Background Consistent condom use reduces HIV-1 risk and is important for HIV-1 serodiscordant couples (where one partner is HIV-1-infected and the other is HIV-1-uninfected). This study explored barriers to consistent condom use among heterosexual HIV-1 serodiscordant couples.

Methods This qualitative study used 28 in-depth interviews and 9 focus group discussions. The participants were purposively-selected heterosexual HIV-1 serodiscordant couples from Thika and Nairobi districts in Kenya.

Results A majority of HIV-1 serodiscordant couples reported challenges in consistent condom use. The main barriers to consistent condom use included male partners' reluctance to use condoms regardless of HIV-1 status, female partners' inability to negotiate condom use, poor knowledge of condom use leading to condom breakage, misconceptions about HIV-1 serodiscordance, challenges in disclosing HIV-1 positive results to new sexual partners, desire for conception, and reduced sexual pleasure reported by both male and female partners. Condom use was cited as one of the main challenges of living with HIV-1 serodiscordance.

Conclusions Serodiscordant couples face multiple challenges in using condoms for HIV-1 prevention, and need couples-centred counselling to address barriers to consistent condom use. Specific areas of focus should include provision of information about the substantial risk of HIV-1 transmission within serodiscordant partnerships, development of skills for women to effectively negotiate condom use, disclosure of HIV-1 serostatus to new sexual partners, and strategies for conception that minimise risk of HIV-1 transmission.