Social Construction of Condom Non-Use: Implications for Condom Promotion Interventions in Bangladesh

This is a qualitative study designed to investigate Bangladeshi men's "emic" views on condom non-use. While many cross-cultural studies focus on women's perspectives of why men refuse to use condoms few have investigated the male perspective thoroughly and women's understandings of men's reasons for condom refusal may not reflect men's understandings. More importantly to the authors, however, is the idea that individual men's perceptions and experiences about condom non-use have been inadequately reported and responses have not been analysed in a broader socio-cultural framework. This article attempts to explain reasons for condom non-use in the local socio-cultural, structural and political context through qualitative interviews with men of diverse socio-demographic, economic and occupational backgrounds from both urban and rural Bangladesh. The purpose is to expose some of the social "scripts" that determine men's resistance to condom use.

This is a phenomenological study in which the reasoning behind condom non-use and the organisation of men's sexual activities were analysed in light of the Bangladeshi cultural background. Fifty men of 18 to 56 years from diverse socio-demographic backgrounds and five HIV/AIDS professionals as key-informants were interviewed. Recorded interviews were subject inter-subjective interpretation through examining a wide variety of interview-texts, researchers' field-diaries, referred cultural scripts in the framework of line by line content, contextual and thematic analysis.

The authors identified several key themes throughout the course of their interviews that characterised men's reasons for condom non-use. These findings suggested that refusal to use condoms is not a personal choice, but rather a social decision deeply embedded in the relational context.

Some of the themes behind non-use were:

1. The notion of reduced physical pleasure has social and masculine realities attached to men's lives and emotions. Men commonly claimed genital desensitisation and reduced pleasure when wearing condoms. Some had "learned" from friends that condoms reduce pleasure of sexual intercourse. In some cases, condoms were perceived as barriers to the "right" to enjoy sexual pleasure with a paid sex worker. It was also noted that many men think that women themselves cannot achieve sexual pleasure when a man is wearing a condom. The authors note that in Bangladeshi culture, men generally teach women about the meanings of sexual pleasure from male perspectives.
2. Some men also suggested that condoms were a barrier to emotional closeness and a barrier to naturalness between a man and woman. Some suggested that the exchange of fluids was a necessity for a "pure" sexual interaction.
3. Condoms were perceived as barriers to keeping a "good man" image, and are for promiscuous men. The authors argue that this is a feature reinforced by HIV/AIDS prevention messages that focus on condom usage among high risk men or those with multiple partners. The advertisement of condoms from a disease prevention framework has imposed a bad reputation on condoms.
4. Condoms were also see as barriers to peer sex culture, which involved taking risks and proving ones manliness in front of other men, this included participation in group sex activities (colloquially know as "sex programmes") in which condoms are not used.
5. Pornographic media was discovered to be a major non-condom use influence as most actors did not use condoms and many Bangladeshi men wished to emulate the virility and long sexual performances of the "western" porn men.
6. The study also revealed that storage and disposal of condoms was a barrier as it is always embarrassing for men to be seen with condoms in Bangladeshi society or to have their condom stash discovered.
7. Finally, many Bangladeshi men reported that condoms were too small and that they were excessively lubricated and smelled. This is a structural problem not being properly addressed by condom manufacturers in Bangladesh.

The authors conclude that since men already believed that condoms would reduce pleasure and destroy erections, the first negative experiences resulted in permanent non-use of condoms. These negative experiences are shared among friends, and through this dialogue the negative notions about condoms among men become common. Pleasure is not solely implanted in bodily experiences, but constructed by internalised negative influences of condoms on one hand, and the social domain of masculine sexuality on the other. The challenge for condom promotion activities is to find a way to promote condoms as a neutral object that is not stigmatised by association with promiscuity.

According to the authors, despite many studies of condom use, meanings of condom non-use are not adequately understood. They feel that condom use is probably one of the most ambiguous and complex behaviours ever experienced by men and women. Refusal to use condoms does not appear to be simply a private choice of an individual. The authors suggest that instead, individually focused condom interventions are ineffectual because they do not address social and masculine dimensions of male sexuality.