Exploring Why Young African-American Women Do Not Change Condom Use Behavior Following Participation in an HIV Prevention Intervention

Background: HIV interventions can significantly reduce risky sexual behaviors among vulnerable populations, including African-American young women. However, not everyone exposed to an intervention will reduce their sexual risk behavior. Little is known about the factors associated with “failure to change” high risk behaviors following participation in an HIV prevention intervention. Thus, this qualitative study sought to identify factors associated with young African-American females' failure to change their condom use behaviors post-intervention. Method: Semi-structured interviews were conducted with 50 African-American females (18-23 years) after participating in a demonstrated effective HIV prevention intervention; 24 had not changed their condom use behavior after intervention participation. Interviews were transcribed verbatim and thematically coded for barriers to condom-use post-intervention. Results: Although nearly all reported partner-associated challenges to using condoms, there were differences in the relationships described by those who changed verses those who did not change their condom use. Many “non-changers” were in “on and off” relationships, with high rates of infidelity, often with the father of their child, where they were scared to ask for condom use. “Non-changers” also reported more substance use, being incapable of change, and not thinking about condom use. Conclusion: Individual and relationship-level factors differentiated young African-American women who changed their condom use behaviors from those who did not following HIV prevention intervention participation. Future HIV prevention efforts may benefit from incorporating strategies on how young mothers can maintain a non-sexual relationship with their co-parent, as well as elaborating on the intersection of substance use and sexual decision making.