I know, I know, enough with the MSM already, but I had a really crazy interview yesterday evening that is still making me chuckle. A disheveled-looking guy came into the interview room, and, after shaking his hand and catching a whiff of his breath, I was pretty sure he was drunk—or at the very least tipsy. I debated whether I should carry on, but given that he had actually shown up on time and had made it into his seat without incident, I decided to proceed. We meandered through the opening questions and started talking about the number of sex partners he's had in the last month. "Honey, more than I can count," he said. I asked something to the effect of "Why so many?" He looked at me with astonishment and exploded with, "Well, just look at me! I'm gorgeous. They can't keep their hands off of me!" Self-confidence—alcohol induced or otherwise—really is a wonderful thing.
Part of doing interviews involves keeping a straight face when all you want to crack up and say, "Ohmigod!" or just cry because someone is sharing such an awful experience with you. Unlike focus groups—where the discursive energy is more diffuse and the goal is to get information on issues at the group level—open-ended interviews require intense concentration and involvement with the interview subject. As a technique, interviewing is crucial for gaining a deep understanding of sensitive issues because people tend to be much more honest when they don't feel as though they are going to be judged by their peers, as sometimes happens in a focus group setting. And almost every interview I have ever done has been fascinating—even if the most salient information veers off of the original topic. Some of the most challenging interviews I have done centered on the issue of partner violence.
Today I am working with my colleague Anjum on a paper that focuses on domestic violence as it affects condom use. Anjum directed a large population-based survey that looked at a variety of health issues, this one among them. There is a copious amount of literature from many disciplines on domestic violence and condom use, especially as it relates to HIV prevention. The unique aspect of our survey is that it is a population-based survey of New York City and thus representative of NYC as a whole, not of a population sub-group as many of the other studies tend to be. Anjum is the numbers whiz who is pulling all the quantitative material from the survey together. (She is also going to India soon, and I'm hoping that publicly singing her praises will result in a karmic return of a beautiful bedspread …) The numbers are indicating that issues of power in a relationship (which are directly related to partner violence) do make a difference in condom use. Our hypothesis is that there are some women who do not feel empowered to negotiate condom use, potentially due to fear of violence from their partners.
In general, it is problematic to speak of condom use by women. Obviously a woman cannot wear a condom, she can only ask her partner to do so. There are many reasons a woman might not ask her partner to use condoms and her partner might not offer. (In other instances women do ask, but nonetheless condoms are not used.) I have more firsthand information on why a woman won't ask for a condom than why a man won't wear one. (Some think that there is one obvious answer to this.) As one of my informants said to me once: "Why would I ask him to wear a condom? I don't want him to be angry at me! I need him to give me money for Pampers and rent and I don't need to be thinking about condoms, I have Norplant!" And another: "If I ask him to wear a condom he's going to be thinking that I'm sleeping around. I'm not sleeping around, but I know that he is. Still, we play like I don't know that and never use them." While these explanations speak to issues of power and keeping the peace, other women talk about the heat-of-the-moment dynamic: "I knew I shouldn't do it," one explained, "but he was so damn hot and when he didn't put one on and I didn't have one in my apartment, I just said the hell with it."
Perhaps not surprisingly, there are some striking similarities between why some women aren't able to negotiate condom use with men and why some men aren't able to negotiate condom use with men. Hierarchies of power and communication, and the irrationality that is almost always a part of sexual decision-making come together to impact safer sex in hetero- and homosexual sex. Yet the issue of disease prevention is crucial among women, too, especially since AIDS is the leading cause of death for women in NYC aged 25 to 34. Women also have pregnancy to contend with. Clearly, when it comes to encouraging condom use, there is a lot of work still to be done.
And with that we come full circle—back to the ever-so-popular latex condom. May your weekend be fun and your sex safe!