Quirk A, Rhodes T, Stimson G V
Department of Social Science and Medicine, Imperial College School of Medicine, London, UK.
AIDS Care. 1998 Feb;10(1):105-14. doi: 10.1080/713612349.
To describe forms of unsafe protected sex (vaginal or anal intercourse where condoms are used unsafely) among a sample of drug users in London, data are drawn from a qualitative study of the sexual and drug taking lifestyles of opioid and stimulant users. Depth one-to-one interviews (n = 96) elicited detailed descriptions from interviewees of their sexual behaviour, including the last occasions they had protected and unprotected sex. Analysis of these accounts identified the phenomenon of 'unsafe protected sex' (UPS). Three forms of UPS were identified: (1) Condoms for ejaculation only. This is where a condom was used for penetrative sex, but only when ejaculation was imminent. In these situations, the perceived function of the condom related more to the prevention of unwanted pregnancy than the prevention of HIV/STDs. (2) Condoms after limited unprotected penetration. This is where sexual partners commenced unprotected penetration but used a condom soon after. Participants tended to see such unprotected penetration as a coerced or collaborative transgression from their usual safer sexual practices. (3) Condom failure. This is where condoms split or came off during penetration. This was sometimes only discovered after ejaculation and withdrawal, and was invariably perceived by participants to have been unsafe. The likelihood of condom failure may be increased in penetrative sex prolonged through the use of drugs. Findings point to the possibility that surveys of sexual risk behaviour underestimate levels of unprotected and unsafe sex. A broader and more sophisticated definition of 'sexual risk behaviour' is required with regard to condom use, one which incorporates UPS. If some forms of UPS are perceived to be 'safer sex', future interventions need to highlight the STD transmission risks associated with this activity. Also, some people may view UPS as a transgression towards unsafe behaviour, and this may be proffered as a rationalization for not using condoms at all.
为了描述伦敦吸毒者样本中不安全的保护性性行为（使用避孕套但方式不安全的阴道或肛交）的形式，数据取自一项关于阿片类药物和兴奋剂使用者的性与吸毒生活方式的定性研究。深度一对一访谈（n = 96）从受访者那里引出了他们性行为的详细描述，包括他们最近进行有保护和无保护性行为的情况。对这些描述的分析确定了“不安全的保护性性行为”（UPS）这一现象。确定了UPS的三种形式：（1）仅在射精时使用避孕套。即避孕套用于插入式性行为，但仅在即将射精时使用。在这些情况下，避孕套的感知功能更多地与预防意外怀孕而非预防艾滋病毒/性传播感染有关。（2）在有限的无保护插入后使用避孕套。即性伴侣开始无保护的插入，但随后很快使用了避孕套。参与者倾向于将这种无保护的插入视为对他们通常更安全的性行为的一种强迫或协同的违规行为。（3）避孕套破裂。即避孕套在插入过程中破裂或脱落。这有时仅在射精和抽出后才被发现，并且参与者始终认为这是不安全的。通过使用药物延长插入式性行为时，避孕套破裂的可能性可能会增加。研究结果表明，性风险行为调查可能低估了无保护和不安全的性行为水平。在避孕套使用方面，需要一个更广泛、更复杂的“性风险行为”定义，其中纳入UPS。如果某些形式的UPS被视为“更安全的性行为”，未来的干预措施需要强调与此类行为相关的性传播感染传播风险。此外，一些人可能将UPS视为迈向不安全行为的违规行为，这可能被用作完全不使用避孕套的一种合理化理由。
