Condom Use Errors and Problems: A Comparative Study of HIV-Positive Versus HIV-Negative Young Black Men Who Have Sex With Men

Development and Evidence of the Validity of the Condom Use Attitudes Scale for Youth and Adults in a Chilean Context

Condom use is the most effective preventive behavior against HIV transmission, and its inadequate use is a public health problem that occurs mostly among youth and young adults. Although there are scales that measure condom use, those that exist correspond to English-speaking developments or do not have psychometric evidence to support them, so it is possible that the available adaptations of instruments do not adequately reflect the phenomenon in the Chilean population. Thus, the study aims to develop a scale to assess attitudes toward condom use in Chilean youth and young adults. Initially, a sample of students between 18 and 39 years (n = 520) was used for debugging the instrument. Then, a second sample was taken from the general population aged 18 to 40 (n = 992) to confirm the factor structure of the proposed model. The final scale has 10 items and 3 attitudinal dimensions (affective, cognitive, and behavioral). The results show that the identified structure provides adequate levels (ω > 0.7) or at least sufficient of reliability (ω > 0.6) and presents evidence of validity, based on the internal structure of the test, through ESEM (CFI = 0.993; TLI = 0.984; RMSEA = 0.056). In addition, evidence of validity was obtained based on the relationship with other variables and strong invariance between the scores of men and women. It is concluded that the scale developed has adequate psychometric properties to assess, in brief form, condom use attitudes in equal samples for research and screening purposes.

Factors Associated with Condom Use in Anal Intercourse Among Spanish Men Who Have Sex with Men: Proposal for an Explanatory Model

Men who have sex with men (MSM) account for more than half of the new HIV diagnoses in Spain. This study aims to carry out a descriptive analysis of the sexual practices and frequency of condom use of MSM and identify the variables that explain inconsistent condom use during anal intercourse. The sample consists of 405 men between 18 and 60 years of age (M = 28.94; SD = 9.35). The results indicate that the percentage of consistent condom use is 72.9% for anal intercourse. Lack of risk perception, high self-esteem, and greater sensation-seeking are risk factors for risky sexual behavior. In contrast, high levels of sexual assertiveness and self-efficacy are protective factors. The proposed model explains between 33.8 and 49.2% of the variance. These findings highlight the importance of designing and implementing condom promotion programs for MSM who engage in anal intercourse with specific sections that consider the acquisition of assertive skills and reduce the risks associated with a perceived invulnerability to HIV.

Condom Use Consistency and Associated Factors Among College Student Men Who Have Sex with Men from Seven Colleges in Changsha City: A Cross-Sectional Survey

Background

College student men who have sex with men (MSM) are at high risk for HIV infection due to multiple social and behavioral factors. Consistent condom use is nationally advocated for HIV prevention. This study explored the sexual behaviors and factors associated with condom use consistency in the past six months among college student MSM from seven colleges in Hunan Province, China.

Methods

A cross-sectional survey was conducted from September 2017 to March 2018. Condom use consistency, sexual behaviors, HIV testing performance, substance use, and alcohol consumption were examined using researcher-created questionnaires. Condom use self-efficacy and HIV-related knowledge were assessed using the Condom Use Self-Efficacy Scale and the unified National AIDS Sentinel Surveillance Questionnaire. Univariate and multivariate logistic regressions were used. P <0.05 was considered significant.

Results

In the 214 respondents, the rate of consistent condom use was 56% (n = 119) during the past six months. Participants who were studying at first-tier universities (odds ratio [OR]: 2.522, 95% confidence interval [CI]: 1.255–5.067) and had higher scores for condom use self-efficacy (OR: 2.617, 95% CI: 1.462–4.685) were more likely to report consistent condom use than the others. The risk factor was having suspicious symptoms of sexually transmitted diseases (OR: 0.357, 95% CI: 0.163–0.780).

Conclusion

Numerous students were at high risk of HIV infection with inconsistent condom use. Comprehensive and specific topics about safe sex education from parents and peers should be offered on campuses in China.

