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HIV Risk Behavior among College Students in the United States

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Title: HIV Risk Behavior among College Students in the United States
Language: English
Authors: Lewis, John E., Miguez-Burban, Maria-Jose, Malow, Robert M.
Source: College Student Journal. Jun 2009 43(2):475-491.
Availability: Project Innovation, Inc. P.O. Box 8508 Spring Hill Station, Mobile, AL 36689-0508. Tel: 251-343-1878; Fax: 251-343-1878; Web site: http://www.projectinnovation.biz/csj.html
Peer Reviewed: Y
Page Count: 17
Publication Date: 2009
Document Type: Information Analyses
Journal Articles
Reports - Research
Education Level: Higher Education
Descriptors: College Students, Intervention, Self Efficacy, Sexually Transmitted Diseases, At Risk Persons, Health Behavior, Sexuality, Acquired Immunodeficiency Syndrome (AIDS), Drinking, Drug Use, Health Promotion, Literature Reviews, Knowledge Level, Student Attitudes
Geographic Terms: United States
ISSN: 0146-3934
Abstract: Objective: This article updates our 1997 review that examined the literature on HIV risk behavior among college students. Methods: The current review focuses on college student sex-risk behaviors related to HIV-related knowledge, communication with sex partners, self efficacy, and behavioral skills. Results: As reported in our original review, the majority of students continue to have multiple sex partners, use condoms inconsistently during intercourse, and have a tendency to combine alcohol and/or other drugs with their sexual experiences. They remain very knowledgeable about the virus and routes of basic transmission, but that does not impact condom use. Communication among partners about safer sex continues to be limited. Conclusions: Enhancing self efficacy should be an important focus for intervention strategies among students, given consistent evidence for its impact on lowering risk for HIV transmission. Additional evidence-based recommendations for strategies to prevent the spread of HIV within the college population are provided.
Abstractor: As Provided
Number of References: 93
Entry Date: 2010
Access URL: https://www.projectinnovation.biz/csj_2006.html
Accession Number: EJ872262
Database: ERIC
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  Value: <anid>AN0042427175;cgl15jun.09;2019Feb22.05:56;v2.2.500</anid> <title id="AN0042427175-1">HIV RISK BEHAVIOR AMONG COLLEGE STUDENTS IN THE UNITED STATES </title> <p>Objective. This article updates our 1997 review that examined the literature on HIV risk behavior among college students. Methods. The current review focuses on college student sex-risk behaviors related to HIV-related knowledge, communication with sex partners, self efficacy, and behavioral skills. Results. As reported in our original review, the majority of students continue to have multiple sex partners, use condoms inconsistently during intercourse, and have a tendency to combine alcohol and/or other drugs with their sexual experiences. They remain very knowledgeable about the virus and routes of basic transmission, but that does not impact condom use. Communication among partners about safer sex continues to be limited. Conclusions. Enhancing self efficacy should be an important focus for intervention strategies among students, given consistent evidence for its impact on lowering risk for HIV transmission. Additional evidence-based recommendations for strategies to prevent the spread of HIV within the college population are provided.</p> <p>Fifty percent of all new HIV infections occur among people under 25 years of age (Centers for Disease Control and Prevention, 2004) and the majority of sexually transmitted infections (STI) is contracted in people between the ages of 19 and 24 (DiClemente & Crosby, 2003). Studies of STI prevalence on college campuses are limited, but those infected are thought to range from 12% (Patrick, Covin, Fulop, Calf as, & Lovato, 1997) to 25% (Reinisch, Hill, Sanders, & Ziemba-Davis, 1995) of students. About 75% to 90% of all students are sexually active (Dalton, Donald, & Ratliff-Crain, 1999; LaBrie, Earleywine, Schiffman, Pedersen, & Marriot, 2005) and on average they report more than 2 partners per year (DiLorio, Dudley, & Soet, 1998; LaBrie et al., 2005) and over 6 lifetime partners (Civic, 2000). The actual number of HIV-infected college students is estimated to be low relative to other populations (Karon, Fleming, Steketee, & De Cock, 2001). To date only one national study has been conducted (Gayle et al., 1990), and college students still have not been labeled at high-risk as the epidemic has spread (Sepkowitz, 2001). Two recent studies found that HIV infection in college men in the Southeastern United States was significant and their sexual networks were expansive (Hightow et al., 2005; Hightow et al., 2006). Given the extended time between contracting HIV and exhibiting clinical symptoms and since many college students engage in conduct that places them at risk for serious health problems (Centers for Disease Control and Prevention, 1997) such as inconsistent condom use, alcohol drinking, and other drug use, the number of infected college students may be underestimated.