to use condoms with a primary sexual partner. In turn, beliefs that condoms inhibit sexual romance and decrease sexual pleas ure strongly predicted outcome expectancies. Therapy processes found to be associated with these constructs included: self-liberation, counter conditi oning and stimulus control/reinforcement. Results suggest that HIV risk red uction interventions using a group format and targeting condom beliefs rela ted to sexual romance and pleasure will decrease negative outcome expectanc ies about condom use. Also, reinforcing attempts to use condoms with intima te partners should increase positive outcome expectancies and intention to initiate or maintain condoms with a primary sexual partner.