The Context of HIV Risk Among Drug Users and Their Sexual Partners

safety in some studies (Corby and Wolitski 1992; Lo Conte et al. 1993);
it is important that questions be asked in terms of potential risk given
unsafe behavior, or subjects will base responses on current behavior,
obscuring the relationship. Self-efficacy beliefs, a central component of
social cognitive theory (Bandura 1986), are another factor that has been
examined in several studies. Self-efficacy refers to a person’s belief that
an individual can successfully execute skilled behavior necessary to
achieve a desired outcome (in the present case, safer sex). Self-efficacy
operates by affecting people’s behavior choices, the amount of effort they
will exert in performing the behavior, and the degree of persistence they
will display in the face of difficulty. Self-efficacy beliefs regarding one’s
safer sex ability are relevant in three domains (O’Leary 1992): technical
use of condoms and nonpenetrative sexual techniques; negotiation with
partners; and self-control as related to use of alcohol, other drugs, and
sexual arousal. Negotiation self-efficacy has been associated with higher
rates of condom use by commercial sex workers (Corby and Wolitski
1992), other disadvantaged women (Lo Conte et al. 1993; O’Leary et al.
1992), and adolescents (Catania et al. 1989; Jemmott et al. 1992). One
recent study found that self-efficacy perceptions were more closely linked
to behavioral safety for women than for men (Lo Conte et al. 1993).
Self-efficacy enhancement takes place through systematic skill-building,
through modeling (demonstrating the behavior), and practice of
increasingly difficult skills (Bandura 1986). A recent study of African-
American female adolescents demonstrated that increases in self-efficacy
were associated with increased behavioral intention to practice safer sex
(Jemmott and Jemmott 1992).
Expected outcomes of condom use also are important influences on
behavior. One belief is that condoms interfere with sexual pleasure
(Jemmott and Jemmott 1991). Another belief is that safer practices will
win the social approval of peers (Jemmott et al. 1992; Valdiserri et al.
1989). These beliefs, attitudes, and skills are important elements to
address in prevention interventions, and they lend themselves readily to
influence. Skill and self-efficacy–building techniques are specified
particularly well in social cognitive theory (Bandura 1986).
Personal Characteristics
Relatively little research has been conducted to identify personal
characteristics and resources that may condition women’s ability to
respond to AIDS messages. However, one recent study found that
disenfranchised women with higher self-esteem and a greater sense of
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