</p> <p>In assessing articles for this review, we utilized an exhaustive electronic search of the published literature with PsychlNFO, ERIC, EMBASE, and OVID Medline databases. To ensure that we only selected appropriate papers, keywords included "college students," "condom use," and "HIV risk behavior." In addition, articles were taken from the third author's weekly HIV Lserv. In order for studies to be selected for this review article, the work had to be: (<reflink idref="bib1" id="ref1">1</reflink>) only among US college students; (<reflink idref="bib2" id="ref2">2</reflink>) peer-reviewed publications; (<reflink idref="bib3" id="ref3">3</reflink>) published between 1997 and 2007; and (<reflink idref="bib4" id="ref4">4</reflink>) in the context of utilizing psychosocial mediators of HIV risk based on popular theoretical models, including the Health Belief Model (HBM) (Janz & Becker, 1984), Self Efficacy Theory (Bandura, 1990), the Theory of Reasoned Action (TRA) (Ajzen & Fishbein, 1980), the AIDS Risk Reduction Model (ARRM) (Catania, Kegeles, & Coates, 1990), and the Information-Motivation-Behavioral Skills Model (1MB) (Fisher & Fisher, 1992). Studies were excluded from this analysis if the article: (<reflink idref="bib1" id="ref5">1</reflink>) was conducted on students outside the US (<reflink idref="bib2" id="ref6">2</reflink>) focused on non-heterosexual college students, since the dynamics of HIV risk behavior are likely to be significantly different from heterosexual students.</p> <p>Psychosocial variables theorized as important contextual factors used to frame this review were: (a) HIV knowledge and information, (b) normative beliefs (c) perceived susceptibility of HIV and attitudes toward safer sex (d) self efficacy (e) sex communication (f) behavioral skills</p> <p>Condom use, sex behaviors, alcohol and other drug use prior to and during sex, gender, and ethnicity were the other variables used to structure the findings. Salient points will also be presented in comparison to our previous review paper on college students (Lewis, Malow, & Ireland, 1997).</p> <hd id="AN0042427175-2">Condom Use and Sex Partners</hd> <p>Even with the risk of the transmission of HIV and STI, college students typically inconsistently use condoms and have multiple lifetime sex partners. Without an effective vaccine for HIV, short of abstinence, the best way to reduce the risk of HIV is still through the use of condoms. Thus, increasing the use of condoms is the primary outcome measure to determine the level of sex-risk behavior. In addition, measuring the number of lifetime partners and partner type, e.g., casual or committed, is also an important indicator of sex-risk behavior.</p> <p>Perhaps the largest self-report survey of college student sex behavior is a 2006 national survey of 34 colleges and universities including almost 24,000 students. This study revealed in the prior 30 days that over 43% had engaged in oral sex, over 46% had vaginal intercourse, and a little over 4% had anal sex (American College Health Association, 2007). Of those who had oral sex, fewer than 4% used a condom during the last episode, for vaginal intercourse 54% used a condom during the last act, and for anal sex over 26% used a condom during the last incident. Students who are experienced in anal sex are more likely to engage in risky vaginal sex and not use condoms during the last act (Baldwin & Baldwin, 2000). About 35% of sexually-active students always use condoms and only half of those who report being concerned about HIV always used condoms (Opt & Loffredo, 2004). About half of students report that they never use condoms and only 10% use condoms 100% of the time (Prince & Bernard, 1998). Condom use and HIV knowledge have been shown to increase following a brief, computerized 1MB model intervention (Kiene & Barta, 2006).</p> <p>Gender differences continue to be found for sex-risk behavior, as college males report greater condom use than females (Rhodes et al., 2007), but males engage in more unsafe sex practices (Lance, 2001). Males also typically report more lifetime partners (McCormack, 1997; Siegel, Klein, & Roghmann, 1999). For college women, higher levels of condom use are related to the ability to be assertive, intentions to use condoms, and avoidance of substance use (Roberts & Kennedy, 2006). Students also feel that using condoms is not necessary with a primary partner, but they are more inclined to use a condom with a casual partner, especially among women (Weinberg, Lottes, & Aveline, 1998).