Condom refusal and young black men: It's all about sex, maybe!

Objective: This study investigated pleasure-related correlates of recent condom refusal in young Black men attending local STD clinics. Methods: Data were collected in three US cities from clinics treating sexually transmitted diseases. Inclusion criteria were self-identified as Black/African American, male, being between 15-23 years old, and recent (past three months) use of a male condom. Of 1144 eligible young men, 697 (61.0%) enrolled in study and completed a baseline ACASI survey. Condom refusal was dichotomized to compare those who recently (past two months) refused to wear a condom to all other participants. Regression methods were used to predict the influence of condom attitudes and beliefs on this outcome. Results: Mean age was 19.6 years (SD=1.87). Nearly one of every two young men (46.8%) indicated recent refusal to use a condom when the partner has asked him to do so. Significant correlates of refusing to use a condom were: condoms change the climax or orgasm (OR=3.35, 95% confidence interval (CI) 2.02-5.55), condoms are messy (OR=2.47, 95% CI=1.58-3.83), I feel closer to my partner without a condom (OR=1.88, 95% CI=1.17-2.99), condoms make sex hurt for the girl (OR=1.78, 95% CI=1.14-2.78). There was a significant yet inverse association between condom refusal and the belief that condoms feel unnatural (OR=0.55, 95% CI=.32-.95). Conclusions: Condom beliefs and attitudes are antecedents to condom refusal behaviors of young Black males. Interventions to address pleasure-related condom attitudes and beliefs as barriers are warranted.