Condom induced erectile dysfunction (COINED): a unique predictor of deliberate sexual risk
Background: Insight into the predictors of deliberate sexual risk behavior such as barebacking, as opposed to non-deliberate or coincidental risk, has long eluded HIV-prevention. Our aim was to investigate the relationship between condom induced erectile dysfunction (COINED) and deliberate risk behavior with casual and steady partners among men who have sex with men (MSM).
Methods: In total, 435 men of the Amsterdam Cohort Studies among Homosexual Men with a mean of age 34 (SD=7.7, range 18-65) completed questionnaires regarding self-reported COINED, deliberate and non-deliberate risky unprotected anal intercourse (UAI) with casual and steady partners, and intentions to use condoms. COINED was defined as loss of erection because of condom use and was corrected for other types of erectile dysfunctions. Deliberate risk was defined as UAI that was self-reportedly planned in advance. The study design was longitudinal, measuring COINED and intentions at time 1, while UAI was measured six months later at time 2. Multinomial regressions and mediation analyses were performed.
Results: Rates of UAI reached 18% (55/306) with casual partners, and 17% (46/272) with steady partners of discordant or unknown HIV status. 10% (32/306) frequently experienced COINED with casual partners and 7% (19/272) with steady partners. Analysis indicated that COINED was not associated with UAI with steady partners. Among casual partners, COINED was significantly associated with deliberate UAI (OR=6.57, 95%CI 2.14-20.18) but not with non-deliberate UAI. Mediation analysis indicated that intentions to use condoms at time 1 mediated the effect of COINED on deliberate UAI, hence, intentions took over the effect of COINED when placed together in the model to predict UAI.
Conclusions: COINED is a unique predictor of deliberate UAI between casual partners. COINED influences the intentions to use condoms in advance and therefore, traditional, intention-based prevention strategies will probably not be able to address this problem and alternative strategies should be applied.
-Full abstract available at link below-