</p> <p>African-American college students report inconsistent condom use during prior sexual encounters and many of them had at least two sex partners over the previous year (Bazargan, Kelly, Stein, Husaini, & Bazargan, 2000; Lewis, Melton, Succop, & Rosenthal, 2000; Whaley & Winfield, 2003), but they may have higher rates of condom use compared to Hispanics and Caucasians (Valentine, Wright, & Henley, 2003). African-Americans are also more likely to engage in sex-risk behaviors with a steady partner, black women are more likely than men not to use condoms (Winfield & Whaley, 2005), and more mature black allied health students engage in safer-sex practices (Valentine et al., 2003). Among other black students, condom use was found to be related to: being male, HIV knowledge, positive attitudes about condoms, non-monogamy, and better behavioral skills within an 1MB model framework (Bazargan, Kelly, Stein, Husaini, & Bazargan, 2000).</p> <p>Similar to their white and African-American counterparts, Hispanic college students infrequently use condoms during their last act of oral (4.9%), vaginal (41.3%), or anal (27.8%) sex (Gurman & Borzekowski, 2004), and only a little over one-quarter use a condom at every episode of intercourse and just under 10% report never using a condom (Polacek, Hicks, & Oswalt, 2007). The majority of Hispanic students reports being sexually active, with more lifetime partners related to older students (Polacek et al., 2007), younger Hispanics are more likely to use a condom (Gurman & Borzekowski, 2004b), and those students with committed partners are less likely to use condoms, compared to those students in casual relationships (Fierros-Gonzalez & Brown, 2002).</p> <p>Asian-American students comprise a sub-sample of the college population that has not been typically assessed for sex-risk behaviors. Among one sample of Asian-Americans, the lifetime prevalence of unprotected sex was just under 40% (So, Wong, & DeLeon, 2005). The prevalence of lifetime anal sex was under 10%, but nearly all of those who had performed anal sex did not use a condom.</p> <hd id="AN0042427175-3">Alcohol and Drug Use Concomitant to Sex</hd> <p>Alcohol and substance use likely mediate HIV transmission risk among college students (Gullette & Lyons, 2005). In addition to inconsistent condom use and multiple sex partners, the primary reason that college students are at high risk for acquiring HIV or STI is alcohol and/or substance use combined with sexual activity (Anderson & Mathieu, 1998). Over 30% of college students report drinking alcohol before sex (Brown & Vanable, 2007) and about 15% of students who drank alcohol also had unprotected sex (American College Health Association, 2007). Sex-risk behaviors are also related to more days of drinking and binge drinking days (Noormohamed, Ferguson, Baghaie, & Cohen, 1998. Alcohol with sex may also result in episodes of sexual assault, other criminal behavior, or unconsensual sex due to intoxication (Hingson, Heeren, Zakocs, Kopstein, & Wechsler, 2002). Alcohol's effect on sex-risk behavior changes with the status of the sex partner; resulting in more frequent unprotected sex with casual partners (Brown & Vanable, 2007). Alcohol use before sex significantly predicted the rate of casual sex among a sample of college spring breakers (Apostolopoulos, Sonmez, & Yu, 2002).</p> <p>College males typically consume more alcohol than females, use condoms more often with new sex partners, followed by casual and then primary partners, and the effect of alcohol on condom use is most detrimental with casual partners (LaBrie et al., 2005). Drinking, inconsistent condom use, and multiple sex partners are correlated among college men (Poulson, Eppler, Satterwhite, Wuensch, & Bass, 1998). Alcohol has also been related to intentions to use condoms for men, but not women (LaBrie, Schiffman, & Earleywine, 2002). College women who use drugs and alcohol less often and have low perceived risk of catching HIV engage in less sex-risk behavior (Roberts & Kennedy, 2006).</p> <p>While most studies investigating alcohol and drug using behavior in the context of sex-risk have sampled white students, others have found some specific findings among minorities. White college women report significantly higher substance use correlating with perceived and actual sex-risk behavior, compared to Hispanics and African-Americans (Roberts & Kennedy, 2006). Over 50% of African-American college women report that they never use alcohol or marijuana, but almost 40% report sometimes or always being drunk or high during sex and such use does not relate to condom use (Lewis, Melton, Succop, & Rosenthal, 2000). However, drug use and alcohol abuse are related to high-risk sex practices among Hispanic college students (Fierros-Gonzalez & Brown, 2002). Under one-quarter of Asian-American college students use alcohol before sex, but only 6% use drugs before sex, and they have more sex-risk with greater use of alcohol and drugs and lifetime alcohol use predicts unprotected sex (So, Wong, & DeLeon, 2005).