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Health, Trust, or “Just Understood”: Explicit and Implicit Condom Decision-Making Processes Among Black, White, and Interracial Same-Sex Male Couples

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Abstract

Among gay and bisexual men, primary partners are a leading source of HIV infection. Trust, intimacy, and advancements in HIV treatment may impact same-sex male (SSM) couples’ decisions to engage in unprotected anal intercourse (UAI). This qualitative study explored how Black, White and interracial couples discussed, and made decisions regarding condoms. Qualitative interviews were conducted with 48 SSM couples in the New York and San Francisco metropolitan areas. Stratified purposive sampling was used to include Black (n = 16), White (n = 17), and interracial (Black–White) (n = 15) couples. Twenty-six couples were concordant HIV-negative and 22 were HIV-discordant. Interviews were recorded, transcribed, coded, and analyzed using a grounded theory approach. Some couples described explicit processes, which involved active discussion, while others described implicit processes, where condom-use decisions occurred without any explicit discussion. These processes also differed by race and HIV status. Black couples tended to report condom-use as “just understood.” White, HIV-discordant couples decided not to use condoms, with some identifying the HIV-positive partner’s suppressed viral load and high CD4 count as deciding factors. After an unplanned episode of UAI, White, HIV-negative couples tended to discontinue condom use while Black HIV-negative couples decided to revert to using condoms. HIV prevention efforts focused on same-sex, male couples must consider the explicit/implicit nature of condom decision-making processes. Understanding differences in these processes and considering relationship dynamics, across race and HIV status, can promote the development of innovative couple-level, HIV prevention interventions.

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Notes

  1. Interview questions are available from the corresponding author upon request.

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Acknowledgments

The authors extend their thanks to the participants for their time and effort and to the Research Assistants Carla Garcia, Sean Arayasirikul, H. Lenn Keller, Pamela Valera, Anthony Morgan, Allison Hamburg, and Terry Dyer for their work recruiting, scheduling, and interviewing participants. This research was supported by Grant R01 #MH089276 from the National Institute of Mental Health.

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Authors and Affiliations

  1. Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Market Street, Suite 523, San Francisco, CA, 94103, USA

    Chadwick K. Campbell, Anu Manchikanti Gómez, Jaih McReynolds & Colleen Hoff

  2. Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA

    Shari Dworkin

  3. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA

    Patrick A. Wilson & Kirk K. Grisham

  4. Department of Sociology, Vanderbilt University, Nashville, TN, USA

    Peter Vielehr

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  1. Chadwick K. Campbell
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  2. Anu Manchikanti Gómez
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Correspondence to Chadwick K. Campbell.

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Campbell, C.K., Gómez, A.M., Dworkin, S. et al. Health, Trust, or “Just Understood”: Explicit and Implicit Condom Decision-Making Processes Among Black, White, and Interracial Same-Sex Male Couples. Arch Sex Behav 43, 697–706 (2014). https://doi.org/10.1007/s10508-013-0146-5

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