Background: Understanding the drivers of passive and indifferent attitudes toward condom use provides important insights into African American MSM’s sexual risk behaviors, and can inform prevention strategies for this highest priority HIV-risk population.
Methods: Thirty four semi-structured interviews were conducted with African American MSM in the northeastern US. In-depth thematic analysis sought to describe mechanisms driving passive and indifferent attitudes toward condom use in this population.
Results: The majority of participants who expressed passive or indifferent attitudes toward condom use (e.g. “yeah, whatever”) did not raise the subject of condom use themselves, but did use condoms if it was suggested by their sexual partner(s). At the same time, they conveyed an awareness of protected sexual behaviors as “the responsible thing to do,” and often expressed regret after engaging in unprotected sex. Childhood familial health promotion messages regarding personal responsibility emerged as an important driver of their present day attitudes toward condom use. In addition, because immediate or “near-future” needs (e.g., securing food or shelter) were prioritized over “distant-future” needs (e.g., sexual health and condom use) within their childhood family dynamics, this belief system extended into participants’ current approaches to sexual health in adulthood such that immediate needs and benefits were prioritized over future outcomes. Within this context, preventing STIs/HIV was not considered a pressing need, and therefore not prioritized, leading to passive or indifferent attitudes toward condom use.
Conclusions: Prevention messages promoting sexual health may need to be broadened to consider the context of family and childhood dynamics that may affect HIV risk. Reframing HIV risk in a developmental context may provide insight into the low priority that some adult African American MSM place on their own sexual risk behaviors, and will be critical to improving men’s attitudes and self-efficacy toward condom use and sexually protective behaviors.