Background Condom use at first coitus is associated with greater lifetime condom use. Little is known, however, about factors which influence non-use of condoms at first coitus.
Methods Data were analysed from a cross-sectional study on condom use behaviours conducted among 98 heterosexual male students attending two Georgia universities. Men were asked to recall condom use during first and subsequent coitus. Multivariable logistic regression was conducted to evaluate factors associated with non-use of condoms at first coitus and how non-use influenced their future condom beliefs and use.
Results Participant averaged 22.4 years at interview, 16.8 years at first intercourse (range:13–23), and 5.6 years (range:0–12) between first condom use and time of interview. Overall, 47 men (48%) reported not using condoms at first coitus, and not initiating use until an average of 13 acts after sexual debut (med=5; range:1–100). Reasons for eventual condom initiation included: concern about infection/pregnancy (53%), partner insistence (32%), and condoms being available (15%). Compared with men who used condoms at first intercourse, men initiating use afterwards were significantly more likely to report their first condom experience was negative (62% vs 35%, aOR=2.8, 95% CI 1.1 to 7.2), and were less inclined to use condoms subsequently based on this first experience (34% vs 14%, aOR=3.4, 95% CI 1.2 to 8.8). However, measurement of condom use during most recent coitus did not differ significantly between men who initiated condom use after vs at their first intercourse both at last sex (43% vs 55%) and for both consistent use during the last month (43% vs 39%) and year (26% vs 20%).
Conclusions Public health efforts should emphasise the importance of condom use at first intercourse. Counselling should be provided to help prepare men for a positive first experience with condoms, given that this experience may affect immediate subsequent condom use following sexual debut.