Delayed Application of Condoms With Safer and Unsafe Sex: Factors Associated With HIV Risk in a Community Sample of Gay and Bisexual Men

Delayed condom application (DCA) "has been implicated in HIV transmission among gay and bisexual men," noted the authors. The current study examines the prevalence of DCA in a gay population and explores factors associated with condom use among two groups: those who practice only safer sex and those who report at least some unprotected anal sex.

Data were derived from an anonymous, cross-sectional study of a sample of 5,080 self-identified gay and bisexual men. Multivariate polytomous logistic regressions were used to identify variables associated with DCA among 2,614 men who responded to relevant questions.

Almost half the men reported DCA for insertive anal intercourse in the preceding 12 months. The majority of this group also reported episodes of unprotected anal sex; however, more than 25 percent of those who reported DCA said they engaged only in safer sex practices. Most of the sociodemographic variables found to be associated with unsafe sex in other studies were not found to be associated with DCA. Negative condom use experiences, such as tearing, splitting or slipping, were associated with DCA among the two groups.

"DCA, which may be considered by men as an effective harm reduction strategy, requires attention," the authors concluded. "Interventions to address this behavior need to consider the physical issues of condom use along with the complex array of social, structural, psychological, and interpersonal issues."