Men in stable relationships use condoms less, study finds

A study focusing on the sexual behavior of Brazilian cisgender men reveals important aspects of their perception of condom use. Published in June in the journal Ciência & Saúde Coletiva , the study was conducted by researchers from Minas Gerais and Rio Grande do Sul.

The team analyzed the responses given by 30,000 sexually active men, collected from the 2019 National Health Survey (PNS) . Produced by the Brazilian Institute of Geography and Statistics (IBGE) in partnership with the Ministry of Health, the survey allowed for cross-referencing data on the declaration of condom use, the diagnosis of STIs and the sexual orientation declared by the individuals.

The results reveal that only 25.7% of heterosexuals used a condom during all sexual intercourse in the last year. Among gay and bisexual men, this figure was 56.3%. In the case of their most recent sexual encounter, while 80.5% of same-sex individuals reported using a condom during sexual activity, only 41.1% of heterosexual men did so.

Among participants living with a partner, the team found that 37.9% of men who identify as homosexual or bisexual use condoms regularly. Among those who do not live with a partner, this percentage was 62.4%. The pattern also applies to heterosexuals: only 13.4% of those living with a partner use condoms, compared to 57% of those who do not live with a partner.

For the authors, these results offer new perspectives for updating existing prevention programs to reach an even larger population. "Our goal was to deconstruct the idea of 'risk groups,' indicating that the context in which individuals are inserted is more important for thinking about prevention than belonging to a particular sexual orientation group," says researcher Flávia Pilecco, first author of the study and a professor at the Federal University of Minas Gerais (UFMG). "It is essential that public policies encourage discussions about negotiating condom use in stable homosexual/bisexual and heterosexual relationships."

Out of the stereotype

At the height of the human immunodeficiency virus (HIV) epidemic in the 1980s and 1990s, gay and bisexual men were considered "at-risk" for this and other sexually transmitted infections. This made them targets of condom use campaigns promoted by national prevention programs.

But it also reinforced the stigma that they were the only victims of these diseases. "As we showed in our study, condom use may not necessarily be associated with the subjects' sexual orientation, but rather with the type of relationship they are in," Pilecco emphasizes.

Previous research has observed that couples who move in together often choose to forgo condoms. "This occurs both because of a reduced concern about STIs, due to trust in the exclusivity pact of monogamous relationships, and because of an attempt to seek more pleasure in relationships," analyzes urologist Daniel Zylbersztejn, from Einstein Hospital Israelita.

Although some men claim that condoms reduce sensitivity during sex, there are now several product options on the Brazilian market, including thinner ones. "These condoms provide an experience very similar to that of unprotected sex, so much so that many report not even feeling the presence of the condom during intercourse," Zylbersztejn emphasizes.

Imbalance in prevention campaigns

In the Brazilian survey, one finding that remained relevant even after all adjustments for cohabitation concerns reported STI diagnoses in the last year. Gay and bisexual men reported infections at a rate almost ten times higher than straight men—6% versus 0.5%, respectively.

This result raised the hypothesis that, in addition to greater exposure to specific risks, this population also undergoes more routine testing (such as rapid tests for HIV, syphilis, and hepatitis), which increases the chance of detecting an infection. Among heterosexuals, the feeling of not being at risk may lead to low uptake of testing, contributing to possible underreporting of cases.

"There are no testing and counseling policies aimed at heterosexual men, and this is a very important gap," observes Flávia Pilecco. "In another qualitative study I participated in, we found that men who identify as heterosexual only test for HIV when they believe they have been exposed to the virus, during blood donation screening or during prenatal care and testing of their partners."

In Daniel Zylbersztejn's view, it's necessary to expand communication about condom use beyond specific groups. "I believe that perhaps the best way to ensure the entire population is protected against infections is to invest in niche campaigns for each sexual group," assesses the Einstein urologist. "This strategy would allow us to use images and jargon that make sense for each group, thus ensuring that the message truly reaches the target audience."

For the study's author, the ideal would be to invest in strategies that speak to all citizens, adapting them to the population's diverse social and cultural contexts. "For us [ the study's authors ], everyone should be covered by health actions, respecting their specificities," says Flávia Pilecco.

Another important measure would be to encourage men to take care of their own health from an early age. Just as girls are encouraged to see a gynecologist, boys should be taken to a trusted urologist or general practitioner. "We have all the necessary materials in our offices to explain the importance of safe sex and how to practice it," assures Zylbersztejn.

Source: Einstein Agency

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