Condom Use Errors and Problems in a Sample of Young Colombian Adults

Condom effectiveness can be reduced by a number of problems and errors that take place during use. The purpose of the present study was to translate and adapt the Condom Use Errors and Problems Survey (CUES) into Spanish and to use it for testing the prevalence of these issues in a sample of young Colombian adults. A total of 775 people (414 women and 361 men) between 18 and 26 years of age participated in the study. Participants completed the following questionnaires online: Condom Use Errors and Problems Survey, Sexual Opinion Survey, Sexual Assertiveness Scale, Multidimensional Condom Attitudes Scale, a sociodemographic and sexual history questionnaire, plus two questions concerning condom-associated erectile problems. Results showed significant differences in the prevalence of condom use errors/problems associated with gender, sexual orientation, and whether the participant had a stable sexual partner. The occurrence of problems/errors ranged from 9.4% to 69.5%. Except for certain specific practices, observations were similar to those of studies performed in North America. Results indicate that the present linguistic adaptation of the CUES for its use in Colombian Spanish-speaking populations is an effective instrument to assess problems and errors associated with the use of male condoms.

Does internalized racism matter in HIV risk? Correlates of biomedical HIV prevention interventions among Black men who have sex with men in the United States

Black men who have sex with men (MSM) account for 26% of all new HIV infections in the United States. Biomedical HIV interventions have proven to reduce HIV infections however the use of these interventions by Black MSM is inconsistent. Research suggests that internalized racism may contribute to inconsistent biomedical HIV interventions (condom use and PrEP use) among Black MSM. Using a national sample of 432 Black MSM, we examined the relationship between condom and PrEP use and internalized racism. The results suggest there is some evidence for an association between internalized racism and PrEP use. In addition, internalized racism was not associated with condom use for both insertive and receptive anal sex among Black MSM. These finding suggest the relationship between internalized racism and HIV prevention strategies is not facile and more attention is needed to understand the true impact of racism, both internal and societal, on HIV prevention strategies among Black MSM. These findings underscore the nature of racism in the daily lives of Black MSM and how it impacts HIV prevention strategies adopted by these men.

Bias Adjustment Techniques Are Underutilized in HIV Sexual Risk Estimation: A Systematic Review

Background: Valid measurement of determinants of HIV infection among men who have sex with men (MSM) is critical for intervention planning and resource allocation. However, sexual minority research concerning HIV risk often relies on proxy exposures of sexual behaviors such as sexual orientation and partner gender. Inferring high risk sexual behaviors (i.e., condomless anal intercourse) from these proxies inaccurately captures HIV risk, but few studies have attempted to correct for this bias. Methods: We performed a systematic review of methodological practices for estimating risk of HIV infection among MSM. Results: We identified 32 studies in which high risk sexual behavior was assessed: 82% (n = 26) measured and used sexual risk behaviors (e.g., condomless anal intercourse or sexual positioning) to assess risk of HIV infection; 9% (n = 3) used proxy measures; and 9% (n = 3) used both behavior and proxy variables. Various treatments of misclassification reported by investigators included the following: 82% (n = 26) discussed misclassification of sexual behavior as a potential limitation; however, among these studies, no attempts were made to correct misclassification; 12% (n = 4) did not report exposure misclassification, and 6% (n = 2) explicitly considered this information bias and conducted a Bayesian approach to correct for misclassification. Conclusions: Our systematic review indicates that a majority of studies engaging in collecting primary data have taken additional steps to acquire detailed information regarding sexual risk behaviors. However, reliance on population-based surveys may still lead to potentially biased estimates. Thus, bias analytic techniques are potential tools to control for any suspected biases.

Effects of cognitive-behavioural therapy on anxiety, depression and condom use in people with HIV in Mexico City: a pilot study

Anxiety and depression in people living with HIV (PLWH) are negatively associated with healthy sexual behaviours. We pilot-tested a Cognitive-Behavioural Therapy (CBT)-based intervention to reduce anxiety and depression, aimed to increase serostatus disclosure to sexual partners, quality of sexual life (QoSL) and condom use. The study had a single-case experimental design (AB) with follow-up measures. Eleven PLWH with moderate/severe anxiety/depression received six-module CBT intervention delivered in ten one-hour individual weekly sessions. Anxiety, depression, consistent/correct condom use and QoSL were measured. Depression and anxiety decreased after the intervention (depression baseline [BL] Mdn = 21, final [F] Mdn = 3, z = -2.934, p = .003; anxiety BL Mdn = 30, F Mdn = 4, z = -2.941, p = .003). QoSL improved (BL Mdn = 28, F Mdn = 13, z = -2.625, p = .009), along with participants' ability to use condoms (57.14 vs.100, z = -2.937, p = .003). Effect size was large, changes were maintained at follow-up measurements. The CBT intervention had positive effects in reducing anxiety and depression, which could facilitate the acquisition of healthy sexual behaviours. Further studies are important to clarify the benefits of targeting emotional variables to improve wellbeing and prevention behaviours in PLWH.

