title: Elements of Condom-Use Decision Making among South African Men Who Have Sex with Men.
abstract: South African men who have sex with men (MSM) are at increased risk for HIV infection, and male condoms are fundamental to HIV prevention programs. We explored condom use experiences through in-depth interviews with 34 South African MSM from Cape Town and Port Elizabeth. For data analysis, we generated a codebook and used the constant comparison method. Condom use reinforcing elements included use of alternative sexual strategies, having a high level of self-worth that was linked to protective behaviors, and use of ready-made condom negotiation scripts. Elements inhibiting condom use included perceiving substantial declines in sexual pleasure/performance, experiences of condom failure (possibly related to petroleum-based lubricant), and being in trusted relationships. Our findings suggest nuanced HIV prevention approaches such as bolstering condom negotiation skills based on successful tactics already in use. Further research is needed to address how to mitigate perceptions and experiences that condoms negatively impact sexual pleasure and performance.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA asiegle@emory.edu.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Siegler
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Alex de
authors.initials: Ad
authors.lastname: Voux
authors.affiliation: HIV/AIDS/STI/and TB (HAST), Human Sciences Research Council, Pretoria, Port Elizabeth, South Africa.
authors.forename: Nancy
authors.initials: N
authors.lastname: Phaswana-Mafuya
authors.affiliation: Desmond Tutu HIV Foundation, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Linda-Gail
authors.initials: LG
authors.lastname: Bekker
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Sullivan
authors.affiliation: Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Baral
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Winskell
authors.affiliation: HIV/AIDS/STI/and TB (HAST), Human Sciences Research Council, Pretoria, Port Elizabeth, South Africa.
authors.forename: Zamakayise
authors.initials: Z
authors.lastname: Kose
authors.affiliation: Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Wirtz
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Rob
authors.initials: R
authors.lastname: Stephenson
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000517:prevention & control; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D021841:Safe Sex / Q000523:psychology* / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
keywords: HIV prevention; South Africa; condom