Fifty ways to leave your rubber: how men in Mombasa rationalise unsafe sex

Abstract

Objective: To explore the reasons why men who have sex with sex workers in Kenya refuse to use condoms in order to develop potential interventions that might help to overcome these barriers. Methods: We conducted participant observations over a period of 2 months in the bars, discos, shebeens, and guesthouses of Mombasa, Kenya, where many of the sexual transactions are initiated. Results: Analysis of the participant observations revealed at least 50 reasons for not using a condom, which we grouped into six categories: condoms are not pleasurable, condoms are defective, condoms are harmful, condoms are unnecessary, condoms are too hard to use, and external forces prohibit using condoms. Conclusions: Some of the reasons men say they do not use condoms would be difficult to affect directly. Others are the result of gaps in knowledge and have not been impacted through better communication strategies. Finally, some of the reasons for not using condoms, such as men's weaknesses, and the loss of pleasure, could possibly be addressed through the introduction of female controlled devices. However, the most important conclusion of this paper is that men who pay for sex do so because it is pleasurable and many men do not find the male condom pleasurable. Therefore, messages targeted at men who have sex with sex workers may not be 100% successful if they only emphasise the benefits of condom use as disease control.

HIV/AIDS knowledge and attitudes among West African immigrant women in Western Australia

“…Nevertheless, the results replicate those of similar studies (30,32), resemble findings in the country of origin (1,9,11,13,14,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26), and provide some insight into issues of HIV-awareness and attitudes toward condom use in the Australian context. Likewise, findings from the convenience sample of Australian women probably do not reflect the full spectrum of HIV knowledge and attitudes in the Australian community because the majority of respondents were highly educated, most had part-or full-time jobs, and all lived in or close to a major capital city.…”

“…The West African women were less certain that condoms are effective at protecting against HIV/AIDS than their Australian counterparts, and fewer of the less-educated group believed that sex without a condom increases the risk of sexually transmitted infection. Although not explored in the present study, many Africans believe that using condoms is pointless because they slip or break easily (18,22,26), and some hold concerns about the safety of condom use because of the misconception that HIV can slip through tiny holes in the condom (21,26). These misconceptions need to be corrected.…”

“…Moreover, many African people still believe that having sex with a virgin can cure AIDS (13,15). Although most African men and women are aware of the protective benefits of condoms, negative attitudes towards the acceptability and safety of condom use are widespread (13,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)). …”

Pleasure and Prevention: When Good Sex Is Safer Sex

“…1,[7][8][9] This is the ''power of pleasure'' . Since condoms are generally perceived to reduce sexual pleasure, [10][11][12] it is vital for public health campaigns to address how to increase sexual pleasure when promoting condoms.…”

Beliefs that Condoms Reduce Sexual Pleasure—Gender Differences in Correlates Among Heterosexual HIV-Positive Injection Drug Users (IDUs)

“…Because condoms are worn by men, and thus, because men may be the ones to actually experience physical discomfort such as erection problems and loss of sensation, [30][31][32][33] men may have more negative condom beliefs than women and differential correlates of negative condom beliefs could be found between men and women. To explore gender differences, the majority of analyses were conducted separately by gender.…”