Desire to Father a Child and Condom Use: A Study of Young Black Males at Risk of Sexually Transmitted Infections

Abstract

Purpose: In the U.S., young Black males (YBM) continue to be disproportionally likely to acquire sexually transmitted infections (STIs) and Human Immunodeficiency Virus (HIV). Condom use is the primary public health strategy to prevent these infections. However, condom use is antithetical to conception of a child; thus desire to father a child or perception of partners' desire may be a primary barrier to STI/HIV protection. While an unavoidable reality when partners mutually desire conception, a very different situation exists when desire is not mutual.We examined whether malereported discrepant desire to conceive was associated with elevated rates of unprotected vaginal sex (UVS) among a sample of YBM at high risk of STI/HIV acquisition. Methods: Young Black males 15-23 years of age experiencing recent penile-vaginal sex were recruited from STI clinics in three U.S. cities for an NIH-funded randomized controlled trial of a safer sex intervention program. Baseline datawere used for this analysis. An audio survey was administered which assessed condom use behaviors, participants' desire, and perceptions of partners' desire, for pregnancy. The correlate (Pregnancy Desire) was created by combining items into a trichotomy (No Desire, Discrepant Desire, Mutual Desire). Bivariate associations between the trichotomy and two dichotomous outcomes (any UVS and any condom breakage) and two continuous-level outcomes (frequency of UVS and proportion of condom-protected penile-vaginal sexual encounters) were detected using Chi-Square and one-way ANOVA respectively. Multiple logistic regressionwas used to calculate odds ratios for the association of the trichotomy with dichotomous outcomes, adjusted for age and report of multiple sex partners. Multiple linear regression models were used to calculate age-adjusted, and multiple partner-adjusted, Beta values for each of the assessed correlations. Results: "No Desire" to conceive was associated with significant differences in UVS, condom breakage, frequency of UVS and condom usage compared to each of the other groups. Logistic regression demonstrated any UVS was 2.81 times more likely amongst Mutual Desire and 1.85 times more likely amongst Discrepant Desire Groups compared to the No Desire Group. Multiple linear regression models controlling for age and multiple sex partners demonstrated a positive significant Beta for frequency of UVS and negative significant Beta for proportion of condom use suggesting the proportion of condom use increases as group membership progresses from Mutual Desire to No Desire. Conclusions: Findings from this study of 578 YBM attending STD clinics support the concept that YBM trying to conceive or who perceive somebody wants to be pregnant with their child are relatively unlikely to use condoms, despite STI/HIV risks. In planning public health interventions consideration must be given to the outcomes demonstrating YBM may be both yielding to or disregarding the desires of their female sex partners regarding conception. This suggest a potentially beneficial behavioral intervention model to avert HIV/STI acquisition amongst YBM may be dual-prevention, structurally addressing motives for and perceptions about conceptionwiththe necessity of protecting ahigh-riskpopulationagainst an ever-expanding epidemic of STIs, including HIV.