Skip to main content

Advertisement

Log in

Factors Associated with Condom Use in Anal Intercourse Among Spanish Men Who Have Sex with Men: Proposal for an Explanatory Model

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

Abstract

Men who have sex with men (MSM) account for more than half of the new HIV diagnoses in Spain. This study aims to carry out a descriptive analysis of the sexual practices and frequency of condom use of MSM and identify the variables that explain inconsistent condom use during anal intercourse. The sample consists of 405 men between 18 and 60 years of age (M = 28.94; SD = 9.35). The results indicate that the percentage of consistent condom use is 72.9% for anal intercourse. Lack of risk perception, high self-esteem, and greater sensation-seeking are risk factors for risky sexual behavior. In contrast, high levels of sexual assertiveness and self-efficacy are protective factors. The proposed model explains between 33.8 and 49.2% of the variance. These findings highlight the importance of designing and implementing condom promotion programs for MSM who engage in anal intercourse with specific sections that consider the acquisition of assertive skills and reduce the risks associated with a perceived invulnerability to HIV.

Resumen

Los hombres que tienen sexo con hombres (HSH) constituyen más de la mitad de los nuevos diagnósticos por VIH en España. El objetivo de este estudio es realizar un análisis descriptivo de las prácticas sexuales y la frecuencia de uso del preservativo en HSH e identificar las variables explicativas del uso inconsistente del preservativo en el coito anal. La muestra está formada por 405 hombres con edades comprendidas entre 18 y 60 años (M = 28.94; DT = 9.35). Los resultados indican que el porcentaje de uso sistemático del preservativo es del 72.9% en el coito anal. La ausencia de percepción de riesgo, un elevado nivel de autoestima y una mayor búsqueda de sensaciones sexuales constituyen factores de riesgo para la conducta sexual de riesgo. Por el contrario, altos niveles de asertividad sexual y de autoeficacia son factores de protección. El modelo propuesto explica entre el 33.8% y el 49.2% de la varianza. Estos hallazgos determinan la importancia de diseñar e implementar programas de promoción del uso del preservativo para HSH que practican coito anal con secciones específicas que consideren la adquisición de habilidades asertivas y reduzcan los riesgos asociados a la sensación de invulnerabilidad frente al VIH.

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

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. ECDC. EMIS-2017.The European men-who-have-sex-with-men internet SurveyKey. Findings from 50 countries. Stockholm: European Centre for Disease Prevention and Control; 2019.

  2. Rojo A, Arratibel P, Bengoa R. El VIH en España, una asignatura pendiente. Bilbao: The Institute for Health and Strategy (SiHealth); 2017.

    Google Scholar 

  3. Plan Nacional sobre Sida, Centro Nacional de Epidemiología. Vigilancia Epidemiológica del VIH y sida en España 2018. https://www.mscbs.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/vigilancia/doc/InformeVIH_SIDA_2018_21112018.pdf.

  4. Grulich AE, Zablotska I. Commentary: probability of HIV transmission through anal intercourse. Int J Epidemiol. 2010;39(4):1064–5.

    Article  PubMed  Google Scholar 

  5. Kelley CF, Kraft CS, De Man TJ, Duphare C, Lee H, Yang J, et al. The rectal mucosa and condomless receptive anal intercourse in HIV-negative MSM: implications for HIV transmission and prevention. Mucosal Immunol. 2017;10(4):996–1007.

    Article  CAS  PubMed  Google Scholar 

  6. Koutentakis K, Hoyos J, Rosales-Statkus M, Guerras JM, Pulido J, de la Fuente L, et al. HIV self-testing in Spain: a valuable testing option for men-who-have-sex-with-men who have never tested for HIV. PLoS ONE. 2019;14(2):e0210637.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Becker MH, Maiman LA. Sociobehavioral determinants of compliance with health and medical care recommendations. Med Care. 1975;13(1):10–24.

    Article  CAS  PubMed  Google Scholar 

  8. Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;111(3):455–74.

