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Try out PMC Labs and tell us what you think. Learn More. This study examined reasons for non-use of condoms among an online survey sample of non-condom using MSM to 1 identify major domains, themes and encompassing reasons for non-use of condoms, and 2 examine whether reasons varied by role-in-sex insertive or receptive and meeting venue online or offline. A thematic analysis was completed on participant responses to an open-ended question about reasons for non-condom use. Preference for not using condoms and contextual factors were the top two reasons given for not using condoms, followed by a reasoned judgment based on risk assessment, relationship status and interpersonal communication.

No major differences were found between men Woman wants real sex Rosser reported non-condom use at last receptive and insertive anal intercourse. By contrast when meeting online, men were more likely to report reasons for non-condom use that corresponded to individual preference and mutual agreement not to use condoms.

When meeting offline, men were more likely to cite reasons related to context and relationships. In developing HIV prevention interventions for this population, researchers should address both venues separately, as reasons why men engage in non-use of condoms appear to differ. Sexual risk-taking behaviour, such as engaging in unprotected anal intercourse UAIposes a high risk for contracting HIV.

Although condoms are known to be effective in reducing the risk of transmission, high proportions of MSM continue to report non-use or inconsistent use of condoms Sanchez et al. Given the changing landscape of sexual exchanges e. More recent research also reflects these three. Individual factors are determinants that are unique to each individual, such as demographic characteristics, mental health factors, and personal beliefs about sexual pleasure. Interpersonal factors occur between sexual partners that predict sexual practices, such as relationship status, intimacy issues, and interpersonal communication.

Wolitski and others found that MSM in regular relationships felt a responsibility to protect the health of their partners by practicing safer sex, which may extend to non-primary partners Klausner et al.

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However, other studies associate a heightened level of intimacy in primary relationships with sexual risk-taking behaviour Theodore et al. While individual, interpersonal and situational variables involved in non-condom use have been well-researched in offline studies, they have not been established in online HIV prevention studies.

In addition, two under-researched areas include whether non-use of condoms varies by role-in-sex receptive or insertive and meeting venue online or offline. Increased awareness among MSM of HIV status and variation in risk potentially makes role-in-sex an important factor in decisions about whether to use condoms. Knowledge of this may influence individual perceptions of HIV risk and affect condom use behaviour Parsons et al.

Seeking sex online has been associated with more sexual risk-taking behaviour than seeking sex in traditional venues Benotsch, Kalichman and Cage ; Liau, Millett and Marks ; Rosser et al. Men who seek sex online appear younger, more likely to have a STI, less likely to identify as gay, and more likely to be polysubstance users Grov, Parsons and Bimbi ; Mimiaga et al. Meeting partners online for sex has also been associated with methamphetamine use, higher s of sexual partners, and higher rates of UAI Benotsch, Kalichman and Cage ; Liau, Millett and Marks Other researchers conclude that meeting venue may not be as important in determining risky sexual behaviour as other factors, and that the Internet may have little or no influence Woman wants real sex Rosser UAI Mettey et al.

A further complication is that many MSM may seek sexual partners both online and offline, providing greater opportunity to engage in UAI Horvath, Rosser and Remafedi Given the contradictory evidence there is need for further study of differences in sexual risk-taking behaviour by meeting venue. Our primary aims were to: 1 identify domains, themes, and of reasons for non-use of condoms reported by a large sample of Internet-using MSM, and 2 examine whether reasons varied by two key factors: role-in-sex insertive or receptive and meeting venue online or offline.

We wanted to update understanding of reasons for non-use of condoms among MSM using an online survey, with its practical advantages of greater anonymity, reduced potential for social desirability bias, and recruiting a large sample of men nationally Zhang et al.

Given that research has suggested sexual risk behaviour may be influenced by individual perceptions of HIV risk Parsons et al. We also hoped to advance understanding of online cultures, specifically among men who use the Internet to seek sex with men. Participants ranged in age from 18 to 65 Table 1.

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The sample was racially diverse; most had more than a high school education; 42 9. A full description of study methods is reported elsewhere Rosser et al. To be eligible for participation, individuals needed to identify themselves as male, 18 years or older, living in the USA and having engaged in sex with another man in their lifetime. Eligible participants completed an online survey consisting of up to questions. Data collection occurred between June and September A thematic analysis was completed by hand on responses to the open-ended question.

