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AIDS Res Treat. 2012; 2012: 659853.
Published online May 27, 2012. doi:  10.1155/2012/659853
PMCID: PMC3368177
Decision Processes about Condom Use among Shelter-Homeless LGBT Youth in Manhattan
Geoffrey L. Ream, 1 * Kate F. Barnhart, 2 and Kevin V. Lotz 3
1School of Social Work, Adelphi University, Garden City, NY 11530, USA
2New Alternatives for Homeless LGBT Youth, New York, NY 10009, USA
3Trinity Place Shelter, New York, NY 10025, USA
*Geoffrey L. Ream: ream/at/adelphi.edu
Academic Editor: Bonita Stanton
Received January 23, 2012; Accepted March 24, 2012.
Abstract
Health behavior interventions based on Theory of Planned Behavior address participants' personally-held beliefs, perceived social norms, and control over the behavior. New data are always needed to “member check” participants' decision processes and inform interventions. This qualitative study investigates decision processes around condom use among 81 homeless LGBT youth ages 18–26. Findings indicated considerable endorsement of the conventional policy of always using condoms, promulgated in HIV prevention education targeting this population. Although some participants reported risk behavior in contexts of sex work, survival sex, casual encounters, open relationships, and substance use, most were aware of these risks and consistently safe in those situations. Condoms use boundaries became vulnerable in states of emotional need and negative mood. The only effect participants acknowledged of homelessness on condom use was indirect, through negative mood states. The most prevalent context of condom non-use was with long-term primary partners, a potential area of vulnerability because, of 13 participants for HIV or HCV, nine mentioned how they had been infected, and all nine believed they had acquired it from a primary partner. Findings imply programs should emphasize HIV risk potential within long-term romantic partnerships and mental health services to remediate negative mood states.
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