Condom Perceptions Research Articles

Let’s Talk About Condoms: Social Engagement in a Sexual Health Intervention Targeting Young Adults in Denmark

Objectives We tested whether social activities and interactions as part of a condom campaign strengthened young adults’ condom-use intentions and normative perceptions of condoms compared to simple exposure to campaign information. Method Data from 3,041 young adults collected after four annual condom campaigns were analyzed and combined into a meta-analysis. Results Interaction about the campaign and engagement in campaign-related activities was associated with higher condom use intention and more positive pro-condom norms. Conclusions The authors call for a greater emphasis on social influence in youth-aimed sexual health campaigns. Implications for the research are discussed.

Stigma of infidelity associated with condom use explains low rates of condom uptake: qualitative data from Uganda and Tanzania

Despite widespread messaging supporting male (external) condom use to prevent HIV in endemic settings, utilization of condoms is low across sub-Saharan Africa. A thorough understanding of barriers to condom use as a form of HIV prevention is necessary to reduce HIV transmission. Here, we present qualitative data from rural eastern Africa to explain low utilization of condoms among heterosexual adults. Focus groups and interviews were conducted in Tanzania and Uganda between 2016 and 2019. A content analysis approach was used to identify attitudes about condoms and factors related to use/non-use. We found that strategies such as abstinence and being faithful to one’s partner are perceived as ideal but rarely achievable methods of HIV prevention. Condoms are used in the setting of “failure” to abstain or be faithful and are therefore stigmatized as markers of infidelity. As such, use within cohabiting and long-term relationships is low. Our data suggest that negative perceptions of condoms may stem from persistent effects of the formerly applied “ABC” HIV prevention approach, a public health messaging strategy that described A—abstinence, B—be faithful, and C—use a condom as tiered prevention tools. Condom uptake could increase if HIV prevention messaging acknowledges existing stigma and reframes condom use for proactive health prevention. These studies were approved by Weill Cornell Medicine (Protocols 1803019105 and 1604017171), Mbarara University of Science and Technology (Protocol 16/0117), Uganda National Council of Science and Technology (Protocol SS-4338), and the Tanzania National Institute for Medical Research (Protocol NIMR/HQ/R.8c/Vol.I/1330).

HIV and syphilis knowledge, perceptions, and practices among Myanmar migrant workers in Samut Sakhon Province, Thailand

BackgroundThailand has been one of the largest migration hubs in Southeast Asia for the past four decades and keeps attracting migrants from neighboring countries. Due to difficulties associated with their status, migration can place individuals at a heightened risk for sexually transmitted diseases. This study aimed to examine factors influencing HIV and syphilis preventive behaviors among Myanmar migrants in Samut Sakhon, Thailand.MethodsA cross-sectional mixed-method study was conducted among Myanmar migrants aged 18 years and above in Samut Sakhon Province, Thailand. To fulfill this study's aims, four hundred seventy-three respondents completed a survey to provide quantitative data, and eight participants completed in-depth qualitative interviews. The factors associated with protective sexual behaviors were identified with multiple logistic regression analysis of the quantitative study data and thematic analysis of the qualitative data.ResultsThe respondents showed good knowledge of HIV and syphilis (50.1%), but over half (55.6%) exhibited the negative perception of sexually transmitted disease prevention; about 81.4% of male respondents never used a condom when they had sexual intercourse in the past year. Based on multivariate analysis, income expenses-balance (adjusted odds ratio (AOR) = 2.379, 95% confidence interval (CI): 1.002–5.731, p = 0.049), number of sex partners (AOR = 3.044, 95% CI: 1.339–6.924, p = 0.008), and having sex with a prostitute (AOR = 6.085, 95% CI: 1.28–28.918, p = 0.023) were all statistically associated with unprotected sex. In the qualitative analysis, knowledge, understanding, beliefs; the influence of culture, community, and environment; and condom perceptions were also important factors.ConclusionLow use of condoms in sexual practice was identified, and the appropriate intervention or approach to improve the utilization of condoms in the community was provided.

