“I always prefer to withdraw than use a condom”: contextualising condomless sex among East Asian and sub-Saharan African international students in Sydney

Abstract

Background Incidence and prevalence of blood-borne viruses and sexually transmissible infections among young people continue to necessitate population-based studies to understand how contextualised sexual health services can be developed and implemented to promote protective behaviours such as consistent condom use. This study examined condomless sexual practice among a sample of East Asian and sub-Saharan African international university students in Sydney, Australia. Methods This qualitative study was methodologically guided by interpretative phenomenological analysis. Data was provided by 20 international students sampled from five universities in Sydney, who participated in either face-to-face or telephone semi-structured in-depth interviews. The interview sessions were audio-recorded, transcribed verbatim, coded in NVivo and analysed using reflexive thematic analysis. Results Condomless sexual practices appear to be common among the study group based on participants’ self-reports of their own practices and the practices of friends and peers. Three themes contextualising condomless among the study participants were generated from the interview transcripts: (1) unanticipated sex, condom related stigma and alcohol use (2) pleasure-seeking, curiosity and intimacy (3) condomless sex as a gendered practice. Conclusions The result of this study has implications for public health research, practice and policy around design, implementation and evaluation of multi-layered and population-specific sexual health services that are tailored to addressing the needs of international students, who migrate from traditional sexual cultures to Australia, where sexual norms are more liberal.

“Compared to COVID, HIV is nothing”: exploring how onshore international students in an Australian City navigate COVID-19 versus BBV/STI risk

“…These disruptions impacted condom accessibility and contributed to condomless sex. Pre-pandemic, condom accessibility has been reported as one of the issues contributing to condomless sex among the study population 32 . In the face of the disruptions to supply chains and panic buying associated with the pandemic, pre-pandemic condom accessibility issue may become compounded, thereby increasing the likelihood of condomless sex during the pandemic and the risks of the spread of infections.…”

“…Using sex as a strategy for relief from pandemic-related mental health distress poses concern for BBV/STI risks as found in the present study and supported by previous ones. First, young people, generally, do not use condoms consistently [48][49][50] and this also applies to this study population 32 . Therefore, pre-pandemic practice of inconsistent condom use may increase risks of transmitting and contracting BBV/STI.…”

“…Third, stressors 51 , including COVID-19 pandemic related stress 52 affect decision-making, including decisions around condom use, increasing the likelihood of poor and impulsive decisions 53,54 . Moreover, the possibility of mixing sex with alcohol while seeking relief from mental health distress, as indicated during the interviews, could also impair decisions to make safer sex-related choices as alcohol may impair condom use decision 32 .…”

“…The interviews also showed that disruptions to distribution of essential commodities also affected condom accessibility at that time. This disruption may increase condomless sex as pre-COVID evidence shows that some members of this study population engage in condomless sex because of some complexities around condom availability and accessibility 32 .…”

“…Theoretically, the study is foregrounded on an interpretivist paradigm and methodologically guided by Interpretative Phenomenological Analysis (IPA) 31 . The research design has been described elsewhere 32 .…”