If the condom fits, wear it: a qualitative study of young African-American men

Delayed Ejaculation Due to Improper Male Condom Size: A Case Report

Introduction

Delayed ejaculation (DE) is a poorly understood and uncommon male sexual dysfunction. The etiology of DE includes psychological and biological factors, which are usually combined. Herein, we report a case of acquired and situational DE due to improper male condom size.

Aims

To identify and correct the possible cause of acquired and situational DE.

Methods

A male patient presented with new-onset DE for 6 months. His physical and mental examination was unremarkable. Laboratory results were all normal. He was diagnosed with acquired, situational DE and received sessions of sexual counseling. However, his DE persisted until he accidentally used a larger condom. He then reported normal orgasm.

Main outcome measures

Resolution of acquired and situational DE.

Results

His DE was improved after using a more proper condom size.

Conclusion

Most patients are believed to have psychological problems and proper condom use is under-recognized. To the best of our knowledge, this is the first report of DE caused by this etiology.

Wainipitapong S, Wiwattarangkul T, Bumphenkiatikul T. Delayed Ejaculation Due to Improper Male Condom Size: A Case Report. Sex Med 2021;9:100373.

Validation of an Event-Level, Male Sexual Pleasure Scale (EMSEXpleasure) Among Condom-Using Men in the U.S

Sexual pleasure is a key determinant of condom use. We developed and validated a male, event-level sexual pleasure scale (EMSEXpleasure) among a sample of condom-using men in the U.S. in order to facilitate improved measurement of sexual pleasure. Based on an expert panel process, a 12-item scale was developed. An online sample of 169 men who have sex with men and 162 men who have sex with women were recruited. Factor analysis yielded a two-factor solution that matched domains identified a priori by the expert panel, general pleasure and condom-specific pleasure, indicating internal validity of the instrument. One item was deleted from the scale due to poor validity performance. The overall EMSEXpleasure scale, and each subscale, had high (> 0.8) Cronbach's alpha coefficients, indicating internal reliability. The scale demonstrated convergent validity, with theoretically related constructs associated both with individual scale items and with scale totals. Overall relationship quality (b 3.0, 95% CI 2.0, 4.0), sexual relationship quality (b 2.9, 95% CI 2.0, 4.0), foreplay quality (b 7.5, 95% CI 2, 13), positive feelings about condoms (b 18.8, 95% CI 15, 23), and erection problems while using condoms (b - 17.9, 95% CI - 22, - 14) were associated with the EMSEXpleasure scale in expected directions. The validated EMSEXpleasure event-level scale may be advantageous for future assessments of the ephemeral experience of sexual pleasure, including clinical trials of condoms and other interventions, because it can be used immediately after sex, potentially limiting recall error.

Increasing condom use in heterosexual men: development of a theory-based interactive digital intervention

Increasing condom use to prevent sexually transmitted infections is a key public health goal. Interventions are more likely to be effective if they are theory- and evidence-based. The Behaviour Change Wheel (BCW) provides a framework for intervention development. To provide an example of how the BCW was used to develop an intervention to increase condom use in heterosexual men (the MenSS website), the steps of the BCW intervention development process were followed, incorporating evidence from the research literature and views of experts and the target population. Capability (e.g. knowledge) and motivation (e.g. beliefs about pleasure) were identified as important targets of the intervention. We devised ways to address each intervention target, including selecting interactive features and behaviour change techniques. The BCW provides a useful framework for integrating sources of evidence to inform intervention content and deciding which influences on behaviour to target.

The Role of Condom Use Self-Efficacy on Intended and Actual Condom Use Among University Students in Ghana

Little attention has been paid to the dimensions that help to predict and understand condom use among university students within an African context. A cross-sectional study involving 518 university students in Accra, Ghana was conducted to determine how the Condom Use self-Efficacy Scale-Ghana (CUSES-G) can predict both actual condom use and future condom use. Of all the participants, 84% were sexually active but less than half of the sample (48%) reported to have used condom during their last sexual intercourse. A hierarchical regression analysis showed that components of the Condom Use Self-Efficacy Scale (CUESE-G) such as appropriation, assertiveness, pleasure and intoxication, and STDs predicted condom use and condom use intentions. Behavioural change campaigns targeting university students should encourage condom use self-efficacy, as this would strengthen condom use, which is economically cheap and practically effective means of preventing STIs including HIV.

Resilience, tipping, and hydra effects in public health: emergent collective behavior in two agent-based models

Background

Collective health behavior often demonstrates counter-intuitive dynamics, sometimes resisting interventions designed to produce change, or even producing effects that are in the opposite direction than intended by the intervention, e.g. lowering infectivity resulting in increased infections. At other times collective health behavior exhibits sudden large-scale change in response to small interventions or change in the environment, a phenomenon often called “tipping.” I hypothesize that these seemingly very different phenomena can all be explained by the same dynamic, a type of collective resilience.

Methods

I compared two simple agent-based models of interactions in networks: a public health behavior game, in which individuals decide whether or not to adopt protective behavior, and a microbial-level game, in which three different strains of bacteria attack each other. I examined the type of networks and other conditions that support a dynamic balance, and determined what changes of conditions will tip the balance.

