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Little is known about HIV-seropositive men's awareness and use of untested barrier methods during anal intercourse. A sample of 240 HIV-seropositive men (69.2% men of color) completed a self-administered survey that included items on nonoxynol-9 (N-9), female condoms, and the simultaneous use of two male condoms (double bagging). Most participants (79.6%) had heard of N-9 being used to prevent HIV transmission during anal intercourse. Of these, 20.0% rated N-9 as more effective than condoms, and 14.6% had used N-9 instead of condoms. Fewer men (35.4%) were aware of female condoms being used during anal intercourse. Overall, few respondents (5.4%) had used female condoms; 53.8% of whom rated the device as more pleasurable than male condoms. Most men (69.6%) had heard of double bagging, and 35.2% had engaged in this practice. Of these, 45.1% rated the practice as less pleasurable than using a single condom. Few associations were observed between participant characteristics and the awareness or use of these barrier methods. The widespread use of these untested methods emphasizes the urgent need to further educate HIV-seropositive men about the potential risks of N-9 use and to test the effectiveness of other strategies that may serve as alternatives to male condom use.
Latex condoms have been shown to be effective for reducing the risk of HIV transmission and tend to be the primary risk reduction method recommended to gay and bisexual men who engage in anal intercourse (Centers for Disease Control and Prevention [CDC], 1993; Feldblum, Morrison, Roddy, & Cates, 1995; Pinkerton & Abramson, 1997; Stone, Timyan, & Thomas, 1999). Despite dramatic increases in gay and bisexual men's condom use since the 1980s, consistent condom use during anal sex has not been adopted by some gay men (Doll & Ostrow, 1999; Hospers & Kok, 1995; Stall, Hays, Waldo, Ekstrand, & McFarland, 2000; Wolitski, Valdeserri, Denning, & Levine, 2001). In an attempt to explain why some men are not using condoms, a large number of studies has examined factors associated with condom use and unprotected sex (Doll & Ostrow, 1999; Hospers & Kok, 1995; Stall et al., 2000). Most of these studies have placed a heavy emphasis on characteristics of gay and bisexual men (e.g., age, substance use, self-efficacy) that are associated with unprotected anal intercourse and...