Journal of American College Health
ISSN: 0744-8481 (Print) 1940-3208 (Online) Journal homepage: http://www.tandfonline.com/loi/vach20
Gender, Knowledge about AIDS, Reported Behavioral Change, and the Sexual Behavior of College Students Leo Carroll PhD To cite this article: Leo Carroll PhD (1991) Gender, Knowledge about AIDS, Reported Behavioral Change, and the Sexual Behavior of College Students, Journal of American College Health, 40:1, 5-12, DOI: 10.1080/07448481.1991.9936252 To link to this article: http://dx.doi.org/10.1080/07448481.1991.9936252
Published online: 09 Jul 2010.
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Gender, Knowledge About AIDS, Reported Behavioral Change, and the Sexual Behavior of College Students
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LEO CARROLL, PhD
This article reports on an analysis of the relationshipsamong knowledge about AIDS, self-reported changes in sexual behavior, and independent measures of those behaviors-condom use, coital frequency, and number of partners. The sample consisted of 195 sexually active, heterosexual college students attending a northeastern state university in spring 1988. With other relevant variables held constant, statistically significant associations in the predicted direction were found between knowledge and reported change and each of the dependent variables among the men, especially the men not involved in relationships. Among women, however, the only significant association was that between reporting the beginning of condom use and the frequency with which condoms were used in the past year. Possible reasons for these gender differences are discussed.
Recent estimates are that 2 in every 1,OOO American college students are infected with human immunodeficiency virus (HIV).' This estimate, although lower than expected, i s nonetheless cause for concern, considering that some three quarters of the American college student population is sexually active, that sexually active students average more than 2 partners per year, and that perhaps one third to one half will have 6 or more partners before marriage.*-" Recognition of the potential for high rates of HIV infection among college students in the United States has prompted a considerable amount of research on this population. In general, this research indicates that college students have a high level of knowledge about AlDS5-8and that 40% or more claim to have changed their sexual behavior in some way as a result of their
Leo Carroll is a professor of sociology at the University of Rhode Island in Kingston.
VOL 40, lULY 7991
concern about the disease.','' Despite the coincidence of high knowledge about AIDS and stated changes in sexual behavior among students, the few studies that have correlated the two have found no relation between knowledge and change when other influences were held constant.','' Moreover, there is reason to suspect the validity of measuring change by merely asking students w.hether or not their sexual behavior has changed in particular ways over a period of time. At least one study found that students who claimed to have engaged in sex less frequently in the previous year as a result of their concern over AIDS reported a level of coital frequency in that year equal to those who claimed no effect on their beh a ~ i o r . ~ Finally, none of the studies looked at the behavior of men and women separately when, in fact, there are solid reasons for doing so. Despite the recent increase in AIDS among women," the majority of those infected with the virus are men, and the mistaken belief that women have a natural immunity to the disease continues to persist, even among relatively well-educated people (see Table 1). Moreover, although the differences are narrowing, unmarried, sexually active, heterosexual men tend to have more partners than do similar women.* Thus, on the one hand, men may perceive themselves as at greater risk and thereby be more motivated to seek knowledge and to make changes in their sexual behavior. On the other hand, unmarried men and women differ greatly in motives, values, and attitudes surrounding premarital (PM) sex. In particular, college women tend to be significantly less permissive," to view sex in emotional rather than physical term^,'^ and to score higher on measures of sexual responsibility and conventionality.14 This more cautious orientation toward premarital
5
COLLECE HEALTH TABLE 1 Descriptive Statistics on Dependent and Independent Variables
Women = 108)
(n
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Variable In the past year, used condoms all or almost every time had sex oncelweek or more had more than one partner began to use condoms engaged in sex less frequently became more selective Knew that a person infected with HIV may look and feel healthy for years you cannot get AIDS from someone with AIDS who sneezes near you latex condoms are the best protection when having sex you cannot get AIDS from giving blood anal sex i s more risky than oral or vaginal sex women do not have a greater immunity than men the only drug licensed to treat AIDS is ATT AIDS is less contagious than measles it may be 3 months or more before detection by blood test < 5% of the known cases have been transmitted heterosexually *p
Men = 87)
(N
Total = 195)
%
OIO
30.5
32.2
31.3
52.7 43.5 13.0 15.7 31.5
47.0 50.6 19.5 23.0 44.8*
50.2 46.7 15.9 19.0 37.4
97.2
93.1
95.4
91.7
73.6*
83.6
89.8
89.7
89.7
87.0
78.2*
83.1
73.1
72.4
72.8
68.5
62.1
65.6
65.7
60.9
63.6
56.5 39.8
50.6 34.5
53.8 37.4
11.1
28.7*
19.0
< .05.
sex suggests that w o m e n may be more likely to respond to the threat of AIDS by seeking knowledge and by changing their behavior. In any event, it i s important to determine whether behavioral change, if it occurs, is occurring equally among m e n and women. The present research, then, had three objectives. First, it sought to determine whether those students w h o are more knowledgeable about AIDS did, in fact, report practicing “safer sex” than did similar students who were less knowledgeable. Second, it sought t o determine whether students who reported changing their behavior in specific ways also reported practicing safer sex than did similar students who reported n o change. Third, it sought to determine whether these relationships occur equally among men and women.
METHOD The data for this analysis were collected by means of a questionnaire distributed i n April 1988 t o 592 students enrolled in a random sample of courses at the University of Rhode Island. The courses included i n the
6
(n
sample were 4 lower division general education courses with large enrollments (120+) and 15 upper division courses for majors; at least 1 course was in each of the university’s seven col leges. I distributed the questionnaires i n each class. Before distributing the forms, I explained the purposes of the study and informed the students that the questionnaire contained questions concerning intimate sexual behavior. Students were also told that participation was voluntary, that they were free not t o answer any individual question, that the questionnaire contained n o identifying marks, and that no names were to be placed o n the questionnaire. Questionnaires were t o be completed at home and returned to the instructor at the next class. Fifty-two percent (n = 307) were returned. Compared with the university undergraduate population, the resuIti ng sample appears t o be slightly overrepresentative of women (57% v 49%), those with higher grade point averages (2.81 v about 2.401, and probably underrepresentative of gay and bisexual students--only 14 indicated they were gay or bisexual.