Results

Both models show lasting dynamic equilibrium and resilience, resulting from negative feedback that supports oscillating coexistence of diversity under a range of conditions. In the public health game, health protection is followed by free-riding defectors, followed by a rise in infection, in long-lasting cycles. In the microbial game, each of three strains takes turns dominating. In both games, the dynamic balance is tipped by lowering the level of local clustering, changing the level of benefit, or lowering infectivity or attack rate. Lowering infectivity has the surprising effect of increasing the numbers of infected individuals. We see parallel results in the microbial game of three bacterial strains, where lowering one strain’s attack rate (analogous to lowering infectivity) increases the numbers of the restrained attacker, a phenomenon captured by the phrase, “the enemy of my enemy is my friend.”

Conclusions

Collective behavior often shows a dynamic balance, resulting from negative feedback, supporting diversity and resisting change. Above certain threshold conditions, the dynamic balance is tipped towards uniformity of behavior. Under a certain range of conditions we see “hydra effects” in which interventions to lower attack rate or infectivity are self-defeating. Simple models of collective behavior can explain these seemingly disparate dynamics.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2938-8) contains supplementary material, which is available to authorized users.

Revitalizing condom-centered HIV prevention strategies

HIV infection rates remain steady in the USA despite the numerous prevention programs and tools available. Condoms play a central role in HIV prevention because they are highly effective, readily available, and affordable. Unfortunately, condom promotion efforts often incite fear as a motive force, while also taking the common "one-size-fits-all" approach. Reframing condom promotion through a sexual health framework, focusing on pleasure and highlighting condom fit issues, improves intervention efficacy. Condom distribution policies may further perpetuate condom users' difficulty, by withholding particular condom styles, brands, and information highlighting the nuances in shape, size, and material. Condom education and distribution practices focused on pleasure, proper fit, and condom access issues might increase condom utilization among high-risk populations.

The intimate link: a systematic review of highly effective reversible contraception and women's sexual experience

Contraception is expressly designed for nonprocreative sexual activity, but we know little about how methods shape women's sexual experience. To systematically review the literature on highly effective reversible contraception (HERC) and sexual experiences. MEDLINE, SCOPUS, and Google Scholar were searched for relevant literature. Eleven studies met the inclusion criteria; all were conducted outside of the United States. All studies reviewed found either improvements or no change in sexual experience and function outcomes with HERC use. A need exists for more prospective studies with a wider range of measures to assess HERC methods' impact on women's sexual experiences.

A qualitative examination of men's condom use attitudes and resistance: "it's just part of the game"

The purpose of this study was to investigate the variability in young heterosexual men's perceptions of the advantages and disadvantages of condom use in their casual sexual relationships. Because men who perceive greater disadvantages of condom use may be more likely to resist using them, we also explored the tactics that men employ to avoid using condoms. Semi-structured focus groups were conducted with single men who have sex with women (n = 60), aged 21-35 years, all of whom reported using condoms inconsistently. Transcripts were analyzed using a framework analysis approach. As expected, participants reported advantages and disadvantages to condom use that pertained to the likelihood and quality of sex, physical sensations during intercourse, and the risk of sexually transmitted infections and unwanted pregnancies. Within each of these topics, however, participants' appraisals of the relative pros and cons of condom use varied considerably. Additionally, participants reported that men use a wide range of condom use resistance tactics, including seduction, deception, and condom sabotage, and that the use of these tactics was viewed as normative behavior for men their age. These findings suggest that the effectiveness of sexual health prevention efforts could be enhanced by increasing young men's motivations to use condoms and by targeting social norms regarding condom use resistance. Additionally, the issue of men's condom use resistance clearly merits increased empirical investigation and intervention attention.

A novel, self-guided, home-based intervention to improve condom use among young men who have sex with men

OBJECTIVE

This pilot study tested the efficacy of a brief, novel, theory-driven, self-guided, home-based intervention designed to promote condom use among young men who have sex with men (YMSM).

PARTICIPANTS

Thirty YMSM were recruited from a large public US midwestern university during spring of 2012.

METHODS

The intervention was tested using a repeated measures design with the primary follow-up assessment occurring 6 weeks after enrollment.

RESULTS

Forty-five percent of men reported a reduced frequency of unprotected insertive penile-anal intercourse in the past 30 days compared with baseline (p = .01). Consistency of condom use improved (p = .013), as did motivation to use condoms correctly, condom use self-efficacy, and condom attitudes. All participants indicated that they were glad they participated, would recommend the program, and that overall, they had liked the program.

CONCLUSIONS

This pilot study supports an expanded trial of this intervention with MSM at high-risk of acquiring human immunodeficiency virus/sexually transmitted infections (HIV/STIs).

Condom effectiveness against non-viral sexually transmitted infections: a prospective study using electronic daily diaries

OBJECTIVES

To prospectively evaluate the protective value of consistent and correct use of latex condoms against the acquisition of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis.

