Is condomless sex associated with nonadherence to COVID-19 prevention behaviors among young black men who have sex with women?

ABSTRACT

Background Health behaviors in young people tend to cluster. The objective of this study was to determine if condomless sex among young Black men who have sex with women was associated with non-adherence to COVID-19 prevention behaviors. Methods Men previously enrolled in a community-based chlamydia screening program for Black men who have sex with women, aged 15-24, were enrolled in a sub-study between May-June, 2020 and asked about adherence to the City of New Orleans requirements for proper hand-washing, maskwearing, social-distancing, staying-at-home and condomless vaginal sex while COVID-19 restrictions were in place. Results Of 105 men included in analysis, the mean age was 20.5 (s.d.2.0) and 17.3% previously tested positive for chlamydia in the parent study. During COVID-19 stay-at-home orders, 37.1% engaged in at least one act of condomless sex and responded sometime/never to the following hand-washing for 20 seconds (8.1%), physical-distancing (21.6%), maskwearing (18.8%) and staying-at-home except for essential needs (24.3%). Some men were not able to get PPE (36.9%) or thought a homemade mask would subject them to discrimination (14.4%). Men who engaged in condomless sex were more likely than those who either did use condoms/did not have vaginal sex to not wash their hands properly (19.4% vs. 3.0%, p<0.03) and not wear a mask (30.8% vs. 10.6%, p<0.02);there was a trend for them to not physically distance (28.2% vs. 16.7%, p< 0.17) and there was no association for not following stay-at-home orders (28.2% vs. 22.7%, p<0.54). Age, access to masks, and perception that maskwearing could subject them to discrimination were not associated with mask-wearing (p>0.40). Conclusion Overall, adherence to disease prevention behaviors was high. Non-adherent behaviors such as condomless sex, lack of mask-wearing and lack of hand-washing were associated. Men with one non-adherent behavior may benefit from counseling in other potentially non-adherent behaviors..