Background: Condom use remains central to sexually transmitted infections/HIV prevention among gay men and other men who have sex with men (MSM). To support the development of accurate and appropriate interventions, a better understanding is needed as to how the characteristics of a given sexual event differentially influence condom use during anal intercourse.
Methods: Daily diary data were collected from (n = 3877) HIV-negative MSM who were members of several online Web sites facilitating social or sexual interactions with other men. Sexual event-specific factors related to condom use during anal intercourse were evaluated using logistic regression, with generalized estimating equation adjustment for multiple within-participant sexual events (STATA, 10.0; all P < 0.05).
Results: Participants contributed 25,149 behavioral diaries. Of these, men reported 730 (2.9%) acts of anal intercourse as insertive partner and 662 (2.6%) as receptive partner. Condoms were used during 25.5% (n = 184) of insertive events, and 18.8% (n = 125) of receptive events. For both insertive and receptive anal roles, condom use was more likely with casual partners (OR = 4.24–6.59). Positive ratings of sexual pleasure were associated with condom use among men who were the insertive partner during anal intercourse, whereas condom nonuse was significantly related to higher ratings of pleasure among men who were the receptive partner.
Conclusions: Event-level relational and sexual-situational factors predict condom use differently, depending on whether men are the insertive or receptive partner in anal intercourse. Understanding these differences will help clinicians and health educators engage MSM in dialogue to increase condom use in situations where it is warranted.
From the *Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN; †Department of Sociology, Indiana University Purdue University-Indianapolis, Indianapolis, IN; ‡Department of Global and Community Health, George Mason University, Fairfax, VA; §OLB Research Institute, Online Buddies, Inc., Cambridge, MA; and ¶Center for Sexual Health Promotion, Indiana University, Bloomington, IN
Correspondence: Joshua G. Rosenberger, PhD, MPH, Department of Global and Community Health, George Mason University, 4400 University Dr, MSN 5B7, Fairfax, VA 22030. E-mail: firstname.lastname@example.org.
Received for publication October 19, 2011, and accepted February 7, 2012.