Condom use patterns in sexual/romantic relationships: Implications for public health practice

Steady increases in heterosexual transmission of HIV and disproportionately high HIV/STI rates among minority populations underscore the need for effective and ‘doable' prevention strategies. While condoms represent one highly effective strategy, consistent use within and across relationships is not always desirable/doable. In an effort to gain a better understanding of the factors influencing condom use decisions, communications, and behaviors in the context of heterosexual relationships, we conducted a mixed methods study involving 18-25 year old Puerto Rican and African American men and women in Philadelphia, PA and Hartford, CT.

Triangulated retrospective life history interview (N = 120), prospective coital diary (N = 70), and community-based survey (N = 483) data will be presented to highlight findings in three key areas: differential use of condoms in serious/casual relationships; negative impact of condoms on male and female sexual pleasure; and use of HIV/STI testing to monitor risk in lieu of condom use. Survey findings regarding condom usage at last sex with serious and casual partners (38.7% v. 76.2%) confirmed life history and diary findings that condom use is normative with new or sex-only partners and non-normative in relationships involving greater levels of emotional investment. Regardless of relationship context, physical discomfort (e.g., burning) served as a disincentive to condom use for many participants, regardless of relationship context. In addition to the influence of relationship context and physical discomfort on condom use, our finding that testing is a common strategy to manage risk in the absence of condom use has important public health implications.