</p> <hd id="AN0042427175-4">HIV-Related Knowledge</hd> <p>Studies have found that college students are very knowledgeable about HIV (Shapiro, Radecki, Charchian, & Joseph-son, 1999), but they still practice high-risk behaviors (Lance, 2001; Opt et al., 2004). More specifically, in spite of correctly knowing the modes of HIV transmission and how to prevent the virus, students continue to have risky sex (Winfield & Whaley, 2002). In fact, knowing more about HIV may actually increase transmission risk, since HIV knowledge is related to a reduced concern about HIV and subsequently a less frequent need to use condoms (Demmer & Caroleo, 2001). However, condom perception significantly predicts HIV knowledge (Brown, Jara, & Braxton, 2005). In addition, students are apparently not changing their sex behaviors in light of new information about HIV (McCormack, 1997). Among African-Americans, a critical problem related to higher risk of HIV transmission concerns the "knowledge-behavior gap," which suggests that knowledge does not result in condom use (Bazargan, Kelly, Stein, Husaini, & Bazargan, 2000; Valentine et al., 2003; Winfield et al., 2002).</p> <p>While students are typically well-informed about HIV overall, they are still incorrect about certain facts regarding transmission, such as how the virus can be spread (McCormack, 1997). Approximately 25% of students believe that a spermicidal agent would prevent the trans-mission of HIV (Lance, Morgan, & Columbus, 1998). While most Asian-American college students know that condoms reduce the risk of HIV transmission, less than half are aware that sitting on a toilet seat is not a risk factor for HIV, females are more knowledgeable, and knowledge is inversely related to alcohol and marijuana use (Yi, 1998). Other Asian-American students have inadequate HIV knowledge compared to others (Shapiro et al., 1999), but they become more informed with increasing acculturation (So, Wong, & DeLeon, 2005). Among Hispanics, some myths and inconsistencies in transmission remain, especially among males (Polacek et al., 2007). Thus, opportunities still exist to heighten the level of HIV knowledge among college students.</p> <hd id="AN0042427175-5">Perceived Normative Beliefs</hd> <p>Perceived social norms were theorized as important for committing to safer sex (Catania et al., 1990), a key component of TRA (Ajzen et al., 1980), and research suggests that norms are significantly related to commitment to use condoms with sex partners (Catania, Coates, & Kegeles, 1994). In addition, college students commonly believe that their peers are actively using alcohol and drugs and engaging in sex-risk behaviors (Brown, 1998; Hines, Saris, & Throckmorton-Belzer, 2002). College students also believe that an exaggerated number of other students will contract HIV (Seal & Agostinelli, 1996) and STI (Scholly, Katz, Gascoigne, & Hoick, 2005), so correcting these false social norms may improve risky behaviors (Agostinelli, Brown, & Miller, 1995).</p> <p>Normative beliefs of HIV-risk behavior and the number of recent sex partners are the strongest predictors of sex-risk when not drunk or high (Bon, Hittner, & Lawandales, 2001), and normative influences predict condom use when students are confident in their peers' beliefs (Trafi-mow, 2001). However, HIV-risk behavior when drunk or high is predicted by the normative beliefs of peer sexual behavior, substance use, and the number of recent sex partners, suggesting a need to improve overestimated perceptions of other students' sex-risk behavior (Bon, Hittner, & Lawandales, 2001). Peer influences also significantly predict the rate of casual sex among vacationing college students (Apostolopoulos, Sonmez, & Yu, 2002). While most students recognize that their peers are at risk, they do not self-identify as being susceptible to contracting the virus (McCormack, 1997), but Hispanic students believe that other college students are at greater risk for HIV than themselves (Polacek et al., 2007). However, among other Hispanics, perceived peer approval of condom use results in greater intentions to use condoms (Jemmott, Jemmott, & Villarruel, 2002). African-American college women believe that their peers use condoms more often than they do (Lewis, Melton, Succop, & Rosenthal, 2000).</p> <hd id="AN0042427175-6">Perceived Susceptibility of HIV and Attitudes toward Safer Sex</hd> <p>College students may believe that the need to practice safer sex is not as great now due to new HIV treatments that have increased survivability, although males may think they are more susceptible to HIV (McCormack, 1997). While many students are familiar with new treatments for HIV, less than 20% believe that HIV is not as serious as in the past, and fewer than one-quarter report that they engage in safer sex less often since the discovery of new disease treatments (Demmer & Caroleo, 2001). Although the threat of HIV is viewed seriously by students, they continue to feel little need to practice safer sex (Brown, 1998; Demmer & Caroleo, 2001). Hispanic students report that they are not susceptible to HIV, especially among the youngest students (Polacek et al., 2007). Hispanics are more concerned about HIV than whites, but more Hispanic students know someone who has HIV (Opt et al., 2004).