Meanings related to condom use and nonuse during anal sex among MSM in Mexico City
F.J. Arellano-Ayala1, B. Allen-Leigh2, G. Núñez-Noriega3, J. Thrasher4
1Clinica Especializada en HIV/AIDS Condesa (Mexico City AIDS Program), Prevention Deparment, Mexico City, Mexico, 2Instituto Nacional de Salud Pública de México, Centro de Salud Poblacional, Mexico City and Cuernavaca, Mexico, Mexico, 3Centro de Investigación en Alimentación y Desarrollo, A.C., Hemosillo, Sonora, Mexico, 4University of South Carolina, Carolina del Sur, United States
Background: Many Latin American countries have concentrated HIV epidemics with high HIV prevalence (16.1% in one meta-analysis) in men who have sex with men (MSM), and this is also true for Mexico. HIV prevention campaigns targeted at MSM in Mexico usually promote risk prevention through condom use, not harm reduction nor do they focus on pleasure or desire. Limited data indicate Mexican MSM do not use condoms consistently. This study aimed to explore meanings related to condom use and nonuse among MSM, linked to both pleasure and risk.
Methods: Nine MSM living in Mexico City who reported being HIV-negative, recruited with respondent-driven sampling, were interviewed during 2009. Audio-taped interviews lasted 30-60 minutes and were analyzed qualitatively with the constant comparative method.
Results: Most men associated condom use during anal sex with pleasure, but some also experienced pleasure during nonuse of condoms while others reported always using condoms but fantasizing about nonuse. Semen exchange during anal or oral sex (necessitating nonuse of condoms) was thought of as pleasurable by some men, although very young men disliked the idea. Some men reported perceiving less risk of HIV infection if their sexual partner appeared physically healthy; the men perceived HIV infection risk as unrelated to their sexual partner's age. The men reported boredom and burnout related to condom use and most spoke of difficulty discussing partners' HIV status.
Conclusions: These findings indicate the need for novel prevention approaches for MSM in Mexico, in addition to increased availability of condoms and lubricants. Also needed are campaigns focusing on pleasure and promotion of prevention and harm reduction strategies that offer an alternative to condom burnout, including pre-exposure prophylaxis, use of lubricants, STD treatment and sexual practices with lower exposure to HIV. In the long term, development of rectal microbicides could also be an option.
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