    Article  CAS  PubMed  Google Scholar 

  9. Arnold EA, Kegeles SM, Pollack LM, Neilands TB, Cornwell SM, Stewart WR, et al. A randomized controlled trial to reduce HIV-related risk in African American men who have sex with men and women: the bruthas project. Prev Sci. 2019;20(1):115–25.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Eaton LA, Kalichman SC, Kalichman MO, Driffin DD, Baldwin R, Zohren L, et al. Randomised controlled trial of a sexual risk reduction intervention for STI prevention among men who have sex with men in the USA. Sex Transm Infect. 2018;94(1):40–5.

    Article  PubMed  Google Scholar 

  11. Li H, Xue L, Tucker JD, Wei C, Durvasula M, Hu W, et al. Condom use peer norms and self-efficacy as mediators between community engagement and condom use among Chinese men who have sex with men. BMC Public Health. 2017;17(1):641.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sullivan S, Stephenson R. Perceived HIV prevalence accuracy and sexual risk behavior among gay, bisexual, and other men who have sex with men in the United States. AIDS Behav. 2018;22(6):1849–57.

    Article  PubMed  Google Scholar 

  13. Khumsaen N, Stephenson R. Beliefs and perception about HIV/AIDS, self-efficacy, and HIV sexual risk behaviors among young Thai men who have sex with men. AIDS Educ Prev. 2017;29(2):175–90.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Jiang H, Chen X, Li J, Tan Z, Cheng W, Yang Y. Predictors of condom use behavior among men who have sex with men in China using a modified information-motivation-behavioral skills (IMB) model. BMC Public Health. 2019;19:261.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Jones J, Tiwari A, Salazar LF, Crosby RA. Predicting condom use outcomes via the information motivation behavioral skills model: an analysis of young black men. Int J Sex Health. 2018;30(1):1–11.

    Article  CAS  Google Scholar 

  16. Ministerio de Sanidad, Servicios Sociales e Igualdad. Encuesta on-line europea para hombres que tienen relaciones sexuales con hombres (EMIS). Resultados en España. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad; 2013.

  17. Crosby R, Mena L, Yarber WL, Graham CA, Sanders SA, Milhausen RR. Condom use errors and problems: a comparative study of HIV-positive versus HIV-negative young Black MSM. Sex Transm Dis. 2015;42(11):634.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W III, Carry M, et al. Using the information-motivation-behavioral skills model to guide the development of an HIV prevention smartphone application for high-risk MSM. AIDS Educ Prev. 2015;27(6):522–37.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Smith NG, Hart TA, Moody C, Willis AC, Andersen MF, Blais M, et al. Project PRIDE: a cognitive-behavioral group intervention to reduce HIV risk behaviors among HIV-negative young gay and bisexual men. Cogn Behav Pract. 2016;23(3):398–411.

    Article  Google Scholar 

  20. Macapagal K, Greene GJ, Andrews R, Mustanski B. Evaluating the relationship-oriented information, motivation, and behavioral skills model of HIV preventive behaviors in young men who have sex with men. AIDS Educ Prev. 2016;28(2):165–79.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Tucker A, Liht J, de Swardt G, Jobson G, Rebe K, McIntyre J, et al. Homophobic stigma, depression, self-efficacy and unprotected anal intercourse for peri-urban township men who have sex with men in Cape Town, South Africa: a cross-sectional association model. AIDS Care. 2014;26(7):882–9.

    Article  PubMed  Google Scholar 

  22. Xu W, Zheng L, Liu Y, Zheng Y. Sexual sensation seeking, sexual compulsivity, and high-risk sexual behaviours among gay/bisexual men in Southwest China. AIDS Care. 2016;28(9):1138–44.

    Article  PubMed  Google Scholar 

  23. Gao M, Xiao C, Cao Y, Yu B, Li S, Yan H. Associations between sexual sensation seeking and AIDS-related knowledge, attitudes and behaviors among young men who have sex with men in China. Psychol Health Med. 2017;22(5):596–603.