METHODS

Patients (N=929) attending clinics that treat sexually transmitted infections (STIs) were prospectively followed for up to 6 months. Urine STI nucleic acid amplification testing was performed at baseline, 3 months and 6 months. Participants were instructed to respond to daily prompts from a handheld device by completing a report for each penile-vaginal sexual intercourse event. Generalised estimating equation models examined associations of consistent as well as consistent and correct condom use with STI incidence over 3-month intervals.

RESULTS

Consistent condom use was not significantly associated with STI incidence (Estimated OR (EOR)=0.75; 95% CI (CI) 0.43 to 1.30; p=0.31). However, individuals who used condoms both correctly and consistently were estimated to have 59% lower odds of acquiring an STI (EOR=0.41; 95% CI  0.19 to 0.90; p=.026), compared to those who did not.

CONCLUSIONS

The correct as well as the consistent use of condoms greatly reduces the odds of non-viral STI acquisition.

Condom use by partner type among military and police personnel in Peru

The aim of this study was to analyze the rates of condom use among military and police populations in Peru, focusing on differences in use by type of partner. A Knowledge Attitudes and Practices survey was conducted among 6,808 military and police personnel in 18 Peruvian cities between August-September 2006 and September-October 2007. A total of 90.2% of the survey respondents were male; mean age was 37.8 years and 77.9% were married/cohabiting. In all, 99.5% reported having had sex; 89% of the participants had their last sexual contact with their stable partner, 9.7% with a nonstable partner, and 0.8% with a sex worker. Overall, 20.4% used a condom during their most recent sexual contact. Reasons for nonuse of condoms included the following: perception that a condom was not necessary (31.3%) and using another birth control method (26.7%). Prevention efforts against sexually transmitted diseases should focus on strengthening condom use, especially among individuals with nonstable partners.

The effects of condom choice on self-reported condom use among men in Ghana, Kenya and South Africa: a randomized trial

BACKGROUND

Male condoms are readily available and affordable in many settings, but risky sexual acts still go unprotected.

STUDY DESIGN

This unblinded randomized trial, conducted in Ghana, Kenya and South Africa, was designed to assess the impact of providing a choice of condoms on self-reported use and uptake over 6 months.

RESULTS

We enrolled 1,274 men. The mean subject-specific proportion of protected acts with all partners increased from baseline to 6 months by 0.07 in the control group compared to 0.03 in the choice group (p=.025). The observed results were largely consistent across all three countries. In the choice group, men clearly preferred one condom type over the others, and this preference was consistent across all three countries.

CONCLUSIONS

Providing one type of male condom in public sector programs appears justified. Programs should not focus on the number of brands available, but should encourage effective promotion and consistent and correct use of available brands.

A cognitive analysis of college students' explanations for engaging in unprotected sexual intercourse

Young adults, including college students, engage in high levels of unprotected sexual activity despite relatively high rates of HIV/STI and pregnancy-related knowledge. Little is known about the cognitive strategies that young people use to explain this inconsistency. The current study examined young people's explanations for engaging in unprotected sexual activity in their committed relationships. A total of 63 young adults (32 women and 31 men) completed daily diaries over a 3-week period, providing a total of 1,284 daily reports tracking their condom use and non-use during intercourse. Diary collection was followed by in-depth interviews designed to explore participants' decision-making regarding their participation in sexual intercourse unprotected against infection or unwanted pregnancy. Less than a quarter of the sample used condoms or oral contraceptives consistently. Participants primarily viewed condoms as a means of preventing pregnancy; few described disease prevention as a main motivation for their use. Analysis of the cognitions underlying explanations for condom and contraception non-use were classified as (1) general biased risk evaluation, (2) biased evidence evaluation, (3) endorsement of poor alternatives, (4) focus on spurious justifications, (5) dismissing risk, and (6) ignoring risk. Prevention interventions should incorporate methods to challenge young people to acknowledge personal risk and commit themselves to taking steps to reduce this risk.

Patterns of condom acquisition by condom-using men in the United States

Condom-distribution programs have striven to make condoms more accessible to sexually active individuals, particularly adolescents and populations disproportionately affected by HIV and other STIs. Despite such programs, little is known about where condom-using men in the United States acquire their condoms. The purpose of this study was to document condom-access trends among a large sample of sexually active condom-using men in the United States. Data were collected from 1,832 men from all 50 U.S. states and the District of Columbia by using an Internet-based survey in which men provided details regarding the source of condoms that they had used within the past 30 days. Men reported acquiring their condoms from a variety of sources, including free condom-distribution programs (56.7%) and from venues where they had purchased condoms for themselves (75.7%). Bivariate analyses indicated that participants who reported using free condoms tended to be younger, self-identified as not heterosexual, or not currently in a monogamous relationship. Further, results indicated that those participants who accessed only free condoms did not differ from those who used only purchased condoms, indicating that perhaps efforts to make condoms more accessible through public health distribution campaigns are reaching a more general population of condom-using men than expected. Findings illustrate the importance of continuing free condom-distribution efforts but also suggest benefits of facilitating linkages between public health and a community's retail venues to increase access to the growing diversity of condoms in the marketplace.

