"Stealthing": Factors associated with young men's nonconsensual condom removal

How Intimate Partner Violence Is Influenced by Social Identity Among Sexual Minority Men

Purpose: Sexual minority men (SMM) experience intimate partner violence (IPV) at disproportionately high rates. The objective of this article was to identify the experiences of SMM and health care providers on how social identity impacts IPV. Methods: SMM participants (N = 23) were recruited from online community settings and a lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) organization in Los Angeles; providers (N = 10) were recruited from LGBTQ+ organizations. Semistructured interviews were audio recorded and transcribed verbatim. An applied thematic analysis approach was implemented to create memos, inductively generate a codebook, apply codes to the transcripts, and identify key themes in data. Results: Three main themes were identified. The first theme was weaponizing social identity to control a partner, which had three subthemes: (1) immigration status, race/ethnicity, and skin color, (2) threatening to "out" the partner's sexual orientation, and (3) abusing power inequity. Men who perpetrated IPV often used minority identities or undisclosed sexuality to leverage power over their partner. The second theme was use of IPV to establish masculinity, by exerting power over the more "feminine" partner. The third theme was internalized homophobia as a root cause of IPV, which details how internalized homophobia was often expressed in violent outbursts toward partners. Conclusion: These findings highlight how IPV among SMM can be influenced by social and sexual identity. Future research must consider socially constructed power structures and the multiple identities of SMM when developing interventions to address IPV in this population.

Rape and Sexual Coercion Related Pregnancy in the United States

INTRODUCTION

Sexual violence is a major public health problem in the U.S. that is associated with numerous health impacts, including pregnancy. U.S. population-based estimates (2010-2012) found that three million women experienced a rape-related pregnancy during their lifetimes. The current study presents more recent estimates of rape and sexual coercion-related pregnancy and examines prevalence by demographic characteristics.

METHODS

Data years 2016/2017 were pooled from the National Intimate Partner and Sexual Violence Survey, a random-digit-dial telephone survey of U.S. non-institutionalized adults 18 years and older. The analysis, conducted in 2023, examined lifetime experience of rape-related pregnancy, sexual coercion-related pregnancy, or both among U.S. women. Authors calculated prevalence estimates with 95% CIs and conducted pairwise chi-square tests (p-value<0.05) to describe experiences by current age, race/ethnicity, and region of residence among U.S. women overall and among victims.

RESULTS

One in 20 women in the U.S., or over 5.9 million women, experienced a pregnancy from either rape, sexual coercion, or both during their lifetimes. Non-Hispanic Multiracial women experienced a higher prevalence of all three outcomes compared with non-Hispanic White, non-Hispanic Black, and Hispanic women. Among victims who experienced pregnancy from rape, 28% experienced a sexually transmitted disease, 66% were injured, and over 80% were fearful or concerned for their safety.

CONCLUSIONS

Pregnancy as a consequence of rape or sexual coercion is experienced by an estimated six million U.S. women. Prevention efforts may include healthcare screenings to identify violence exposure and use of evidence-based prevention approaches to reduce sexual violence.

A Scoping Review of Nonconsensual Condom Removal ("Stealthing") Research

Nonconsensual condom removal (NCCR; also known as "stealthing") involves the removal of a condom before or during sexual intercourse without a partner's sexual consent. Within the past several years, nations across the globe have codified NCCR as a form of sexual violence penalized by civil and/or criminal penalties. Given the recent legal attention to this behavior, we performed a scoping review of the peer-reviewed, empirical, English-language studies conducted on NCCR in order to summarize the current state of this field of research. Our scoping review yielded 27 articles meeting study inclusion criteria. Data on NCCR victimization and perpetration prevalence rates and correlates, as well as perceptions of NCCR, were extracted. The majority of the reviewed studies were conducted within the past 5 years and pertained to NCCR victimization. Rates of NCCR victimization ranged from 7.9% to 43.0% for women and 5.0% to 19.0% for men who have sex with men; rates of NCCR perpetration ranged from 5.1% to 9.8% for men and 0% for women. NCCR correlates included sociodemographic variables, relationship type, psychological factors, and sexual health concerns. Perceptions of NCCR were largely negative. The nascent field of NCCR research provides empirical evidence from several countries regarding concerning rates of NCCR. Building upon this foundation, continued research regarding NCCR is imperative. Studies that further delineate NCCR prevalence, risk factors, and outcomes would provide critical information beneficial to the development of evidence-based prevention and intervention programs targeting reductions in NCCR.

