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Background: Non-consensual removal of condoms, colloquially referred to as 'stealthing', is the removal of a condom during sex by a sexual partner when consent has been given for sex with a condom only. Methods: We conducted a cross-sectional survey to determine how commonly women and men who have sex with men (MSM) attending Melbourne Sexual Health Centre had experienced stealthing, and analysed situational factors associated with the event. Responses were linked to demographic information extracted from patient files. Results: 1189 of 2883 women (41.2%), and 1063 of 3439 MSM (30.9%) attending the clinic during the study period completed the survey. Thirty-two percent of women (95% CI: 29%,35%) and 19% of MSM (95% CI: 17%,22%) reported having ever experienced stealthing. Women who had been stealthed were more likely to be a current sex worker (Adjusted Odds Ratio [AOR] 2.87, 95% CI: 2.01,4.11, p <0.001). MSM who had experienced stealthing were more likely to report anxiety or depression (AOR 2.13, 95% CI: 1.25,3.60, p = 0.005). Both female and male participants who had experienced stealthing were three times less likely to consider it to be sexual assault than participants who had not experienced it (OR 0.29, 95% CI: 0.22,0.4 and OR 0.31, 95% CI: 0.21,0.45 respectively). Conclusions: A high proportion of women and MSM attending a sexual health service reported having experienced stealthing. While further investigation is needed into the prevalence of stealthing in the general community, clinicians should be aware of this practice and consider integrating this question into their sexual health consultation. Understanding situational factors would assist in the development of preventive strategies, particularly female sex workers and MSM.
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RESEARCH ARTICLE
Non-consensual condom removal, reported
by patients at a sexual health clinic in
Melbourne, Australia
Rosie L. LatimerID
1
*, Lenka A. Vodstrcil
1,2
, Christopher K. Fairley
1,2
, Vincent
J. CornelisseID
1,2
, Eric P. F. Chow
1,2
, Tim R. H. Read
1,2
, Catriona S. Bradshaw
1,2
1Central Clinical School, Monash University, Melbourne, Australia, 2Melbourne Sexual Health Centre,
Alfred Health, Melbourne, Australia
These authors contributed equally to this work.
‡ Joint Senior Authors
*rlatimer@mshc.org.au
Abstract
Background
Non-consensual removal of condoms, colloquially referred to as ‘stealthing’, is the removal
of a condom during sex by a sexual partner when consent has been given for sex with a con-
dom only.
Methods
We conducted a cross-sectional survey to determine how commonly women and men who
have sex with men (MSM) attending Melbourne Sexual Health Centre had experienced
stealthing, and analysed situational factors associated with the event. Responses were
linked to demographic information extracted from patient files.
Results
1189 of 2883 women (41.2%), and 1063 of 3439 MSM (30.9%) attending the clinic during
the study period completed the survey. Thirty-two percent of women (95% CI: 29%,35%)
and 19% of MSM (95% CI: 17%,22%) reported having ever experienced stealthing. Women
who had been stealthed were more likely to be a current sex worker (Adjusted Odds Ratio
[AOR] 2.87, 95% CI: 2.01,4.11, p <0.001). MSM who had experienced stealthing were more
likely to report anxiety or depression (AOR 2.13, 95% CI: 1.25,3.60, p = 0.005). Both female
and male participants who had experienced stealthing were three times less likely to con-
sider it to be sexual assault than participants who had not experienced it (OR 0.29, 95% CI:
0.22,0.4 and OR 0.31, 95% CI: 0.21,0.45 respectively).
Conclusions
A high proportion of women and MSM attending a sexual health service reported having
experienced stealthing. While further investigation is needed into the prevalence of steal-
thing in the general community, clinicians should be aware of this practice and consider
PLOS ONE | https://doi.org/10.1371/journal.pone.0209779 December 26, 2018 1 / 16
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OPEN ACCESS
Citation: Latimer RL, Vodstrcil LA, Fairley CK,
Cornelisse VJ, Chow EPF, Read TRH, et al. (2018)
Non-consensual condom removal, reported by
patients at a sexual health clinic in Melbourne,
Australia. PLoS ONE 13(12): e0209779. https://doi.
org/10.1371/journal.pone.0209779
Editor: Junjie Xu, China Medical University, CHINA
Received: August 22, 2018
Accepted: December 11, 2018
Published: December 26, 2018
Copyright: ©2018 Latimer et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: Information obtained
in this survey is highly sensitive and confidential
and includes patient health record data.
Furthermore, we are unable to share data as it
would be in breach our ethics approval. Our
participant information and consent form
specifically states that individual participant
information will only be accessible to the study
team and will not be disseminated further in an
identifiable way, i.e. only presented as aggregated
data or statistics - "Information obtained in this
research project that can identify you will remain
confidential and will be stored securely indefinitely.
integrating this question into their sexual health consultation. Understanding situational fac-
tors would assist in the development of preventive strategies, particularly female sex work-
ers and MSM.
Introduction
Non-consensual removal of condoms, colloquially referred to as ‘stealthing’[1] or ‘stealth-
breeding’ [2], refers to the practice of a sexual partner covertly removing a condom, when con-
sent has been given for condom protected sex only [1]. Condoms are used as a primary pre-
ventative method of protecting against sexually transmitted infections (STI), human
immunodeficiency virus (HIV) and pregnancy, being 80 to 98.6% effective [35]. Stealthing
may result in the transmission of STIs, HIV, or unintended pregnancy, and could have signifi-
cant personal and public health implications.
Studies of undergraduate students have found consent for sexual intercourse to be mostly
communicated through non-verbal means [6,7], with consent for sexual intercourse often
implied in the process of asking for or applying a condom [6]. Brodsky has argued that con-
dom removal without mutual agreement violates consent to sex [1].
