In Mexico City, unmarried young men who discuss their personal problems with one, two, or three or more confidants are significantly more likely to have used contraceptives for STI prevention at last intercourse than are men without a confidant (odds ratios, 2.4-2.8).1 Compared with men who last had sex with a girlfriend, those whose last female partner was neither a friend nor a girlfriend have significantly elevated odds of contraceptive use for pregnancy or STI prevention (4.0). These results underscore the importance of social factors - in addition to individual characteristics - as predictors of contraceptive use among single young men.
Data came from a representative sample of 8,086 men aged 15-60 who were surveyed in 1992-1993. The questionnaire asked respondents about their demographic characteristics and sexual history, contraceptive use at last intercourse, attitudes toward condoms, knowledge and perceived risk of HIV/AIDS, and people with whom they discussed their personal problems. The sample for analysis comprised all unmarried respondents who were younger than 25 and had had sex in the past 12 months. The researchers conducted univariate and multivariate regression analyses to evaluate relationships between social and individual-level variables and contraceptive use at last sex for pregnancy prevention, for STI prevention and for either purpose.
Univariate analyses revealed a number of significant predictors of contraceptive use for pregnancy or STI prevention: a secondary or higher education, having a top-level job or being a student, having a positive attitude toward condoms, perceived lack of risk for HIV infection, high level of knowledge about HIV/AIDS, two cumulative female partners and a coital frequency of once per month during the past year. The odds of contraceptive use were also significantly elevated among men who indicated that they discussed personal issues with two or more people.
Similar results emerged in univariate analyses that distinguished between contraceptive use for pregnancy and STI prevention. Additional predictors of contraceptive use to prevent pregnancy only included having known one's partner for more than one month and being the same age or younger than the woman. The odds of condom use for STI prevention only were significantly decreased among men who had known their partner for more than a month and were significantly increased among those who had last had sex with someone other than a girlfriend.
In multivariate analyses, men who had a secondary or higher education were significantly more likely to have used contraceptives for one or both reasons than were those who had attained less schooling (odds ratios, 2.2-3.3). The odds were also significantly higher among men who had positive attitudes toward condoms than among those with ambivalent or negative attitudes (2.5); among respondents who had had two cumulative partners than among those who had had only one (2.0); and among men with a coital frequency of once per month during the past year than among those with a higher coital frequency (1.5). Having last had sex with someone other than a friend or girlfriend was significantly associated with contraceptive use for any reason (4.0).
In multivariate analyses that focused on contraceptive use for pregnancy prevention only and for STI prevention only, relationships between use at last intercourse and individual-level variables were similar to those found for the combined outcome. These analyses also revealed that men with one, two, or three or more confidants were significantly more likely to have used condoms to protect against STIs than were those without a confidant (odds ratios, 2.4-2.8). Moreover, limiting the outcome to STI prevention intensified the relationship between contraceptive use and having had sex with someone other than a friend or girlfriend (6.4). Finally, men who had known their partner for more than one month were significantly more likely than those who had known her for less time to have used contraceptives solely for pregnancy prevention (1.8-1.9).
The researchers acknowledge that their study would have been improved if the survey had been specifically designed to capture social context and interactions between partners. Their results, they suggest, indicate that "men are ready to use condoms with women who are not girlfriends or friends, and are motivated to avoid STIs," but increasing men's knowledge of HIV transmission "will be unlikely to change behaviors if their partners are simply not seen to be risky." Moreover, the researchers note, the link between men's use of condoms and their communication of personal matters with others suggests that "programs that aim to enhance communication should be able to increase contraceptive use." Given these findings, they support interventions that "take account of the wider context, and the role of communication and social networks."
1. Marston C, Juarez F and Izazola JA, Young, unmarried men and sex: do friends and partners shape risk behaviour? Culture, Health & Sexuality, 2004, 6(5): 411-424.