</p> <p>Within the HBM framework, perceived benefits and barriers of safer sex are predictive of both condom use intentions and behavior, but students' beliefs and attitudes toward HIV did not influence their decision to use condoms (Poureslami, Roberts, & Tavakoli, 2001; Prince et al., 1998), whereas attitudes toward condoms and perceived vulnerability to HIV significantly correlate with condom use among white (Boone & Lefkowitz, 2004), Asian-American (Wang & Pillai, 2004), and Hispanic (Jemmott et al., 2002) students. However, attitudes toward condoms do not predict sex partners or condom use among college women (Salina, Razzano, & Lesondak, 2000). Among African-Americans, perceived barriers to safer sex and gender significantly predict condom use, and condom use increases when perceived barriers is controlled in the model for men (Win-field et al., 2002). African-American and Hispanic college students are at even higher risk of HIV, compared to white students, because they fail to carry out safer sex intentions due to their partner's attitude toward condoms (Smith, 2003). However, college men report more negative attitudes toward condoms regarding sexual pleasure compared to women (Conley & Collins, 2005).</p> <p>Although African-American students are projected by some to be the next group significantly affected by the HIV epidemic, both genders express negative views of condoms and this attitude is the primary barrier to safer sex (Duncan et al., 2002). "Living for the moment" and "feeling invincible" also impact the ability to use condoms and are typical of the college population (Duncan et al., 2002). In addition, black women believe they are at higher risk of HIV because their partners have more sex partners and because they do not use condoms due to their male partners' preferences (Ferguson, Quinn, Eng, & Sandelowski,2006).</p> <hd id="AN0042427175-7">Self Efficacy</hd> <p>Self efficacy was developed as part of Social Learning Theory (Bandura, 1990) and is defined as confidence in one's personal ability to achieve a specific behavioral outcome (e.g., using condoms). People with high self efficacy are confident in their ability to achieve behavioral outcomes and thus are more likely to engage in that behavior. Persons who have high levels of self efficacy may be better able to use condoms (Catania, Coates, & Kegeles, 1994). Self efficacy has been found to be related to sex-risk behaviors (DiLorio, Dudley, Soet, Watkins, & Maibach, 2000; Parsons, Halkitis, Bimbi, & Borkowski, 2000) and condom use self efficacy, when predicting condom use during intoxication (Abbey, Parkhill, Buck, & Saenz, 2007).</p> <p>Studies have been inconsistent in comparing levels of self efficacy by gender, as some females report higher levels of sexual self efficacy (Parsons et al., 2000), whereas college men also report higher self efficacy and condom perception than women (Brown et al., 2005; Farmer & Meston, 2006). Self efficacy was improved in both genders and condom use increased during the last episode of sex with a committed partner after watching a video on condom promotion (Sanderson & Yopyk, 2007). Other research has shown that younger students scored higher on measures of self efficacy compared to older students (Brown et al., 2005).</p> <p>Condom use self efficacy significantly correlates with condom use in white students (Boone et al., 2004) and in Taiwanese students (Wang et al., 2004). A higher level of self efficacy is related to an increased likelihood of condom use among black college students (Burns & Dillon, 2005), but Hispanics have lower condom use self efficacy compared to white and Asian students (Farmer et al., 2006). However among African-American students, a high level of condom self efficacy is more related to high-risk sexual behaviors (Duncan, Harrison, Toldson, Malaka, & Sithole, 2005).</p> <hd id="AN0042427175-8">Communication with the Sex Partner</hd> <p>Much like self efficacy, communication skills and the ability to negotiate safer sex with partners are thought to be critically important for HIV prevention (Catania, Coates, & Kegeles, 1994). In fact, safer sex communication is related to communication self efficacy, but not condom use (DiLorio, Dudley, Lehr, & Soet, 2000). Improving sexual communication skills among young adults continues to be critically needed for reducing HIV risk, since if the person is inept at discussing situations with the sex partner in a convincing and constructive manner, then the partner could be unwilling to enact safer behaviors. Sex-risk behavior is related to direct sexual communication with the partner (Koch, Palmer, Vicary, & Wood, 1999; Prince et al., 1998; Sadovszky et al., 2007). Improved HIV knowledge increases the ability of students to communicate with their partners about sex-related issues (Shapiro et al., 1999). A brief course emphasizing attitudes and behaviors improves safe sex communication (Mac-Nair-Semands, Cody, & Simono, 1997). Among sexually active college students, communication skills training results in more skill to request condom use and to deal with negative partner attitudes, however the actual impact on the use of condoms is limited (Tulloch, McCaul, Miltenberger, & Smyth, 2004).