Contraceptive decision-making in sexual relationships: young men's experiences, attitudes and values

Much attention has been focused on efforts to reduce unintended pregnancy by improving contraceptive use among high-risk women; however, there is limited information to guide interventions to engage young men in contraceptive decision-making. We conducted focus groups of young men, aged 19-26, from diverse racial backgrounds from low-income communities in the San Francisco Bay Area to examine social norms about sexual relationships and how they impact on contraceptive use. The data were analysed using content analysis. A range of relationships were described, however casual relationships predominated. While young men expressed strong desires to avoid pregnancy in casual relationships, the unpredictable nature of relationships, together with low communication and regard for the women involved, made stressing consistent contraceptive use among partners unlikely. The themes expressed by these young men about sex and behaviour in different relationships illustrate a spectrum of decision-making dilemmas and illustrate the inherent difficulty in fully engaging young men in contraceptive decision-making. A strategy is needed to address relationship values, dynamics and condom use beyond STI-prevention frameworks and young women's ability to make appropriate contraceptive choices in light of the inherent difficulties and uncertainty associated with casual relationships.

Problems with condoms may be reduced for men taking ample time to apply them

Background: One potentially important antecedent of experiencing problems with condom use during penile-vaginal sex is the amount of time that men (and perhaps women) allow for condom application. To examine whether men reporting that ample time was available to apply a male condom (the last time a condom was used for penile-vaginal sex) were also less likely to report problems with condom use such as breakage, slippage and erection difficulties during that sexual event. Methods: A convenience sample of men (n = 440) was recruited via advertisements in newspapers (two urban and one small town) and a blog on the website of a condom sales company. Men completed a questionnaire posted on the website of The Kinsey Institute for Research in Sex, Gender, and Reproduction. Inclusion criteria were that participants were: at least 18 years old; used condoms for penile-vaginal intercourse in the past 3 months; and able to read English. Results: In controlled, event-specific analyses, men reporting that they did not have sufficient time for condom application were ~three times more likely to report breakage and ~2.4 times more likely to report slippage. In addition, men who reported that they lacked time for condom application were ~2.4 times more likely to experience any of nine sexual problems, 3.4 times more likely to report difficulty with erection, 2.1 times more likely to report reduced sexual pleasure, 2.2 times more likely to report reduced sexual pleasure of their female partner and 2.6 times more likely to report that the condom irritated their partner’s vagina. Conclusions: This is the first study using an event-specific analysis to examine the effect of not having enough time for condom application on condom breakage, slippage and several outcomes related to sexual pleasure. Sexually transmissible infections and pregnancy prevention messages should include recommendations to men to take their time applying condoms.

Correlates of Correct Condom Use Among High-Risk African American Men Attending an Urban STD Clinic in the South

The purpose of this cross-sectional study was to assess prevalence and correlates of correct condom use among high-risk African American men attending a publicly-funded sexually transmitted disease (STD) clinic. Men 18 through 29 years of age and newly diagnosed with a sexually transmitted disease were further assessed for study eligibility. Of 296 meeting eligibility criteria, 271 agreed to participate thereby yielding a participation rate of 91.5%. Correct use, assessed by an index, was reported by 38%. Correct use was associated with having sex with 3 or fewer female sex partners (AOR=3.1), being in an exclusive relationship (AOR=3.2), not indicating problems with the fit or feel of condoms (AOR=2.9), and not being drunk/high while using condoms (AOR=2.6). The correct use of condoms among young African American men newly diagnosed with an STD may be a function of situational factors. These factors could potentially be addressed in the context of clinic-based behavioral intervention programs.

Condom failure: examining the objective and cultural meanings expressed in interviews with African American adolescents

The purpose of this study was to explore the meaning and context of self-reported "condom failure" among sexually active African American adolescents. Semistructured interviews regarding methods of protection from pregnancy and sexually transmitted disease (STD) with 124 youth (ages 14-19 years) were content analyzed. The findings suggested three meanings of condom failure. First, condom failure represents a legitimate and important risk related to sexual activity. Second, it can serve as an excuse repertoire for adolescents who engaged in unprotected sex and later experienced either pregnancy or a STD. Third, it may serve as an explanation for males who deceive their partners into having unprotected sex. The findings are discussed with regard to their implications for HIV or STD prevention and research.

Learning from successful interventions: A culturally congruent HIV risk-reduction intervention for African American men who have sex with men and women

Few HIV prevention interventions have been developed for African American men who have sex with men or who have sex with both men and women. Many interventions neglect the historical, structural or institutional, and sociocultural factors that hinder or support risk reduction in this high-risk group. We examined ways to incorporate these factors into Men of African American Legacy Empowering Self, a culturally congruent HIV intervention targeting African American men who have sex with men and women. We also studied how to apply key elements from successful interventions to future efforts. These elements include having gender specificity, a target population, a theoretical foundation, cultural and historical congruence, skill-building components, and well-defined goals.