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AIDS AND COLLEGE STUDENTS' SEXUAL BEHAVIOR Of the 307 completed questionnaires, 195 were included in this analysis. Those excluded were 51 students who were not sexually active, 18 who were married, the 14 who were gay or bisexual, and 29 for whom information on one or more of the variables was missing. The analysis was done separately for men and women, and grade point average was entered as a control. The three dependent variables were frequency with which condoms were used in the preceding year; frequency of coitus in the past year; and number of different partners with whom the respondent had sex in the previous year. These were measured by questions phrased, "Thinking back over the past year, how. . . ?" The five response categories to the question concerning condom use ranged from never through about half the time to every time. Coital frequency was measured by 10 categories ranging from not at all to more than three times per week. Students were merely asked to provide the number of partners. Relevant summary statistics, listed by sex of respondents, for these and the independent variables are shown in Table 1. About 50% of the students reported they had engaged in sex once or more per week during the previous year, and nearly half reported having had more than one partner. Proportionately more women than men reported having had sex once or more per week, and a somewhat higher percentage of men than women reported having had more than one partner. Neither of these differences was statistically significant, however, and virtually the same proportion of men and women-about 30%-reported using condoms almost every time they had sex in the previous year. Self-reported change in sexual behavior was measured by asking, "Has concern about AIDS caused you to change your sexual behavior in any way during the past year?" Those students who indicated a change were then asked to check, from a list of five possible changes, all those ways in which they had changed: began using condoms, became more selective in choice of partners, engaged in sex less frequently, stopped sex altogether, stopped engaging in certain practices. An individual student who checked more than one change, eg, became more selective and engaged in sex less frequently, was included in both categories. In this analysis, those who completely stopped having sex were counted both as becoming more selective and engaging in sex less frequently. Those who indicated that they had stopped engaging in certain practices were considered as not having changed unless they also checked one or more of the other categories. To prevent responses to these questions biasing responses to those concerning the frequencies of the behaviors, these questions were placed at the end of the 10-page questionnaire; the frequency questions were placed earlier, on pages 5 and 6. Forty-four percent of the sexually active students indicated that they had changed in the past year. The most common change was that they were more selecVOL 40,IULY 7997
tive in choice of partners; a significantly higher percentage of men than women reported that they were more selective in the preceding year. Nearly 1 student in 5 indicated having engaged in sex less frequently, and 16% said they began to use condoms in the past year. Men were slightly more likely than women to claim they had made these changes, but the differences were not statistically significant. Knowledge about AIDS was measured by a 10-item scale; each of the items had a statistically significant (p < .05) correlation to the sum of the other 9. The maximum possible score on the scale was 20; the mean score for women was 14.49, that for males was 13.98. Although the mean scores were not significantly different, as can be seen in Table 1, there were significant gender differences on several questions. Women were less likely than men to hold misperceptions, such as that you can get AIDS from being near a carrier who sneezes or from giving blood; men were more likely to have an accurate perception of the number of known cases of AIDS that have been transmitted heterosexually. In addition to the variables of primary interest, the questionnaire elicited information on a number of other variables known to influence premarital sexual behavior. These variables, used as controls, included gender; the number of years the student had been sexually active; parents' marital status; grade point average; whether the respondent was currently involved in an exclusive relationship, and, if so, for how many months he or she had been so involved; and the individual's attitude toward premarital sex. The last-named was measured by a question asking students to check at what point in a relationship they thought it morally permissable to engage in sex. The six response categories ranged from just met through dating a person exclusively to never. Two questions were asked, one for each sex; only that for the respondent's sex was used to measure attitudes in this analysis. Also included as controls in particular equations were the other dependent variables. That is, frequency of condom use was, at least initially, included as a control in the equations for coital frequency and number of partners; coital frequency was evaluated as a control in the equations for frequency of condom use and number of partners; and number of partners was initially entered as a control in the equations for condom use and coital frequency. The data were analyzed using ordinary least squares (OLS) regression. Equations were built by first entering the control variables alone. Those variables that had at least a nearly significant relationship (p < .lo) with the dependent variable when the others were entered were retained in further analyses. Knowledge of AIDS was entered next. If nearly significant, knowledge was retained in the next equation in which the appropriate measure of reported change (began using condoms, became more selective, engaged in sex less frequently) was entered.
7
COLLEGE HEALTH RESULTS
ly associated with the number of partners and negatively related to condom use. With these variables held constant, there was no relationship between knowledge about AIDS and reported frequency of sex. Moreover, although the association between claiming to have engaged in sex less frequently and the reported incidence of coitus was in the direction expected, it was not strong enough to be statistically significant. Although few background characteristics of these women were related to the frequency with which they engaged in sex or used condoms, this was not the case with the number of people with whom they had sex. Not being in an exclusive relationship, having a permissive attitude toward premarital sex, having a lower grade point average, and being from a family broken by death or divorce were all, other things being equal, associated with reporting more partners in the previous year. With these variables held constant, however, neither knowledge of AIDS nor even reporting having become more selective in the choice of partners had any discernible association with the number of partners reported.
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Women There was a significant negative relationship between the number of years a woman had been sexually active and reported frequency of condom use in the year prior to the survey. The frequency with which these women used condoms may also have been negatively related to the number of months in the past year in which they were involved in an exclusive relationship and the frequency with which they engaged in sex, although these relationships were not statistically significant (see Table 2). With the relevant control variables entered, there was no discernible relationship between knowledge about AIDS and the frequency with which condoms were reportedly used. There was, however, a rather strong relationship in the expected direction between claiming to have begun use of condoms and the frequency with which they were reportedly used. Apparently women who know more about AIDS were no more or less likely to use condoms than were similar women with less knowledge, but those who claimed to have begun use in the previous year did, in fact, report a higher frequency of use. The frequency with which these women reported having intercourse was positively related to the number of months in the past year in which they had been involved in a relationship and the number of years they had been sexually active. With relationship status held constant, coital frequency also appeared to be positive-
Men For men, being in an exclusive relationship was negatively associated with frequency of condom use, and, when this variable was held constant, condom use was also negatively associated with attitudes toward premarital sex, ie, those who were more permissive re-
TABLE 2
0 1 s Estimatest of the Associations Between AIDS Knowledge, Reported Behavioral Change, and Measures of Sexual Behavior in Past Year for Women (n = 108) Dependent variables Independent variable Parents’ marital status+ Years sexually active Grade point average Attitude toward PM sex§ Exclusive relationship Frequency of condom use Frequency of coitus Number of partners Knowledge about AIDS Self-reported change11
R2 R2 adjusted
Frequency of condom use
- .29* -
- .28*
Frequency of coitus -
.23*
-
-
-
-
.37* -.11
-
.24* -
.32* -.11
-
- .05 -
-.13
-.15
-
-
-
- .03
-
.14 -.04
-
-
- .11
-.13
-
.17 .14
-
.25* .22 .19
.22 .18
-
.14
.23 .19
Number of partners
-.15* - .23*
.29* -.33* -
.14 -
.02 -
.27 .23
-.16* - .23*
.30* - .35* -
.15
- .05
.27 .23
-
tstandardized regression coefficients; $0 divorced, widowed; 1 = married; §high score permissive attitude; 110 = no change; 1 = began condom use, less frequent sex, or more selective in partners, depending upon equation.
