Condom-related problems among a racially diverse sample of young men who have sex with men

HIV prevalence remains disproportionately high among men who have sex with men (MSM) [1]. Young MSM (YMSM) exhibit particularly high HIV prevalence and are one of the few populations to demonstrate recent increases in their HIV infection rate [1]. Racial disparities in HIV prevalence exist among YMSM; African Americans have a higher prevalence than non-African Americans [1]. This is despite an increasing body of evidence that indicates African American YMSM engage in HIV transmission behaviors such as unprotected anal intercourse and drug use prior to sex at similar or lower rates than other YMSM [2, 3]. Researchers have not reconciled how African American YMSM have higher HIV rates yet lower HIV transmission risk behavior rates, compared to other YMSM. One potential and unexplored explanation for this phenomenon is that African American YMSM may engage in safe sexual practices like condom use at similar levels as other YMSM, but that African American YMSM experience more condom errors and related problems than their counterparts. Common condom errors include not checking the condom package for damage before use, not leaving space at the end of the condom when placing it on the penis, and incomplete usage – putting the condom on after sex begins or taking the condom off before sex ends [4]. Research indicates that among non-YMSM populations, making condom errors can lead to condom failures, i.e., the condom breaking during sex or slipping off during or after sex [5]. Among African American males, erection problems during protected sex also may relate to condom removal and unprotected sex [6]. Nonetheless, the relationship between HIV risk and condom errors, failures, and erection-problems has not been explored in a racially diverse sample of YMSM. This study has two goals. First, we aim to report the frequency of condom errors, and to characterize the relationship between condom errors and failures, in a racially diverse sample of YMSM. Second, we aim to test racial differences in condom-related problems as an explanation for racial disparities in HIV rates among YMSM. We hypothesize that African American YMSM will experience condom errors and failures more frequently than non-African American YMSM. Results will indicate to what extent behavioral interventions should focus on correct condom use as an effective HIV prevention mechanism among YMSM.