In young adult heterosexual relations, it is common for male partners to engage in condom
resistance tactics [8]. Several studies have identified stealthing as a method of birth control sab-
otage [9,10], as well as a means of intentional HIV transmission [11]. Anecdotal research by
Brodsky focusing on heterosexual and heteronormative relations, and theoretical research by
Brennan focusing on condom-less sex between men, argue these are not the primary motiva-
tors for this act [1,2].
In spite of public interest in stealthing, there are no scientific articles that investigate how
common it is, who is most at risk, and the outcomes for those who report being stealthed. We
aimed to investigate the proportion of sexual health centre patients reporting nonconsensual
removal of condoms: 1) among heterosexual women and 2) among men who have sex with
men, as well as associated risk factors. For the purpose of this study, ‘stealthing’ was defined as
condom removal without consent, where consent to sex was conditional upon use of a
condom.
Methods
Population and setting
This was a cross-sectional questionnaire-based study conducted amongst women and gay and
other men who have sex with men (MSM) attending the Melbourne Sexual Health Centre
(MSHC) in Victoria, Australia, between the 22
nd
December 2017 and the 22
nd
February 2018.
MSHC is the largest public sexual health service in Victoria, Australia. The centre provides
around 50,000 consultations every year, 37% with women and 36% with MSM [12]. Clinic
attendees routinely complete a computer assisted self-interview (CASI) about their sexual his-
tory prior to seeing a triage nurse.
Study measurement
Women and MSM presenting to MSHC, aged 18 or over, were invited to complete an elec-
tronic questionnaire containing questions about stealthing after completing CASI. Participants
read a patient information and consent form which detailed the nature of the survey, and
Non-consensual condom removal or ’stealthing’
PLOS ONE | https://doi.org/10.1371/journal.pone.0209779 December 26, 2018 2 / 16
The database containing the questionnaires and the
code linking these to your name will remain at
Melbourne Sexual Health Centre, on password-
protected servers, and only the study team will
have access. Your information will only be used for
this research project, or future research at this
centre, and will not be disclosed except as required
by law. The results of this research will be
published and presented at conferences in such a
way that you are not identified." Therefore we have
presented all data collected in an aggregate way in
the paper so that it is non-identifiable, as approved
by our ethics committee. Data is required to be
securely stored in keeping with requirements from
Alfred Hospital Ethics Committee who can be
contacted through Angela Henjak at
research@alfred.org.au for queries regarding
accessing the data. Any questions regarding the
data itself should be directed to Rosie Latimer at
rlatimer@mshc.org.au or A/Professor Catriona
Bradshaw at cbradshaw@mshc.org.au.
Funding: RLL and VJC are supported by an
Australian Government Research Training Program
(RTP) Scholarship. TRHR and EPFC are supported
by NHMRC early career fellowship no.1091536,
1091226, respectively. The funders had no role in
study design, data collection and analysis, decision
to publish, or preparation of the manuscript.
Competing interests: The authors have declared
that no competing interests exist.
patients could only commence the questionnaire after ticking a box stating ‘Yes- willing to
help’. Due to the potential of the questionnaire to cause distress when recalling the stealthing
event, the participant information included advertisement of free counselling services available
at MSHC and elsewhere. The Alfred Hospital Ethics Committee approved the study (number
494/17).
Age, number of sexual partners, and HIV status were extracted electronically from rou-
tinely collected clinic records for respondents and non-respondents, de-identified for non-
respondents, and linked to questionnaire responses for respondents (Fig 1).
The questionnaire asked whether the participant had ever had a condom removed during
sex with or without permission and at what point the participant noticed. Participants could
choose from a hierarchy of seven responses describing the circumstances. Multiple responses
were allowed for those reporting multiple occurrences, and there was no time limit applied to
the reported event. Participants were deemed not to have experienced stealthing if they
responded either: 1) they had never had a condom removed during sex, 2) that a condom had
been removed with permission, or 3) that a condom was removed without permission but they
willingly continued sex. Participants were deemed to have experienced stealthing if they
reported: 4) condom removal without permission and sex continued unwillingly, 5) condom
removal without permission and sex was discontinued, 6) condom removal during sex but they
did not realise until afterwards, or 7) the condom was never put on despite being requested. If a
participant only selected options between 1 and 3 they were classified as never having been
stealthed. If a participant selected any option between 4–7, regardless of whether they had also
selected options between 1 and 3, they were classified as ever having been stealthed (Fig 1).
Participants who reported stealthing were asked further questions about the specific event
(Fig 1). Participants who had selected multiple options were asked about the incident with the
highest assigned number. For instance if they reported several stealthing events with differing
scenarios and selected both response 4 and 5, then specific questions were asked about “event
5” only–i.e. condom removal without permission and sex was discontinued. Questions
included: when the incident occurred, how long they had known the partner, how they would
describe the relationship, where they had met, whether either person had been using drugs or
alcohol, whether the event was reported to the police, and what they perceived were the conse-
quences of the condom removal. All respondents were asked whether they considered the
removal of a condom without consent to be sexual assault.
Statistical analysis
All analyses were performed using Stata IC version 14. MSM who reported only insertive anal
sex and no receptive anal sex while completing CASI were excluded from the dataset prior to
analysis of questionnaire responses, as experiencing stealthing was considered unlikely if the
male was only the insertive partner. Risk factors for experiencing stealthing in women and
MSM were not compared to each other as they are different populations. Univariable and mul-
tivariate analyses were performed to determine the differences in demographics between non-
respondents and respondents, and the differences between those who had and had not experi-
enced stealthing. Variables were included in multivariate models if the p-value was 0.1; if
correlated, the variable most strongly associated with the outcome was used. Models were built
in a backward-stepwise fashion, using the likelihood ratio test to determine the significance of
the contribution of each variable. Ninety-five percent binomial confidence intervals (CIs) were
calculated for all proportions. We assumed 100 patients would complete the survey each week
and estimated 2% would report ever being stealthed. The 95% confidence interval around an
estimated 2% prevalence of stealthing after six weeks (600 responses) would be 1.0%, 3.5%.
