Academic journal article International Public Health Journal

Condom Use Attitudes and HIV Risk among American MSM Seeking Partners for Unprotected Sex Via the Internet

Academic journal article International Public Health Journal

Condom Use Attitudes and HIV Risk among American MSM Seeking Partners for Unprotected Sex Via the Internet

Article excerpt

Introduction

Men who have sex with men (MSM) represent one of the groups considered most at risk for the sexual transmission of HIV, at least in part due to their comparatively high risk per exposure via anal sex. The risk per exposure is estimated to be 1.00% for receptive anal sex and 0.06% for insertive anal sex as compared to 0.01-0.32% for receptive vaginal sex and 0.01-0.10% for insertive vaginal sex (1). As condoms represent an effective method of HIV prevention, extensive efforts have been made by researchers to understand condom use attitudes in a variety of populations and to promote consistent condom use. In the United States, recent research shows that among MSM, increases in safer sex fatigue are associated with increases in the number of partners with whom they reported engaging in unprotected sex (2). Surprisingly, there has been limited research addressing condom-related attitudes among MSM in the United States. A few studies, however, have examined condom attitudes and behavior in subpopulations of MSM, such as African American MSM (3,4), Latino MSM (5), and methamphetamine-using HIV-positive MSM (6). These studies have shown that, among African American MSM, stronger peer condom use norms were associated with a lower frequency of risk behavior involvement (3); and lesser involvement in HIV risk behavior was associated with the perception of social norms that support condom use (4). In a sample of Latino MSM, participants most commonly cited pleasure as the reason for a lack of condom use (5). In a sample of methamphetamine-using HIV-positive MSM, researchers found that among men with negative attitudes about condoms, there was an association between methamphetamine use frequency and unprotected sex (6).

Although condoms are highly effective for HIV prevention when used correctly, research has shown that most individuals do not use condoms consistently (7), and others intentionally seek partners for unprotected sex. Previous research indicates a variety of factors associated with the motivation among MSM for barebacking (that is, the intentional practice of engaging in unprotected anal intercourse) (8). These factors include the desire to: cope with psychosocial vulnerabilities (9), create intimacy with partners (9), exchange semen (10), maximize physical and/or emotional pleasure (11), and overcome social isolation (12). Research efforts are underway to develop alternative methods of HIV prevention that are acceptable among MSM (13). Condoms are currently the best known strategy for HIV prevention during sexual contact. Therefore, understanding the condom-related attitudes and behavior of men who seek other men for unprotected sexual contact is an important part of strategizing ways in which this subpopulation of MSM can increase safety and health by preventing HIV infection. As we previously noted, though, little has been written about condom-related attitudes among MSM, especially with regard to specific attitudes about particular aspects of condom use (e.g., perceived inconvenience, embarrassment regarding use, discomfort, etc.). Most of the published studies have reported, simply, that negative attitudes toward condoms are associated with greater involvement in risky practices (14).

Recent research has examined the use of the Internet among MSM for meeting potential sex partners, typically finding that this practice is associated with a variety of HIV risk behaviors. For example, one recent study (15) showed that 40% of MSM Internet users acknowledged engaging in unprotected anal sex. Similarly, in a study comparing self-identified barebackers and non-barebackers, barebackers were more likely to spend more time on the Internet looking for potential sex partners [16]. Furthermore, researchers have found that men who seek sex online report more unprotected sex and sexually transmitted infections compared to their peers who do not use the Internet to identify sex partners (17,18). In a study that examined online ads and profiles on MSM-oriented unprotected sex-focused websites, the rates of advertised high-risk sexual behaviors were very high, including oral sex with ejaculation in the mouth (88. …

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