    Article  PubMed  Google Scholar 

  24. Gil-Llario MD, Ruiz-Palomino E, Morell-Mengual V, Giménez-García C, Ballester-Arnal R. Validation of the AIDS prevention questionnaire: a brief self-report instrument to assess risk of HIV infection and guide behavioral change. AIDS Behav. 2018;23(1):272–82.

    Article  Google Scholar 

  25. Jiménez-Vázquez V, Onofre-Rodríguez DJ, Benavides-Torres RA. Imagen corporal, búsqueda de sensaciones sexuales y prácticas sexuales más seguras en hombres que tienen sexo con hombres de Nuevo León, México. Salud drogas. 2018;18(2):207–15.

    Google Scholar 

  26. Schnarrs PW, Rosenberger JG, Satinsky S, Brinegar E, Stowers J, Dodge B, et al. Sexual compulsivity, the Internet, and sexual behaviors among men in a rural area of the United States. AIDS Patient Care STDS. 2010;24(9):563–9.

    Article  PubMed  Google Scholar 

  27. Folch C, Fernández-Dávila P, Ferrer L, Soriano R, Díez M, Casabona J. Alto consumo de drogas recreativas y conductas sexuales de riesgo en hombres que tienen relaciones sexuales con hombres. Med Clin. 2015;145(3):102–7.

    Article  Google Scholar 

  28. Tobin KE, Yang C, King K, Latkin CA, Curriero FC. Associations between drug and alcohol use patterns and sexual risk in a sample of African American men who have sex with men. AIDS Behav. 2016;20(3):590–9.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Amola O, Grimmett MA. Sexual identity, mental health, HIV risk behaviors, and internalized homophobia among black men who have sex with men. J Couns Dev. 2015;93(2):236–46.

    Article  Google Scholar 

  30. Træen B, Hald GM, Noor SW, Iantaffi A, Grey J, Rosser BRS. The relationship between use of sexually explicit media and sexual risk behavior in men who have sex with men: exploring the mediating effects of sexual self-esteem and condom use self-efficacy. Int J Sex Health. 2014;26(1):13–24.

    Article  PubMed  Google Scholar 

  31. Millar BM, Starks TJ, Grov C, Parsons JT. Sexual risk-taking in HIV-negative gay and bisexual men increases with depression: results from a US national study. AIDS Behav. 2017;21(6):1665–75.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Klein H. Condom use self-efficacy and HIV risk practices among men who use the internet to find male partners for unprotected sex. Am J Mens Health. 2014;8(3):190–204.

    Article  PubMed  Google Scholar 

  33. Fletcher JB, Reback CJ. Depression mediates and moderates effects of methamphetamine use on sexual risk taking among treatment-seeking gay and bisexual men. Health Psychol. 2015;34(8):865–9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Crosby RA, Salazar LF, Mena L, Geter A. Associations between internalized homophobia and sexual risk behaviors among young black men who have sex with men. Sex Transm Dis. 2016;43(10):656–60.

    Article  PubMed  Google Scholar 

  35. Holtzman S, Landis L, Walsh Z, Puterman E, Roberts D, Saya-Moore K. Predictors of HIV testing among men who have sex with men: a focus on men living outside major urban centres in Canada. AIDS Care. 2016;28(6):705–11.

    Article  PubMed  Google Scholar 

  36. Gil-Llario MD, Morell-Mengual V, Ruiz-Palomino E, Ballester-Arnal R. Factorial structure and psychometric properties of a brief scale of the condom use self-efficacy for spanish-speaking people. Health Educ Behav. 2019;46(2):295–303.

    Article  PubMed  Google Scholar 

  37. Martín-Albo J, Núñez JL, Navarro JG, Grijalvo F. The Rosenberg Self-Esteem Scale: translation and validation in university students. Span J Psychol. 2007;10(2):458–67.

    Article  PubMed  Google Scholar 

  38. Rosenberg M. Society and the adolescent self-image. Princeton: Princeton University Press; 1965.

    Book  Google Scholar 

  39. Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.