Non-consensual condom removal or ’stealthing’
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Non-consensual condom removal or ’stealthing’
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Results
During the study period, 2883 women and 3439 MSM attended the clinic, of whom 1189
women (41%, 95%CI: 39%,43%) and 1063 MSM (31%, 95%CI: 29%,32%) completed the survey
(classified as respondents).
Female respondents were more likely than non-respondents to have had sex overseas in the
last twelve months (adjusted odds ratio [AOR] 1.49, 95% CI: 1.26,1.77, p<0.001) and were less
likely to be a current sex worker (AOR 0.78, 95% CI: 0.63,0.96, p = 0.02) (Table 1). Compared
to MSM non-respondents, the men who responded were more likely to have had sex overseas
in the last twelve months (AOR 1.70, 95% CI: 1.37,2.11, p<0.001), and were less likely to be
HIV positive (AOR 0.60, 95% CI: 0.38,0.95, p = 0.029) (Table 1).
Of the 1189 women and 1063 MSM who consented to the survey and answered the first
question: 60 (5%) women and 64 men (6%) declined to answer whether they had experienced
stealthing, 45 (4%) women and 37 (3%) men deemed the question to be not applicable to them
i.e. they never used condoms, or did not engage in penetrative sex with men and 90 (8%) men
were removed from the analysis, as they had only reported insertive anal sex and not reported
receptive anal sex in CASI (Table 2).
Three hundred and forty-six of the remaining 1084 women (32%, 95% CI: 29%,35%) and
168 of the remaining 872 MSM (19%, 95% CI: 17%,22%) reported having ever experienced
stealthing (Table 3). Of those who had experienced stealthing, forty-two women (12%, 95% CI:
9%,16%) and 23 MSM (14%, 95% CI: 9%,20%) presented to the clinic on the day of the ques-
tionnaire following a reported stealthing incident (Table 4).
Data missing from up to 5% of female respondents and up to 3% of male respondents; pro-
portions are calculated using available data.
On multivariate analysis, women who had been stealthed were more likely to be a current sex
worker than those who had never experienced stealthing (AOR 2.87, 95% CI: 2.01,4.11, p<0.001)
(Table 3), and MSM who had been stealthed were more likely to report ‘health issues, such as anx-
iety or depression which may have affected their decision to use condoms for anal sex’ than those
who had never experienced stealthing (AOR 2.13, 95% CI: 1.25,3.60, p = 0.005) (Table 3).
Most women met the male partner who had stealthed them through friends (29%, 95% CI:
24%,34%) or sex work (23%, 95% CI: 19%,28%). MSM reporting stealthing most commonly
described the partner as someone they “did not know well” (61%) and had predominantly met
them through geosocial dating applications or online (67%, 95% CI: 59%,74%) (Table 4).
At the time of the stealthing incident, 41% (95% CI: 36%,47%) of women and 54% (95% CI:
46%,62%) of MSM reported being sober, while 57% (95% CI: 51%,62%) of women and 41%
(95% CI: 33%,49%) of MSM had consumed alcohol. Twelve percent of women and 13% of
MSM had used other drugs either in addition to or without alcohol (Table 4). The majority of
women reported their partner had consumed alcohol (68%, 95% CI: 62%,73%) and/or other
drugs (19%), with only 27% (95% CI: 22%,33%) stating the partner had been sober when the
incident occurred. Many MSM believed their partner to be sober (53%, 95% CI: 44%,62%),
with 40% (95% CI: 31%,50%) of partners under the influence of alcohol, and 12% using addi-
tional/or other drugs (Table 4).
Fig 1. Possible pathways for patients offered the survey, and the classification for analysis of nonconsensual condom removal.
Abbreviations: MSM = men who have sex with men; CASI = computer assisted self-interviewing.
a
Participants were classified as never
having experienced stealthing if they responded either: 1) they had never had a condom removed during sex, 2) that a condom had been
removed with permission, or 3) that a condom was removed without permission but they willingly continued sex.
b
Participants were deemed
to have experienced stealthing if they reported: 4) condom removal without permission and sex continued unwillingly, 5) condom removal
without permission and sex was discontinued, 6) condom removal during sex but they did not realise until afterwards, or 7) the condom was
never put on despite being requested.
https://doi.org/10.1371/journal.pone.0209779.g001
Non-consensual condom removal or ’stealthing’
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Table 1. Demographics and epidemiological features of respondents versus non-respondents to survey on rates of non-consensual removal of condoms (stealthing)
in a STI clinic (N = 6322).