A Review of Indian Perceptions on Condom Use

In the late 1960s, India's National Family Planning Programme introduced condoms as one of the family planning methods. Since its inception, the condom has been promoted as a method of family planning through social marketing. With the rising prevalence and incidence of sexually transmitted infections (STIs), such as HIV/AIDS, the condom has been promoted as a dual method of protection against both unintended pregnancies and sexually transmitted infections. Despite different initiatives at various levels, overall condom use among Indian couples remains low. In this paper, we examine the research on condom perception among Indian couples. The report specifically evaluates research and strategies designed to enhance condom usage among couples; predictors of condom use; reasons for not using a condom; and perception versus the experience of condom failure. Non-acceptance by partners, perceived ineffectiveness, reduced comfort, lack of sexual satisfaction, husband's alcohol usage, depression, and anxiety, and not being accessible at the time were among the reported condom-related issues. The importance of the media in promoting condom use was mentioned as a significant strategy to raise awareness and use. Acceptance of male condoms would be aided in a variety of ways.

Male Condom Has No Influence on Male Physiological Sexual Arousal

Background: Men are not using male condoms because of several reasons, which can result in a public health problem. One of these is connected to Condom-Associated Erectile Problems. Methods: This research aimed to assess the effect of a male condom made of a material other than latex on the arousal response of heterosexual men. A total of 82 young men (Mage = 23.17 years, SD = 3.04, range age = 18-30) participated in this experimental study. Two random groups (i.e., experimental and control, n = 41 each) were compared. The experimental group used condoms while controls did not. Fit and feel condom perceptions, initial erectile scores, age, substance use among other were controlled. Erection was measured while viewing a sexual video by means of penile plethysmography and subjective arousal. Findings: Results showed no significant difference in both, subjective and physiological sexual arousal. Interpretation: There is no evidence that condoms influence erectile response. More research is needed in this area to provide treatments and clinical interventions or sexual and reproductive education to mitigate the occurrence of sexual dysfunction, unplanned pregnancies, or sexually transmitted infections. Funding: Fundacion Universitaria Konrad Lorenz and the Administrative Department of Science, Technology and Innovation (Colciencias). Declaration of Interest: None to declare. Ethical Approval: The study was approved by the Ethics Committee of the Konrad Lorenz University Foundation.

The Trouble with Rubbers: A History of Condoms in Modern China

Abstract In recent years, public health officials and scholars have voiced their concerns about comparatively low condom use in China, citing high rates of abortion and the growing HIV/AIDS crisis. By examining condom use through the lenses of gender and the history of medicine, this article traces heterosexual condom consumption in China from the early twentieth century to the present and situates contemporary attitudes toward condoms within long-term contraceptive patterns. Rather than simply taking for granted the role that men play in family planning decisions, this research takes men and masculinity as a central focus. An eye to the past reveals numerous historical obstacles to condom use, as well as an enduring aversion to condoms grounded in fears of reduced male sexual pleasure, and the gendered assumption that birth control is the sole responsibility of women. Analyzing evolving perceptions of condoms sheds light on constructions of sexuality, gender relations, and the roles of the state, society, and the individual in contraceptive decision-making in China.

"I'd Rather Use a Refuse Bag:" A Qualitative Exploration of a South African Community's Perceptions of Government-Provided Condoms and Participant-Preferred Solutions.

