A Mixed-Methods Study of Condom Use and Decision Making Among Adolescent Gay and Bisexual Males

Abstract

Young men who have sex with men have the highest rates of new HIV infections in the U.S., but they have been understudied relative to other populations. As a formative step for the development of a text messaging HIV prevention intervention, this mixed methods study aimed to understand how adolescent gay and bisexual males (AGBM) make decisions about condom use and factors that may differ based on age, sexual experience, and rural versus urban residency. Four online, asynchronous focus groups were conducted with 75 14–18 year old AGBM across the U.S. Qualitative analyses uncovered themes related to relationship influences on condom use (e.g. marriage, trust), access issues, and attitudes and experiences that both encouraged as well as discouraged condom use. Mixed methods analyses explored differences between groups in endorsement of themes. For example, younger and sexually experienced participants were more likely to report the cost of condoms was prohibitive and sexually experienced and rural youth were more likely to describe being influenced by emotional aspects of the relationship. These data highlight both opportunities for as well as the importance of tailoring HIV prevention programs for sub-groups of AGBM.

Iteratively Developing an mHealth HIV Prevention Program for Sexual Minority Adolescent Men

“…Qualitative data were analyzed both to increase understanding of sexual health decision making among AGBM, and to develop and revise program content. For example, to examine decision making about condom use, two rounds of constant comparison analysis were applied [25, 31]. Review of transcripts and thematic analyses were used to develop and revise text message content.…”

“…Feedback was also solicited about condom use [25], sexual decision making [26] and the FG experience [25–27], which has been reported elsewhere.…”

Differences in the prevalence of risk behaviors between heterosexual and lesbian, gay, bisexual, and questioning (LGBQ) female adolescents in the juvenile justice system

“…These data also contribute to the literature on differences in risky sexual behaviors between heterosexual and LGBQ youths. The inconsistent use of condoms is concerning given the elevated HIV and STI risk of adolescents and LGBQ youths in particular (Foulkes, Pettigrew, Livingston, & Niccolai, 2009;Kann et al, 2011;Mustanski, Dubois, Prescott, & Ybarra, 2014). This study had several important limitations that warrant further discussion.…”

Future Directions in Research on Sexual Minority Adolescent Mental, Behavioral, and Sexual Health

“…There have been a relatively small number of studies of samples of SM or MSM participants starting at ages 14 or 16 (e.g., D'Augelli, Grossman, & Starks, 2006; Mustanski, DuBois, Prescott, & Ybarra, 2014; Mustanski, Newcomb, & Garofalo, 2011; Mustanski et al, 2010; Newcomb & Mustanski, 2013; Newcomb, Ryan, Garofalo, & Mustanski, 2014; Rosario, Hunter, & Gwadz, 1997), but even fewer that have longitudinally followed adolescents over multiple years to allow for charting of the developmental course of health issues or the identification of predictors of later health issues (e.g., Bauermeister et al, 2010; Newcomb, Heinz, Birkett, & Mustanski, 2014; Newcomb, Ryan, et al, 2014). Some large longitudinal studies of general samples of youth, such as the National Longitudinal Study of Adolescent Health (Add Health) and the Growing Up Today Study (GUTS) , have queried sexual orientation of participants as well.…”