A brief, clinic-based, safer sex intervention for heterosexual African American men newly diagnosed with an STD: a randomized controlled trial

OBJECTIVE

We evaluated the efficacy of a brief, clinic-based, safer sex program administered by a lay health adviser for young heterosexual African American men newly diagnosed with a sexually transmitted disease (STD).

METHODS

Subsequent to STD diagnosis, eligible men (N = 266; aged 18-29 years) were randomized to either a personalized, single-session intervention (delivered by a lay health adviser) or standard of care. We conducted behavioral assessments at baseline and 3 months postintervention (retention was 74.1%). We also conducted a 6-month clinic record review.

RESULTS

Compared to men randomized to the control condition, those receiving the intervention were significantly less likely to acquire subsequent STDs (50.4% vs 31.9%; P = .002) and more likely to report using condoms during last sexual intercourse (72.4% vs 53.9%; P = .008). They also reported fewer sexual partners (mean 2.06 vs 4.15; P < .001) and fewer acts of unprotected sex (mean 12.3 vs 29.4; P = .045). Based on a 9-point rating scale, men in the intervention group had higher proficiency scores for condom application skills (mean difference = 3.17; P < .001).

CONCLUSION

A brief clinic-based intervention delivered by a lay health adviser may be an efficacious strategy to reduce incident STDs among young heterosexual African American men.

Condom 'turn offs' among adults: an exploratory study

An exploratory study compared the prevalence of multiple types of condom-associated 'turn offs' in men and women. Nearly 2000 people completed a web-based questionnaire. Data were analysed from 464 men and women who reported that condoms had turned them off the last time they were used. Gender differences were not observed for the majority (9) of 15 turn offs. The most common turn offs related to loss of pleasure. For example, more than three-quarters of the men and nearly 40% of the women reported decreased sexual sensation (P = 0.0001). Putting on condoms was reported by 43.2% of the men versus 30.2% of the women (P = 0.02). Smell was a relatively frequent turn off, with about one-third indicating this issue and no significant gender difference (P = 0.32). Turn offs pertaining to arousal and orgasm were also common. Findings suggest that numerous physical and psychological condom turn offs may be experienced by men and women while using male condoms. Although some turn offs differed as a function of gender, there was remarkable similarity between men and women.

Relationships between condoms, hormonal methods, and sexual pleasure and satisfaction: an exploratory analysis from the Women's Well-Being and Sexuality Study

BACKGROUND

Little is known about how condoms and other contraceptives influence women's sexual enjoyment, which could shape use patterns.

METHODS

Data from an online study of women's sexual health and functioning were used to examine how three categories of contraceptive use - hormonal method only, condoms primarily, and dual use - could help predict decreased sexual pleasure associated with contraceptive method and overall sexual satisfaction in the past 4 weeks.

RESULTS

In analyses controlling for age, relationship length, and other variables, male condoms were most strongly associated with decreased pleasure, whether used alone or in conjunction with hormonal methods. Women who used hormonal methods alone were least likely to report decreased pleasure, but they also had significantly lower overall scores of sexual satisfaction compared with the other two groups. Dual users, or women who used both condoms and a hormonal method, reported the highest sexual satisfaction scores.

CONCLUSIONS

Because male condoms were viewed by many of these women as decreasing sexual pleasure, sexual risk practices are likely to be affected. Although hormonal only users were highly unlikely to report decreased pleasure, they reported lower sexual satisfaction compared with the other two groups. Dual users, who had the highest sexual satisfaction scores, may have been the most sexually satisfied because they felt more fully protected against unwanted pregnancy and sexually transmissible infections - consistent with previous qualitative documentation of 'eroticising safety.' This exploratory study suggests that different contraceptives affect sexuality in various ways, warranting further research into these sexual dimensions and how they influence contraceptive practices.

Barriers to condom use

OBJECTIVE

To identify barriers to condom use.

METHODS

Data were extracted through MEDLINE from papers published between 1993 and 2007. Surveys, reviews, clinical studies and comments were included in this review. The impact of cost, moral, social, personal and psychological factors were taken into consideration.

RESULTS

Several factors were associated with non-use of a condom during sexual intercourse. Their cost often posed a barrier to condom use for the poor, even in developed countries. In many communities, moral values, ethnic and religious factors also played a role. Among other social factors, gender inequality, lack of a dialogue among partners with regard to condom use, and the stigma attached to the condom could all lead to unprotected sexual intercourse. Personal factors such as aversion to the condom, consumption of alcohol or use of drugs prior to sexual intercourse, and anxiety and depression all were negatively associated with condom use.

CONCLUSION

Their cost evidently poses a barrier to the use of condoms by the poor. Beside social stigmas and personal reluctance, prevailing moral norms and religious interdicts also adversely affect use of these devices in many communities. Because of their disastrous consequences in the domain of public health each of these barriers must be effectively addressed.