Female non-respondents
n = 1694 (%; 95% CI) or
median [range]
Female respondents
n = 1189 (%; 95% CI)
or median [range]
Unadjusted Odds
Ratio (95% CI)
p-value Adjusted Odds Ratio
a
(95% CI)
p-value
Age 27 [16–74] 26 [18–64]
Employment
Employed 958 (60; 57,62) 689 (60; 57,62) 1
Not in the labour force
b
641 (40; 38,43) 467 (40; 38,43) 1.01 (0.87,1.18) 0.87
Aboriginal and/or Torres Strait Islander
peoples
No 1479 (99; 98,99) 1074 (99; 98,99) 1
Yes 16 (1; 0,2) 14 (1; 1,2) 1.20 (0.59,2.48) 0.613
Sex overseas
No 817 (60; 57,62) 485 (48; 45,52) 1 1
Yes 552 (40; 38,43) 517 (52; 48,55) 1.58 (1.35,1.86) <0.001 1.49 (1.26,1.77) <0.001
Injecting drug use
Never injected 1420 (98; 97,99) 1023 (98; 97,99) 1
Ever injected 26 (2; 1,3) 22 (2; 1,3) 1.17 (0.66,2.08) 0.582
Current sex worker
No 1095 (76; 74,78) 856 (82; 79,84) 1 1
Yes 348 (24; 22,26) 191 (18; 16,21) 0.70 (0.58,0.86) <0.001 0.78 (0.63,0.96) 0.020
Condom Use in the last 3mo with male
partners
Not always 1014 (83; 81,85) 765 (82; 80,85) 1
Always 204 (17; 15,19) 163 (18; 15,20) 1.06 (0.84,1.33) 0.619
Number of male sexual partners
in the last 3mo
1 [0–50] 1 [0–15]
Male non-respondents
n = 2376 (%; 95% CI) or
median [range]
Male respondents
n = 1063 (%; 95% CI)
or median [range]
Unadjusted Odds
Ratio (95% CI)
p-value Adjusted Odds Ratio
c
(95% CI)
p-value
Age 30 [16–82] 30 [18–75]
Employment
Employed 1480 (67; 65,69) 644 (64; 61,67) 1
Not in the labour force
b
742 (33; 31,35) 361 (36; 33,39) 1.12 (0.96,1.31) 0.161
Aboriginal and/or Torres Strait Islander
peoples
No 2114 (99; 98,99) 978 (99; 99,100) 1 1
Yes 26 (1; 1,2) 5 (1; 0,1) 0.42 (0.16,1.09) 0.073 0.64 (0.21,1.97) 0.441
Sex overseas
No 1365 (70; 69,72) 542 (61; 58,64) 1 1
Yes 587 (30; 28,32) 345 (39; 36,42) 1.48 (1.25,1.75) <0.001 1.70 (1.37,2.11) <0.001
Injecting drug use
Never injected 2048 (96; 96,97) 914 (97; 96,98) 1
Ever injected 75 (4; 3,4) 28 (3; 2,4) 0.84 (0.55,1.3) 0.428
Current sex worker
No 2126 (>99; 99,100) 933 (99; 98,99) 1 1
Yes 9 (<1; 0,1) 10 (1; 1,2) 2.53 (1.03,6.25) 0.044 2.72 (0.97,7.59) 0.057
Condom Use in the last 3mo with male
partners
Not always 1379 (74; 72,76) 616 (71; 68,74) 1
Always 492 (26; 24,29) 246 (29; 26,32) 1.12 (0.93,1.34) 0.220
(Continued)
Non-consensual condom removal or ’stealthing’
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The majority of women (61%) and MSM (55%) discussed the removal of the condom with
their partners after the event. Over half of the participants reported being emotionally stressed
following the incident. Eight percent of women and five percent of MSM reported they
thought they had acquired an STI following the event. One percent of women and two percent
of MSM believed they had acquired HIV as a consequence of being stealthed (Table 4). Only
1% of people stealthed reported this experience to the police (Table 4).
Table 1. (Continued)
HIV status
Negative 1279 (91; 90,93) 558 (95; 92,96) 1 1
Positive 119 (9; 7,10) 32 (5; 4,8) 0.62 (0.41,0.92) 0.019 0.61 (0.38,0.97) 0.038
Use of prep
No 1844 (81; 79,82) 861 (83; 81,85) 1
Yes 436 (19; 18,21) 174 (17; 15,19) 0.85 (0.70,1.04) 0.112
Number of male sexual partners
in the last 3mo
3 [0–100] 3 [0–140]
Abbreviations: n = number; CI = confidence interval; mo = months; HIV = human immunodeficiency virus; PrEP = HIV pre-exposure prophylaxis
a
Adjusted model for females includes: sex overseas and current sex worker
b
Not in the labour force includes both those who are unemployed and/or students
c
Adjusted model for males includes: Aboriginal and/or Torres Strait Islander peoples, sex overseas, current sex worker and HIV status.
Data missing for: <5% of PrEP data; <5%-10% of employment data; 5–15% of Aboriginal and/or Torres Strait Islander peoples data; 10–15% of current sexworker data;
10%-20% of sex overseas data and injecting drug use data; 15- 20% of condom use data; and >20% of HIV data. Proportions are calculated using available data.
https://doi.org/10.1371/journal.pone.0209779.t001
Table 2. Reported events of non-consensual removal of condoms (stealthing) amongst patients presenting to a
STI clinic (N = 2252)
a
.
Female
respondents
n = 1189 (%; 95%
CI)
Male respondents
n = 1063 (%; 95%
CI)
Classified as not experiencing ‘stealthing’
Never stealthed 420 (35; 33,38) 496 (47; 44,50)
Condom removed w permission 455 (38; 35,41) 315 (30; 27,32)
Condom removed w/o permission but continued willingly 104 (9; 7,10) 77 (7; 6,9)
Classified as experiencing ‘stealthing’
Condom removed w/o permission, and continued unwillingly 108 (9; 8,11) 52 (5; 4,6)
Condom removed w/o permission, and stopped 135 (11; 10,13) 65 (6; 5,8)
Condom removed w/o permission, but didn’t realise until afterwards 147 (12; 11,14) 60 (6; 4,7)
Condom never put on but had been requested 84 (7; 6,9) 41 (4; 3,5)
Removed from further analysis
Not applicable
b
45 (4; 3,5) 127 (12; 10,14)
Decline answer 60 (5; 4,6) 64 (6; 5,8)
Abbreviations: n = number; CI = confidence interval; w = with; w/o = without.
