Inconsistent condom use among men who have sex with men in Brazil: the role of trusting the sexual partner.

OBJECTIVE

To analyze the statistical association of trust in a sexual partner and inconsistent condom use among men who have sex with men in Brazil.

METHODS

Data came from a nationwide biological and behavioral surveillance cross-sectional study conducted in 2016 across 12 Brazilian cities with 4,176 men who have sex with men, utilizing respondent-driven sampling. This analysis focused on 2,010 men who have sex with men. We analyzed the data using Poisson Regression with robust standard errors. Weights and design were incorporated.

RESULTS

Almost half of the men who have sex with men had inconsistent condom use during their last anal intercourse (48.9%, n=880). Inconsistent condom use was more prevalent among men who have sex with men who said they accept having sex without using a condom when trusting their sexual partner (84.2%, p<0.0001). Trust in a sexual partner had a strong association with inconsistent condom use during last anal intercourse among all men who have sex with men (adjusted prevalence ratio (PRa) of 1.73, 95%CI 1.25-2.40, p<0.0001). This association remains statistically significant in our stratified analysis among single/separated/widowed men who have sex with men (PRa=1.93, 95%CI 1.44-2.60, p<0.0001) and among men who have sex with men who are married/live together (PRa=1.31, 95%CI 1.11-1.77, p=0.045), indicating that trust can be experienced in different relationship contexts, not only with main or steady partners, such as a husband or boyfriend.

CONCLUSION

Trust plays an important role in sexual behavior among men who have sex with men, and it is related to a higher prevalence of inconsistent condom use. Since the HIV epidemic among men who have sex with men in Brazil appears to be growing, future prevention strategies have to consider this and incorporate trust into counseling actions because trusting relationships also carry a risk of HIV infection.