Men's Coercive Condom Use Resistance: The Roles of Sexual Aggression History, Alcohol Intoxication, and Partner Condom Negotiation

Receipt of Coercive Condom Use Resistance: A Scoping Review

Condom use resistance (CUR) refers to practices used to obtain unprotected sex with a partner who wishes to use a condom. Coercive CUR is a manipulative and aggressive form of CUR, which is associated with detrimental mental, physical, and sexual health consequences. This review synthesizes quantitative evidence on the prevalence and correlates of experiencing coercive CUR. A systematic approach, including title, abstract, and full-text review, was used to identify relevant empirical studies. Thirty-seven articles met the inclusion criteria. Prevalence of experiencing coercive CUR ranged from 0.1% to 59.5%. Significant correlates of receiving coercive CUR included interpersonal violence, sexually transmitted infection (STI) diagnosis, emotional stress, and drug use. Importantly, vulnerable populations (e.g., racial/ethnic minorities, men who have sex with men, sex workers) and people with low perceived control and resistive efficacy (i.e., the ability to say "no") had an increased likelihood of experiencing coercive CUR. Methodological weaknesses in the current literature include a lack of longitudinal studies and studies that examine the effectiveness of interventions, as well as failure to use consistent measures and include samples of men and sexual minorities. Future research should address these limitations. Intervention and prevention strategies should prioritize populations that are at greater risk for experiencing coercive CUR to achieve better health equity outcomes.

Negative Sexual Experiences Among Gay, Bisexual, and Other Men Who Have Sex with Men Using GPS-Enabled Hook-Up Apps and Websites

Gay, bisexual, and other men who have sex with men (GBMSM) often use GPS-enabled dating apps and websites to facilitate in-person sexual encounters. Many of these encounters are positive and enjoyable. However, there is limited research on GBMSM's negative experiences with partners from hookup and dating apps/websites, especially those characterized by threats to GBMSM's sexual, physical, and/or psychological safety. In this report, we investigated this matter. We analyzed data from interviews with GBMSM (N = 60) and identified four categories of negative sexual experiences, each of which were comprised by sub-categories: 1) sexual violence (physical sexual assault, verbal sexual coercion, intoxicated assault/coercion), 2) sexual health risk behaviors (condom use resistance and coercion, deception related to HIV/STI status), 3) non-negotiated behaviors (undiscussed/unexpected sex acts, rough sex, sexualized racism, undesired substance use by the partner), and 4) threats to physical safety beyond sexual violence (being blocked from leaving, stalked, robbed, drugged). These results can inform future research and interventions that aim to promote safety on dating apps/websites within the GBMSM community.

The Effect of State, Trait, and Situational Factors on Young Men's Coercive Condom Use Resistance

Coercive Condom Use Resistance (CUR) is a significant problem, associated with increases in STIs, unplanned pregnancy, feelings of betrayal, and a loss of sexual autonomy. Furthermore, young men are much more likely to perpetrate coercive CUR than young women. Thus, the present study sought to examine the past experiences, trait characteristics, and state emotions which may precede coercive CUR perpetration intentions, including alcohol intoxication, childhood emotional abuse, trait impulsivity, sexual sensation seeking, state impulsivity, and state anxiety, using an alcohol administration procedure. Young, single, non-problem drinking, and sexually active men who have sex with women from the United States (N = 297; 66% White, 9.4% Black, 10.7% Multi-racial, 5.1% Asian, 1.0% Native American, 1.0% Pacific Islander, and 10.4% Hispanic or Latino) were recruited for participation. They were randomly assigned to either receive alcohol or remain sober before projecting themselves into a hypothetical sexual scenario with a woman who asked to use a condom. Results showed that greater levels of childhood emotional abuse were associated with increased trait impulsivity and sexual sensation seeking, and that sexual sensation seeking was associated with increased state impulsivity and subsequent anxiety during the scenario. Finally, alcohol intoxication moderated the relationship between state anxiety and coercive CUR such that state anxiety was positively associated with coercive CUR among intoxicated men only. Findings suggest that interventions targeting coercive CUR behavior may be improved by focusing on men who have experienced childhood trauma, as well as their alcohol consumption and in-the-moment experiences of impulsivity and anxiety.