Nonconsensual Condom-Use Deception: An Empirically Based Conceptualization of Stealthing

In recent years, the act of stealthing, also termed nonconsensual condom removal (NCCR), has become an emerging important topic related to nonconsensual sexual experiences. We performed a rapid review by searches in Web of Science (245 articles), Medline (157 articles), and PsycINFO (72 articles). The studies, in English, French, Italian, or Spanish, that reported empirical data on stealthing were included, except for those focusing on the legal response to the phenomenon. The final sample of 16 articles of various design is analyzed. According to this review, more than 10% of women experience stealthing in their lifetime, and men having sex with men also experience stealthing. The article describes the empirical research literature in the field, explores terminological and conceptual challenges, and proposes a new and more comprehensive term (nonconsensual condom-use deception), and a revised definition and categorization of the behavior, according to the concrete manifestation of consent breach, the associated practices, or the underlying motivation. We argue that research, as well as policy and practice responses to this growing problem need to be guided by a conceptual framework that uses information gathered directly from those who experienced it.

Associations Among Alcohol-Related Factors and Men's Nonconsensual Condom Removal Perpetration

Nonconsensual condom removal (NCCR) is a form of sexual violence that a significant minority of men use to obtain unprotected sex. Experiencing NCCR is associated with serious physical and mental health consequences, such as sexually transmitted infections, unplanned pregnancies, anxiety, and depression. Alcohol use is known to be associated with sexual violence in general; however, limited research has been done on the association between alcohol-related factors and NCCR specifically. Thus, the present study examined the associations between event-level drinking, daily drinking, drinking motives, alcohol expectancies, and NCCR. Young, single, heterosexually active men (N = 96) completed cross-sectional measures of their NCCR behavior, event-level drinking, drinking motives, and alcohol expectancies. A total of 19 (19.8%) participants reported successfully engaging in NCCR at least once since age 14. Results showed that consuming more alcohol during the event, having more highly intoxicated partners, drinking to enhance sex, and holding more negative alcohol expectancies were associated with increased likelihood of NCCR. To effectively decrease the rates of NCCR, prevention efforts could aim to decrease event-level alcohol consumption for both men and their partners and to challenge men's beliefs regarding alcohol's role in sexual behavior. Given the current study's limitations, future studies should consider employing an ecological momentary assessment design to avoid recall bias and include more diverse samples to increase the generalizability of findings.

An exploratory study of condom sabotage and sexual health risk indicators in college students

Condom sabotage is a form of sexual assault that violates bodily autonomy, increasing the risk of unintended pregnancy and sexually transmitted infections (STI). The current study explored associations between reports of condom sabotage and sexual risk indicators among college students. College students (N = 466) completed a web-based cross-sectional survey. Students who reported experiencing condom sabotage were significantly more likely to describe themselves as single in comparison to students who described themselves as partnered (p = .002). After adjusting for relationship status, condom sabotage was significantly associated with reporting having multiple sexual partners (adjusted OR [aOR], 2.27; 95% CI, 2.22-42.28; p = .003), and being treated in the past 12 months for an STI (adjusted OR [aOR], 1,84; 95% CI, 1.82-21.98; p = . 004). The manuscript offers practical recommendations to develop health communication campaigns and public health interventions to prevent sexual assault, including condom sabotage, among college students.

The Roles of Emotion Regulation, Alcohol Consumption, and Women's Condom Request Style in Men's Coercive Condom Use Resistance Intentions

Condom use resistance (CUR) remains a significant problem, and many men employ coercive CUR strategies to avoid using condoms with partners who do not consent to unprotected sex. To assess the decision-making process underlying men's coercive CUR, the present study administered alcohol to assess the effects of alcohol intoxication, condom request style, and emotion regulation (ER) strategies (i.e., cognitive reappraisal, expressive suppression) on intentions to use coercive CUR to have unprotected sex during a hypothetical sexual scenario. Sexually active, male social drinkers (N = 297) were randomly assigned to either consume alcohol or remain sober, and to project themselves into a hypothetical sexual scenario during which they received either indirect, direct, or insistent condom requests. Results showed that, although cognitive reappraisal had no relationship with coercive CUR or unprotected sex intentions, expressive suppression's relationship with intentions to have unprotected sex was mediated by coercive CUR and moderated by alcohol intoxication and condom request. Specifically, suppression was positively associated with coercive CUR among sober individuals who received an indirect condom request only. Such results suggest that sober men with suppressive tendencies may use coercive CUR to regulate negative emotions, such as frustration at not being able to have unprotected sex.

OlaOlorun F, Koffi AK, Radloff S, Ahmed S, O. Tsui A. Gendered power dynamics and threats to sexual and reproductive autonomy among adolescent girls and young adult women: A cross-sectional survey in three urban settings

BACKGROUND

Gendered economic and social systems can enable relational power disparities for adolescent girls and young women (AGYW), and undercut autonomy to negotiate sex and contraceptive use. Less is known about their accumulation and interplay. This study characterizes relationship power imbalances (age disparity, intimate partner violence [IPV], partner-related fear, transactional sex, and transactional partnerships), and evaluates associations with modern contraceptive use, and sexual/reproductive autonomy threats (condom removal/"stealthing", reproductive coercion, ability to refuse sex, and contraceptive confidence).

