Skip to main content

Advertisement

SpringerLink
Log in

A Mixed-Methods Study of Condom Use and Decision Making Among Adolescent Gay and Bisexual Males

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Young men who have sex with men have the highest rates of new HIV infections in the U.S., but they have been understudied relative to other populations. As a formative step for the development of a text messaging HIV prevention intervention, this mixed methods study aimed to understand how adolescent gay and bisexual males (AGBM) make decisions about condom use and factors that may differ based on age, sexual experience, and rural versus urban residency. Four online, asynchronous focus groups were conducted with 75 14–18 year old AGBM across the U.S. Qualitative analyses uncovered themes related to relationship influences on condom use (e.g. marriage, trust), access issues, and attitudes and experiences that both encouraged as well as discouraged condom use. Mixed methods analyses explored differences between groups in endorsement of themes. For example, younger and sexually experienced participants were more likely to report the cost of condoms was prohibitive and sexually experienced and rural youth were more likely to describe being influenced by emotional aspects of the relationship. These data highlight both opportunities for as well as the importance of tailoring HIV prevention programs for sub-groups of AGBM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Notes

  1. We use the AGBM identifier because this study focuses specifically on adolescent boys that identify as gay, bisexual, or queer. These young men do not need to be sexually active to be involved in the study. However, much of the existing literature focuses on men who have sex with men (MSM) or lesbian, gay, bisexual, and transgender (LGBT) individuals. As such we use these additional identifiers as appropriate to the context of the literature we are describing.

References

  1. Mustanski BS, Newcomb ME, Du Bois SN, Garcia SC, Grov C. HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions. J Sex Res. 2011;48:218–53.

    Article  PubMed  PubMed Central  Google Scholar 

  2. CDC. Vital signs: HIV infection, testing, and risk behaviors among youths—United States. MMWR Morb Mortal Wkly Rep. 2012;61:971–6.

    Google Scholar 

  3. CDC. Compendium of evidence-based HIV prevention interventions. 2013; http://www.cdc.gov/hiv/prevention/research/compendium/rr/index.html. Accessed 10/07/2013.

  4. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363:2587–99.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  5. Hart T, Peterson JL, Community Intervention Trial for Youth Study T. Predictors of risky sexual behavior among young African American men who have sex with men. Am J Public Health. 2004;94:1122–4.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mustanski B, Newcomb ME, Clerkin EM. Relationship characteristics and sexual risk-taking in young men who have sex with men. Health Psychol. 2011;30:597–605.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Thiede H, Valleroy LA, MacKellar DA, et al. Regional patterns and correlates of substance use among young men who have sex with men in 7 US urban areas. Am J Public Health. 2003;93:1915–21.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bingham TA, Harawa NT, Johnson DF, Secura GM, MacKellar DA, Valleroy LA. The effect of partner characteristics on HIV infection among African American men who have sex with men in the Young Men’s Survey, Los Angeles, 1999–2000. AIDS Educ Prev. 2003;15:39–52.

    Article  PubMed  Google Scholar 

  9. Miller RL, Reed SJ, McNall MA, Forney JC. The effect of trauma on recent inconsistent condom use among young black gay and bisexual men. J HIV/AIDS Soc Serv. 2013;12:349–67.

    Article  Google Scholar 

  10. Dudley MG, Rostosky SS, Korfhage BA, Zimmerman RS. Correlates of high-risk sexual behavior among young men who have sex with men. AIDS Educ Prev. 2004;16:328–40.

    Article  PubMed  Google Scholar 

  11. Shafii T, Stovel K, Davis R, Holmes K. Is condom use habit forming? Condom use at sexual debut and subsequent condom use. Sex Transm Dis. 2004;31:366–72.

    Article  PubMed  Google Scholar 

  12. Robertson A, Levin ML. AIDS knowledge, condom attitudes, and risk-taking sexual behavior of substance-abusing juvenile offenders on probation or parole. AIDS Educ Prev. 1999;11:450–61.

    PubMed  CAS  Google Scholar 

  13. Lawrence JS, Scott CP. Examination of the relationship between African American adolescents’ condom use at sexual onset and later sexual behavior: implications for condom distribution programs. AIDS Educ Prev. 1996;8:258–66.

    PubMed  CAS  Google Scholar 

  14. Hendriksen ES, Pettifor A, Lee SJ, Coates TJ, Rees HV. Predictors of condom use among young adults in South Africa: the Reproductive Health and HIV Research Unit National Youth Survey. Am J Public Health. 2007;97:1241–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Shafii T, Stovel K, Holmes K. Association between condom use at sexual debut and subsequent sexual trajectories: a longitudinal study using biomarkers. Am J Public Health. 2007;97:1090–5.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hatzenbuehler ML. Social factors as determinants of mental health disparities in LGB populations: implications for public policy. Soc Issues Policy Rev. 2010;4:31–62.