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.

Exploring experience of and engagement in coercive pregnancy behaviors among sexually active young men from five clinics in Baltimore, MD

OBJECTIVES

To explore young men's perceived experience of coercive pregnancy behaviors by female partners, and engagement in and behavioral overlap of these occurrences in this sample.

STUDY DESIGN

Heterosexually active young men aged 15 to 24 (n = 39), recruited from 3 primary care and 2 sexually transmitted disease clinics in Baltimore, MD city over a 2-week period, were surveyed on their perceived experience of and engagement in coercive pregnancy behaviors, attitudes about women, and background characteristics.

RESULTS

Of 130 invited, 66 (51%) agreed to participate, 39 of whom were heterosexual young men; 87% were non-Hispanic Black and 59% were aged 20 to 24. Eleven (28%) perceived one or more coercive pregnancy behaviors by a partner and nine (23%) engaged in one or more coercive behavior. Most (58%) agreed women are responsible for birth control decisions, but 55% believed women could not be trusted to tell the truth about contraceptive use and 68% believe women would like to get pregnant.

CONCLUSIONS

Over one-third of young men in this sample perceived experience of coercive pregnancy behaviors by partners and/or engaged in these behaviors. Findings have implications for promoting healthy relationships among young people.

IMPLICATIONS

This study found over one-third of young men perceived experience of coercive pregnancy behaviors by partners and/or engaged in these behaviors. Findings highlight the need for research to include young men in examining coercive pregnancy behaviors. Findings also highlight the need to develop strategies to support educational and clinical approaches to address young men's role as partners in healthy contraceptive practices.

Predicting rape events: The influence of intimate partner violence history, condom use resistance, and heavy drinking

Sexual aggression perpetration is a public health epidemic, and burgeoning research aims to delineate risk factors for individuals who perpetrate completed rape. The current study investigated physical and psychological intimate partner violence (IPV) history, coercive condom use resistance (CUR), and heavy episodic drinking (HED) as prospective risk factors for rape perpetration. Young adult men (N = 430) ages 21-30 completed background measures as well as follow-up assessments regarding rape events perpetrated over the course of 3 months. Negative binomial regression with log link function was utilized to examine whether these risk factors interacted to prospectively predict completed rape. There was a significant interaction between physical IPV and HED predicting completed rape; men with high HED and greater physical IPV histories perpetrated more completed rapes during follow-up than men with low HED at the same level of physical IPV. Moreover, psychological IPV and coercive CUR interacted to predict completed rape such that men with high coercive CUR and greater psychological IPV histories perpetrated more completed rapes throughout the follow-up period than men with low coercive CUR at the same level of psychological IPV. Findings suggest targets for intervention efforts and highlight the need to understand the topography of different forms of aggression perpetration.

Sexual Aggression Analogues Used in Alcohol Administration Research: Critical Review of Their Correspondence to Alcohol-Involved Sexual Assaults

BACKGROUND

Alcohol administration studies are crucial because causal questions about alcohol's role in human behavior can only be answered through experimental research that randomly assigns participants to drink conditions. The primary goal of this review was to catalogue the characteristics of experimental analogues used in alcohol administration research to assess men's sexual aggression proclivity and evaluate the extent to which they represent the scope of alcohol-involved sexual aggression. Although this review focuses on sexual aggression analogues, the identified methodological issues are relevant to a wide range of alcohol administration studies.

METHODS

Online databases were searched for published studies that randomly assigned participants to drink conditions and assessed participants' sexual aggression proclivity with an experimental analogue. Characteristics of the analogues were coded by both authors.

