Minorities, Women Who Lack Influence on Partner Often Fail to Use Condom

The behavioral psychological and social factors which influence condom use by heterosexual men and women were studied in 136 men and 164 women who were screened at a public sexually transmitted disease (STD) clinic in San Francisco California between October 1 and December 31 1989. The patients were aged 18-64 years and reported that they had engaged in heterosexual intercourse within the past 2 months. 57% of the men and 51% of the women were Black or Hispanic; 46% of the patients had an annual income below US $5000; 51% of the men and 64% of the women had a history of STDs; and 47% of the subjects were diagnosed with an STD on the interview day. 40% thought their sex behavior put them at risk for HIV infection but 69% of the men and 57% of the women believed that their partners were not likely to carry the disease. The subjects were very knowledgeable about HIV transmission and the role of condoms in preventing the spread of the disease. 97% had used a condom at least once 82% in the previous year and 60% in the past 2 months but only 25% used a condom during their most recent intercourse (16% of Black 13% of Hispanic and 37% of White subjects a statistically significant difference which remained after control for income and education). 29% of men and 32% of women reported difficulty discussing condom use with a partner. 40% of men and 35% of women said it was difficult to tell a partner they would not have sex without a condom. 79% of men and 56% of women reported that condom use diminished sexual pleasure. When subjects reported recent intercourse with both a steady and a casual partner men were just as likely to use a condom with one as with the other but women were more likely to use a condom with a casual partner. All subjects were more likely to have used drugs or alcohol with a casual than with a steady partner. Among men drug and alcohol use were more often associated with failure to use a condom as was having a partner who failed to endorse condom use. The independent factors associated with failure to use a condom among women were being Black or Hispanic and having difficulty exerting control over condom use. Factors of borderline significance were having a steady partner at most recent intercourse and believing that condoms decrease pleasure. The lower rate of condom use with a steady partner is disturbing because more than 50% of women reported that their steady partner may be having sex with others. Future educational programs should emphasize the risk of acquiring STDs or HIV infection from a steady partner and should present ways of initiating a discussion on condom use with sexual partners.