    Article  Google Scholar 

  17. Poon CS, Saewyc EM. Out yonder: sexual-minority adolescents in rural communities in British Columbia. Am J Public Health. 2009;99:118–24.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hall HI, Li J, McKenna MT. HIV in predominantly rural areas of the United States. J Rural Health. 2005;21:245–53.

    Article  PubMed  Google Scholar 

  19. D’Augelli AR. Coming out in community psychology: personal narrative and disciplinary change. Am J Community Psychol. 2003;31:343–54.

    Article  PubMed  Google Scholar 

  20. D’Augelli AR, Hart MM. Gay women, men, and families in rural settings: toward the development of helping communities. Am J Community Psychol. 1987;15:79–93.

    Article  PubMed  Google Scholar 

  21. Oswald RF, Culton LS. Under the rainbow: rural gay life and its relevance for family providers. Fam Relat. 2003;52:72–81.

    Article  Google Scholar 

  22. Stroup J, Glass J, Cohn TJ. The adjustment to U.S. rural college campuses for bisexual students in comparison to gay and lesbian students: an exploratory study. J Bisex. 2014;14:94–109.

    Article  Google Scholar 

  23. Bell J. Why embarrassment inhibits the acquisition and use of condoms: a qualitative approach to understanding risky sexual behaviour. J Adolesc. 2009;32:379–91.

    Article  PubMed  Google Scholar 

  24. Garside R, Ayres R, Owen M, Pearson VA, Roizen J. Anonymity and confidentiality: rural teenagers’ concerns when accessing sexual health services. J Fam Plann Reprod Health Care. 2002;28:23–6.

    Article  PubMed  Google Scholar 

  25. Mustanski B. Ethical and regulatory issues with conducting sexuality research with LGBT adolescents: a call to action for a scientifically informed approach. Arch Sex Behav. 2010;40:673–86.

    Article  Google Scholar 

  26. Mustanski B, Newcomb M, Garofalo R. Mental health of lesbian, gay, and bisexual youth: a developmental resiliency perspective. J Gay Lesbian Soc Serv. 2011;23:204–25.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Patton MQ. Qualitative research & evaluation methods. 3rd ed. Thousand Oaks: Sage Publications; 2001.

    Google Scholar 

  28. Hadden L, Zdeb M. A well-kept SAS® secret. 31st Annual SAS® Users Groups International Conference (SUGI 31). San Francisco, CA 2006.

  29. Fisher JD, Fisher WA, Williams SS, Malloy TE. Empirical tests of an information-motivation-behavioral skills model of AIDS-preventive behavior with gay men and heterosexual university students. Health Psychol. 1994;13:238–50.

    Article  PubMed  CAS  Google Scholar 

  30. Dedoose: Web application for managing, analyzing, and presenting qualitative and mixed method data. [computer program]. Version 4.5.91. Los Angeles, CA: SocioCultural Research Consultants, LLC.; 2012.

  31. Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. Chicago: Aldine Publishing Co; 1967.

    Google Scholar 

  32. Carey MA, Smith MW. Capturing the group effect in focus groups: a special concern in analysis. Qual Health Res. 1994;4:123–7.

    Article  Google Scholar 

  33. Ryan GW, Bernard HR. Techniques to identify themes. Field Methods. 2003;15:85.

    Article  Google Scholar 

  34. MacQueen KM, McLellan E, Kay K, Milstein B. Codebook development for team-based qualitative analysis. Field Methods. 1998;10:31.

    Article  Google Scholar 

  35. De Vries H, Elliot MN, Kanouse DE, Teleki SS. Using pooled kappa to summarize interrater agreement across many items. Field Methods. 2008;20:10.

    Article  Google Scholar 

  36. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

    Article  PubMed  CAS  Google Scholar 

  37. Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook. 2nd ed. Thousand Oaks: Sage Publications; 1994.

    Google Scholar 

  38. Axinn WG, Pearce LD. Mixed method data collection strategies. Cambridge: Cambridge University Press; 2006.

    Book  Google Scholar 

  39. Boardman F, Griffiths F, Kokanovic R, Potiriadis M, Dowrick C, Gunn J. Resilience as a response to the stigma of depression: a mixed methods analysis. J Affect Disord. 2011;135:267–76.

    Article  PubMed  Google Scholar 

  40. DeHaan S, Kuper LE, Magee JC, Bigelow L, Mustanski BS. The interplay between online and offline explorations of identity, relationships, and sex: a mixed-methods study with LGBT youth. J Sex Res. 2013;50:421–34.

    Article  PubMed  Google Scholar 

  41. Magee JC, Bigelow L, Dehaan S, Mustanski BS. Sexual health information seeking online: a mixed-methods study among lesbian, gay, bisexual, and transgender young people. Health Educ Behav. 2012;39:276–89.