Separate analyses were performed for each of the four scenarios. Rather than assume an individual, interpersonal and contextual framework, repeating ideas were identified and responses were organised into. In cases where responses contained multiple reasons, each reason was ased to its relevant category. Inter-rater reliability was assessed. A second rater independently coded all responses for each of the four scenarios.

Wide coding discrepancies between raters were discussed until a consensus was reached and codes were revised. Inter-rater agreement was were organised into themes, and themes into domains. These groupings were re-evaluated and finalised. Comparisons were conducted using a content analysis approach which employs counts and percentages to determine the relative importance of statements and ideas. A total of participants provided reasons for non-use of condoms. Most respondents gave a single reason; some provided multiple reasons.

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Responses averaged 15 words and ranged from short two-word expressions to several sentences. Shorter responses were often easier to code than longer responses, which could be complex and coded into more than one category. Responses that were nonsensical e. At the highest level, the three domains common to offline studies also emerged from our data: Individual, Contextual and Interpersonal.

The individual domain had the highest proportion of reasons for non-condom use, followed by the contextual and interpersonal.

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Across the comparisons online vs. UIAIindividual preference and contextual factors were the top two thematic reasons, followed by a reasoned judgment based on risk assessment, relationship status and interpersonal communication. Personal or partner preferences for not using condoms fell into four distinct categorical patterns.

Examples include statements of displeasure with the feel of condoms e. He is able to get there faster without a condom.

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A final category, Sexual difficulty, loss of erection or latex allergywas used to code responses when participants complained of erectile difficulty e. Responses here indicated a reasoned judgement based on factors that participants perceived as lessening their risk of contracting HIV. These responses were often descriptive and complex, offering several reasons why condoms were not used or why it was low risk:.

We have had sex in the past multiple times, I trusted him with being truthful about his HIV status negativeand I know my risk of exposure to HIV infection as an unprotected top is ificantly low. In addition to the fact that I prefer to have sex without using a condom for reason of increased pleasure and sensation. Five distinct emerged.

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Negotiated safety was also observed in some responses e. A second category, HIV positive statusincluded responses that indicated knowledge that both partners were HIV positive e.

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Responses that indicated reliance on withdrawal before ejaculation e. I didnt [ sic ] have anyone to guide me. A third theme within the individual domain we attributed to a small proportion of responses that may suggest less concern over possible long-term effects of HIV or sexually transmitted infections.

Some men were caught up in the moment, situation or mood e. We were being rather rough and wrestling around when he pinned me. Then his penis pressed against my hole and he playfully teased me, before long we were in an all out fuck session. Some respondents referred to an unavailability of condoms e. No real answer I guess.

When we talked on the phone we were all about using protection, but when we got to his bed we were drunk. This theme consists of three. Responses that emphasised Being in a monogamous relationship were separated from those that did not specify an exclusive, committed relationship. Also included are responses about the reciprocity of non-use e. Three comprise this theme. A third category, No discussionincludes cases where condoms were never discussed e. Reasons that pertained to love, mutual affection, attraction, desire and fantasy appear uncategorised under this theme as no clear breakdown emerged.

Probably because he stated that he enjoyed it better without a condom, and I was in love with him, so I allowed him to do it without a condom. There is a heightened sensation without a condom, so it is better enjoyed by both partners, it is a more intimate act. There were no statistically ificant differences in reasons for non-use of condoms by sexual role. However, there were ificant differences between reasons among men who first met online versus offline. There were two aims of this study. The first was to identify major reasons for non-use of condoms among MSM.

Our study identified seven thematic reasons which we further collapsed into three domains individual, contextual, interpersonal. The highlight the importance of individual factors in decisions not to use condoms. It is clear that some individuals enter a sexual experience with negative preconceived ideas about condoms based on past experience and personal preference. For others, a reasoned judgment based on perception of risk takes place. In cases where perceived risk is low, harm reduction strategies involving HIV serodisclosure, serosorting, strategic positioning, and negotiated safety are, as reported in other studies, being used instead of condoms Belcher et al.

Contextual factors, such as acting in the heat of the moment, condom availability, and substance use, are also influential and of similar importance to interpersonal factors. A full understanding of the dynamic interplay of reasons that underlie non-use of condoms among MSM will require further research.

HIV prevention interventionists interested in developing inventories of reasons for non-condom use should consider using as their basis, the seven thematic Woman wants real sex Rosser identified in this study, possibly with examples from some of the sub.

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Reasons for Non-use of Condoms among Men-who-have-Sex-with-Men: A Comparison of Receptive and Insertive Role-in-Sex and Online and Offline Meeting Venue