The men were recruited by the ‘snowball sampling’ method whereby two MSM volunteers were originally recruited in each area and were asked to recruit others.The 85 came from 11 districts in Uganda that had HIV high prevalence, but were also chosen to provide a geographical spread across the country and an urban-rural balance.

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Gay men and other men who have sex with men (MSM) in Uganda, who had not used a condom the last time they had anal sex with another man, were most likely to say that condoms not being strong enough for anal sex, a lack of suitable lubricant and, in rural areas, a lack of access to condoms were the most common reasons they did not use them.

A number of other reasons were also mentioned, such as pressure from primary or commercial sex partners, false beliefs about the safety of anal sex, lack of pleasure, and ignorance about how to use condoms.

Alcohol was also mentioned frequently as a disinhibitor of condomless sex.

While there have been numerous studies among gay and other MSM in high-income, more liberal countries about why they don’t always or ever use condoms, researchers have rarely asked the same questions of MSM in low-income countries, especially ones where male/male sex is criminalised and highly stigmatised.

Nonetheless, as the researchers point out, MSM are as disproportionately affected by HIV in such countries as they are elsewhere.

HIV prevalence in MSM in sub-Saharan Africa is 25% compared with a continent-wide adult-population prevalence of 9%.

In Uganda the figures are 13.5% and 7.3% respectively.

The data come from a qualitative study with 85 self-identified MSM.

The most common reasons cited for not using condoms involved the practical difficulties of getting hold of quality materials.