</p> <p>Discussing sexual intercourse prior to initiating sex is increasing among women, perhaps because they are more responsible for providing contraception, especially for older students (Siegel, Klein, & Roghmann, 1999). However, college women who can assert themselves in the relationship and are intent on using condoms still do not consistently use condoms, suggesting that perception of their skills may be higher than their actual communication ability (Roberts & Kennedy, 2006).</p> <p>Skills to negotiate safer sex and how to properly use condoms are crucial for reducing high-risk behaviors among African-American students (Bazargan, Kelly, Stein, Husaini, & Bazargan, 2000). However, African-American females fail to discuss safer sex concepts, particularly about condoms, with their sex partners (Foreman, 2003). Asian-American women use different sex communication strategies depending on the ethnicity and age of their partners (Lam & Barnhart, 2006) and women use more nonverbal indirect communication (Lam, Mak, Lindsay, & Russell, 2004). Sexual communication about condoms is determined by the male partner's potential reaction and attitude toward condoms, the status of the relationship, and normative behaviors among peers (Foreman, 2003).</p> <hd id="AN0042427175-9">Behavioral Skills</hd> <p>Behavioral skills are recognized as a crucial component of HIV preventive behavior (Fisher & Fisher, 1992). Behavioral skills comprise a person's ability to perform certain behaviors to protect oneself from HIV transmission and are also related to self efficacy. Students are amenable to participating in a condom use skills program and improvements in behavioral skills occur after a three-session intervention, compared to only one session (Lindemann, Brigham, Harbke, & Alexander, 2005; Singh, 2003). A motivational-enhancement skills program is more effective in increasing intent to use condoms compared to skills-only and information-only programs, but shows no advantage over a motivation-only program (Vrungos, 2003). Condom use over time is greater among participants in the motivational-enhancement skills program compared to the information and motivation programs, but not the skills program. Thus, improving safer sex behavior will need emphasis on motivational enhancement of behavior change.</p> <hd id="AN0042427175-10">Conclusion</hd> <p>This assessment of college students' HIV risk behavior is congruent with our previous review article, which described high levels of sex, inconsistent condom use, and the use of alcohol and drugs before or during sex (Lewis et al., 1997). These data suggest that college students normally use condoms about half the time during vaginal intercourse and much less during oral and anal sex (American College Health Association, 2007; Gurman & Borzekowski, 2004; Polacek et al., 2007). Almost all college students are sexually active, have multiple lifetime partners, and alcohol and substance use negatively affects condom use, especially among males (Civic, 2000; Dalton et al., 1999; LaBrie et al., 2005).</p> <p>HIV knowledge has a limited impact on condom use, regardless of whether alcohol is involved with sex (Dalton et al., 1999). Such knowledge does not appear to contribute to improving risk behavior among college students because they all possess high HIV knowledge (Lance, 2001), although some myths do persist, especially among minorities, who report that the information they receive about HTV is inadequate (Yi, 1998). Certain subtle distinctions about the risk of HIV transmission are important and need attention among African-Americans (Bazargan, Kelly, Stein, Husaini, & Bazargan, 2000). Opportunities for improving HIV/AIDS knowledge and awareness should be tailored to each gender, as college women receive their disease-related information from newspapers and magazines, but college men get theirs from school and television (Lance et al., 1998). To improve sex-risk behavior, information should be presented in a comprehensive approach, as more HIV knowledge and fewer sex partners were found among college women who participated in a comprehensive program (Jaworski & Carey, 2001).</p> <p>Many students believe that using condoms every time for vaginal and anal sex is not necessary as a relationship progresses, so condoms are used more frequently during the initial stages of a relationship, but subsequently decline (Civic, 2000). Other birth control methods tend to replace condoms for preventing pregnancy during vaginal intercourse and because pregnancy is not an issue during anal intercourse condoms are not likely to be used (Civic, 2000). Continuing to address the notion that "serial monogamy" offers limited protection from HIV and to point out gender-specific needs are necessary as part of an overall approach to reducing the risk of HIV. However, while students are not reducing the number of times they have sex because of HIV, they are reducing their casual partners (Weinberg, Lottes, & Aveline, 1998).