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In Costa Rica, the number of newly diagnosed HIV infections per year is slightly growing and shows the pattern of a concentrated epidemic: 79.4% of persons diagnosed with HIV in the years 2002–2012 were men, among them a large proportion of MSM. This corresponds with the fact that MSM are disproportionally affected by HIV globally. Although studies have assessed the condom use among MSM in Costa Rica, the concrete and locality-specific dynamics underlying this HIV protective behavior has not been investigated.
Against this background, this project aimed to establish the predictors of condom use by MSM aged 18–24 in Costa Rica when having anal sex with casual partners.
The theoretical framework was drawn from an extended version of the Information-Motivation-Behavioral Skills (IMB) Model developed in Europe. Besides the socio-cognitive variables comprised by the original IMB Model, this extended version also includes the personal HIV protection strategy adopted, as well as cultural, social and economic resources. The extended model also considers inhibitors of condom use related to the sex partner or the situation in which sex was engaged in.
Methods
A convenience sample of MSM aged 18–24 living in Costa Rica was gathered. Participants were addressed by flyers, social media, specific dating websites, NGOs, key persons in the scene and peers. Data were collected using standardized personal interviews. Data were analysed using descriptive statistics. The IMB model was tested by means of structural equation modelling using the scale-free least square method.
Results
The sample of 238 MSM aged 18–24 included 221 men self-identified as homosexual/gay, 15 as bisexual and 2 as heterosexual. Among them 134 reported having had sex with casual partners in the last six months. Of the 119 respondents who had anal sex, 13.4% reported using a condom each time, 23.5% most times and 15.1% often, whereas 32.8% reported using a condom a few times, 8.4% almost never and 6.7% never.
The analysis showed that the constructs Information, Motivation and Behavioural skills (IMB) were predicting condom use. Considering the single variables in these constructs it turned out that perceived severity of an HIV infection was the strongest and direct predictor of condom use while behavioral skills and knowledge had small effects. A further strong predictor is the personal HIV protection strategy (intention to have “safer sex”). Determining inhibitors were not having the condom to hand during the sex act, trusting one’s partner, and a sex partner rejecting condom use. The behavioral skills were predicted by knowledge, stereotypic health beliefs, attitudes, subjective norms, perceived severability and perceived vulnerability. These socio-cognitive variables, the personal protection strategy and the inhibitors in turn were determined by economic, cultural, and social resources.
Conclusions
The HIV protective behavior of young MSM in Costa Rica turned out to be inconsistent. The extended IMB model proved capable of explaining condom use. In particular the influence of cultural, economic, and social resources was confirmed. It will be a challenge to social work to develop prevention offers considering this impact.