Although research has demonstrated that men's aggression against women and inconsistent condom use are related phenomena, little is known about what factors increase risk for aggression to avoid condom use. The present article tests a theory-based model of condom avoidance through use of sexual aggression. Adult male participants (N = 289) were recruited nationally through online advertisements. Aggressive tactics to avoid condom use were measured using an adapted version of the revised Sexual Experiences Survey, and a variety of aggressive behaviors spanning coercion to physical force were assessed. One hundred participants (35.3%) reported at least one instance of coercion or aggression to avoid using a condom. Structural equation modeling indicated that attitudes toward women, inconsistent condom use, and number of sexual partners were significant predictors of aggressive tactics to avoid condom use. A better understanding of the attitudinal and behavioral pathways through which men avoid condom use through aggressive and coercive means will ultimately result in improved education and prevention efforts for at-risk men and women.
KEY WORDS: condom avoidance; confluence model; risky sexual behavior; sexual aggression
Despite prevention efforts, sexual assault remains a widespread public health concern estimated to affect 25% of women in the United States, with approximately 300,000 women raped each year (Koss, 1988; Tjaden & Thoennes, 2006). Sexual assault may adversely affect a woman's physical and mental health in a variety of ways, including negative sexual and reproductive health consequences. For example, sexual assault involving penetration results in 3% to 20% of victims acquiring a sexually transmitted infection (STI) (Jenny et al., 1990; Tjaden & Thoennes, 2006). Among women of reproductive age, approximately 5% of those raped became pregnant from the assault, with more than 32,000 pregnancies resulting from rape each year (Holmes, Resnick, Kilpatrick, & Best, 1996). Empirical research investigating the factors that may increase the likelihood of these negative consequences for sexual assault victims would further inform efforts to reduce these harmful outcomes.
The use of a condom during penetrative sexual assault, as during consensual sexual situations, can decrease the risk of both STI transmission and unwanted pregnancies. Although there is very little published research regarding the use of condoms during sexual assault events, these few studies indicated that sexually aggressive acts involving penetration often do not involve condom use (Davis, Schraufnagel, George, & Norris, 2008; Peterson, Janssen, & Heiman, 2010; Raj et al., 2006). For example, Davis et al. found that approximately 40% of sexual assault perpetrators reported that they never used condoms during their assaults, whereas another 30% reported using condoms inconsistently. This nonuse of condoms during rape may be more likely than unprotected consensual sex to result in STI transmission because of the higher likelihood of vaginal tissue injury in sexual assault incidents (Briere, 2004). Moreover, because men who report engaging in sexual or physical violence against women also report more sexual partners (for example, number of partners in the last year, one-night stands) and inconsistent or no condom use during consensual vaginal and anal sexual intercourse, they present an elevated STI transmission risk to their victims (Peterson et al., 2010; Raj et al., 2006).
Because of these associations between sexual violence and risky sexual behavior in heterosexual men, researchers have started examining men's use of coercive and forceful strategies to obtain unprotected sex from a female sex partner who wants to use a condom (Abbey, Parkhill, Jacques-Tiura, & Saenz, 2009; Davis, 2010). Compared with non-perpetrators, men who had previously committed sexual assault reported greater justification for using coercive tactics to obtain unprotected sex in a hypothetical situation (Abbey et al., 2009). To date, these studies have used laboratory-based experimental methods. The present study uses survey methods to assess the frequency and predictors of young men's use of sexually aggressive and coercive tactics to obtain unprotected sex.
APPLICATION OF THE CONFLUENCE MODEL TO CONDOM AVOIDANCE
One of the most widely tested models of sexual aggression perpetration is the confluence model (Malamuth, Sockloskie, Koss, & Tanaka, 1991). According to the confluence model of sexual aggression, two key pathways toward sexual aggression involve negative attitudes toward women (also termed "hostile masculinity") and impersonal sex. Malamuth et al. (1991) also predicted that the interaction--or confluence--of these pathways would predict the greatest levels of sexual aggression. Measurement of men's negative attitudes toward women has included such factors as rape myth acceptance, sexual dominance, adversarial beliefs about heterosexual relationships, and misogyny (Hersh & Gray-Little, 1998; Lanier, 2001; Wheeler, George, & Dahl, 2002). Impersonal sex originally included age at first intercourse and number of intercourse partners but has also included attitudes toward casual sex, frequency of masturbation, and pornography use (Malamuth, Linz, Heavey, Barnes, & Acker, 1995; Malamuth, Addison, & Koss, 2000). This model has been replicated in multiple reports with diverse populations (for example, Hall, Teten, DeGarmo, Sue, & Stephens, 2005; Martin, Vergeles, Acevedo, Sanchez, & Visa, 2005) and has also been expanded to include other factors pertinent to sexually aggressive behavior (Parkhill & Abbey, 2008; Logan-Greene & Davis, 2011).
On the basis of this model, we predicted three primary pathways to condom avoidance through aggressive and coercive tactics. First, we hypothesized that men's negative attitudes toward women would directly predict their use of aggressive strategies to obtain unprotected sex. Second, we hypothesized that impersonal sex factors, such as inconsistent condom use and more sex partners, would directly predict use of aggression and coercion to avoid condom use and would also correlate with each other, consistent with prior research (Peterson et al., 2010). Third, in accordance with the original model, we predicted that men who report a high degree of both negative attitudes toward women and impersonal sex factors would also report the greatest use of aggression and coercion to obtain unprotected sex. Thus, we tested whether the interactions between these factors would significantly predict use of aggression to avoid condom use.
Because the original confluence model was designed to predict sexual aggression generally and not sexual aggression specific to condom avoidance, we expanded the model to include factors previously shown to be relevant to factors regarding condom use. We included the predispositional variable of sexual sensation seeking, which refers to a general tendency to pursue unconventional and exciting sexual activities (Kalichman & Rompa, 1995) and has been identified as a predictor of high-risk sexual behavior, including having a higher numbers of sex partners (Hendershot, Stoner, George, & Norris, 2007). Thus, we hypothesized that the relationship between sexual sensation seeking and the use of aggression to obtain unprotected sex would be mediated by the impersonal sex factor of number of sex partners.
Attitudes about condoms have also been shown to be a significant...