</p> <p>Students still typically report moderate levels of HIV-related susceptibility and do not label their sexual behavior as risky, despite having sex with multiple partners and using condoms inconsistently. HIV interventions have typically demonstrated limited effectiveness in reducing high-risk sexual behaviors of college students because programs have been inadequate in addressing the important motivational role of perceived vulnerability to HIV in condom use decisions. In addition, skills-training approaches that focus on behavioral implementation and presume individuals are sufficiently motivated to change risk behaviors, but lack the requisite skills, appear inappropriate for individuals who perceive little vulnerability to HIV. Thus, effectively changing college students' perceptions of HIV risk requires additional intensive evaluation, so that successful strategies can be improved and/or developed.</p> <p>Academic-community partnerships integrating policies to change the social context of the perception of HIV have shown that they can be successful in improving students' risk behavior (Anderko & Uscian, 2002). At the end of the intervention students reported fewer partners, increased condom use, less STI, and a decline in unwanted pregnancy (Anderko & Uscian, 2002). These partnerships can also be utilized, so that more students are provided risk behavior intervention, as the resources of each institution are combined together. Because certain areas may have limited healthcare resources, innovative programs of this type may decrease the spread of HIV.</p> <p>Sex-risk behavior continues to be highly related to alcohol consumption among college students. Alcohol may enhance sexual expression, but for unknown reasons. However, people are thought to become more sexualized after drinking because it is expected, but cognition is reduced with greater intake of alcohol, thereby deflating the ability of expectations to affect behavior. Sexual sensation seeking and compulsivity among college students should be explored further to determine if these traits are related to sex-risk behaviors. Interventions to help women better cope with the effects of alcohol may improve risk-taking behavior.</p> <p>Other intervention strategies among the college population should include: (<reflink idref="bib1" id="ref7">1</reflink>) HIV testing to not only determine HIV prevalence among students, but to be used as a tool for prevention since students reconsider their health beliefs and change sex-risk behaviors post-testing (Mattson, 2002); (<reflink idref="bib2" id="ref8">2</reflink>) continuing to address improvements in communication and negotiation skills because many students report engaging in unprotected sex, even though they wanted to use a condom, but did not, due to the partner's influence (Smith, 2003); (<reflink idref="bib3" id="ref9">3</reflink>) utilizing normative feedback and goal setting among sexually active college students that appear to be effective in improving condom use among men and reducing sex partners among women (Chernoff & Davison, 2005); and (<reflink idref="bib4" id="ref10">4</reflink>) engaging students in motivation-skills programs to improve self efficacy and behavioral skills (Vrungos, 2003).</p> <p>As HIV risk prevention efforts continue to be focused in the historically-affected groups, i.e., gay men and drug users, the college population still offers the potential for much-needed involvement. While this updated body of research includes a limited amount of interventional work, most of the research conducted on college students continues to be cross-sectional in nature. Although several investigations included data in a multifactorial framework using the HBM or 1MB, a crucial need exists to enroll college students in follow-up studies. Given that most students will be captive on campus for several years, the opportunity exists to greatly improve the current state of HIV risk knowledge in this population. Unlike non-collegiate adolescents or adults who may be frequently transient, college students should be relatively easy to engage on a continuing basis. Additional progress has been made in determining HIV risk and the contextual factors important for women and minorities, such as Hispanics and African-Americans, but additional work needs to be done for the Asian-American population, where information appears to be lacking, and the different sub-groups of Hispanics, e.g., Mexicans, South Americans, and Central Americans, who have strong differences in culture.</p> <ref id="AN0042427175-11"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt"></bibl> <bibtext>Abbey, A., Parkhill, M. R., Buck, P. 0., & Saenz, C. (2007). Condom use with a casual partner: . what distinguishes college students' use when intoxicated? Psychol. Addict. Behav., 21, 76-83.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt"></bibl> <bibtext>Agostinelli, G., Brown, J. M., & Miller, W. R. (1995). Effects of normative feedback on consumption among heavy drinking college students. J. 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  Data: <searchLink fieldCode="AR" term="%22Lewis%2C+John+E%2E%22">Lewis, John E.</searchLink><br /><searchLink fieldCode="AR" term="%22Miguez-Burban%2C+Maria-Jose%22">Miguez-Burban, Maria-Jose</searchLink><br /><searchLink fieldCode="AR" term="%22Malow%2C+Robert+M%2E%22">Malow, Robert M.</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22College+Student+Journal%22"><i>College Student Journal</i></searchLink>. Jun 2009 43(2):475-491.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Project Innovation, Inc. P.O. Box 8508 Spring Hill Station, Mobile, AL 36689-0508. Tel: 251-343-1878; Fax: 251-343-1878; Web site: http://www.projectinnovation.biz/csj.html