* p < .05.
8
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AIDS AND COLLEGE STUDENTS’ SEXUAL BEHAVIOR ported having used condoms less frequently than others. Men who had sex more frequently also reported more frequent condom use. With these influences entered into the equation and controlled, there was no relation between knowledge of AIDS and the reported frequency with which condoms were used in the preceding year. Those men who reported that they had begun to use condoms in the previous year because of their concern about AIDS did, however, report more frequent usage (see Table 3). Among the men, the reported frequency of sex was strongly associated with the number of months in the past year in which they were involved in an exclusive relationship. When I controlled for length of involvement, coital frequency was also higher among those men who had more partners, those with more permissive attitudes, and those who used condoms more frequently. With these four variables held constant, knowledge about AIDS also had a significant negative association with reported frequency of sex, and those who reported having engaged in sex less frequently did, in fact, report a lower level of coitus to a degree that approached statistical significance (p = .07). As was true for the women, the number of partners with whom a male respondent reported having had sex in the previous year was associated with a greater number of the background variables than it was with either condom use or frequency of sex. Length of involvement in an exclusive relationship was the strongest predictor, and those involved for the entire year reported significantly fewer partners. With length of in-
volvement held constant, the number of partners was positively associated with the number of years a man had been sexually active, coital frequency, being from an intact family, and marginally with having a more permissive attitude toward premarital sex. Knowledge about AIDS, however, was not related to the number of partners, and although those who reported becoming more selective in their choice of partners did report fewer partners, the difference was not so great as to be statistically significant.
Interactions Thus far, the analysis provides only very limited support for the hypothesis that students who are more knowledgeable about AIDS will be more likely to adopt safer sexual practices than will those who are less knowledgeable. Indeed, in my study, knowledge of AIDS was significantly associated in the expected direction only with the coital frequency reported by men. Moreover, reported changes in behavior were significantly related to reported frequencies of the behavior in the past year only for condom use, although, among men, the associations approached statistical significance in the predicted direction for both frequency of coitus and number of partners. It may be, however, that the expected associations are dependent upon the values of other variables. In particular, it seems reasonable to expect that relations between knowledge of AIDS and the practice of safer sex may vary, depending upon whether a person is in-
TABLE 3
0 1 s Estimatest of the Associations Between AIDS Knowledge, Reported Behavioral Change, and Measures of Sexual Behavior in Past Year for Men (n = 87)
Independent variable Parents’ marital status* Years sexually active Grade point average Attitude toward PM sex§
Exclusive relationship Frequency of condom use Frequency of coitus Number of partners Knowledge about AIDS Self-reported change11
DeDendent variables Frequency of Frequency of condom use coitus -
- .27* - .45*
-
.22*
-
-
-
.25* .64* .18
.19
-
.24* .61* .18
.02
-
.18 .14
.22* .23 .19
-
R2 R2 adjusted
- .27* - .41* -
-
-
-
.26* -.17*
.25* -.17* -.15 .47 .44
-
.46 .42
-
Number of partners .17* .24* - .18* .15 - .40* -
.26* -
.05 -
.34 .28
.18* .26* - .16* .15 - .42* -
.24*
-
-.12 .35 .29
-
Wandardized regression coefficients; $0 divorced, widowed; 1 married; §high score permissive attitude; //0 = no change; 1 began condom use, less frequent sex, or more selective in partners, depending upon equation. * p < .05.
-
VOL 40, lULY 1997
9
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COLLEGE HEALTH volved in an exclusive relationship and, if so, for how long they have been involved. A knowledgeable person who is uninvolved, we might expect, would be more motivated to use that knowledge than would a similarly knowledgeable person who has been involved for several years with a person he or she trusts. To test for the possibility that the associations between knowledge of AIDS and reported changes in behavior with reported sexual behavior vary depending upon involvement in a relationship, I formed two-way interaction terms by multiplying each independent variable by the control variable (relationship) and then adding these terms to the equations shown in Tables 2 and 3.’’ Of the 12 interactions tested in this manner, only 3 were statistically significant beyond .05 and improved the fit of the equations to the data as measured by the explained variance ( P I , adjusted for the degrees of freedom. All 3 of the significant interactions were for men (see Tables 4 and 5). Among men, the direction of the relationship between knowledge of AIDS and frequency of condom use in the past year varied between those who had not been involved all year and those who had (see Table 5). Among the former, those with more knowledge about AIDS tended also to report using condoms more frequently; the reverse was true among those who had been involved in a relationship for all or part of the past year. When this interactive effect was properly specified in the first equation of Table 4, the net effect of knowledge of AIDS on frequency of condom use was significantly positive. The correlation between AIDS knowledge and the coital frequency reported by men also varied by involvement in a relationship. Among those men who had not been involved all year, the relationship was significantly negative. It was negative, but not statistically significant, among those involved for less than a year; and it was negligible, but positive, among those involved for the entire year. Again, when these varying associations were taken into account by the interaction term in the second equation in Table 2, knowledge about AIDS was shown to have a significant negative association with coital frequency. Claiming to have become more selective in choice of partners in the previous year had a significant negative correlation with the number of partners reported by men who had not been involved in a relationship all year (see Table 5). Among those who had been involved all year, however, the relationship was significantly positive. When these influences were fully taken into account and held constant by the interaction term (Table 4), the net association of reported greater selectivity to the number of partners reported in the previous year was significantly negative.
