Condom use and HIV/STDs: A grounded theory analysis of social norms, relationship roles, and negotiation styles among heterosexual undergraduate students

Background: Incidence and prevalence of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome, and other sexually transmitted diseases, in the United States continue to increase among young, heterosexual males and females. Despite interventions to promote condom use and testing, few qualitative studies examine why young males and females, though particularly males, are not engaging in safe sex behaviors. The purpose of the study was to examine the social norms, attitudes, and behaviors surrounding safe sex practices for young, heterosexual females and males, to investigate the roles females and males play in negotiating safer sex with a partner, and to examine intervention strategies that could be adopted to increase condom use. Methods: A secondary grounded theory analysis was conducted using data from a Photovoice study of undergraduate female and male students attending a four-year public institution in the Northeast. Results: The theory was developed through open coding, axial coding, and selective coding, which revealed gender differences in safe sex behaviors. Grounded theory analysis of the Photovoice data highlighted that condom use is dependent on existing social norms, gender roles, power and conversations in relationships, access to trusted condoms, and perceptions. The analysis exposed drastic gender differences in terms of perceptions and attitudes surrounding condom use behaviors, and a generational emphasis on pregnancy prevention. Gender differences in attitudes, perception, and knowledge lead to barriers to negotiating roles and communicating safe sex behaviors. Conclusion: Future interventions should focus on increasing the dialogue of sexual activity and safe sex behaviors among young, heterosexual males and females.