HIV‐negative participants in an Internet‐based study of men who have anal sex with men reported that their use of condoms varied in different sexual situations.1 For example, condom use was more likely with casual than with steady partners during both insertive and receptive anal intercourse. The odds of condom use during insertive sex were positively associated with men's level of sexual pleasure, but negatively associated with their level of arousal. During receptive sex, the odds of condom use declined as ratings of sexual pleasure increased.
The 2010 longitudinal survey, part of the Men's National Sex Study, included 30‐day sexual diaries provided by a subsample of HIV‐negative men. Researchers used the diary data to explore participant, partner and situational characteristics associated with condom use during insertive and receptive anal sex. They used multivariate logistic regression to assess associations between these characteristics and condom use during each act of intercourse.
A total of 3,877 HIV‐negative men aged 18–79 (mean, 36 years) were included in the analyses. Eighty‐three percent were white, 82% identified themselves as gay and 64% were not currently romantically involved. Some 71% said their health was at least very good, and virtually all had ever engaged in some kind of sexual behavior, most commonly, solo masturbation and receiving and performing oral sex.
Overall, participants contributed 25,149 diary days during a four‐week period. In 3% of all diary days, participants were the insertive partner during anal sex, and in the same proportion of days, participants were the receptive partner. A condom was used in 25% of insertive acts and in 19% of receptive acts.
In bivariate analyses, condom use during insertive and receptive sex was negatively associated with relationship duration and with a history of enema use prior to sex. Condom use during insertive sex was positively associated with a recent diagnosis of syphilis. Condom use during receptive sex was negatively associated with a history of such sex and of receptive oral sex.
In multivariate analyses, the odds of condom use during insertive or receptive sex were elevated when partners were casual (odds ratios, 4.2 and 6.6, respectively). During insertive sex, the odds rose with the participant's perception of sexual pleasure (1.8) and fell with increasing levels of sexual arousal (0.6); they were reduced when a sexual partner had used an enema beforehand (0.98). During receptive sex, the odds of condom use were reduced when unprotected sex had occurred during the past week (0.04), and they declined as sexual pleasure increased (0.04).
The researchers note that the study's limitations include its reliance on an Internet‐based sample of men, who may have had greater sexual awareness than others and therefore were not representative of the general population of men who have sex with men. Nevertheless, they conclude, the study identified characteristics and situations that are associated with routine condom use among these men, and that may guide clinicians and health educators in their efforts to promote safer sex.—A. Kott