CONCLUSION The level of knowledge about AIDS among the students in this sample was high, a finding that i s consis-
70
tent with what has been found in other research on student populations. There were no gender differences in the overall level of knowledge, but women were less likely to hold certain common misbeliefs about AIDS, whereas men more accurately perceived the risk of heterosexual transmission. On the one hand, these differences may reflect the fact that about 15% of the female respondents were enrolled in nursing, where they receive formal instruction about AIDS and especially in nonsexual modes of transmission; on the other hand, it may result from a greater concern among men with the risks entailed by sex. More than 40% of the students claimed to have changed their sexual behavior in some way during the previous year as a result of their concern about AIDS. The most common change, by far, was to have become more selective in their choice of partners, and men were much more likely than women to claim they had become more selective. That men in this sample did not have significantly more partners in the past year than did the women may result, in part, from a rather long-term trend toward more partners among college women, but also, from a recent short-term swing toward fewer partners on the part of college men. This study found some evidence that knowledge about AIDS is significantly associated with safer sexual practices among at least some students, evidence that is contrary to the findings in some other research. The results also suggest circumspection in accepting positive responses to simple questions about behavioral change as valid indicators of change and point up the necessity of taking gender differences into account. Finally, it suggests that an important contextual factor influencing change in sexual behavior in response to the threats posed by AIDS is whether or not the student is in a long-term, exclusive relationship. The male college students I studied who were more knowledgeable about AIDS engaged in sex less frequently than did similar men who were less knowledgeable, and they were more likely to use condoms when having intercourse. This was especially true of men who were not involved in exclusive relationships. There was also a strong association between the men’s claiming to have changed their behavior in the previous year and independent measures of the behavior. Men who claimed to have begun using condoms, to have become more selective in choice of partners, or to have engaged in sex less frequently did, in fact, report more frequent condom use, fewer partners, and less frequent sex than did similar men who reported no change. Among the men, of six possible associations between the independent variables-AIDS knowledge and reported change in behavior-and the three behavioral measures, only one was not statistically significant in the expected direction: that between knowledge and number of partners in the past year. This may simply reflect that knowledge did not lead men to decrease the
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AIDS AND COLLEGE STUDENTS’ SEXUAL BEHAVIOR ~
~~~
~~~
TABLE 4 OLS Estimatest of the Associations Between AIDS Knowledge, Reported Behavioral Change, and Measures of Sexual Behavior in Past Year With Interactions, Men Only (n = 87)
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Independent variable
Frequency of condom use
Parents’ marital status* Years sexually active Grade point average Attitude toward PM sex§ Exclusive relationship Frequency of condom use Frequency of coitus Number of partners Knowledge about AIDS Self-reported changell Relationship x Knowledge Relationship x Change
Dependent variables Frequency of coitus
- .29*
-
.65
- .25
-
.23*
-
.21* -
.25*
-
.90* -
-
R’ R2 adjusted
.27 .21
-
- .62*
-
.55* .39 .33
.50 .46
- -
.18* .26* -.17* .13 - .56 .20
.26* - .58* -.17*
.55* .26* -1.11*
Number of partners
-
-
tstandardized regression coefficients; $0 divorced, widowed; 1 married; §high score perno change; 1 began condom use, less frequent sex, or more selective in missive attitude; / / O partners, depending upon equation.
-
* p < .05.
TABLE 5 Selected Zero-Order Correlations by Length of Involvement in a Relationship in the Past Year, Men Only (n = 87)
Involvement in a relationship Current < 12 months All year Not at all (n = 35) (n t 27) (n 25)
-
r of knowledge with frequency of
condom use r of knowledge with frequency of sex r of reporting more selective with partners *p
- .279
- .351* - .353*
- .235 .285
-.190 .lo2 .419*
< .05.
number of partners, but this lack of association seems curious in light of the publicity given t o monogamy as a protection and in light of the other strong associations. It i s also possibly an artifact of the limitations of crosssectional designs in studying change over time. If, say, in 1986, men who were more indiscriminate in choosing partners became concerned about AIDS and sought information t o protect themselves, and if that information caused them t o restrict their number of partners in 1987 to the same number as less knowledgeable men, there would be no relationship between knowledge of AIDS and number of partners, despite considerable change in the direction of safer sex on the part of
VOL40, )UlY 7 99 1
.159
the more knowledgeable men. Thus, the lack of association cannot be accepted as strong evidence that AIDS knowledge does not lead men to decrease the number of people with whom they have sex. Although there was substantial evidence t o suggest that increased knowledge about AIDS had led to changes in the sexual behavior of at least some men, the evidence suggested little change among women. Knowledge of AIDS was not associated with increased condom use, less frequent sex, or with fewer partners. Moreover, even women who claimed to have changed their behavior differed from others only in the extent to which they reported using condoms. That is, women
77
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COLL ECE HEALTH who reported becoming more selective in partners or engaging in sex less frequently in the past year reported as many partners and a coital frequency in the past year that were equal to those of women who claimed no change. Further research is necessary to interpret these gender differences, in particular to understand why there was apparently so little relation between knowledge about AIDS, and even reported changes in behavior, and independent measures of those behaviors among women when the relationships were substantial among men. Two hypotheses seem plausible. One is that women perceive themselves to be at less risk than men and are thus less motivated to put knowledge about AIDS into practice. Even today, AIDS is still perceived by many as a disease that i s primarily of concern to men. In this sample of college students, for example, nearly one woman in three (Table 1) either believed that women have a greater natural immunity to AIDS than do men or were not sure about it. Moreover, among the women, those who were most knowledgeable about AIDS tended to be involved in exclusive relationships for a year or more (r = .21, p = .01). The trust and security of a long-term relationship may have reduced motivation to use the knowledge these women had. Among men, the correlation between knowledge and being in a relationship was equally strong but in the reverse direction ( r = .22, p = .03). It was the uninvolved men who were, on average, more knowledgeable about AIDS. Because they were uninvolved, they may have been more motivated to change. In brief, it seems plausible that absence of significant relationships between knowledge of AIDS and the sexual behavior of college women was that these women did not see themselves as being at risk. A second factor may be that the women have less sense of self-efficacy and control than do men. Psychological research suggests this is generally so among adolescents,'6 and it may be especially true with respect to sex, where traditional sex-role definitions endow men with greater initiative. Women reporting change may be responding more than men in terms of intent rather than actual behavior. In turn, their behavior may be more influenced by male partners than male behavior is by their female partners. The association between reportedly beginning condom use and the reported frequency of condom use by women may have been precisely because this behavior is one that i s so subject to the discretion of the male partner. Clearly, there are gender differences in the ways i n which, and the processes by which, college students are adjusting their behavior in response to AIDS. These differences should be explicitly recognized by college
12
health professionals and incorporated into AIDS education programs. Recognition of such difference raises many questions demanding further research.
INDEX TERMS AIDS-knowledge, gender differences, sexual behavior
ACKNOWLEDGMENT The author gratefully acknowledges the funding for this research, which was provided by the University of Rhode Island Foundation.