Pleasure, power, and inequality: incorporating sexuality into research on contraceptive use

We know surprisingly little about how contraception affects sexual enjoyment and functioning (and vice versa), particularly for women. What do people seek from sex, and how do sexual experiences shape contraceptive use? We draw on qualitative data to make 3 points. First, pleasure varies. Both women and men reported multiple aspects of enjoyment, of which physical pleasure was only one. Second, pleasure matters. Clear links exist between the forms of pleasure respondents seek and their contraceptive practices. Third, pleasure intersects with power and social inequality. Both gender and social class shape sexual preferences and contraceptive use patterns. These findings call for a reframing of behavioral models that explain why people use (or do not use) contraception.

Young African American men having sex with multiple partners are more likely to use condoms incorrectly: a clinic-based study

This study tested the research hypothesis that men's errors using condoms would be associated with having multiple sex partners. Specifically, men engaging in sex with three or more women were compared with those having sex with two or fewer women. Recruitment (N = 271) occurred in a publicly funded sexually transmitted disease (STD) clinic located in a metropolitan area of the Southern United States. All men were clinically diagnosed with an STD. They completed a self-reported questionnaire (using a 3-month recall period). Those reporting sex with men were excluded from the analysis. About one half of the men (48.5%) reported penetrative sex with three or more women. The authors found that among young African American men, newly diagnosed with an STD, reporting recent (past 3 months) sex with multiple partners may be emblematic of condom errors. These men may benefit from clinic-based, targeted counseling and education designed to foster improved quality of condom use.

Using culture-centered qualitative formative research to design broadcast messages for HIV prevention for African American adolescents

The need for formative research in designing mass media health-education messages is widely accepted; however, distinct methodologies for developing such messages are less well documented. This article describes a culture-centered approach for developing messages to promote sexual risk reduction in urban African American adolescents. The method uses qualitative formative research to identify "competing narratives" that support healthy behavior despite the dominance of messages that favor risk-taking behavior. The method is illustrated using qualitative analysis of semistructured interviews with 124 adolescents. Analysis focuses on two barriers to sexual risk reduction: (a) social pressure for early initiation of sexual intercourse and (b) perceptions that condoms reduce sexual pleasure. We demonstrate how competing narratives identified in the analysis can be featured in radio and television messages advocating healthy behavior by modeling risk-reducing negotiation skills.

Slips, breaks and ‘falls’: condom errors and problems reported by men attending an STD clinic

Summary

The objective was to comprehensively assess the prevalence of condom-use errors and problems among male clients attending a public sexually transmitted disease (STD) clinic. Men ( n = 278) attending an STD clinic completed an anonymous questionnaire. Seven errors and six problems were assessed. Summative scores were tested for associations with three key variables. Of 834 condom-protected events: 19% were associated with ‘fit and feel’ problems, 15% involved breakage, 14% involved lost erection, 9% were associated with lost erection while applying condoms, 8% involved slippage during withdrawal and 7% involved slippage during sex. A mean of 6.4 errors/problems were observed. None of these summative variables (total errors, total problems or total of errors and problems) were significantly associated with age, minority status or whether men indicated they had ever been taught how to use condoms. Multiple types of condom-use errors and problems may be highly prevalent among high-risk men attending public STD clinics.

Sexual agency versus relational factors: a study of condom use antecedents among high-risk young African American women

Background: The influence that female partners exert regarding condom use is not well known. In the present study, the relative roles of personal sexual agency and relational factors in determining whether young African American women engaged in unprotected vaginal sex (UVS) were studied. Methods: A cross sectional study of 713 young, African American women (aged 15–21 years) was conducted. Data were collected using an audio-computer assisted self-interview. Three measures of sexual agency were assessed and three relational factors were assessed. To help assure validity in the outcome measure, condom use was assessed in five different ways. Multivariate analyses were used to determine whether variables independently predicted UVS. Results: Two of the six predictor variables achieved multivariate significance with all five measures of condom use: (1) fear of negotiating condom use with male partners, and (2) indicating that stopping to use condoms takes the fun out of sex. A relational factor (male-dominated power imbalances) achieved multivariate significance for four of the five measures of UVS. A sexual agency factor (whether young women greatly enjoyed sex) achieved multivariate significance for three of the five measures. Conclusion: The results suggest that young African American women at high-risk of sexually transmissible infections (STI)/HIV acquisition may experience male-dominated power imbalances and also fear the process of negotiating condom use with their male partners. Although these factors were independently associated with UVS, two factors pertaining to sexual agency of these young women were also important predictors of UVS. Intervention efforts designed to avert STI/HIV acquisition among young African American women should therefore include programs to address both sexual agency and relational factors.

Pending research issues in male condom use promotion

Sufficient evidence has accumulated to warrant the expansion of condom use research in several additional directions. Possible risk compensation pertaining to human papillomavirus vaccination and vaginal microbicides is one example. A second area of needed research involves the question of when couples can be advised to safely discontinue condom use given that ‘lifelong’ condom use is not a realistic goal for most people. A third example is intensified research designed to identify more effective means of mass marketing condoms and their use as a health-protective behaviour. As the AIDS and sexually transmissible infection pandemics persist, intensified condom promotion research is an ethical imperative.