METHODS

Cross-sectional surveys were conducted with unmarried, currently-partnered AGYW aged 15-24 recruited via respondent-driven sampling in Abidjan, Côte d'Ivoire (n = 555; 2018-19), Nairobi, Kenya (n = 332; 2019), and Lagos, Nigeria (n = 179; 2020). Descriptive statistics, Venn diagrams, and multivariate regression models characterized relationship power imbalances, and associations with reproductive autonomy threats and contraceptive use.

FINDINGS

Relationship power imbalances were complex and concurrent. In current partnerships, partner-related fears were common (50.4%Nairobi; 54.5%Abidjan; 55.7%Lagos) and physical IPV varied (14.5%Nairobi; 22.1%Abidjan; 9.6%Lagos). IPV was associated with reproductive coercion in Nairobi and Abidjan. Age disparate relationships undermined confidence in contraception in Nairobi. In Nairobi and Lagos, transactional sex outside the relationship was associated with condom stealthing.

INTERPRETATION

AGYW face simultaneous gendered power differentials, against the backdrop of gendered social and economic systems. Power imbalances were linked with coercive sexual/reproductive health experiences which are often underrecognized yet represent a potent link between gendered social systems and poor health. Pregnancy prevention efforts for AGYW must address reproductive autonomy threats, and the relational power imbalances and broader gendered systems that enable them.

A conceptual re-evaluation of reproductive coercion: centring intent, fear and control

BACKGROUND

Reproductive coercion and abuse (RCA) is a hidden form of violence against women. It includes behaviours intended to control or dictate a woman's reproductive autonomy, for the purpose of either preventing or promoting pregnancy.

MAIN TEXT

In this commentary, we argue that there is a lack of conceptual clarity around RCA that is a barrier to developing a robust evidence base. Furthermore, we suggest that there is a poor understanding of the way that RCA intersects with other types of violence (intimate partner violence; sexual violence) and-as a result-inconsistent definition and measurement in research and healthcare practice. To address this, we propose a new way of understanding RCA that centres perpetrator intent and the presence of fear and/or control. Recommendations for future research are also discussed.

CONCLUSION

We suggest that IPV and SV are the mechanisms through which RCA is perpetrated. In other words, RCA cannot exist without some other form of co-occurring violence in a relationship. This has important implications for research, policy and healthcare practice including for screening and identification of women in reproductive healthcare settings.

Condoms, Trust and Stealthing: The Meanings Attributed to Unprotected Hetero-Sex

University students tend to have greater sexual health knowledge than the general public, yet condom use among this group continues to be a public health concern because effective condom use could reduce sexually transmitted infections and, for heterosexual women, unwanted pregnancies. We report findings from a small, qualitative study of condom use among sexually active heterosexual university students in the UK. In interviews, students shared their views about condom use and sometimes their personal experiences too. This paper identifies some of the meanings attributed to condom use in the accounts of nine heterosexually active 20-25 year-olds. Participants explained that when they felt comfortable communicating with their partners, they were more likely to use condoms, and those with negative sexual experiences or under social or psychological pressure were less likely to use them. The findings highlight issues of trust and power between men and women in heterosexual relationships, and describe contexts for dishonest sexual practice, including the traditional notions of femininity that were linked to condom use by this group. The issue of stealthing arose in one woman's account of her experience and in several others' reports of what occurs commonly. Stealthing, the secretive removal of a condom by a (usually male) partner during sexual intercourse without a partner's knowledge or permission, produces non-consensual unprotected sex. We present stealthing as a product of the sexual double-standards described and as a form of interpersonal violence (IPV) and, among these heterosexual partners, as a form of gender-based violence. This study provides a glimpse into university students' decision-making regarding condom use and highlights how gendered inequalities shape heterosex, in particular, communication about safer sex, that in some cases, compromise women's decisions about (safer) sex.

Exploring the gray areas between "stealthing" and reproductive coercion and abuse

The aim of this qualitative study was to understand and differentiate between women's experiences of "stealthing" (non-consensual condom removal) and reproductive coercion and abuse (RCA) which is defined as any deliberate attempt to control a woman's reproductive choices or interfere with her reproductive autonomy. These two experiences are often conflated within the literature, yet little is known about whether this understanding reflects women's lived reality. We recruited female participants from a large Australian metropolitan hospital who self-identified as having experienced a partner interfering with contraception or trying to force them to get pregnant or end a pregnancy against their wishes. Fourteen women (predominantly white, educated and employed) participated in an in-depth interview. Interviews were transcribed verbatim and a process of thematic narrative analysis was undertaken, focusing on the meanings women assigned to their experiences and the differences and similarities across the stories. Analysis revealed that stories about stealthing were characterized by disrespect and selfishness, whereas RCA stories highlighted control with intent. The concepts of intent and control can therefore be understood as central to defining RCA and differentiating it from stealthing. It seems likely that stealthing is primarily a form of sexual violence, as it lacks the specific reproductive intent that characterizes RCA. These findings have important implications for how RCA and stealthing are addressed and measured in research and responded to in practice.