Correlation between knowledge on transmission and prevention of HIV/STI and proficiency in condom use among male migrants from Africa and Middle East evaluated by a Condom Use Skills score using a wooden penile model

BACKGROUND

Migrants in Italy are prevalently young adults, with a higher risk of sexual transmitted infections (STI) and HIV infection. Promoting consistent as well as correct use of condoms could reduce failure rate due to their improper use. The aim of our study was to evaluate Condom Use Skills among a migrant population recently landed in Italy, hosted in a government center for asylum seekers.

METHODS

The study sample was composed of 80 male migrants. Sanitary trained interviewers submitted a questionnaire to participants to investigate age, provenience, marital status, educational level and knowledge about transmission and prevention of HIV/STI. Then, we assessed participants' level of condom use skill with the Condom Use Skills (CUS) measure by using a wooden penile model. The interviewer filled in a checklist and assigned 1 point for correct demonstration of each behavior that may prevent condom failure during sex.

RESULTS

Participants' median age was 26 years and the sample was composed of 54 migrants from sub-Saharan Africa and 26 from Middle East. Most of them were married, with a lower middle level of education, up to 8 or 5 years. Half of the sample achieved the highest score in the questionnaire and our CUS showed a large number of people with middle high score classes. The Spearman's rho was 0.30, therefore answers to the questionnaire and CUS score appeared correlated (p < 0.05). In the multivariate model, to have a higher CUS score resulted to be associated to be older than 26 years (p < 0.05), with a higher level of education (p = 0.001), and a higher score in the questionnaire (p < 0.05). There were no significant differences in the level of CUS between single or married men and between African and Middle Asian migrants of the sample.

CONCLUSIONS

Our study shows that educational level influences the quality of knowledge and awareness about STI/AIDS and contribute to correct condom use. Since the half of participants had a low educational level and linguistic problems, the risk of missing campaigns messages or misunderstanding informative materials increases. Direct observation of condom-application on penile model may offer realistic assessment of application skills in these individuals.

Correlates of Enhanced Sexual Pleasure from Condom Use: A Study of Young Black Men Who Have Sex with Men in the United States

This study of young Black MSM (YBMSM) explored the correlates and outcomes of enhanced sexual pleasure from condom-protected sex. Six-hundred YBMSM were enrolled from an sexually transmitted infection clinic in the southern United States. Men completed a computer-assisted self-interview. A 3-item scale assessed perceptions related to condoms enhancing sexual pleasure. Nine of 14 correlates met the screening level of significance and were tested in a regression model. Three obtained multivariable significance: (1) Men discussing condom use with sex partners had greater odds (AOR = 1.67, 95 % CI 1.20-2.34) of experiencing enhanced pleasure; (2) Insertive-partners had lower odds (AOR = 0.63, 95 % CI 0.44-0.91) of experiencing enhanced pleasure; and (3) men scoring higher in internalized homophobia had lower odds (AOR = 0.66, 95 % CI 0.47-0.93) of experiencing enhanced pleasure. Also, men experiencing enhanced pleasure were less likely to report any condomless anal sex. The experience of enhanced sexual pleasure during condom-protected sex may be an important "target" of behavioral intervention efforts.

Development and Psychometric Properties of a Condom Use and Its Cognitive Determinants Questionnaire (CUCDQ)

AIM

The aim of this study was to assess the psychometric properties of Condom Use and its Cognitive Determinants Questionnaire (CUCDQ) among married women in Tabriz, Iran.

MATERIALS AND METHODS

In this cross-sectional study, applying multistage cluster sampling 388 married women were recruited to participate in the study. A comprehensive literature review was conducted to develop CUCDQ. Face, content, and construct validity, as well as reliability, were investigated.

