Skip to main content
PMC home page
Sexually Transmitted Infections logoLink to Sexually Transmitted Infections
. 2004 Dec;80(6):430–434. doi: 10.1136/sti.2004.010421

Fifty ways to leave your rubber: how men in Mombasa rationalise unsafe sex

S Thomsen 1, M Stalker 1, C Toroitich-Ruto 1
PMCID: PMC1744938  PMID: 15572608

Abstract

Objective: To explore the reasons why men who have sex with sex workers in Kenya refuse to use condoms in order to develop potential interventions that might help to overcome these barriers.

Methods: We conducted participant observations over a period of 2 months in the bars, discos, shebeens, and guesthouses of Mombasa, Kenya, where many of the sexual transactions are initiated.

Results: Analysis of the participant observations revealed at least 50 reasons for not using a condom, which we grouped into six categories: condoms are not pleasurable, condoms are defective, condoms are harmful, condoms are unnecessary, condoms are too hard to use, and external forces prohibit using condoms.

Conclusions: Some of the reasons men say they do not use condoms would be difficult to affect directly. Others are the result of gaps in knowledge and have not been impacted through better communication strategies. Finally, some of the reasons for not using condoms, such as men's weaknesses, and the loss of pleasure, could possibly be addressed through the introduction of female controlled devices. However, the most important conclusion of this paper is that men who pay for sex do so because it is pleasurable and many men do not find the male condom pleasurable. Therefore, messages targeted at men who have sex with sex workers may not be 100% successful if they only emphasise the benefits of condom use as disease control.