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ISSN: 0744-8481 (Print) 1940-3208 (Online) Journal homepage: http://www.tandfonline.com/loi/vach20
Gender, Knowledge about AIDS, Reported Behavioral Change, and the Sexual Behavior of College Students Leo Carroll PhD To cite this article: Leo Carroll PhD (1991) Gender, Knowledge about AIDS, Reported Behavioral Change, and the Sexual Behavior of College Students, Journal of American College Health, 40:1, 5-12, DOI: 10.1080/07448481.1991.9936252 To link to this article: http://dx.doi.org/10.1080/07448481.1991.9936252
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Gender, Knowledge About AIDS, Reported Behavioral Change, and the Sexual Behavior of College Students
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LEO CARROLL, PhD
This article reports on an analysis of the relationshipsamong knowledge about AIDS, self-reported changes in sexual behavior, and independent measures of those behaviors-condom use, coital frequency, and number of partners. The sample consisted of 195 sexually active, heterosexual college students attending a northeastern state university in spring 1988. With other relevant variables held constant, statistically significant associations in the predicted direction were found between knowledge and reported change and each of the dependent variables among the men, especially the men not involved in relationships. Among women, however, the only significant association was that between reporting the beginning of condom use and the frequency with which condoms were used in the past year. Possible reasons for these gender differences are discussed.
Recent estimates are that 2 in every 1,OOO American college students are infected with human immunodeficiency virus (HIV).' This estimate, although lower than expected, i s nonetheless cause for concern, considering that some three quarters of the American college student population is sexually active, that sexually active students average more than 2 partners per year, and that perhaps one third to one half will have 6 or more partners before marriage.*-" Recognition of the potential for high rates of HIV infection among college students in the United States has prompted a considerable amount of research on this population. In general, this research indicates that college students have a high level of knowledge about AlDS5-8and that 40% or more claim to have changed their sexual behavior in some way as a result of their
Leo Carroll is a professor of sociology at the University of Rhode Island in Kingston.
VOL 40, lULY 7991
concern about the disease.','' Despite the coincidence of high knowledge about AIDS and stated changes in sexual behavior among students, the few studies that have correlated the two have found no relation between knowledge and change when other influences were held constant.','' Moreover, there is reason to suspect the validity of measuring change by merely asking students w.hether or not their sexual behavior has changed in particular ways over a period of time. At least one study found that students who claimed to have engaged in sex less frequently in the previous year as a result of their concern over AIDS reported a level of coital frequency in that year equal to those who claimed no effect on their beh a ~ i o r . ~ Finally, none of the studies looked at the behavior of men and women separately when, in fact, there are solid reasons for doing so. Despite the recent increase in AIDS among women," the majority of those infected with the virus are men, and the mistaken belief that women have a natural immunity to the disease continues to persist, even among relatively well-educated people (see Table 1). Moreover, although the differences are narrowing, unmarried, sexually active, heterosexual men tend to have more partners than do similar women.* Thus, on the one hand, men may perceive themselves as at greater risk and thereby be more motivated to seek knowledge and to make changes in their sexual behavior. On the other hand, unmarried men and women differ greatly in motives, values, and attitudes surrounding premarital (PM) sex. In particular, college women tend to be significantly less permissive," to view sex in emotional rather than physical term^,'^ and to score higher on measures of sexual responsibility and conventionality.14 This more cautious orientation toward premarital
5
COLLECE HEALTH TABLE 1 Descriptive Statistics on Dependent and Independent Variables
Women = 108)
(n
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Variable In the past year, used condoms all or almost every time had sex oncelweek or more had more than one partner began to use condoms engaged in sex less frequently became more selective Knew that a person infected with HIV may look and feel healthy for years you cannot get AIDS from someone with AIDS who sneezes near you latex condoms are the best protection when having sex you cannot get AIDS from giving blood anal sex i s more risky than oral or vaginal sex women do not have a greater immunity than men the only drug licensed to treat AIDS is ATT AIDS is less contagious than measles it may be 3 months or more before detection by blood test < 5% of the known cases have been transmitted heterosexually *p
Men = 87)
(N
Total = 195)
%
OIO
30.5
32.2
31.3
52.7 43.5 13.0 15.7 31.5
47.0 50.6 19.5 23.0 44.8*
50.2 46.7 15.9 19.0 37.4
97.2
93.1
95.4
91.7
73.6*
83.6
89.8
89.7
89.7
87.0
78.2*
83.1
73.1
72.4
72.8
68.5
62.1
65.6
65.7
60.9
63.6
56.5 39.8
50.6 34.5
53.8 37.4
11.1
28.7*
19.0
< .05.
sex suggests that w o m e n may be more likely to respond to the threat of AIDS by seeking knowledge and by changing their behavior. In any event, it i s important to determine whether behavioral change, if it occurs, is occurring equally among m e n and women. The present research, then, had three objectives. First, it sought to determine whether those students w h o are more knowledgeable about AIDS did, in fact, report practicing “safer sex” than did similar students who were less knowledgeable. Second, it sought t o determine whether students who reported changing their behavior in specific ways also reported practicing safer sex than did similar students who reported n o change. Third, it sought to determine whether these relationships occur equally among men and women.
METHOD The data for this analysis were collected by means of a questionnaire distributed i n April 1988 t o 592 students enrolled in a random sample of courses at the University of Rhode Island. The courses included i n the
6
(n
sample were 4 lower division general education courses with large enrollments (120+) and 15 upper division courses for majors; at least 1 course was in each of the university’s seven col leges. I distributed the questionnaires i n each class. Before distributing the forms, I explained the purposes of the study and informed the students that the questionnaire contained questions concerning intimate sexual behavior. Students were also told that participation was voluntary, that they were free not t o answer any individual question, that the questionnaire contained n o identifying marks, and that no names were to be placed o n the questionnaire. Questionnaires were t o be completed at home and returned to the instructor at the next class. Fifty-two percent (n = 307) were returned. Compared with the university undergraduate population, the resuIti ng sample appears t o be slightly overrepresentative of women (57% v 49%), those with higher grade point averages (2.81 v about 2.401, and probably underrepresentative of gay and bisexual students--only 14 indicated they were gay or bisexual.
