Diverging trends in US male-female condom use by STI risk factors: a nationally representative study

Sex Transm Infect. 2022 Feb;98(1):50-52. doi: 10.1136/sextrans-2020-054642. Epub 2020 Nov 10.


Objective: Condom use behaviours are proximal to recent STI increases in the USA, yet it remains unclear whether the use of condoms has changed over time among unmarried, non-cohabiting young men who have sex with women (MSW) and how this variability is influenced by STI risk factors.

Methods: To examine condom use over time among MSW aged 15-29, we used three cross-sectional surveys from the 2002, 2006-2010 and 2011-2017 National Survey of Family Growth. We estimated weighted percentages, adjusted prevalence ratios (APRs) and 95% confidence intervals (CI) to assess changes in condom use, stratified by whether MSW reported any STI risk factors in the past 12 months (ie, perceived partner non-monogamy, male-to-male sex, sex in exchange for money or drugs, sex partner who injects illicit drugs, or an HIV-positive sex partner).

Results: We observed a divergence in trends in condom use at last sex between men aged 15 -29 with STI risk factors in the past 12 months and those without such history. We saw significant declines in condom use from 2002 to 2011-2017 among men with STI risk factors (APR=0.80, 95% CI 0.68 to 0.95), specifically among those aged 15-19 (APR=0.73, 95% CI 0.57 to 0.94) or non-Hispanic white (APR=0.71, 95% CI 0.54 to 0.93). In contrast, trends in condom use among men with no STI factors remained stable or increased. Across all time periods, the most prevalent STI risk factor reported was perception of a non-monogamous female partner (23.0%-26.9%). Post-hoc analyses examined whether condom use trends changed once this variable was removed from analyses, but no different patterns were observed.

Conclusions: While STIs have been increasing, men aged 15-29 with STI risk factors reported a decline in condom use. Rising STI rates may be sensitive to behavioural shifts in condom use among young MSW with STI risk factors.

Keywords: condoms; heterosexual; surveillance.

MeSH terms

  • Adolescent
  • Adult
  • Condoms / statistics & numerical data*
  • Condoms / trends*
  • Cross-Sectional Studies
  • Heterosexuality / statistics & numerical data*
  • Humans
  • Male
  • Prevalence
  • Risk Factors
  • Safe Sex
  • Sex Work / statistics & numerical data
  • Sexual Behavior / statistics & numerical data*
  • Sexual Partners
  • Sexually Transmitted Diseases / epidemiology*
  • Sexually Transmitted Diseases / prevention & control
  • Sexually Transmitted Diseases / transmission*
  • United States
  • Young Adult