Despite South Africa experiencing one of the largest HIV epidemics in the world, condom use has decreased since 2008. However, condoms are the only low-cost HIV prevention technology widely available in South Africa. This study aims to explore a South African community's perceptions of condoms, recent condom use decrease, and suggestions for increasing condom use. In 2014, we conducted seven focus groups (n = 40 men) and 20 in-depth interviews (n = 9 men, n = 11 women) with participants aged ≥ 18years recruited from four urban settlement health clinics in Cape Town, South Africa. Data were collected, coded, and analysed using a general inductive approach. Participants perceived government-provided condoms negatively, with themes including "disgust" for condom physical properties, concerns with social status associated with free condoms, and performance concerns. There was an intersection of themes surrounding masculinity, condom use, and sexual pleasure. Solutions to increase condom use included improving the quality and variety of free condoms and rebranding free condoms. Participants suggested that condoms are distributed with novel attributes (e.g., more colors, smells/flavors, sizes, and in-demand brands) and that government programs should consider offering all brands of condoms at no or low cost. This study suggests a substantial rethinking of condom branding for government-provided condoms. Our findings suggest that condom dissemination and promotion programs should proactively address public concerns regarding condoms. Existing societal and structural norms such as hegemonic masculinity must also be addressed using gender-transformative interventions. We also strongly suggest the creation of a Male Condom Acceptability Scale to understand condom users' needs.

Condom Use Completeness, Perceptions, and Sexual Quality at Most Recent Sexual Event: Results from a U.S. Nationally Representative Probability Sample

Objectives: To explore perceptions of condoms associated with complete use and evaluate relationships between condom perceptions, condom use, and sexual quality.Methods: Using data from a U. S. nationally representative probability sample, we assessed individuals’ condom use perceptions and related characteristics of their most recent sexual event through bivariate and regression analyses (n = 234).Results: Most participants reported complete condom use and neutral or positive perceptions of condoms. Though incomplete use was associated with orgasm among women, arousal and pleasure did not differ by gender or duration of condom use.Conclusions: We found no evidence that delayed application or early condom removal increased sexual arousal or pleasure, which may help sexual health promotion interventions address negative cultural ideas about condoms.

Exploring gender and partner communication: Theory of planned behavior predictors for condom use among urban youth in Zambia

To understand how knowledge and perceptions of condoms and partner communication influence use of condoms in a high HIV prevalence setting and gender-specific differences. A cross-sectional study was conducted in Zambia from 2015 to 2016. The survey included questions on demographics, sexual behavior, contraceptive perceptions, and behaviors. We constructed multivariate regression models using the Theory of Planned Behavior to determine associations between knowledge, perceptions, and perceived control with intended, communicated, and reported use of condoms by gender. The participants were 2388 sexually active urban residents aged 18-24years. In the sample, 1646 (69%) were female, 841 (35%) married,and 1894 (61%) unemployed. Partner communication was the predictor most associated with use of condoms. Among women, partner communication was associated with over three times higher odds of condom use (odds ratio [OR] 3.51, 95% confidence interval [CI] 2.65-4.65) but being married reduced the odds of condom use by 76% (OR 0.24, 95% CI 0.17-0.33). For men, a network of friends that was supportive of the use of contraception was associated with increased odds of 55% for use of condoms (OR 1.55, 95% CI 1.10-2.18). Public health programs aimed at increasing safer sexual behavior and use of condoms must consider improving gender equity and partner communication, as knowledge of contraceptives and positive perceptions are not enough to ensure their use.

Engaging the capacity of comadronas as HIV prevention providers in rural Guatemala

In this study the author address rural Guatemala’s poor maternal health and HIV status by integrating an effective evidence-based HIV intervention (SEPA), with local implementing health partners to extend the capacity of comadronas (traditional Mayan birth attendants) to encompass HIV prevention. I employed a multi-method design consisting of a focus group, an interview, and participant observation to identify important factors surrounding comadrona receptivity towards expanding their capacity to HIV prevention. I analyzed data using thematic analysis and identified four categories: Project logistics, HIV knowledge and risk assessment, condom perceptions, and HIV testing perceptions. I affirm comadrona receptivity toward HIV prevention, and that will guide future cultural adaptation and tailoring of SEPA for comadrona training. I will use my results to create a prototype intervention that could be applied to other similarly underserved indigenous communities.

