This dissertation applies the Health Belief Model (HBM) and the Theory of Reasoned Action (TRA) to an analysis of unsafe sexual practices (inconsistent condom use with prostitutes) among men living in a high HIV-prevalence area. The empirical analysis is based primarily upon a survey of sexual practices that was conducted by the author and his Thai colleagues during the fall of 1992. The survey sample includes university undergraduates, soldiers, clerks, and laborers living in Chiang Mai, Thailand (n = 1,472).
Both theories rely on individual assessments of the anticipated costs and benefits of behavior, but TRA provides a more parsimonious model of the empirical results, most likely because of TRA's more adequate incorporation of peer group effects. Thai males usually visit prostitutes with small groups of close friends, and of all the hypothesized predictors derived from the two theoretical frameworks, the individual's perception of the peer group norm regarding condom use is the most significant predictor of consistent condom use, and makes the most important contribution to the explanatory model in multivariate analysis.
Other covariates positively associated with consistent condom use in the multivariate models include knowledge about the consequences of HIV infection, knowledge about the benefits of condom use for preventing infection, positive attitudes about condoms, absence of heavy alcohol consumption, low general propensity towards risk-taking, and high socioeconomic status.
Both TRA and HBM are criticized for their neglect of indirect social influences on individual behavior. It is argued that not only can peers influence individual decision-making through the employment of positive and negative sanctions that alter an individual's assessment of the relative costs and benefits of a particular action, but these groups can also influence how the individual interprets and evaluates the anticipated consequences of behavior. Theoretical perspectives of AIDS risk-taking behavior should attempt to incorporate these more structural aspects of peer influence.
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