    Article  PubMed  Google Scholar 

  42. Mustanski B, Lyons T, Garcia S. Internet use and sexual health of young men who have sex with men: a mixed-methods study. Arch Sex Behav. 2011;40:289–300.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Diclemente RJ. Predictors of HIV-preventive sexual behavior in a high-risk adolescent population: the influence of perceived peer norms and sexual communication on incarcerated adolescents’ consistent use of condoms. J Adolesc Health. 1991;12:385–90.

    Article  PubMed  CAS  Google Scholar 

  44. Pedlow CT, Carey MP. Developmentally appropriate sexual risk reduction interventions for adolescents: rationale, review of interventions, and recommendations for research and practice. Ann Behav Med. 2004;27:172–84.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Mustanski B, Newcomb ME, DuBois SN, Garcia SC, Grov C. HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions. J Sex Res. 2011;48:218–53.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Ronis ST, LeBouthillier DM. University students’ attitudes toward purchasing condoms. Can J Hum Sex. 2013;22:86–94.

    Article  Google Scholar 

  47. Burke RC, Wilson J, Bernstein KT, et al. The NYC condom: use and acceptability of New York City’s branded condom. Am J Public Health. 2009;99:2178–80.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Cohen DA, Farley TA, Bedimo-Etame JR, et al. Implementation of condom social marketing in Louisiana, 1993 to 1996. Am J Public Health. 1999;89:204–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  49. Cohen D, Scribner R, Bedimo R, Farley TA. Cost as a barrier to condom use: the evidence for condom subsidies in the United States. Am J Public Health. 1999;89:567–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  50. CDC. High-impact HIV prevention: CDC’s approach to reducing HIV infections in the United States: Centers for Disease Control and Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Division of HIV/AIDS Prevention; 2011.

  51. Newcomb ME, Ryan DT, Garofalo R, Mustanski B. The effects of sexual partnership and relationship characteristics on three sexual risk variables in young men who have sex with men. Arch Sex Behav. 2014;43:61–72.

    Article  PubMed  Google Scholar 

  52. Choi KH, Han CS, Hudes ES, Kegeles S. Unprotected sex and associated risk factors among young Asian and Pacific Islander men who have sex with men. AIDS Educ Prev. 2002;14:472–81.

    Article  PubMed  Google Scholar 

  53. Hart T, Peterson JL, Community Intervention Trial for Youth Study Team. Predictors of risky sexual behavior among young African American men who have sex with men. Am J Public Health. 2004;94:1122–4.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Stueve A, O’Donnell L, Duran R, San Doval A, Geier J. Being high and taking sexual risks: findings from a multisite survey of urban young men who have sex with men. AIDS Educ Prev. 2002;14:482–95.

    Article  PubMed  Google Scholar 

  55. Davidovich U, de Wit JB, Stroebe W. Behavioral and cognitive barriers to safer sex between men in steady relationships: implications for prevention strategies. AIDS Educ Prev. 2004;16:304–14.

    Article  PubMed  Google Scholar 

  56. Theodore PS, Duran RE, Antoni MH, Fernandez MI. Intimacy and sexual behavior among HIV-positive men-who-have-sex-with-men in primary relationships. AIDS Behav. 2004;8:321–31.

    Article  PubMed  Google Scholar 

  57. Zea MC, Reisen CA, Poppen PJ, Bianchi FT. Unprotected anal intercourse among immigrant Latino MSM: the role of characteristics of the person and the sexual encounter. AIDS Behav. 2009;13:700–15.

    Article  PubMed  PubMed Central  Google Scholar 

  58. CDC. Prevalence and awareness of HIV infection among men who have sex with men: 21 cities, United States. MMWR Morb Mortal Wkly Rep. 2008;2010(59):1201–7.

    Google Scholar 

  59. Stephenson R, Sullivan PS, Salazar LF, Gratzer B, Allen S, Seelbach E. Attitudes towards couples-based HIV testing among MSM in three US cities. AIDS Behav. 2011;15(Suppl 1):S80–7.

    Article  PubMed  PubMed Central  Google Scholar 

  60. CDC. Couples HIV Testing and Counseling. 2013; https://www.effectiveinterventions.org/en/HighImpactPrevention/PublicHealthStrategies/CHTC.aspx. Accessed 10 Jan 2014.

  61. Brown LK, DiClemente R, Crosby R, et al. Condom use among high-risk adolescents: anticipation of partner disapproval and less pleasure associated with not using condoms. Public Health Rep. 2008;123:601–7.

    PubMed  PubMed Central  Google Scholar 

  62. Randolph ME, Pinkerton SD, Bogart LM, Cecil H, Abramson PR. Sexual pleasure and condom use. Arch Sex Behav. 2007;36:844–8.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Albarracin D, Ho RM, McNatt PS, et al. Structure of outcome beliefs in condom use. The Project RESPECT Study Group. Health Psychol. 2000;19:458–68.