a
Patients could select multiple options, to report multiple events occurring, i.e. events are not mutually exclusive,
therefore percentages do not sum to 100. Percentages represent the proportion of participants who have reported the
event. If reporting multiple events, patients were classified in the analysis based off the highest numbered event they
reported, if 1 is Never and 7 is ‘Condom never put on even though requested’.
b
Not applicable refers to patients who have not/do not engaged in penetrative penile sex, includes 97 MSM who
responded to survey but reported no receptive anal sex and 30 who selected not applicable.
https://doi.org/10.1371/journal.pone.0209779.t002
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Table 3. Risk factors associated with non-consensual removal of condoms (stealthing) in patients presenting to a STI clinic (N = 2042).
Womenwho have not
had been stealthed
n = 738 (%; 95% CI) or
median [range]
Women who have
have been stealthed
n = 346 (%; 95% CI)
or median [range]
Unadjusted Odds
Ratio (95% CI)
p-value Adjusted Odds Ratio
(95% CI)
a
p-value
Age 26 [18–58] 26 [18–55]
Number of male sexual partners in the
last 3mo
2 [0–15] 1 [0–15]
Employment
b
Employed 439 (61; 57,65) 189 (56; 51,62) 1
Not in the labour force 281 (39; 35,43) 146 (44; 38,49) 1.21 (0.93,1.57) 0.161
Education level
Did not complete high school 18 (2; 1,4) 13 (4; 2,6) 1
High school/Certificate/Diploma 238 (33; 29,36) 134 (39; 34,45) 0.78 (0.37,1.64) 0.512
University degree 475 (65; 61,68) 195 (57; 52,62) 0.57 (0.35,1.47) 0.131
Aboriginal and/or Torres Strait Islander peoples
No 672 (99; 98,99) 319 (98; 96,99) 1
Yes 8 (1; 1,2) 5 (2; 1,4) 1.31 (0.43,4.06) 0.632
Australian/New Zealander
No 441 (63; 59,66) 166 (51; 45,56) 1
Yes 264 (37; 34,41) 160 (49; 44,55) 1.61 (1.23,2.09) <0.001 1.26 (0.94,1.70) 0.122
Current sex worker
No 573 (87; 85,90) 215 (71; 65,76) 1
Yes 83 (13; 10,15) 89 (29; 24,35) 2.86 (2.04,4.01) <0.001 2.87 (2.01,4.11) <0.001
Injecting drug use
Never injected 644 (98; 97,99) 295 (97; 95,99) 1
Ever injected 11 (2; 1,3) 8 (3; 1,5) 1.59 (0.63,3.99) 0.325
Sex overseas
No 303 (47; 44,51) 136 (47; 41,53) 1
Yes 335 (53; 49,56) 153 (53; 47,59) 1.02 (0.77,1.34) 0.903
Use other contraceptives in addition to
condoms
c
No 293 (46; 42,50) 112 (47; 40,53) 1
Yes 339 (54; 50,58) 128 (53; 47,60) 0.94 (0.733,1.33) 0.936
MSM who have not
been stealthed n = 704
(%; 95% CI) or
median [range]
MSM who have been
stealthed n = 168 (%,
95% CI) or median
[range]
Unadjusted Odds
Ratio (95% CI)
p-value Adjusted Odds
Ratio (95% CI)
d
p-value
Age 30 [18–75] 29 [18–58]
Number of male sexual partners in the
last 3mo
3 [0–140] 3 [0–100]
Employment
Employed 435 (65; 61,69) 98 (61; 53,68) 1
Not in the labour force 232 (35; 31,39) 63 (39; 32,47) 1.20 (0.85,1.72) 0.302
Education level
Did not complete high school 24 (3; 2,5) 7 (4; 2,8) 1
High school/Certificate/Diploma 183 (26; 23,30) 34 (20; 14,27) 0.64 (0.25,1.60) 0.336
University degree 494 (70; 67,74) 127 (76; 68,82) 0.88 (0.37,2.09) 0.775
Aboriginal and/or Torres Strait Islander peoples
No 701 (100; 99,100) 166 (99; 97,100) 1
Yes 2 (0; 0,1) 1 (1; 0,3) 2.11 (0.19,23.42) 0.543
(Continued)
Non-consensual condom removal or ’stealthing’
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Table 3. (Continued)
Womenwho have not
had been stealthed
n = 738 (%; 95% CI) or
median [range]
Women who have
have been stealthed
n = 346 (%; 95% CI)
or median [range]
Unadjusted Odds
Ratio (95% CI)
p-value Adjusted Odds Ratio
(95% CI)
a
p-value
Australian/New Zealander
No 343 (50; 46,54) 83 (49; 42,57) 1
Yes 342 (50; 46,54) 85 (51; 43,58) 1.03 (0.73,1.44) 0.877
Current sex worker
No 622 (99; 98,100) 151 (99; 95,100) 1
Yes 5 (1; 0,2) 2 (1; 0,5) 1.65 (0.32,8.57) 0.553
Injecting drug use
Never injected 611 (97; 96,98) 145 (96; 92,99) 1
Ever injected 18 (3; 2,4) 6 (4; 1,8) 1.4 (0.55,3.60) 0.480
Sex overseas
No 354 (60; 56,64) 82 (57; 49,66) 1
Yes 237 (40; 36,44) 61 (43; 34,51) 1.11 (0.77,1.61) 0.577
HIV status
No 375 (95; 93,97) 96 (2; 85,97) 1
Yes 19 (5; 3,7) 8 (8; 3,15) 1.64 (0.70,3.87) 0.255
Use of prep
No 582 (84; 81,87) 126 (78; 71,84) 1 1
Yes 110 (16; 13,19) 35 (22; 16,29) 1.47 (0.96,2.25) 0.077 1.16 (0.70,1.92) 0.567
Drugs use with anal sex w/o a condom in the last 12mo
e
No 222 (58; 53,63) 58 (55; 45,64) 1
Yes 162 (42; 37,47) 48 (45; 36,55) 1.13 (0.74,1.75) 0.569
Drunk during anal sex w/o a condom in the last 12mo
e
No 219 (57; 52,62) 53 (50; 41,60) 1
Yes 166 (43; 38,48) 52 (50; 40,59) 1.29 (0.84,1.99) 0.242
Anal sex w/o a condom with known HIV positive in the last 12mo
e
No 319 (83; 79,87) 83 (82; 73,89) 1
Yes 65 (17; 13,21) 18 (18; 11,27) 1.06 (0.60,1.89) 0.832
Anal sex w/o a condom with someone of unknown HIV status in the last 12mo
e
No 189 (50; 45,55) 39 (38; 29,48) 1 1
Yes 190 (50; 45,55) 63 (62; 52,71) 1.61 (1.03,2.51) 0.038 1.51 (0.96,2.39) 0.075
Self-reported health issues, such as anxiety or depression, which may have affected your decision to use condoms for anal
sex?