Considerations in the Measurement and Reporting of Withdrawal: Findings from the 2018 National Survey of Sexual Health and Behavior

IntroductionAlthough withdrawal use is routinely measured as part of contraceptive surveillance in the United States, its assessment may be prone to underreporting and measurement errors. Additionally, at the population level, little is known about subjective experiences of withdrawal. AimTo measure respondents’ frequency of and reasons for engaging in extra-vaginal ejaculation in the past year, and to compare contraceptive withdrawal vs extra-vaginal/anal ejaculation during the most recent sexual event. MethodsThe 2018 National Survey of Sexual Health and Behavior is a U.S. nationally representative probability survey of adolescents and adults. This study was administered in February–March 2018 via GfK Research’s KnowledgePanel. Respondents who reported consensual penile-vaginal intercourse in the past year were included in the analysis. Logistic regression was used to assess factors associated with finding extra-vaginal ejaculation sexy/arousing. Main Outcome MeasuresMain outcomes were the frequency of and reasons for extra-vaginal ejaculation in the past year, as well as reported contraceptive withdrawal use and the location of ejaculation at the most recent penile-vaginal intercourse. ResultsIn the past year, approximately 60% of respondents reported engaging in any extra-vaginal ejaculation; pregnancy prevention and sexual pleasure were given as common reasons. Those who were men, white, or aged 25–29 were more likely to find extra-vaginal ejaculation sexy or arousing; no gender differences were observed in their partner’s perception of this act. Prevalence of selecting withdrawal on the contraceptive inventory was 12.2% (95% CI 10.6–14.0) at last sexual event, whereas extra-vaginal/anal ejaculation was reported by 20.8% (95% CI 18.7–23.0). This lack of concordance in differing measures was observed consistently across all age groups, and approximately 12% to 14% of individuals reported an ejaculation location that did not correspond to their withdrawal use. Clinical ImplicationsThe results of this study have implications for how healthcare providers discuss withdrawal with their patients and counsel them on using extra-vaginal ejaculation as part of their contraceptive use or part of their sexual repertoire. Strengths & LimitationsThis is the first nationally representative study to directly compare contraceptive withdrawal to extra-vaginal ejaculation. Limited data were collected at event level regarding motivations for extra-vaginal ejaculation, pregnancy attitudes, perceptions of condoms and sexually transmitted infection prevention, or exposure to erotic media, thus limiting further assessment of relationships between various factors and extra-vaginal/anal ejaculation. ConclusionWe found that reporting of withdrawal as a contraceptive method vs extra-vaginal/anal ejaculation was inconsistent and that extra-vaginal/anal ejaculation was commonly used for reasons other than pregnancy prevention; future research should use more precise measures of “withdrawal.”Fu TC, Hensel DJ, Beckmeyer JJ, et al. Considerations in the Measurement and Reporting of Withdrawal: Findings from the 2018 National Survey of Sexual Health and Behavior. J Sex Med 2019;16:1170–1177.

Condom use behaviours and correlates of use in the Botswana Defence Force

Preventing HIV infection is a priority for militaries. HIV prevention research is needed to monitor existing programme, identify areas for modification, and develop new interventions. Correct and consistent condom use is highly effective against HIV. However, use among soldiers is lower than ideal. This study describes condom use behaviours and examines correlates of use in the Botswana Defence Force (BDF). Analyses were based on 211 male BDF personnel, aged 18-30, who completed a cross-sectional survey that collected baseline data for an intervention study. Results showed that 51% of participants reported always using condoms, 35% used condoms most times, and 14% used condoms occasionally/never. Condom use varied by partner type and was typically higher with casual partners in comparison to regular partners. After adjustment for age and marital status, factors associated with lower condom use included excessive alcohol use, perception that using condoms reduce sexual pleasure, and having a trusted partner. However, higher levels of HIV knowledge and reports of being circumcised were protective against lower condom use. HIV interventions aimed at increasing condom use in the BDF should address condom perceptions, alcohol abuse, and issues of trust. Innovative ways to increase condom use in this population should also be explored.

