Background: HIV prevention services have been offered in the emergency departments of Detroit Medical Center since 2006. Alongside the rapid HIV testing, individuals are offered condoms as well as other prevention resources. From October 2023- September 2024, condoms were provided at 1,657 testing encounters. However, 1,455 individuals refused condoms when offered. With a lack of clientele-centric information concerning the condom usage trends and stigma, our program sought to assess the current perceptions and utilization trends of condoms in order to improve our counseling and education services.

Methods: Data was collected during HIV testing sessions from October 2024 to February 2025 from patients age ≥18 years (N = 1,061). Data was collected concerning the following metrics in addition to the standard Counseling, Testing and Referral Form: frequency of condom use, the type of protection used, and the reason for not using protection. Descriptive statistics include counts and 95% Wilson Score confidence intervals (CIs). Chi-square with Bonferroni correction tested for differences in condom use frequency; alpha set at ≤0.05. We employed multinomial logistic regression to estimate odds ratios (ORs) and CIs; alpha set at ≤0.05.

Results: Among 1,061 participants, 56.7% (n=602) were age 25-44 years, 64.8% were biologically female, and 96.5% (n=1,024) identified as Black/African American. In the year prior to survey, 12.3% [95% CI: 10.5, 14.5)] used a condom “every time”, while 43.4% [95% CI: 40.5, 46.5)] “never” did. Condom use frequency proportions were significantly different by age (p<0.001), biological sex (p=0.03), sex with females (p=0.05), and multiple partners (p<0.001). Having multiple partners was significantly associated with using condoms “most of the time” [OR=3.57, 95% CI: (2.40, 5.30)], “sometimes” [OR=2.22, 95% CI: (1.56, 3.15)], and “rarely” [OR=2.69, 95% CI: (1.67, 4.33)] compared to “never”, controlling for age, sex, and sex with females. The most common themes for why individuals did not use condoms were “trusts partner(s)” (n= 491) and “preference” (n=161).

Conclusion: Among our emergency department clientele, there is a need to provide education about consistent use of condoms, especially among those with multiple partners, and identifying ways to address preferences (i.e., offering a wider selection of condoms).