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 17
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2009
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Information Analyses<br />Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Efficacy%22">Self Efficacy</searchLink><br /><searchLink fieldCode="DE" term="%22Sexually+Transmitted+Diseases%22">Sexually Transmitted Diseases</searchLink><br /><searchLink fieldCode="DE" term="%22At+Risk+Persons%22">At Risk Persons</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Behavior%22">Health Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Sexuality%22">Sexuality</searchLink><br /><searchLink fieldCode="DE" term="%22Acquired+Immunodeficiency+Syndrome+%28AIDS%29%22">Acquired Immunodeficiency Syndrome (AIDS)</searchLink><br /><searchLink fieldCode="DE" term="%22Drinking%22">Drinking</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+Use%22">Drug Use</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Promotion%22">Health Promotion</searchLink><br /><searchLink fieldCode="DE" term="%22Literature+Reviews%22">Literature Reviews</searchLink><br /><searchLink fieldCode="DE" term="%22Knowledge+Level%22">Knowledge Level</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22United+States%22">United States</searchLink>
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0146-3934
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: This article updates our 1997 review that examined the literature on HIV risk behavior among college students. Methods: The current review focuses on college student sex-risk behaviors related to HIV-related knowledge, communication with sex partners, self efficacy, and behavioral skills. Results: As reported in our original review, the majority of students continue to have multiple sex partners, use condoms inconsistently during intercourse, and have a tendency to combine alcohol and/or other drugs with their sexual experiences. They remain very knowledgeable about the virus and routes of basic transmission, but that does not impact condom use. Communication among partners about safer sex continues to be limited. Conclusions: Enhancing self efficacy should be an important focus for intervention strategies among students, given consistent evidence for its impact on lowering risk for HIV transmission. Additional evidence-based recommendations for strategies to prevent the spread of HIV within the college population are provided.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 93
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2010
– Name: URL
  Label: Access URL
  Group: URL
  Data: <link linkTarget="URL" linkTerm="https://www.projectinnovation.biz/csj_2006.html" linkWindow="_blank">http://www.projectinnovation.biz/csj_2006.html</link>
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ872262
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ872262
RecordInfo BibRecord:
  BibEntity:
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 17
        StartPage: 475
    Subjects:
      – SubjectFull: College Students
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Self Efficacy
        Type: general
      – SubjectFull: Sexually Transmitted Diseases
        Type: general
      – SubjectFull: At Risk Persons
        Type: general
      – SubjectFull: Health Behavior
        Type: general
      – SubjectFull: Sexuality
        Type: general
      – SubjectFull: Acquired Immunodeficiency Syndrome (AIDS)
        Type: general
      – SubjectFull: Drinking
        Type: general
      – SubjectFull: Drug Use
        Type: general
      – SubjectFull: Health Promotion
        Type: general
      – SubjectFull: Literature Reviews
        Type: general
      – SubjectFull: Knowledge Level
        Type: general
      – SubjectFull: Student Attitudes
        Type: general
      – SubjectFull: United States
        Type: general
    Titles:
      – TitleFull: HIV Risk Behavior among College Students in the United States
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Lewis, John E.
      – PersonEntity:
          Name:
            NameFull: Miguez-Burban, Maria-Jose
      – PersonEntity:
          Name:
            NameFull: Malow, Robert M.
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 06
              Type: published
              Y: 2009
          Identifiers:
            – Type: issn-print
              Value: 0146-3934
          Numbering:
            – Type: volume
              Value: 43
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: College Student Journal
              Type: main
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