    Article  Google Scholar 

  40. Herrero J, Gracia E. Una medida breve de la sintomatología depresiva (CESD-7). Salud Ment. 2007;30(5):40–6.

    Google Scholar 

  41. Currie MR, Cunningham EG, Findlay BM. The Short Internalized Homonegativity Scale: examination of the factorial structure of a new measure of internalized homophobia. Educ Psychol Meas. 2004;64(6):1053–67.

    Article  Google Scholar 

  42. Morell-Mengual V, Gil-Llario MD, Ballester-Arnal R, Salmerón-Sanchéz P. Spanish adaptation and validation of the Short Internalized Homonegativity Scale (SIHS). J Sex Marital Ther. 2017;43(4):298–305.

    Article  PubMed  Google Scholar 

  43. Morokoff PJ, Quina K, Harlow LL, Whitmire L, Grimley DM, Gibson PR, et al. Sexual Assertiveness Scale (SAS) for women: development and validation. J Pers Soc Psychol. 1997;73(4):790–804.

    Article  CAS  PubMed  Google Scholar 

  44. Sierra JC, Vallejo-Medina P, Santos-Iglesias P. Propiedades psicométricas de la versión española de la Sexual Assertiveness Scale (SAS). An Psicol. 2011;27(1):17–26.

    Google Scholar 

  45. Kalichman SC, Rompa D. Sexual sensation seeking and sexual compulsivity scales: validity, and predicting HIV risk behavior. J Pers Assess. 1995;65(3):586–601.

    Article  CAS  PubMed  Google Scholar 

  46. Ballester-Arnal R, Gómez-Martínez S, Gil-Llario MD, Salmerón-Sánchez P. Sexual compulsivity scale: adaptation and validation in the spanish population. J Sex Marital Ther. 2013;39(6):526–40.

    Article  PubMed  Google Scholar 

  47. Gil-Llario MD, Morell-Mengual V, Giménez-García C, Salmerón-Sánchez P, Ballester-Arnal R. Sexual sensation seeking: a validated scale for Spanish gay, Lesbian and Bisexual People. AIDS Behav. 2018;22(11):3525–34.

    Article  PubMed  Google Scholar 

  48. Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale: Lawrence Erlbaum; 1988.

    Google Scholar 

  49. Ellis PD. The essential guide to effect sizes: statistical power, meta-analysis, and the interpretation of research results. Cambridge: Cambridge University Press; 2010.

    Book  Google Scholar 

  50. Folch C, Fernández-Dávila P, Ferrer L, Soriano R, Díez M, Casabona J. Conductas sexuales de alto riesgo en hombres que tienen relaciones sexuales con hombres según tipo de pareja sexual. Enferm Infecc Microbiol Clin. 2014;32(6):341–9.

    Article  PubMed  Google Scholar 

  51. Noar SM, Carlyle K, Cole C. Why communication is crucial: meta-analysis of the relationship between safer sexual communication and condom use. J Health Commun. 2006;11(4):365–90.

    Article  PubMed  Google Scholar 

  52. Eaton LA, Cherry C, Cain D, Pope H. A novel approach to prevention for at-risk HIV-negative men who have sex with men: creating a teachable moment to promote informed sexual decision-making. Am J Public Health. 2011;101(3):539–45.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Nesoff ED, Dunkle K, Lang D. The impact of condom use negotiation self-efficacy and partnership patterns on consistent condom use among college-educated women. Health Educ Behav. 2016;43(1):61–7.

    Article  PubMed  Google Scholar 

  54. Kelley EL, Orchowski LM, Gidycz CA. Sexual victimization among college women: role of sexual assertiveness and resistance variables. Psychol Violence. 2016;6(2):243–52.

    Article  Google Scholar 

  55. Grov C, Parsons J, Bimbi D. Sexual compulsivity and sexual risk in gay and bisexual men. Arch Sex Behav. 2010;39(4):940–9.