e
No 318 (85; 81,89) 74 (73; 63,81) 1 1
Yes 55 (15; 11,19) 28 (27; 19,37) 2.19 (1.30,3.68) 0.003 2.13 (1.25,3.6) 0.005
Abbreviations: n = number; CI = confidence interval; mo = months; MSM = men who have sex with men; HIV = human immunodeficiency virus; PrEP = HIV pre-
exposure prophylaxis; w/o = without
a
Adjusted model for females includes: Australian and current sex worker
b
Not in the labour force includes both those who are unemployed and/or students
c
Women who reported not using contraception due to pregnancy were excluded (2 females who did not have condoms removed, and 10 who did).
d
Adjusted model for males includes: use of prep, condom use with someone of uncertain HIV status, health issues (anxiety & depression) affecting decisions to use
condoms.
e
These questions were asked only to patients who had reported unprotected anal sex since their last HIV test as part of their routine computer assisted self-interviewing
(CASI).
Data missing for: <5% of employment data, education data and PrEP data; <5%-10% of Aboriginal and/or Torres Strait Islander peoples data and Australian data; 10%-
15% of injecting drug use data and current sex worker data, 10%-20% sex overseas data; 10- 20% contraception data; and 20% of HIV status and questions on issues
affecting decisions to use condoms. Proportions are calculated using available data.
https://doi.org/10.1371/journal.pone.0209779.t003
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Table 4. Situational factors surrounding non-consensual removal of condoms (stealthing) reported by patients presenting to a STI clinic (N = 523).
Women
n = 346 (%; 95% CI)
MSM
n = 168 (%; 95% CI)
When the incident occurred
Here today for this reason 42 (12; 9,16) 23 (14; 9,20)
In the last 3mo 59 (17; 13,22) 20 (12; 7,18)
3–12 mo ago 78 (23; 18,28) 35 (21; 15,28)
More than 12 months ago 120 (35; 30,40) 78 (46; 39,54)
More than 1 occasion 43 (13; 9,17) 12 (7; 4,12)
Relationship
Did not know him well 101 (30; 25,36) 102 (61; 54,69)
Friend 33 (10; 7,14) 10 (6; 3,11)
Friend with benefits/ Sex buddy 51 (15; 12,20) 30 (18;13,25)
Casually dating 54 (16; 12,21) 22 (13; 8,19)
Relationship 25 (8; 5,11) 2 (1; 0,4)
Client (of sex worker) 69 (21; 16,25) 0 (0; 0,2)
a
Relationship duration
Less than a day (<24hrs) 126 (38; 33,44) 85 (52; 44,59)
One day to one month 95 (29; 24,34) 39 (24; 17,31)
More than one month 107 (33; 28,28) 41 (25; 18,32)
Met through
Smartphone dating app/Internet 64 (20; 15,24) 110 (67; 59,74)
(Gay) bar or party 50 (15; 12,20) 20 (12; 8,18)
Gay sauna, beats of SOPV, sex party 2 (1; 0,2) 24 (15; 10,21)
Friend, or friend of friend 94 (29; 24,34) 6 (4; 1,8)
Co-workers 22 (7; 4,10) 3 (2; 0,5)
Sex work 76 (23; 19,28) 0 (0; 0,2)
a
Travel 15 (5; 3,7) 0 (0; 0,2)
a
Other (cafe
´, park etc.) 4 (1; 0,3) 1 (1; 0,3)
Drugs used by partner
bc
None 75 (27; 22,33) 63 (53; 44,62)
Alcohol 188 (68; 62,73) 48 (40; 31,50)
Cannabis/marijuana/hash 28 (10; 7,14) 4 (3; 1,8)
Ecstasy 12 (4; 2,7) 4 (3; 1,8)
Speed/ice/meth 5 (2; 1,4) 6 (5; 2,11)
GHB 2 (1; 0,3) 3 (2; 1,7)
Cocaine 10 (4; 2,7) 3 (2; 1,7)
Heroin 1 (<1; 0,2) 0 (0; 0,3)
a
Other 1 (<1; 0,2) 3 (2; 1,7)
Drugs used by respondent
bd
None 135 (41; 36,47) 87 (54; 46,62)
Alcohol 186 (57; 51,62) 65 (41; 33,49)
Cannabis/marijuana/hash 21 (6; 4,10) 3 (2; 0,5)
Ecstasy 9 (3; 1,5) 4 (3; 1,6)
Speed/ice/meth 5 (2; 0,4) 8 (5; 2,9)
GHB 2 (1; 0,2) 3 (2; 0,5)
Cocaine 8 (2; 1,5) 4 (3; 1,6)
Heroin 1 (<1; 0,2) 0 (0; 0,2)
a
Other 0 (0; 0,1)
a
4 (3; 1,6)
(Continued)
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Both female and MSM participants who had experienced stealthing were less likely to con-
sider it to be sexual assault than participants who had not experienced stealthing. Amongst
women, 62% (95% CI: 56%,67%) of those stealthed considered it to be assault, compared to
85% (95% CI: 82%,87%) of those not stealthed (OR 0.29, 95%CI: 0.22,0.4, p<0.001). Amongst
men, 61% (95% CI: 53%,69%) of those stealthed considered it to be assault versus 84% (95%
CI: 81%,86%) of those not stealthed (OR 0.31, 95%CI: 0.21,0.45, p<0.001).
