Condom Use and Concurrent Partnering among Heterosexually Active, African American Men: A Qualitative Report

Abstract

African Americans are overrepresented among heterosexual cases of HIV/ AIDS in the USA. Inconsistent condom use and concurrent partnering are two sexual behaviors driving the heterosexual HIV epidemic in the African American community. To inform the development of an HIV prevention behavioral intervention to decrease concurrent partnering and increase condom use among African American heterosexual men, we conducted formative research, including 61 structured interviews, 5 focus groups with 25 men, and 30 in-depth qualitative interviews between July and December 2009. We used a grounded theoretical approach and categorizing strategies to code and analyze the qualitative data. Results around condom use confirmed earlier findings among heterosexual men in general: condoms diminish pleasure, interfere with erection, and symbolize infidelity. Although valued by some as a form of disease prevention and pregnancy prevention, condoms are often used only with specific types of female partners, such as new or casual partners, or due to visual risk assessment. Sex partner concurrency was described as normative and ascribed to men's "natural" desire to engage in a variety of sexual activities or their high sex drive, with little recognition of the role it plays in the heterosexual HIV epidemic. Fatherhood emerged among many men as a crucial life event and compelling motivation for reducing sexual risk behavior. Based on these results, we conclude that existing HIV prevention efforts to improve attitudes towards and motivate use of condoms either have not reached or have not been successful with African American heterosexual men. In designing behavioral interventions to decrease concurrent partnering and increase condom use, addressing negative attitudes towards condoms and partner risk assessment is critical, as is integrating novel motivational approaches related to identity as fathers and men in the African American community.

Knowing is not enough: a qualitative report on HIV testing among heterosexual African-American men

“…HIV testing is critical in order to reduce the risk of transmission, and awareness of HIV serostatus is a strong determinant of condom use and sexual partnering patterns (Ebrahim, Anderson, Weidle, & Purcell, 2004), yet little is known about HIV testing behaviors among heterosexual African-American men (Marks, Crepaz, & Janssen, 2006). As part of a CDC-funded study designed to develop and test an HIV prevention intervention for African-American heterosexual men, we conducted a formative research study using mixed methods (Frye et al, 2012). Here, we adopt a social cognitive perspective to inform an analysis of how heterosexual African- American men make sense of HIV testing, the influence of their female partners on HIV testing, and the impact of communication about HIV testing in heterosexual relationships.…”

Characteristics of African American Women and Their Partners With Perceived Concurrent Partnerships in 4 Rural Counties in the Southeastern US

“…This may be due to general dislike of condoms as well as the perception that the individual who proposes condom use within a partnership will be perceived as the unfaithful one (13). …”

“…Qualitative studies among African American adults suggest that while concurrency is normative in some circumstances, many report a committed monogamous relationship as the ideal (13, 14). …”

“…We describe the participants' socioeconomic and demographic attributes, sexual and drug use behaviors, as well as interpersonal and sexual characteristics of their most recent partnership. Previous research demonstrates that economic concerns can motivate initiation and continuation of partnerships (15), and women report preference for monogamy (13, 14). Therefore, we hypothesized that compared with participants whose partners were monogamous, those whose partners had concurrent relationships would receive some additional benefit (e.g., economic support, gifts, housing) as a motivating factor for remaining in the relationship.…”

The Role of Relationship Type, Risk Perception, and Condom Use in Middle Socioeconomic Status Black Women’s HIV-prevention Strategies

“…Research suggests that emotional connections, particularly those in monogamous, committed relationships, may decrease some Black women’s perceptions of risk and willingness to use condoms (Epperson et al, 2009; Kyomugisha, 2006). Lastly, scholars have found that older Black women may be at risk for HIV, particularly when married or in committed relationships in which they do not use condoms because pregnancy prevention and sexual concurrency, or having overlapping sexual partnerships, are not major concerns for them (Frye et al, 2013; Smith & Larson, 2015). …”