PREVALENCE AND REASONS FOR DELAYED APPLICATION OF CONDOMS DURING RECEPTIVE ANAL SEX AMONG MEN WHO HAVE SEX WITH MEN (MSM): RESULTS FROM THE POLARIS HIV SEROCONVERSION STUDY

L Calzavara^1,2, A Burchell¹, RS Remis^1,2, C Major³, W Medved¹, P Corey², T Myers^1,2, P Millson^1,2, E Wallace³, Polaris Study Team
¹HIV Social, Behavioural and Epidemiological Studies Unit, Faculty of Medicine, University of Toronto; ²Department of Public Health Sciences, Faculty of Medicine, University of Toronto; ³Ontario Ministry of Health and Long Term Care

Objectives: In our study, delayed application of condoms for receptive anal sex (RAS) was found to be an important predictor of HIV infection among MSM. The objective of the present analysis was to explore the prevalence and correlates of this behaviour.
Methods: Recent seroconverters (cases) were determined based on HIV test results. Cases were asked about behaviour in the time period of infection (median 6 months, range 3-27 months). Controls were asked about an equivalent time period. A subsample of 181 MSM (62 cases and 119 controls) interviewed as of June 2001 was analysed. Quantitative and qualitative methods were used to examine characteristics and correlates of delayed application of condoms for RAS.
Results: RAS was practiced by 90% of cases and 71% of controls (p=0.003). Among men who had RAS (n=146), the partners of 84% of cases and 81% of controls used condoms at least once. Among men who had RAS with condoms (n=122), more cases reported the delayed application of condoms than controls (46% vs 16%, p=0.0002). Among these 122 men, marginally significant correlates of this behaviour included use of poppers (40% vs 18%, p=0.01), problems with alcohol/drugs (43% vs 26%, p=0.10), and meeting a partner in a bathhouse or sex club (36% vs 21%, p=0.08). Qualitative analysis (N=17) revealed that delayed application was related to “heat of the moment”, particularly while under the influence of alcohol/drugs, the perception that pre-ejaculate poses no or minimal risk, and the perception that early penetration poses no risk since rectal trauma/rough sex is necessary for HIV transmission.
Conclusions: Delayed application of condoms during RAS is common among MSM in this study, particularly among those who seroconvert. Prevention messages are urgently needed to dispell myths and reinforce the importance of applying the condom before penetration.