Barriers to Condom Use among High Risk Men Who Have Sex with Men in Uganda: A Qualitative Study.

Geofrey Musinguzi,Jean-Pierre Van Geertruyden,Jim Arinaitwe,Fred Nuwaha,Joseph K B Matovu,Juliet Kiguli,Hilde Bastiaens,Geoffrey Mujisha,Rhoda K Wanyenze,Jesse Lawton Clark

doi:10.1371/journal.pone.0132297

Geofrey Musinguzi, Jean-Pierre Van Geertruyden + Show 8 more

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https://doi.org/10.1371/journal.pone.0132297

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Abstract

BackgroundUnprotected sexual intercourse is a major risk factor for HIV transmission. Men who have sex with men (MSM) face challenges in accessing HIV prevention services, including condoms. However, there is limited in-depth assessment and documentation of the barriers to condom use among MSM in sub-Saharan Africa. In this paper, we examine the barriers to condom use among MSM in Uganda.MethodsThe data for this study were extracted from a larger qualitative study conducted among 85 self-identified adult (>18 years) MSM in 11 districts in Uganda between July and December 2013. Data on sexual behaviours and access and barriers to condom use were collected using semi-structured interviews. All interviews were audio-recorded and transcribed verbatim. This paper presents an analysis of data for 33 MSM who did not use condoms at last sex, with a focus on barriers to condom use. Analysis was conducted using the content analysis approach.ResultsSix major barriers to condom use were identified: Difficulties with using condoms, access challenges, lack of knowledge and misinformation about condom use, partner and relationship related issues, financial incentives and socio-economic vulnerability, and alcohol consumption.ConclusionThe findings suggest that several reasons account for lack of condom use among high-risk MSM. The findings are valuable to inform interventions needed to increase condom use among MSM.

Highlights

Studies from low, middle and high-income countries indicate a high risk of HIV transmission among men who have sex with men (MSM) [1,2,3]
We examine the barriers to condom use among MSM in Uganda
This paper presents an analysis of data for 33 MSM who did not use condoms at last sex, with a focus on barriers to condom use

Summary

Introduction

Studies from low, middle and high-income countries indicate a high risk of HIV transmission among men who have sex with men (MSM) [1,2,3]. Studies in the United States show that some MSM engage in high risk sexual behaviors such as unprotected receptive and insertive anal sex, and multiple sexual partnerships in the absence of consistent condom use [2,3,4]. Some MSM may engage in drug and alcohol abuse prior to sex, which impairs judgment and increases the likelihood of unprotected anal intercourse, sometimes with people of unknown HIV serostatus [2,3,4]. In a study in Mombasa Kenya, MSM had the belief that having anal sex was less risky for HIV acquisition than having vaginal sex [8]. We examine the barriers to condom use among MSM in Uganda

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