    Article  PubMed  CAS  Google Scholar 

  64. Choi KH, Rickman R, Catania JA. What heterosexual adults believe about condoms. N Engl J Med. 1994;331:406–7.

    Article  PubMed  CAS  Google Scholar 

  65. Tanner WM, Pollack RH. The effect of condom use and erotic instructions on attitudes toward condoms. J Sex Res. 1988;25:537–41.

    Article  Google Scholar 

  66. WHO. Defining sexual health: Report of a technical consultation on sexual health. 2006; http://www.who.int/reproductivehealth/publications/general/lancet_1.pdf. Accessed 13 Jan 2014.

  67. Mustanski B, Greene GJ, Ryan D, Whitton SW. Feasibility, acceptability, and initial efficacy of an online sexual health promotion program for LGBT youth: The Queer Sex Ed intervention. J Sex Res 2014. doi:10.1080/00224499.2013.867924.

  68. Duncan C, Miller DM, Borskey EJ, Fomby B, Dawson P, Davis L. Barriers to safer sex practices among African American college students. J Natl Med Assoc. 2002;94:944–51.

    PubMed  PubMed Central  Google Scholar 

  69. Grossman C, Hadley W, Brown LK, et al. Adolescent sexual risk: factors predicting condom use across the stages of change. AIDS Behav. 2008;12:913–22.

    Article  PubMed  Google Scholar 

  70. Thompson SC, Kyle D, Swan J, Thomas C, Vrungos S. Increasing condom use by undermining perceived invulnerability to HIV. AIDS Educ Prev. 2002;14:505–14.

    Article  PubMed  Google Scholar 

  71. Frasca T, Ventuneac A, Balan I, Carballo-Dieguez A. Inner contradictions among men who bareback. Qual Health Res. 2012;22:946–56.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Dufour A, Alary M, Otis J, et al. Correlates of risky behaviors among young and older men having sexual relations with men in Montreal, Quebec, Canada. Omega Study Group. J Acquir Immune Defic Syndr. 2000;23:272–8.

    Article  PubMed  CAS  Google Scholar 

  73. Gruber E, Chambers CV. Cognitive development and adolescent contraception: integrating theory and practice. Adolescence. 1987;22:661–70.

    PubMed  CAS  Google Scholar 

  74. Elkind D. Egocentrism in adolescence. Child Dev. 1967;38(4):1025–34.

    Article  PubMed  CAS  Google Scholar 

  75. Pequegnat W. Family and HIV/AIDs: cultural and contextual issues in prevention and treatment. New York: Springer; 2011.

    Google Scholar 

  76. Mustanski B, Hunter J. Parents as agents of HIV prevention for gay, lesbian, and bisexual youth. In: Pequegnat W, Bell C, editors. Family and HIV/AIDS: cultural and contextual issues in prevention and treatment. New York: Springer; 2011 Chapter 12.

    Google Scholar 

  77. Garofalo R, Mustanski B, Donenberg G. Parents know and parents matter; is it time to develop family-based HIV prevention programs for young men who have sex with men? J Adolesc Health. 2008;43:201–4.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Mustanski B, Newcomb M, Garofalo R. Mental health of lesbian, gay, and bisexual youth: a developmental resiliency perspective. J Gay Lesbian Soc Serv. 2011;23:204–25.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Garofalo R, Herrick A, Mustanski BS, Donenberg GR. Tip of the iceberg: young men who have sex with men, the Internet, and HIV risk. Am J Public Health. 2007;97:1113–7.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Fox FE, Morris M, Rumsey N. Doing synchronous online focus groups with young people: methodological reflections. Qual Health Res. 2007;17:539–47.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was funded by a Grant from the National Institute of Mental Health at the National Institutes of Health (R01MH096660; PIs: Mustanski and Ybarra). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We thank our two study consultants, Drs. Sheana Bull and Jeffrey Parsons, for their feedback on the design of the study.

Author information

Authors and Affiliations

  1. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Suite 2700, Chicago, IL, 60611, USA

    Brian Mustanski & L. Zachary DuBois

  2. Center for Innovative Public Health Research, San Clemente, CA, USA

    Tonya L. Prescott & Michele L. Ybarra

Authors
  1. Brian Mustanski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Zachary DuBois
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tonya L. Prescott
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michele L. Ybarra
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian Mustanski.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mustanski, B., DuBois, L.Z., Prescott, T.L. et al. A Mixed-Methods Study of Condom Use and Decision Making Among Adolescent Gay and Bisexual Males. AIDS Behav 18, 1955–1969 (2014). https://doi.org/10.1007/s10461-014-0810-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-014-0810-3

Keywords

Search

Navigation