Full Text

The Full Text of this article is available as a PDF (67.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bauni E. K., Jarabi B. O. Family planning and sexual behavior in the era of HIV/AIDS: the case of Nakuru District, Kenya. Stud Fam Plann. 2000 Mar;31(1):69–80. doi: 10.1111/j.1728-4465.2000.00069.x. [DOI] [PubMed] [Google Scholar]
  2. Carmel S. The Health Belief Model in the research of AIDS-related preventive behavior. Public Health Rev. 1990;18(1):73–85. [PubMed] [Google Scholar]
  3. Dowsett Gary W. Some considerations on sexuality and gender in the context of AIDS. Reprod Health Matters. 2003 Nov;11(22):21–29. doi: 10.1016/s0968-8080(03)02290-0. [DOI] [PubMed] [Google Scholar]
  4. Fonck K., Kaul R., Kimani J., Keli F., MacDonald K. S., Ronald A. R., Plummer F. A., Kirui P., Bwayo J. J., Ngugi E. N. A randomized, placebo-controlled trial of monthly azithromycin prophylaxis to prevent sexually transmitted infections and HIV-1 in Kenyan sex workers: study design and baseline findings. Int J STD AIDS. 2000 Dec;11(12):804–811. doi: 10.1258/0956462001915327. [DOI] [PubMed] [Google Scholar]
  5. Ford Kathleen, Wirawan Dewa Nyoman, Muliawan Partha. Social influence, AIDS/STD knowledge, and condom use among male clients of female sex workers in Bali. AIDS Educ Prev. 2002 Dec;14(6):496–504. doi: 10.1521/aeap.14.8.496.24113. [DOI] [PubMed] [Google Scholar]
  6. Gysels M., Pool R., Bwanika K. Truck drivers, middlemen and commercial sex workers: AIDS and the mediation of sex in south west Uganda. AIDS Care. 2001 Jun;13(3):373–385. doi: 10.1080/09540120120044026. [DOI] [PubMed] [Google Scholar]
  7. Hawken M. P., Melis R. D. J., Ngombo D. T., Mandaliya K., Ng'ang'a L. W., Price J., Dallabetta G., Temmerman M. Part time female sex workers in a suburban community in Kenya: a vulnerable hidden population. Sex Transm Infect. 2002 Aug;78(4):271–273. doi: 10.1136/sti.78.4.271. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Heise L. L., Elias C. Transforming aids prevention to meet women's needs: a focus on developing countries. Soc Sci Med. 1995 Apr;40(7):931–943. doi: 10.1016/0277-9536(94)00165-p. [DOI] [PubMed] [Google Scholar]
  9. Kelly J. A., Kalichman S. C. Increased attention to human sexuality can improve HIV-AIDS prevention efforts: key research issues and directions. J Consult Clin Psychol. 1995 Dec;63(6):907–918. doi: 10.1037//0022-006x.63.6.907. [DOI] [PubMed] [Google Scholar]
  10. Lowndes C. M., Alary M., Gnintoungbé C. A., Bédard E., Mukenge L., Geraldo N., Jossou P., Lafia E., Bernier F., Baganizi E. Management of sexually transmitted diseases and HIV prevention in men at high risk: targeting clients and non-paying sexual partners of female sex workers in Benin. AIDS. 2000 Nov 10;14(16):2523–2534. doi: 10.1097/00002030-200011100-00015. [DOI] [PubMed] [Google Scholar]
  11. Mahoney C. A., Thombs D. L., Ford O. J. Health belief and self-efficacy models: their utility in explaining college student condom use. AIDS Educ Prev. 1995 Feb;7(1):32–49. [PubMed] [Google Scholar]
  12. Ngugi E. N., Plummer F. A., Simonsen J. N., Cameron D. W., Bosire M., Waiyaki P., Ronald A. R., Ndinya-Achola J. O. Prevention of transmission of human immunodeficiency virus in Africa: effectiveness of condom promotion and health education among prostitutes. Lancet. 1988 Oct 15;2(8616):887–890. doi: 10.1016/s0140-6736(88)92480-4. [DOI] [PubMed] [Google Scholar]
  13. O'Farrell N. Enhanced efficiency of female-to-male HIV transmission in core groups in developing countries: the need to target men. Sex Transm Dis. 2001 Feb;28(2):84–91. doi: 10.1097/00007435-200102000-00005. [DOI] [PubMed] [Google Scholar]
  14. Parsons J. T., Halkitis P. N., Bimbi D., Borkowski T. Perceptions of the benefits and costs associated with condom use and unprotected sex among late adolescent college students. J Adolesc. 2000 Aug;23(4):377–391. doi: 10.1006/jado.2000.0326. [DOI] [PubMed] [Google Scholar]
  15. Peltzer K. Factors affecting condom use among South African university students. East Afr Med J. 2000 Jan;77(1):46–52. [PubMed] [Google Scholar]
  16. Sherman D. W., Kirton C. A. The experience of relapse to unsafe sexual behavior among HIV-positive, heterosexual, minority men. Appl Nurs Res. 1999 May;12(2):91–100. doi: 10.1016/s0897-1897(99)80372-3. [DOI] [PubMed] [Google Scholar]
  17. Voeten Helene A. C. M., Egesah Omar B., Ondiege Mark Y., Varkevisser Corlien M., Habbema J. Dik F. Clients of female sex workers in Nyanza province, Kenya: a core group in STD/HIV transmission. Sex Transm Dis. 2002 Aug;29(8):444–452. doi: 10.1097/00007435-200208000-00003. [DOI] [PubMed] [Google Scholar]
  18. Volk J. E., Koopman C. Factors associated with condom use in Kenya: a test of the health belief model. AIDS Educ Prev. 2001 Dec;13(6):495–508. doi: 10.1521/aeap.13.6.495.21438. [DOI] [PubMed] [Google Scholar]
  19. Wilson D., Chiroro P., Lavelle S., Mutero C. Sex worker, client sex behaviour and condom use in Harare, Zimbabwe. AIDS Care. 1989;1(3):269–280. doi: 10.1080/09540128908253032. [DOI] [PubMed] [Google Scholar]

Articles from Sexually Transmitted Infections are provided here courtesy of BMJ Publishing Group

RESOURCES