Condom use philosophy and behaviors among young men who have sex with men: Variations among HIV pre-exposure prophylaxis users and nonusers

Background: In the United States, sexually transmitted infections, particularly HIV, occur at disproportionally high rates among young men who have sex with men (YMSM). Oral pre-exposure prophylaxis (PrEP) is a highly effective in reducing HIV acquisition. Reduction of condom use has been noted among adult populations of MSM using PrEP. However, less is known about PrEP and condom use among YMSM. Purpose: Our objective was to understand condom attitudes/beliefs and behaviors among YMSM in the context of PrEP use and nonuse. Methodological orientation: We conducted qualitative interviews between May and November, 2017 in Boston, MA. All YMSM were HIV-negative by self-report. We purposively sampled youth who used PrEP and those who did not use PrEP. Data were analyzed using content analysis. Sample: The sample consisted of 31 YMSM aged 17-24 years (mean = 21.5 years). Conclusions: Young men who have sex with men provided rich descriptions of their condom-use philosophies and behaviors. Three themes emerged: 1) Different condom philosophies between youth who used PrEP and youth who do not, 2) Inconsistent or absent condom use by PrEP users, and 3) Similar condom behaviors regardless of PrEP use with certain partner types, if low self-efficacy was reported, and when sex occurred during periods of substance use and/or intoxication. Implications for practice: This study provides understanding of YMSM condom decision-making process in the context of PrEP use or nonuse. Findings are useful to inform development and testing of individually tailored interventions for YMSM based on their personal condom-use philosophies and behaviors to improve risk reduction decision making, use of condoms, and PrEP.

Automated summary

Young men who have sex with men provided rich descriptions of their condom-use philosophies and behaviors in the context of PrEP use or nonuse. Three main themes emerged: differences in condom philosophies between youth who used PrEP and those who did not, inconsistent or absent condom use by PrEP users, and similar condom behaviors regardless of PrEP use under certain circumstances. This study can inform development of tailored interventions for YMSM to improve risk reduction decision making and condom/PrEP use.