Male partner pregnancy-promoting behaviors and adolescent partner violence: findings from a qualitative study with adolescent females

OBJECTIVE

To examine the context of pregnancy and sexual health among adolescent females with a history of intimate partner violence (IPV). This paper reports on a subset of females who described abusive male partners' explicit pregnancy-promoting behaviors (ie, messages and behaviors that led females to believe their partner was actively trying to impregnate them).

METHODS

Semistructured interviews were conducted with 53 sexually active adolescent females, with known history of IPV, about violence, sexual experiences, and related behaviors. Interviews were analyzed using a content analysis approach; 14 interviews in which females reported that partners were actively trying to impregnate them were further analyzed for pregnancy and contraceptive use.

RESULTS

Participants (N = 53) were aged 15 to 20 years, with notable minority representation, 21% African American (n = 11) and 38% Latina (n = 20). Over half (n = 31, 58%) had experienced pregnancy. A key finding was that approximately one quarter of participants (26%, n = 14) reported that their abusive male partners were actively trying to get them pregnant. Females' stories revealed that abusive male partners desiring pregnancy manipulated condom use, sabotaged birth control use, and made explicit statements about wanting her to become pregnant.

CONCLUSIONS

Pregnancy-promoting behaviors of male abusive partners may be one potential mechanism underlying associations between adolescent IPV and pregnancy. These findings suggest that exploring pregnancy intentions and behaviors of partners of sexually active adolescents may help to identify youth experiencing IPV. The frequency of birth control sabotage and explicit attempts to cause pregnancy in adolescent IPV needs to be examined at the population level.

Experiences of condom fit and feel among African-American men who have sex with men

OBJECTIVE

To offer an empirical understanding of characteristics associated with the fit and feel of condoms among African-American men who have sex with men (MSM), a particularly high-risk group for HIV and other sexually transmitted infections (STI) in the United States.

METHODS

Survey data were collected from 178 adult African-American MSM attending a community event in Atlanta, Georgia.

RESULTS

Although the majority of participants reported that condoms generally fit properly and felt comfortable, a substantial number of men reported a variety of problems with the fit and feel of condoms. Specifically, 21% reported that condoms felt too tight, 18% reported that condoms felt too short, 10% reported that condoms felt too loose, and 7% reported that condoms felt too long. There were significant associations between men's reports of condom breakage and slippage, and their perceptions of condom fit and feel. Perceptions of condom fit and feel were also related to men's reports of seeking condoms for their size-specific properties.

CONCLUSIONS

The fit and feel issues that men in this sample identified may be among those that contribute to their likelihood of using, or not using, condoms consistently and correctly. A better understanding of these factors will be beneficial to both condom manufacturers and sexual health professionals who share a common goal of increasing consistent and correct condom use and reducing the incidence of HIV and other STI among this and other communities.

Beliefs that condoms reduce sexual pleasure-gender differences in correlates among heterosexual HIV-positive injection drug users (IDUs)

Studies consistently find that negative condom beliefs or attitudes are significantly associated with less condom use in various populations, including HIV-positive injection drug users (IDUs). As part of efforts to reduce sexual risk among HIV-positive IDUs, one of the goals of HIV interventions should be the promotion of positive condom beliefs. In this paper we sought to identify the correlates of negative condom beliefs and examined whether such correlates varied by gender, using a subsample (those with an opposite-sex main partner; n = 348) of baseline data collected as part of a randomized controlled study of HIV-positive IDUs. In multivariate analyses, we found more significant correlates for women than for men. With men, perception that their sex partner is not supportive of condom use (negative partner norm) was the only significant correlate (Beta = -0.30; p < 0.01; R (2) = 0.18). Among women, negative partner norm (Beta = -0.18; p < 0.05); having less knowledge about HIV, STD, and hepatitis (Beta = -0.16; p < 0.05); lower self-efficacy for using a condom (Beta = -0.40; p < 0.01); and more episodes of partner violence (Beta = 0.15; p < 0.05) were significantly associated with negative condom beliefs (R (2) = 0.36). These findings suggest important gender-specific factors to consider in interventions that seek to promote positive condom beliefs among HIV-positive IDUs.

Correlates of Putting Condoms On After Sex Has Begun and of Removing Them Before Sex Ends: A Study of Men Attending an Urban Public STD Clinic

This study aimed to identify possible correlates of putting condoms on after sex has begun and taking them off before sex has ended among male patients of an urban, public sexually transmitted disease clinic. Participants responded to a questionnaire and were largely African American men, 18 to 35 years old, who had used a condom during penile-vaginal intercourse at least three times in the past 3 months. In controlled analyses, men who were not highly motivated to use condoms correctly were nearly twice as likely to put a condom on after sex had begun. Men who reported erection loss during sex were about twice as likely to remove condoms before sex ended. Men reporting difficulties with the fit and feel of condoms were 2.5 times more likely to remove condoms early. Identified correlates may be amenable to clinic-based education and counseling augmented by offering a variety of condom brands and sizes to patients.