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AIDS AND COLLEGE STUDENTS' SEXUAL BEHAVIOR Of the 307 completed questionnaires, 195 were included in this analysis. Those excluded were 51 students who were not sexually active, 18 who were married, the 14 who were gay or bisexual, and 29 for whom information on one or more of the variables was missing. The analysis was done separately for men and women, and grade point average was entered as a control. The three dependent variables were frequency with which condoms were used in the preceding year; frequency of coitus in the past year; and number of different partners with whom the respondent had sex in the previous year. These were measured by questions phrased, "Thinking back over the past year, how. . . ?" The five response categories to the question concerning condom use ranged from never through about half the time to every time. Coital frequency was measured by 10 categories ranging from not at all to more than three times per week. Students were merely asked to provide the number of partners. Relevant summary statistics, listed by sex of respondents, for these and the independent variables are shown in Table 1. About 50% of the students reported they had engaged in sex once or more per week during the previous year, and nearly half reported having had more than one partner. Proportionately more women than men reported having had sex once or more per week, and a somewhat higher percentage of men than women reported having had more than one partner. Neither of these differences was statistically significant, however, and virtually the same proportion of men and women-about 30%-reported using condoms almost every time they had sex in the previous year. Self-reported change in sexual behavior was measured by asking, "Has concern about AIDS caused you to change your sexual behavior in any way during the past year?" Those students who indicated a change were then asked to check, from a list of five possible changes, all those ways in which they had changed: began using condoms, became more selective in choice of partners, engaged in sex less frequently, stopped sex altogether, stopped engaging in certain practices. An individual student who checked more than one change, eg, became more selective and engaged in sex less frequently, was included in both categories. In this analysis, those who completely stopped having sex were counted both as becoming more selective and engaging in sex less frequently. Those who indicated that they had stopped engaging in certain practices were considered as not having changed unless they also checked one or more of the other categories. To prevent responses to these questions biasing responses to those concerning the frequencies of the behaviors, these questions were placed at the end of the 10-page questionnaire; the frequency questions were placed earlier, on pages 5 and 6. Forty-four percent of the sexually active students indicated that they had changed in the past year. The most common change was that they were more selecVOL 40,IULY 7997
tive in choice of partners; a significantly higher percentage of men than women reported that they were more selective in the preceding year. Nearly 1 student in 5 indicated having engaged in sex less frequently, and 16% said they began to use condoms in the past year. Men were slightly more likely than women to claim they had made these changes, but the differences were not statistically significant. Knowledge about AIDS was measured by a 10-item scale; each of the items had a statistically significant (p < .05) correlation to the sum of the other 9. The maximum possible score on the scale was 20; the mean score for women was 14.49, that for males was 13.98. Although the mean scores were not significantly different, as can be seen in Table 1, there were significant gender differences on several questions. Women were less likely than men to hold misperceptions, such as that you can get AIDS from being near a carrier who sneezes or from giving blood; men were more likely to have an accurate perception of the number of known cases of AIDS that have been transmitted heterosexually. In addition to the variables of primary interest, the questionnaire elicited information on a number of other variables known to influence premarital sexual behavior. These variables, used as controls, included gender; the number of years the student had been sexually active; parents' marital status; grade point average; whether the respondent was currently involved in an exclusive relationship, and, if so, for how many months he or she had been so involved; and the individual's attitude toward premarital sex. The last-named was measured by a question asking students to check at what point in a relationship they thought it morally permissable to engage in sex. The six response categories ranged from just met through dating a person exclusively to never. Two questions were asked, one for each sex; only that for the respondent's sex was used to measure attitudes in this analysis. Also included as controls in particular equations were the other dependent variables. That is, frequency of condom use was, at least initially, included as a control in the equations for coital frequency and number of partners; coital frequency was evaluated as a control in the equations for frequency of condom use and number of partners; and number of partners was initially entered as a control in the equations for condom use and coital frequency. The data were analyzed using ordinary least squares (OLS) regression. Equations were built by first entering the control variables alone. Those variables that had at least a nearly significant relationship (p < .lo) with the dependent variable when the others were entered were retained in further analyses. Knowledge of AIDS was entered next. If nearly significant, knowledge was retained in the next equation in which the appropriate measure of reported change (began using condoms, became more selective, engaged in sex less frequently) was entered.
7
COLLEGE HEALTH RESULTS
ly associated with the number of partners and negatively related to condom use. With these variables held constant, there was no relationship between knowledge about AIDS and reported frequency of sex. Moreover, although the association between claiming to have engaged in sex less frequently and the reported incidence of coitus was in the direction expected, it was not strong enough to be statistically significant. Although few background characteristics of these women were related to the frequency with which they engaged in sex or used condoms, this was not the case with the number of people with whom they had sex. Not being in an exclusive relationship, having a permissive attitude toward premarital sex, having a lower grade point average, and being from a family broken by death or divorce were all, other things being equal, associated with reporting more partners in the previous year. With these variables held constant, however, neither knowledge of AIDS nor even reporting having become more selective in the choice of partners had any discernible association with the number of partners reported.
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Women There was a significant negative relationship between the number of years a woman had been sexually active and reported frequency of condom use in the year prior to the survey. The frequency with which these women used condoms may also have been negatively related to the number of months in the past year in which they were involved in an exclusive relationship and the frequency with which they engaged in sex, although these relationships were not statistically significant (see Table 2). With the relevant control variables entered, there was no discernible relationship between knowledge about AIDS and the frequency with which condoms were reportedly used. There was, however, a rather strong relationship in the expected direction between claiming to have begun use of condoms and the frequency with which they were reportedly used. Apparently women who know more about AIDS were no more or less likely to use condoms than were similar women with less knowledge, but those who claimed to have begun use in the previous year did, in fact, report a higher frequency of use. The frequency with which these women reported having intercourse was positively related to the number of months in the past year in which they had been involved in a relationship and the number of years they had been sexually active. With relationship status held constant, coital frequency also appeared to be positive-
Men For men, being in an exclusive relationship was negatively associated with frequency of condom use, and, when this variable was held constant, condom use was also negatively associated with attitudes toward premarital sex, ie, those who were more permissive re-
TABLE 2
0 1 s Estimatest of the Associations Between AIDS Knowledge, Reported Behavioral Change, and Measures of Sexual Behavior in Past Year for Women (n = 108) Dependent variables Independent variable Parents’ marital status+ Years sexually active Grade point average Attitude toward PM sex§ Exclusive relationship Frequency of condom use Frequency of coitus Number of partners Knowledge about AIDS Self-reported change11
R2 R2 adjusted
Frequency of condom use
- .29* -
- .28*
Frequency of coitus -
.23*
-
-
-
-
.37* -.11
-
.24* -
.32* -.11
-
- .05 -
-.13
-.15
-
-
-
- .03
-
.14 -.04
-
-
- .11
-.13
-
.17 .14
-
.25* .22 .19
.22 .18
-
.14
.23 .19
Number of partners
-.15* - .23*
.29* -.33* -
.14 -
.02 -
.27 .23
-.16* - .23*
.30* - .35* -
.15
- .05
.27 .23
-
tstandardized regression coefficients; $0 divorced, widowed; 1 = married; §high score permissive attitude; 110 = no change; 1 = began condom use, less frequent sex, or more selective in partners, depending upon equation.
