Interventions That Eroticize Safer Sex Improve Condom Use: An Updated Meta-Analysis, 2003 to 2013

Background: Unprotected sex accounts for the largest proportion of new HIV infections even though correct and consistent condom use can prevent HIV. Behavioral interventions typically focus on negative (i.e., disease-prevention) rather than positive (i.e., sexual health, pleasure) aspects of condom use. This meta-analysis examined the efficacy of behavioral interventions that included an eroticization component to improve condom use.

Methods: Comprehensive electronic searches were conducted identifying relevant studies published between 2003 and 2013. To be included, studies had to evaluate a behavioral intervention that reported including an eroticization component, used a randomized controlled trial (RCT) or a quasi-experimental design with a control group, assessed condom use behavior, and provided sufficient information to calculate effect sizes (ES). Independent rates coded participant, design and methodological characteristics, and intervention content. Weighted mean ES were calculated using random-effects models.  

Results: Included were 14 studies (N = 7,609; mean age = 30 years; 52% women; 51% Black) from 6,362 studies identified through the electronic bibliographic database searches. Compared to controls, intervention participants increased their condom use (i.e., mean proportion of condom use: d₊ = 0.38, 95% CI = 0.08, 0.68; k = 12; condom use at last occasion: d₊ = 0.39, 95% CI = 0.13, 0.65; k = 8) at the first post-intervention assessment (median = 13 weeks).       

Conclusions/Implications: The results of this meta-analysis suggest that behavioral HIV interventions that eroticize safer sex increase condom use. Promoting the sexual or sensory aspects of condom use may be important for reducing the incidence of HIV.