Asking Only “Did You Use a Condom?” Underestimates the Prevalence of Unprotected Sex Among Perinatally HIV Infected and Perinatally Exposed But Uninfected Youth

Abstract

Among young adults who use condoms, incomplete condom use (putting a condom on after beginning or taking a condom off before finishing sex) and condom failure (condom breaking or slipping off during sex) are common. Therefore, sexual behavior surveys that ask only if a condom was used are likely to underestimate the actual prevalence of unprotected sex. This study examined data from 135 sexually active perinatally HIV-infected (PHIV+) youth and perinatally exposed but uninfected (PHIV−) youth, ages 13 to 24. Participants were asked whether they used a condom on their first and their most recent occasion of vaginal sex. Youth who reported using a condom were asked a follow-up question about whether there was any time during that occasion when sex was not protected by a condom. This follow-up question identified additional participants— almost double the proportions who initially said they did not use a condom—who had unprotected sex. Incomplete condom use was similar among PHIV+ and PHIV−youth, boys and girls, Latinos and African Americans, and younger and older youth. These findings illustrate the importance of asking specifically about whether any unprotected behavior occurred from start to finish of sex to achieve more valid estimates of sexual risk behavior.

Acknowledgments

This research was supported by a grant from the National Institute of Mental Health (R01MH069133; Principal Investigator: Claude Ann Mellins, Ph.D.). The HIV Center for Clinical and Behavioral Studies is supported by a center grant from the National Institute of Mental Health (P30MH43520; Principal Investigator: Robert H. Remien, Ph.D.). Katherine S. Elkington's effort on this project was supported by a Career Development Award from the National Institute of Mental Health (grant number K01MH089832). We wish to thank Drs. Heino Meyer-Bahlburg and Theresa Exner and the interviewers and staff who provided guidance in the development of the sexual behavior interview. We also especially thank the youth who participated in this study.

Notes

^a A total of 18 mixed (African American and Latino) and 2 “other” race/ethnicity youth were excluded from these results.

^b Example from boys’ version/first vaginal sex occasion: First question = “Did you wear a condom the first time you had vaginal sex?” Follow-up question = “The first time you had vaginal sex, did you ever have your penis in the girl's vagina when you were not wearing a condom?”.