Discussion
Although increasingly discussed in international media, there is little scientific research on
non-consensual removal of condoms, popularly termed ‘stealthing’. To our knowledge this is
the first study investigating how common stealthing is, the context in which it occurred, the
impact on individuals, and how those stealthed perceive the event. A surprising proportion of
clients attending a sexual health centre in Melbourne (32% of women and 19% of MSM)
reported removal of a condom in a situation where they would not have willingly engaged in
sexual intercourse without one—in other words, a violation of their consent [1].
These data need to be interpreted in the context of a STI clinic population which is gener-
ally a higher risk group than the general population. Our data show that 4% of women and 3%
of MSM presenting to our clinic during the study period were attending following a stealthing
incident. This equates to over 1200 consultations per year [12]. These data suggest that steal-
thing is common and should be considered when assessing patients in STI services.
Female respondents were less likely to be a current sex worker and MSM respondents were
less likely to be HIV positive, compared to non-respondents. It is possible that both sex work-
ers and HIV positive men were less likely to complete the survey due to privacy concerns,
Table 4. (Continued)
Women
n = 346 (%; 95% CI)
MSM
n = 168 (%; 95% CI)
Condom removal discussed with partner
No 128 (39; 33,44) 74 (45; 37,52)
Yes 204 (61; 56,67) 92 (55; 48,63)
Consequences of condom removal
b
None 85 (25; 21,30) 62 (38; 30,46)
Emotional stress 190 (56; 51,62) 86 (52; 45,60)
Caught an STI 26 (8; 5,11) 9 (5; 3,10)
Contracted HIV 2 (1; 0,2) 3 (2; 0,5)
Fight 49 (14; 11,19) 15 (9; 5,15)
Relationship broke up 30 (9; 6,12) 6 (4; 1,8)
Other 42 (12; 9,16) 12 (7; 4,12)
Reported to the police
No 336 (99; 97,100) 163 (98; 95,100)
Yes 3 (1; 0,3) 3 (2; 0,5)
Abbreviations: n = number; CI = confidence interval; MSM = men who have sex with men; mo = months; SOPV = sex on premises venue; GHB = Gamma-
hydroxybutyrate; STI = sexually transmitted infection; HIV = human immunodeficiency virus
a
one-sided, 97.5% confidence interval
b
Patients could select multiple options, to report multiple events occurring, i.e. events are not mutually exclusive, therefore percentages do not sum to 100. Percentages
represent the proportion of participants who have reported the event.
c
64 women (19%) and 47 MSM (28%) were unsure as to whether or not their partner had used any alcohol and/or other drugs and were removed from the analysis.
d
11 women (3%) and 6 MSM (4%) were unsure as to whether or not they had used any alcohol and/or other drugs and were removed from the analysis.
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especially with regards to condom use and their legal obligations, which vary state by state in
Australia. In Victoria, sex workers are legally required to use condoms with clients[13], and
while those who are HIV positive are not legally required to disclose their HIV status, they
must take reasonable precautions to prevent HIV transmission to those they are engaging in
penetrative sex with[14]. Reasonable precaution refers to correct use of condoms and lube dur-
ing intercourse. While female sex workers were less represented in respondents than non-
respondents, 18% of participants were sex workers and we still observed an association
between being a sex worker and being more likely to be stealthed. Low numbers of HIV posi-
tive men participating may have limited our ability to examine any association between steal-
thing and HIV status. Lastly, both women and MSM who had been overseas recently were
more likely to respond to our survey. This may bias our findings towards individuals who may
have participated due to recent high risk sexual encounters, in the context of overseas travel
[15].
Women who experienced stealthing were three times more likely to be sex workers com-
pared to those who had not. In the Law and Sex Worker Health (LASH) Survey conducted in
Australia, 8% of respondents reported assault by clients [16]. However the LASH survey did
not compare rates of assault to the general population or differentiate between physical and
sexual assault, and only examined assault in the workplace. Perkins’ (1991) research with Syd-
ney-based brothel workers found that 20% of sex workers experienced rape while working.
Outside the workplace sex workers experienced higher levels of sexual assault compared with
non-sex workers, with 46.9% reporting rape, compared to 21.9% of health workers and 12.7%
of students [17]. Our data are consistent with these findings that sex workers are at increased
risk of non-consensual sex acts.