Men with broken condoms: who and why?

OBJECTIVES

To identify (1) the prevalence of condom breakage, and demographic and sexuality-related differences among young men who have sex with women reporting and not reporting this event; (2) condom-specific behaviours associated with breakage.

METHODS

Young men (n = 278) attending a clinic for treatment of sexually transmitted infections (STIs) responded to an anonymous questionnaire aided by a CD recording of the questions. The samples were screened to include only men who had used a condom during penile-vaginal sex at least three times in the past 3 months. Condom-specific behaviours (including breakage) were assessed using these last three acts of condom use as the recall period. Correlates achieving bivariate significance were subjected to multivariate analysis.

RESULTS

Nearly one third (31.3%) of the men reported recent breakage. The breakage rate was 15%. Three correlates significantly distinguished between men who did and did not report breakage. Men who had past STIs were more likely to report breakage (adjusted odds ratio (AOR) 2.08), as were men who also reported condom slippage (AOR 2.72). Less self-efficacy for correct condom use was also significantly associated with breakage (AOR 1.07). Further, three condom-specific behaviours were significantly associated with breakage: allowing condoms to contact sharp objects (AOR 2.6), experiencing problems with the "fit or feel" of condoms (AOR 2.3) and not squeezing air from the receptacle tip (AOR 2.0).

CONCLUSIONS

Breakage may be common and may occur in a larger context of difficulties with condoms. STI clinics could potentially benefit some men by providing instructions on the correct use of condoms.

Failure to embrace the barrier/condom use message

The objective of this study was to examine the consistency of barrier/condom use among men who have sex with men in the Kansas City metropolitan area. The authors sought to determine if barrier/condom usage patterns were associated with the type of sex act and whether it was insertive or receptive, HIV testing frequency, and number of sexual partners. Data were extracted from a 2003 community health assessment of the gay, lesbian, bisexual, and transgendered community in the metropolitan area. The health assessment instrument was anonymous, self-administered, and distributed at events in that community. Responses from 623 men indicated that consistent use of a barrier/condom was low regardless of the sex act. There was no relationship between barrier/condom usage patterns and HIV testing frequency for any sex act or the number of sex partners, with the exception of anal intercourse. The authors concluded that a different approach is needed to translate the barrier/condom use message into a behavioral response.

Social norms and beliefs regarding sexual risk and pregnancy involvement among adolescent males treated for dating violence perpetration

The present study explored perceived sexual norms and behaviors related to sexual risk and pregnancy involvement among adolescent males (ages 13 to 20) participating in programs for perpetrators of dating violence. The purpose of this study was to generate hypotheses regarding the contexts and mechanisms underlying the intersection of adolescent dating violence, sexual risk and pregnancy. Six focus groups were conducted (N = 34 participants). A number of major themes emerged: 1) male norm of multiple partnering, 2) perceived gain of male social status from claims of sexual activity, 3) perception that rape is uncommon combined with belief that girls claiming to be raped are liars, 4) perception that men rationalize rapes to avoid responsibility, 5) condom non-use in the context of rape and sex involving substance use, 6) beliefs that girls lie and manipulate boys in order to become pregnant and trap them into relationships, and 7) male avoidance of responsibility and negative responses to pregnancy. The combination of peer-supported norms of male multiple partnering and adversarial sexual beliefs appear to support increased male sexual risk, lack of accountability for sexual risk, and rationalization of rape and negative responses to pregnancy. Further research focused on the context of male sexual risk and abusive relationship behaviors is needed to inform intervention with young men to promote sexual health and prevent rape, dating violence, and adolescent pregnancy.

Erection loss in association with condom use among young men attending a public STI clinic: potential correlates and implications for risk behaviour

Background: To assess prevalence of condom-associated erection loss and to identify correlates of erection loss among men attending a sexually transmissible infections (STI) clinic. Methods: Men (n = 278) attending an STI clinic responded to an anonymous questionnaire aided by a CD recording of the questions. The sample was screened to include only men who had used a condom during penile–vaginal sex at least three times in the past 3 months. Erection loss was assessed for ‘the last three times a condom was used’. Results: The mean age of the participants was 23.7 years (s.d. = 4.1); 37.1% of the men reported condom-associated erection loss on at least one occasion. Men who had reported condom-associated erection loss were also reported having more frequent unprotected vaginal sex (P = 0.04) and were less likely to use condoms consistently (P = 0.014) than men without erection loss. Men with erection loss were also more likely to remove condoms before sex was over (P = 0.001). Age and race/ethnicity were not associated with erection loss. In multivariate analysis, three significant statistical predictors were identified: low self-efficacy to use condoms (P = 0.001); problems with ‘fit or feel’ of condoms (P = 0.005); and having more than three sex partners during the previous 3 months (P = 0.02). Conclusions: Condom-associated erection loss may be common among men at risk for STIs. This problem may lead to incomplete or inconsistent condom use. Men may be more likely to experience condom-associated erection loss if they lack confidence to use condoms correctly, if they experience problems with the way condoms fit or feel, and if they have sex with multiple partners.