RESULTS

Seventeen studies were identified that used 12 unique experimental analogues. All of the analogues depicted a completed or potential sexual assault in an apartment between a male perpetrator and female victim who did not know each other well. This information was presented in written (n = 7), audio (n = 1), video (n = 3), or virtual simulation (n = 1) format. Sexual aggression proclivity was measured through participants' self-reports (n = 10) and behavioral responses (n = 2). Perpetrators primarily used physical force which the woman verbally and physically resisted. Only one analogue depicted behavioral signs of the woman's alcohol impairment; none included signs of the man's alcohol impairment.

CONCLUSIONS

These analogues were designed to address important theoretical questions; however, they do not represent the full range of alcohol-involved sexual assaults. This hampers the development of evidence-based prevention and treatment programs because we do not know whether these findings generalize to other types of sexual assaults (e.g., with incapacitated victims, within serious relationships, with sexual and other gender minorities). Funding agencies need to support more alcohol administration research in order to provide a strong foundation for the development of effective interventions.

A Prospective Examination of Men's Condom Use Resistance: Event-Level Associations with Sexual Aggression, Alcohol Consumption, and Trait Anger

Burgeoning research suggests that men engage in a variety of coercive and non-coercive tactics to avoid condom use (condom use resistance; CUR), suggesting a risk nexus regarding sexual risk and sexual aggression (SA). Laboratory-based research has found that acute alcohol intoxication is associated with CUR; however, no study has examined event-level associations among alcohol consumption, SA history, and CUR or the moderating effects of trait anger. Non-problem drinking young adult men who have sex with women (N = 430) completed a background survey and follow-up assessments regarding their sex events and alcohol consumption over three months. CUR was reported in 113 sex events; 6.2% of these involved SA and 40.7% involved alcohol consumption. Generalized estimating equations demonstrated that men with more severe SA histories were more likely to perpetrate CUR. Men lower in trait anger were more likely to perpetrate CUR the more they increased above their typical level of alcohol consumption, whereas men higher in trait anger were similarly likely to perpetrate CUR regardless of their alcohol consumption. Results suggest that men with greater SA histories and high trait anger are at increased risk of perpetrating CUR, and that risk of CUR increases among other men the more they increase their alcohol consumption beyond their average.

"That's not what was originally agreed to": Perceptions, outcomes, and legal contextualization of non-consensual condom removal in a Canadian sample

Non-consensual condom removal (NCCR) is the removal of a condom before or during sexual intercourse without one’s partner's consent. Despite considerable news and media attention devoted to the trend (as stealthing), little empirical research to date has examined people’s views of the practice. The present study aimed to contribute toward generating empirical evidence to guide the discussion surrounding NCCR. We asked participants about whether or not they felt NCCR is wrong, whether there should be consequences for its perpetration, and contextualized responses within legal context. A total of 592 undergraduate students took part in an online survey inquiring about their experiences with and views of NCCR. We used descriptive statistics to determine sample prevalence and outcomes of NCCR and qualitatively analyzed responses to open-ended questions asking about perceptions of NCCR. Of participants who had engaged in penetrative sexual intercourse with a male partner using an external condom, 18.7%, 95% CI [14.4, 22.7] reported that they had NCCR perpetrated against them. The majority of these participants reported that they experienced NCCR negatively and encountered related consequences; several reported contracting an STI, experiencing an unplanned pregnancy, or both. Nearly all participants expressed that NCCR is wrong, citing reasons that included the lack of consent, possibility of unplanned or unwanted outcomes, and a betrayal of trust. In this study, we found that there was agreement that NCCR is wrong, but variability in responses regarding the circumstances under which there should be consequences for the action. These perceptions reflect the current uncertainty in law. We recommend researchers refer to the phenomenon as NCCR (rather than stealthing) and discuss related issues to encourage future research to adopt consistent and accurate labels and definitions for NCCR. We hope that our findings will guide future research and spur public and legal discussion on NCCR.