    Article  PubMed  Google Scholar 

  56. Heidinger B, Gorgens K, Morgenstern J. The effects of sexual sensation seeking and alcohol use on risky sexual behavior among men who have sex with men. AIDS Behav. 2015;19(3):431–9.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Vu NTT, Holt M, Phan HTT, La LT, Tran GM, Doan TT, et al. The relationship between methamphetamine use, sexual sensation seeking and condomless anal intercourse among men who have sex with men in Vietnam: results of a community-based, Cross-Sectional Study. AIDS Behav. 2017;21(4):1105–16.

    Article  PubMed  Google Scholar 

  58. Jacques C, García P, Díez E, Martín S, Caylà JA. Explicaciones de las prácticas sexuales de riesgo en hombres que tienen sexo con hombres. Gac Sanit. 2015;29(4):252–7.

    Article  Google Scholar 

  59. Zhang H, Teng T, Lu H, Zhao Y, Liu H, Yin L, et al. Poppers use and risky sexual behaviors among men who have sex with men in Beijing, China. Drug Alcohol Depend. 2016;160:42–8.

    Article  PubMed  Google Scholar 

  60. Newcomb ME, Mustanski B. Moderators of the relationship between internalized homophobia and risky sexual behavior in men who have sex with men: a meta-analysis. Arch Sex Behav. 2011;40(1):189–99.

    Article  PubMed  Google Scholar 

  61. Santos-Iglesias P, Iglesias JC. El papel de la asertividad sexual en la sexualidad humana: una revisión sistemática. Int J Clin Health Psychol. 2010;10(3):553–77.

    Google Scholar 

  62. Passaro RC, Castañeda-Huaripata A, Gonzales-Saavedra W, Chavez-Gomez S, Segura ER, Lake JE, et al. Contextualizing condoms: a cross-sectional study mapping intersections of locations of sexual contact, partner type, and substance use as contexts for sexual risk behavior among MSM in Peru. BMC Infect Dis. 2019;19(1):958.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Danko M, Buzwell S, Earle M. Men at risk of HIV: sexual sensation seeking, sexual compulsivity and sexual risk behavior among Australian MSM who frequently present for post-exposure prophylaxis. Sex Addict Compuls. 2016;23(4):324–41.

    Article  Google Scholar 

  64. Berg RC. Barebacking among MSM Internet users. AIDS Behav. 2008;12(5):822–33.

    Article  PubMed  Google Scholar 

  65. De Santis JP, Colin JM, Provencio Vasquez E, McCain GC. The relationship of depressive symptoms, self-esteem, and sexual behaviors in a predominantly Hispanic sample of men who have sex with men. Am J Mens Health. 2008;2(4):314–21.

    Article  PubMed  Google Scholar 

  66. Klein H, Kaplan RL. Condom use attitudes and HIV risk among American MSM seeking partners for unprotected sex via the Internet. Int Public Health J. 2012;4(4):419.

    PubMed  PubMed Central  Google Scholar 

  67. Elam G, Macdonald N, Hickson F, Imrie J, Power R, McGarrigle CA, et al. Risky sexual behaviour in context: qualitative results from an investigation into risk factors for seroconversion among gay men who test for HIV. Sex Transm Infect. 2008;84(6):473–7.

    Article  CAS  PubMed  Google Scholar 

  68. Instituto Nacional de Estadística. Encuesta sobre Equipamiento y Uso de Tecnologías de Información y Comunicación en los Hogares. https://www.ine.es/prensa/tich_2019.pdf.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. Dolores Gil-Llario.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morell-Mengual, V., Gil-Llario, M.D., Fernádez-García, O. et al. Factors Associated with Condom Use in Anal Intercourse Among Spanish Men Who Have Sex with Men: Proposal for an Explanatory Model. AIDS Behav 25, 3836–3845 (2021). https://doi.org/10.1007/s10461-021-03282-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-021-03282-0

Keywords

Palabras clave

Navigation