Exploring Condom Use Among Adult Cisgender Black Women in Texas: a Qualitative Analysis

Cisgender Black women (CBW) remain disproportionately affected by HIV in the United States. Condoms, when used consistently and correctly, are an effective and reliable method for reducing acquisition and transmission of HIV and other sexually transmitted infections (STIs). However, consistent condom use among CBW is mixed. This study aimed to garner a contemporary conceptualization of factors impacting condom use among CBW with male sexual partner(s) residing in large urban areas in Texas. Between December 2020 and January 2022, CBW (N = 154) were recruited to complete a one-time online survey about HIV prevention and women’s sexual health. Descriptive statistics were used to characterize the study sample by condom use behavior (used condoms/did not use condoms). An inductive qualitative content analysis (IQCA) was used to analyze two open-ended questions about participants reasoning for their condom use or non-use. Condom use during vaginal sex was similarly proportioned (48.7% users; 51.3% non-users), indicating CBW differed in their condom use behaviors. Four themes described contributing factors for condom use (HIV/STI prevention and family planning) and non-use (relational context and intrapersonal factors). Condom use was motivated primarily by perceived HIV/STI and pregnancy prevention, including dual-protection strategies. Condom non-use was driven largely by relational context, such as trust, perceived monogamy, relationship length, and male partners’ preferences, and intrapersonal factors related to pleasure, comfort, or contraceptive reliance. Across both groups, CBW emphasized partner dynamics, communication, and relationship expectations in shaping decisions. The qualitative findings highlight how individual, relational, and intrapersonal factors intersect to influence condom use among CBW.