RESULTS

Principal component factor analysis with varimax rotation demonstrated a six factors structure as the best solution [Bartlett's Test of Sphericity (Approx. Chi-Square= 4193.07, df= 780, p<0.001); KMO= 0.815] which explained 43.13% of all the variance between the items. CUCDQ represented a proper validity, reliability, simplicity and functionality.

CONCLUSION

CUCDQ may be helpful for family health care providers and family planning decision makers in precise assessing the behavioural, psychological, and educational factors related to condom use. This scale may be useful in a various range of studies including family planning or STIs prevention studies in different communities. Future research is recommended to assess the different dimensions of the tool in different communities.

HIV Infection Rates and Risk Behavior among Young Men undergoing community-based Testing in San Diego

Approximately 80% of new HIV infections in the United States occur in men. Four out of five men diagnosed with HIV infection are men who have sex with men (MSM), with an increasing proportion of young MSM (i.e. ≤24 years of age). We performed a retrospective analysis 11,873 cisgender men participating in a community based HIV screening program in San Diego between 2008 and 2014 to characterize the HIV prevalence and sexual risk behaviors among young men. In young heterosexual men HIV prevalence was lower compared to heterosexual men between 25 and 49 years of age (0.3% vs. 1.4%, p = 0.043). Among young MSM, HIV prevalence was 5.5%, per test positivity rate 3.6%, and HIV incidence 3.4 per 100 person years (95% CI 2.2–5.4). Per test positivity rate (p = 0.008) and incidence (p < 0.001) were significantly higher among young MSM than among MSM above 24-years of age. Young MSM diagnosed with HIV infection reported significantly more serodiscordant condomless anal intercourse, bacterial sexually transmitted infections, and higher rates of methamphetamine and gamma hydroxybutyrate use when compared to young MSM who tested negative. In conclusion, young MSM are particularly vulnerable to HIV infection and may represent ideal candidates for targeted prevention interventions that increase testing uptake and/or decrease the risk of acquiring HIV infection.

Factors Associated With Condom Breakage During Anal Intercourse: A Cross-Sectional Study of Men Who Have Sex With Men Recruited in an Online Survey

Background

Within the United States, HIV affects men who have sex with men (MSM) disproportionally compared to the general population. In 2011, MSM represented nearly two-thirds of all new HIV infections while representing less than 2% of the US male population. Condoms continue to be the foundation of many HIV prevention programs; however, the failure rate of condoms during anal intercourse among MSM is estimated to be 0.5% to 8%, and condom breakages leave those affected at high risk for HIV transmission.

Objective

Estimate the frequency of condom breakage and associated demographic and behavioral factors during last act of anal intercourse using data from a national online HIV prevention survey of MSM.

Methods

From March 19 to April 16, 2009, data were collected on 9005 MSM through an online survey of US MSM recruited through a social networking site. Using multivariable logistic regression and controlling for several demographic and sexual risk behaviors, we estimated odds ratios of the association between condom breakage and several risk factors.

Results

In the study, 8063 participants reported having at least one male sexual partner in the last 12 months. The median age of participants was 21 years (range 18-65). More than two-thirds (68.2%, 5498/8063) reported anal intercourse during last sex and 16.90% (927/5498) reported using a condom during last anal intercourse act. Condom breakage was reported by 4.4% (28/635) participants who engaged in receptive anal intercourse and 3.5% (16/459) participants who engaged in insertive anal intercourse, with an overall failure rate of 4.0% (95% CI 3.2%-6.0%). Age (adjusted odds ratio [aOR] per 5 years: 0.53 (95% CI 0.30-0.94), number of male sex partners (aOR per 5 sex partners: 1.03 (95% CI 1.00-1.08), and being high or buzzed during sex with a casual sex partner (aOR: 3.14, 95% CI 1.02-9.60) were associated with condom breakage.

Conclusions

Our results indicate condom breakage is an important problem for MSM that may be more common for younger men, for men with more partners, and during sex with casual partners after alcohol consumption or drug use. A better understanding of why condom breakage occurs more often in these groups is needed to improve educational efforts. Further, during this time of expanded interest in new condom designs, consideration should be given to how condom design might minimize breakage during anal sex.