Why Do Regular Condom Users Sometimes Decide Not to Use Condoms?

Background: Event level data are useful to public health as they provide insight into the factors unique to specific sexual acts that motivate individuals to decide not to use a condom.

Methods: Data were collected in a prospective daily diary study of 1,834 men who regularly used condoms for disease and pregnancy prevention. For each of 9,889 reports of vaginal and anal intercourse, men indicated whether they used a condom and provided an open-ended description of the reasons for their lack of condom use for specific events when condoms were not used.

Results: Participants described reasons for non use for 11% (n=1120) of vaginal and 2% (n=214) of anal intercourse acts in which a condom was absent. Most frequent reports of deliberate lack of condom use for vaginal intercourse were attributed to the female partner's use of other contraception and a perception that no HIV/STI risk was present. For anal intercourse, deliberate condom absence was most frequently attributed to a desire for increased pleasure and lack of pregnancy potential. Non-deliberate lack of condom use occurred primarily when a sexual encounter was unexpected and when condoms were unavailable.

Conclusions: While one's absolute risk for HIV/STI infection is influenced by a range of factors, some condom users appear to make deliberate decisions about condom use based on factors specific to a particular partner or event, including those associated with perceptions of disease risk. Ensuring that individuals have the knowledge and skills to make such decisions remains an important goal for public health.