* p < .05.
8
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AIDS AND COLLEGE STUDENTS’ SEXUAL BEHAVIOR ported having used condoms less frequently than others. Men who had sex more frequently also reported more frequent condom use. With these influences entered into the equation and controlled, there was no relation between knowledge of AIDS and the reported frequency with which condoms were used in the preceding year. Those men who reported that they had begun to use condoms in the previous year because of their concern about AIDS did, however, report more frequent usage (see Table 3). Among the men, the reported frequency of sex was strongly associated with the number of months in the past year in which they were involved in an exclusive relationship. When I controlled for length of involvement, coital frequency was also higher among those men who had more partners, those with more permissive attitudes, and those who used condoms more frequently. With these four variables held constant, knowledge about AIDS also had a significant negative association with reported frequency of sex, and those who reported having engaged in sex less frequently did, in fact, report a lower level of coitus to a degree that approached statistical significance (p = .07). As was true for the women, the number of partners with whom a male respondent reported having had sex in the previous year was associated with a greater number of the background variables than it was with either condom use or frequency of sex. Length of involvement in an exclusive relationship was the strongest predictor, and those involved for the entire year reported significantly fewer partners. With length of in-
volvement held constant, the number of partners was positively associated with the number of years a man had been sexually active, coital frequency, being from an intact family, and marginally with having a more permissive attitude toward premarital sex. Knowledge about AIDS, however, was not related to the number of partners, and although those who reported becoming more selective in their choice of partners did report fewer partners, the difference was not so great as to be statistically significant.
Interactions Thus far, the analysis provides only very limited support for the hypothesis that students who are more knowledgeable about AIDS will be more likely to adopt safer sexual practices than will those who are less knowledgeable. Indeed, in my study, knowledge of AIDS was significantly associated in the expected direction only with the coital frequency reported by men. Moreover, reported changes in behavior were significantly related to reported frequencies of the behavior in the past year only for condom use, although, among men, the associations approached statistical significance in the predicted direction for both frequency of coitus and number of partners. It may be, however, that the expected associations are dependent upon the values of other variables. In particular, it seems reasonable to expect that relations between knowledge of AIDS and the practice of safer sex may vary, depending upon whether a person is in-
TABLE 3
0 1 s Estimatest of the Associations Between AIDS Knowledge, Reported Behavioral Change, and Measures of Sexual Behavior in Past Year for Men (n = 87)
Independent variable Parents’ marital status* Years sexually active Grade point average Attitude toward PM sex§
Exclusive relationship Frequency of condom use Frequency of coitus Number of partners Knowledge about AIDS Self-reported change11
DeDendent variables Frequency of Frequency of condom use coitus -
- .27* - .45*
-
.22*
-
-
-
.25* .64* .18
.19
-
.24* .61* .18
.02
-
.18 .14
.22* .23 .19
-
R2 R2 adjusted
- .27* - .41* -
-
-
-
.26* -.17*
.25* -.17* -.15 .47 .44
-
.46 .42
-
Number of partners .17* .24* - .18* .15 - .40* -
.26* -
.05 -
.34 .28
.18* .26* - .16* .15 - .42* -
.24*
-
-.12 .35 .29
-
Wandardized regression coefficients; $0 divorced, widowed; 1 married; §high score permissive attitude; //0 = no change; 1 began condom use, less frequent sex, or more selective in partners, depending upon equation. * p < .05.
-
VOL 40, lULY 1997
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COLLEGE HEALTH volved in an exclusive relationship and, if so, for how long they have been involved. A knowledgeable person who is uninvolved, we might expect, would be more motivated to use that knowledge than would a similarly knowledgeable person who has been involved for several years with a person he or she trusts. To test for the possibility that the associations between knowledge of AIDS and reported changes in behavior with reported sexual behavior vary depending upon involvement in a relationship, I formed two-way interaction terms by multiplying each independent variable by the control variable (relationship) and then adding these terms to the equations shown in Tables 2 and 3.’’ Of the 12 interactions tested in this manner, only 3 were statistically significant beyond .05 and improved the fit of the equations to the data as measured by the explained variance ( P I , adjusted for the degrees of freedom. All 3 of the significant interactions were for men (see Tables 4 and 5). Among men, the direction of the relationship between knowledge of AIDS and frequency of condom use in the past year varied between those who had not been involved all year and those who had (see Table 5). Among the former, those with more knowledge about AIDS tended also to report using condoms more frequently; the reverse was true among those who had been involved in a relationship for all or part of the past year. When this interactive effect was properly specified in the first equation of Table 4, the net effect of knowledge of AIDS on frequency of condom use was significantly positive. The correlation between AIDS knowledge and the coital frequency reported by men also varied by involvement in a relationship. Among those men who had not been involved all year, the relationship was significantly negative. It was negative, but not statistically significant, among those involved for less than a year; and it was negligible, but positive, among those involved for the entire year. Again, when these varying associations were taken into account by the interaction term in the second equation in Table 2, knowledge about AIDS was shown to have a significant negative association with coital frequency. Claiming to have become more selective in choice of partners in the previous year had a significant negative correlation with the number of partners reported by men who had not been involved in a relationship all year (see Table 5). Among those who had been involved all year, however, the relationship was significantly positive. When these influences were fully taken into account and held constant by the interaction term (Table 4), the net association of reported greater selectivity to the number of partners reported in the previous year was significantly negative.