A comparison of condom use perceptions and behaviours between circumcised and intact men attending sexually transmitted disease clinics in the United States

This investigation compared circumcised and intact (uncircumcised) men attending sexually transmitted infection (STI) clinics on condom perceptions and frequencies of use. Men (N = 316) were recruited from public clinics in two US states. Circumcision status was self-reported through the aid of diagrams. Intact men were less likely to report unprotected vaginal sex (P < 0.001), infrequent condom use (P = 0.02) or lack of confidence to use condoms (P = 0.049). The bivariate association between circumcision status and unprotected sex was moderated by age (P < 0.001), recent STD acquisition (P < 0.001) and by confidence level for condom use (P < 0.001). The bivariate association between circumcision status and infrequent condom use was also moderated by age (P = 0.002), recent STI acquisition (P = 0.02) and confidence level (P = 0.01). Multivariate findings supported the conclusion that intact men may use condoms more frequently and that confidence predicts use, suggesting that intervention programmes should focus on building men's confidence to use condoms, especially for circumcised men.

Correlates of Condom-Associated Erection Problems in Young, Heterosexual Men: Condom Fit, Self-Efficacy, Perceptions, and Motivations

Questionnaire data from 479 heterosexual men 18-24 years old were analyzed for correlates of CAEP during application (CAEP-Application) and CAEP during penile-vaginal intercourse (CAEP-PVI). Potential correlates were self-efficacy (condom application, product selection, and maintaining arousal), condom perceptions (condom worry/distraction, negative condom perceptions, concerns about application speed), condom fit, and motivation to use condoms. We conclude that (1) experiencing CAEP may become a repeating cycle, both affecting and being affected by, worry and distraction related to losing erections and maintaining arousal while using a condom (2) poorly fitting condoms may contribute to CAEP, and (3) CAEP may decrease motivation to use condoms.

Negative perceptions about condom use in a clinic population: comparisons by gender, race and age

We sought to elucidate the associations of 13 items assessing negative perceptions about condom use with gender, age and race in a sample of clinic attendees. Patients from four clinics, in three US cities, were recruited (N = 928). Data were collected using audio-computer-assisted self-interviewing. The primary measure was a 13-item adapted version of the Condom Barriers Scale. Logistic regression and chi-square tests were employed to relate the 13 items to gender, age and race. Gender, race and age all had significant associations with negative perceptions of condoms and their use. A primary finding was a large number of significant differences between men and women, with negative perceptions more common among women than among men. For African Americans, especially women, negative perceptions were more common among older participants than among younger participants. In conclusion, important demographic differences regarding negative perceptions may inform the tailoring of intervention efforts that seek to rectify negative perceptions about condoms and thus promote condom use among individuals at risk for sexually transmitted infections (STIs) in the USA. On the other hand, our findings also suggest that the majority of STI clinic attendees may hold positive perceptions about condoms and their use; maintaining and building upon these positive perceptions via education, counselling, and access is also important.

Sexual Pleasure during Condom‐Protected Vaginal Sex among Heterosexual Men

Public health condom promotion efforts increasingly focus on the importance of sexual pleasure; however, little is known about sexual event-specific factors that may increase or decrease perceptions of sexual pleasure when condoms are used. To examine event-level factors associated with ratings of sexual pleasure during condom-protected vaginal intercourse. Data were collected in 2008 from 1,875 men during a prospective daily diary study of sexual behavior and condom use. Sexual pleasure was assessed during condom-protected vaginal intercourse considering situational, relational, intrapersonal, and behavioral predictors. Analyses were generalized estimating equation ordinal regression. Event-specific perceptions of sexual pleasure (three categories: not at all enjoyable to extremely enjoyable). Vaginal intercourse was reported on 29.8% (N = 8,876/29,714) of diary days; complete condom use was reported for 59.1% (5,249/8,876) of all vaginal intercourse events. This was confusing by using the word "all sexual events." Higher sexual pleasure ratings during complete condom use were associated with older age, manual stimulation of one's genitals, receiving oral sex, and performing oral sex. Sexual pleasure ratings also increased in association with intercourse duration, intercourse intensity, ejaculation, erection perception, and condom comfort. Sexual pleasure ratings were lower with erection difficulty and partner discomfort during sex. These data advance understanding of sexual pleasure during condom use, suggesting that sexual pleasure increases in conjunction with specific relational, physiological, and condom perceptions. These findings offer points upon which clinicians and health educators can engage men in an ongoing dialogue about augmenting sexual pleasure in the context of condom use.

