Factors influencing inconsistent condom use in Thai HIV-infected heterosexual couples

Objective: To demonstrate the factors why Thai human immunodeficiency virus (HIV)-infected heterosexual couples choose to use, or not to use, condoms. Materials and Methods: At the Siriraj Female sexually transmitted diseases (STDs) Clinic, HIV-infected women who had two or more visits between February 2016 and December 2017 were invited to participate in a qualitative study. To participate, both the man and woman must be 18 years or older, having regular sexual relations during the previous six months, and be aware of their partner's serostatus. Twenty couples that reported 100% condom use and 20 couples reporting less than 100% condom use were included. Each couple was interviewed together and individually. Sociodemographic characteristics, reasons behind condom use, and perceptions regarding condom use were compared. Results: On average, the HIV-infected women were 35 years old and their partners were two years older. Each woman reported having one current partner. Of them, 35% (14/40) were serodiscordant and 70% (28/40) had children during the relationship. Women with inconsistent condom use reported less frequent sexual activity, a longer time since HIV diagnosis, and were more likely to have an HIV-seropositive partner (p<0.05 for all). Both women and men reported that the most common reason for inconsistent condom use was 'unavailability or inadequate effort to find one'. The second most common reason women reported was 'partner's rejection' while male partners stated 'less sexual sensation' followed by 'feeling not natural'. Conclusion: Unavailability is the most commonly reported reason for inconsistent condom use in Thai HIV-infected women and their partners. Male partners' concern about reduced sexual sensation and their rejection of condom use strongly influences protective behaviors.