CONCLUSION The level of knowledge about AIDS among the students in this sample was high, a finding that i s consis-
70
tent with what has been found in other research on student populations. There were no gender differences in the overall level of knowledge, but women were less likely to hold certain common misbeliefs about AIDS, whereas men more accurately perceived the risk of heterosexual transmission. On the one hand, these differences may reflect the fact that about 15% of the female respondents were enrolled in nursing, where they receive formal instruction about AIDS and especially in nonsexual modes of transmission; on the other hand, it may result from a greater concern among men with the risks entailed by sex. More than 40% of the students claimed to have changed their sexual behavior in some way during the previous year as a result of their concern about AIDS. The most common change, by far, was to have become more selective in their choice of partners, and men were much more likely than women to claim they had become more selective. That men in this sample did not have significantly more partners in the past year than did the women may result, in part, from a rather long-term trend toward more partners among college women, but also, from a recent short-term swing toward fewer partners on the part of college men. This study found some evidence that knowledge about AIDS is significantly associated with safer sexual practices among at least some students, evidence that is contrary to the findings in some other research. The results also suggest circumspection in accepting positive responses to simple questions about behavioral change as valid indicators of change and point up the necessity of taking gender differences into account. Finally, it suggests that an important contextual factor influencing change in sexual behavior in response to the threats posed by AIDS is whether or not the student is in a long-term, exclusive relationship. The male college students I studied who were more knowledgeable about AIDS engaged in sex less frequently than did similar men who were less knowledgeable, and they were more likely to use condoms when having intercourse. This was especially true of men who were not involved in exclusive relationships. There was also a strong association between the men’s claiming to have changed their behavior in the previous year and independent measures of the behavior. Men who claimed to have begun using condoms, to have become more selective in choice of partners, or to have engaged in sex less frequently did, in fact, report more frequent condom use, fewer partners, and less frequent sex than did similar men who reported no change. Among the men, of six possible associations between the independent variables-AIDS knowledge and reported change in behavior-and the three behavioral measures, only one was not statistically significant in the expected direction: that between knowledge and number of partners in the past year. This may simply reflect that knowledge did not lead men to decrease the
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AIDS AND COLLEGE STUDENTS’ SEXUAL BEHAVIOR ~
~~~
~~~
TABLE 4 OLS Estimatest of the Associations Between AIDS Knowledge, Reported Behavioral Change, and Measures of Sexual Behavior in Past Year With Interactions, Men Only (n = 87)
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Independent variable
Frequency of condom use
Parents’ marital status* Years sexually active Grade point average Attitude toward PM sex§ Exclusive relationship Frequency of condom use Frequency of coitus Number of partners Knowledge about AIDS Self-reported changell Relationship x Knowledge Relationship x Change
Dependent variables Frequency of coitus
- .29*
-
.65
- .25
-
.23*
-
.21* -
.25*
-
.90* -
-
R’ R2 adjusted
.27 .21
-
- .62*
-
.55* .39 .33
.50 .46
- -
.18* .26* -.17* .13 - .56 .20
.26* - .58* -.17*
.55* .26* -1.11*
Number of partners
-
-
tstandardized regression coefficients; $0 divorced, widowed; 1 married; §high score perno change; 1 began condom use, less frequent sex, or more selective in missive attitude; / / O partners, depending upon equation.
-
* p < .05.
TABLE 5 Selected Zero-Order Correlations by Length of Involvement in a Relationship in the Past Year, Men Only (n = 87)
Involvement in a relationship Current < 12 months All year Not at all (n = 35) (n t 27) (n 25)
-
r of knowledge with frequency of
condom use r of knowledge with frequency of sex r of reporting more selective with partners *p
- .279
- .351* - .353*
- .235 .285
-.190 .lo2 .419*
< .05.
number of partners, but this lack of association seems curious in light of the publicity given t o monogamy as a protection and in light of the other strong associations. It i s also possibly an artifact of the limitations of crosssectional designs in studying change over time. If, say, in 1986, men who were more indiscriminate in choosing partners became concerned about AIDS and sought information t o protect themselves, and if that information caused them t o restrict their number of partners in 1987 to the same number as less knowledgeable men, there would be no relationship between knowledge of AIDS and number of partners, despite considerable change in the direction of safer sex on the part of
VOL40, )UlY 7 99 1
.159
the more knowledgeable men. Thus, the lack of association cannot be accepted as strong evidence that AIDS knowledge does not lead men to decrease the number of people with whom they have sex. Although there was substantial evidence t o suggest that increased knowledge about AIDS had led to changes in the sexual behavior of at least some men, the evidence suggested little change among women. Knowledge of AIDS was not associated with increased condom use, less frequent sex, or with fewer partners. Moreover, even women who claimed to have changed their behavior differed from others only in the extent to which they reported using condoms. That is, women
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COLL ECE HEALTH who reported becoming more selective in partners or engaging in sex less frequently in the past year reported as many partners and a coital frequency in the past year that were equal to those of women who claimed no change. Further research is necessary to interpret these gender differences, in particular to understand why there was apparently so little relation between knowledge about AIDS, and even reported changes in behavior, and independent measures of those behaviors among women when the relationships were substantial among men. Two hypotheses seem plausible. One is that women perceive themselves to be at less risk than men and are thus less motivated to put knowledge about AIDS into practice. Even today, AIDS is still perceived by many as a disease that i s primarily of concern to men. In this sample of college students, for example, nearly one woman in three (Table 1) either believed that women have a greater natural immunity to AIDS than do men or were not sure about it. Moreover, among the women, those who were most knowledgeable about AIDS tended to be involved in exclusive relationships for a year or more (r = .21, p = .01). The trust and security of a long-term relationship may have reduced motivation to use the knowledge these women had. Among men, the correlation between knowledge and being in a relationship was equally strong but in the reverse direction ( r = .22, p = .03). It was the uninvolved men who were, on average, more knowledgeable about AIDS. Because they were uninvolved, they may have been more motivated to change. In brief, it seems plausible that absence of significant relationships between knowledge of AIDS and the sexual behavior of college women was that these women did not see themselves as being at risk. A second factor may be that the women have less sense of self-efficacy and control than do men. Psychological research suggests this is generally so among adolescents,'6 and it may be especially true with respect to sex, where traditional sex-role definitions endow men with greater initiative. Women reporting change may be responding more than men in terms of intent rather than actual behavior. In turn, their behavior may be more influenced by male partners than male behavior is by their female partners. The association between reportedly beginning condom use and the reported frequency of condom use by women may have been precisely because this behavior is one that i s so subject to the discretion of the male partner. Clearly, there are gender differences in the ways i n which, and the processes by which, college students are adjusting their behavior in response to AIDS. These differences should be explicitly recognized by college
12
health professionals and incorporated into AIDS education programs. Recognition of such difference raises many questions demanding further research.
INDEX TERMS AIDS-knowledge, gender differences, sexual behavior
ACKNOWLEDGMENT The author gratefully acknowledges the funding for this research, which was provided by the University of Rhode Island Foundation.
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