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updated 2/5/2004 12:54:07 PM ET 2004-02-05T17:54:07

Many low-income, straight men don't use condoms for disease prevention, despite knowing the risks, a new study shows.

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Rather than wear a condom to prevent syphilis, gonorrhea, or other sexually transmitted diseases (STDs), they would rather take a chance -- and deal with the consequences later, researcher Diane M. Grimley, Ph.D., chair of the Department of Health Behavior at the University of Alabama at Birmingham.

Her paper appears in the current American Journal of Health Behavior.

Public health warnings regarding STD prevention have made some impact, she notes. Rates of syphilis and gonorrhea are at a 50-year low. However, there's still a big problem -- rates of syphilis, gonorrhea, and chlamydia remain far higher in the U.S. than in other industrialized nations, writes Grimley.

Her concern focuses specifically on sexually active men who have multiple partners and/or overlapping relationships. She explains that infected men can readily infect a woman only after one sexual encounter. Typically STD prevention programs target women and this lack of emphasis on heterosexual men is troublesome given their contribution to continuing STD transmission, she writes.

How safe are you?
In their study, Grimley and her colleagues focused on 224 men -- all with STD symptoms -- who sought treatment in a Birmingham STD clinic. The average age was 26, and most men were black.

In face-to-face, private interviews, each was asked the same set of questions

Among them:

How often have you used a condom in the past month? How long have you been using condoms? Do you have any intention of starting condom use? Why do you use condoms? Do you wear condoms for STD prevention or to protect your partner from pregnancy and disease? Why don't you use condoms?

And the results:

80 percent reported that most people their age did not use condoms consistently. They also said that 61 percent of people their age had gonorrhea. 81 percent acknowledged sexual contact with two or more partners during the preceding six months. 45 percent reported sexual relationships that overlapped. 65 percent said they had been diagnosed with one or more STDs in the past.

Despite strong beliefs that condoms could be effective in STD prevention, many men were not motivated to use condoms consistently, Grimley reports.

Of those men with one main sexual partner, two-thirds were not motivated to use condoms.

These men also gave little indication they would start using condoms for STD prevention, she explains.

"They wanted their partners to know that they were committed to the relationship," she writes. Other studies show similar attitudes, indicating that intimate relationship issues are important to many men, as well as women, she says.

Safety is often not a concern
Also, alcohol and drug users gave the least indication they would use condoms.

For many men, safety from disease does not play a central role in their decision-making about condoms, writes Grimley.

"These men do perceive themselves at high risk for STDs, but appear to cope with this risk" by getting treatment once they've got symptoms -- rather than preventing it with condoms, she writes.

Other researchers have found, too, that low-income minority men "calculate their risk and take actions based on what they have learned through their own observations and experiences," writes Grimley.

This study provides "an important window into condom use in a population that is potentially at risk," says Gail Wyatt Ph.D., associate director of the AIDS Institute at the UCLA School of Medicine. She is also author of the book, No More Clueless Sex: 10 Secrets to a Sex Life That Works for Both of You.

However, "you have be careful not to generalize this to other African-American men," Wyatt tells WebMD. In the South, and especially in Alabama, low-income men generally distrust medical researchers -- which could have affected the answers they gave, she says.

"It's important to look at ethnic minorities individually, to take time to understand the issues for each group," Wyatt says. "We know that health services utilization in the South, among poor people, is not the same as for people with jobs and health insurance."

Nonetheless, she says, "a number of studies involving ethnic minority men have shown that heterosexual men don't feel they need to use condoms. Even if they hear the message [to use condoms for STD prevention], they don't want to hear it."

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