Sexual Partnerships, Risk Behaviors, and Condom Use Among Low-Income Heterosexual African Americans: A Qualitative Study

The purpose of the current investigation was to contextualize the sexual relationships and risk behaviors of heterosexually active African Americans. A total of 38 participants (20 females and 18 males) aged 18-44 years were recruited in a large city in the southeastern U.S. to participate in focus group discussions exploring sexual partnerships, general condom perceptions, and condom negotiation. Results indicated that participants distinguished among at least three partner types-one-night stand, "regular" casual partner, and main partner. Partner types were found to shape and influence types of sexual behaviors, perceptions of risk and condom use, and condom negotiation. Participants also shared general perceptions about condoms and elucidated situations in which intentions to use condoms were not realized. Gender differences emerged in many of these areas. Implications of these findings are discussed and directions for future research on sexual partnerships and risk behavior are offered.

When Condom Use is Not Condom Use: An Event‐Level Analysis of Condom Use Behaviors during Vaginal Intercourse

Little is known about event-level condom use errors during vaginal sex. The aim of this article is to examine factors associated with complete condom use compared to forms of incomplete condom use, including delayed condom application and early condom removal, over a 30-day period. Data were collected in 2008 from 1,875 men during a prospective daily diary study of sexual behavior and condom use. Incomplete condom use was assessed during vaginal intercourse considering situational, relational, intrapersonal, and behavioral predictors. Analyses were generalized estimating equation multinomial logistic regression. Condom use during vaginal sex: complete use, delayed application, early removal, and both delayed application/early removal. Of 29,714 diary reports, 30% (8,876) included vaginal intercourse. Analyses were conducted (in 2009) on 83.2% of these intercourse events (6,325), during which condoms were used and for which participants provided complete data. Incomplete condom use included penetration before applying condoms during 12% of events (749), removing condoms before intercourse ended during 3.1% (198), and both types of incomplete use during 2% (129) of events. Erection quality (less than typical erect penile length and circumference, less rigidity, and difficulty maintaining erection) was associated with greater odds of incomplete use, as was a participant's history of other recent incomplete use. Perceptions of condom comfort and recent previous complete use were protective factors against incomplete use. Men's incomplete condom use is associated with recent condom use patterns, as well as with their physiological characteristics and perceptions of condoms during sexual intercourse. Event-level analyses such as these help describe how incomplete condom use occurs among individuals incorporating condoms into their sexual activities.

Condoms and developmental contexts in younger adolescent boys

BackgroundCondom use is a key part of sexually transmitted infection (STI) prevention for young men. Yet little is known about how younger adolescent boys initially learn about and use condoms....

Condom brands, perceptions of condom efficacy and HIV prevention among university students in KwaZulu-Natal, South Africa

University students form an important constituency in interventions against HIV and AIDS. The majority of university students are between ages 18 and 30 years, which, according to recent surveys, is the age category at the highest risk of HIV infection. Even though there is currently no comprehensive statistical data on the HIV prevalence at South African institutions of higher learning, a number of studies have noted increasing AIDS-related deaths and sicknesses among students. This highlights the need for effective intervention against HIV infections within this community. Condom use remains the most effective intervention against HIV infection within sexually active populations. This paper examines perceptions of public-sector condoms and their impact on condom use among university students, based on the findings of research conducted at three universities in KwaZulu-Natal Province, South Africa. Study findings indicate that public-sector condoms are perceived as ineffective, smelly and even ‘infectious’ and are widely seen to be of lower status as compared to the commercial brands. These perceptions were found to influence condom use as some students preferred to engage in unprotected sex rather than use public-sector condoms. The paper highlights the need for communication programmes to demystify the misconceptions surrounding public-sector condoms and to provide reassurance of the quality of such condoms.