Sixty-seven percent of MSM who had experienced stealthing met the partner via geosocial
dating applications, for example Grindr, Tinder or Scruff. This is comparable to the number of
MSM meeting partners through dating applications (70%) [18]. Sexual encounters initiated
online are more likely to include unprotected anal intercourse [19], however it has also been
found that meeting partners online increases the likelihood of discussion between partners of
preferred sexual practices compared to meeting partners offline [19,20]. MSM who had been
stealthed were twice as likely to report having anxiety or depression. Depressive symptoms
and anxiety are predictive of condom non-use [21] and higher levels of depression are related
to lower levels of self-efficacy for sexual safety [22]. MSM who have anxiety or depression may
be vulnerable to stealthing for this reason.
In this study, the majority of women (73%) believed the partner who had stealthed them to
be under the influence of alcohol and/or other drugs. In heterosexual relations, the link
between alcohol consumption and committal of sexual assault is well documented [23,24].
Condom resistance tactics and sexual aggression with female partners are more commonly
employed by men with history of sexual aggression and alcohol intoxication [25,26]. Addi-
tionally, both alcohol consumption [27] and condom use [28,29] have been associated with
erectile dysfunction. Men with erection issues are more likely to engage in unprotected sex,
misuse condoms [28,29], and are more likely to remove condoms before sex is over
(p = 0.001) [29]. Literature supports our finding that heterosexual men who have consumed
alcohol may be at increased risk of committing nonconsensual sex acts, and may be removing
the condom to maintain an erection.
Whilst the majority of those reporting stealthing considered it sexual assault, they were
three times less likely to consider stealthing sexual assault than those who had never experi-
enced it. The US National Crime Victimization Survey found 20% of female victim narratives
contained excuses for offenders’ behaviour, denials of injury, or justification of the incident as
the victims’ fault [30]. This allowed the women to avoid the distress of labelling themselves
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PLOS ONE | https://doi.org/10.1371/journal.pone.0209779 December 26, 2018 12 / 16
victims of a crime, or their partners as criminals [30]. Victims of stealthing may also not yet
view themselves as sexual assault victims as stealthing is a relatively new topic. Sexual assault is
a term with many connotations and there are cultural myths as to who is a ‘real’ sexual victim
[31], with the type of violence experienced influencing society’s view as to whether a woman is
a victim [32]. Our current language around sexual assault (and in this case, stealthing) may
require expansion- until an act is named as assault it cannot be viewed as such, and cannot be
reported or legislated against [33]. A limitation of this study is that we did not ask respondents
why they did not consider stealthing to be sexual assault.
Stealthing has potentially serious consequences. The majority of patients reported conse-
quences following the stealthing incident, with over half experiencing emotional stress. Although
literature contains estimates as to the rate of STI and HIV transmission during sexual assault, it is
difficult to establish if an STI has been acquired from a specific event. The Centers for Disease
Control and Prevention (CDC) guidelines recommend testing all people for STIs following sexual
assault [34], with the caveat that many positive tests will be from a pre-existing STI [35]. MSM
patients with condom malfunction or condom-less sex presenting in a 72 hour window fulfil crite-
ria for HIV Non-Occupational Post Exposure Prophylaxis (nPEP) [36,37], and therefore MSM
who present reporting non-consensual condom removal should be prescribed it.
This study has several limitations. Firstly, this study was offered in English only, which
means it cannot be generalised to attendees who are not fluent in English. Secondly, this study
may be subject to responder bias, as those who have experienced stealthing may have been
more likely to answer the survey. Given this is a retrospective survey, participant responses
may be subject to recall bias, and specific contextual situational factors and outcomes were
asked about one event only for those stating it had happened on more than one occasion.
While some participants within our study attributed the acquisition of STIs to being stealthed,
this cannot be verified. According to attribution theory [38] following an adverse event people
will make attributions to understand and control their environment[39], with situational fac-
tors often exaggerated when there is a negative outcome [40], and thus patients could be incor-
rectly attributing contracting a STI to the stealthing event.
Despite these limitations, this study has a large sample size with over two thousand
responses. Accurate statistics describing the prevalence and incidence of sexual assault are dif-
ficult to obtain since the majority of assaults are not reported to authorities and victims often
do not access services [31]. Only 1% of patients reporting stealthing in this study reported the
event to the police. Although this study may be subject to recall bias, population surveys are
the best means of learning the true extent and nature of these crimes, rather than relying on
crime statistics. This is the first study to describe how commonly this practice is occurring.
In summary, stealthing was commonly experienced by our clinic population, with a third of
women and a fifth of MSM reporting it, with situational contexts often involving alcohol and/
or drugs in women, and geosocial networking applications in MSM. Sex work was a clear risk
factor identified among women, and risk factors for MSM included anxiety and depression.
Knowledge of these risk factors can enable services to ask about stealthing in target groups and
offer specific support and counselling. Further community-based research would help deter-
mine the prevalence in the broader population and studies that link behavioural measures to
biological outcomes would help to quantify the STI risk associated with this practice.
Acknowledgments
We would like to acknowledge Jun Kit Sze and Afrizal for technical assistance and assistance
with data collection for this project, and Melbourne Sexual Health Centre counsellors Jocelyn
Verry and Peter Hayes for their support of this project.
Non-consensual condom removal or ’stealthing’
PLOS ONE | https://doi.org/10.1371/journal.pone.0209779 December 26, 2018 13 / 16
Author Contributions
Conceptualization: Rosie L. Latimer.
Data curation: Rosie L. Latimer.
Formal analysis: Rosie L. Latimer.
Investigation: Rosie L. Latimer.
Methodology: Rosie L. Latimer, Lenka A. Vodstrcil, Vincent J. Cornelisse, Tim R. H. Read,
Catriona S. Bradshaw.
Project administration: Rosie L. Latimer, Tim R. H. Read, Catriona S. Bradshaw.
Resources: Christopher K. Fairley.
Supervision: Lenka A. Vodstrcil, Christopher K. Fairley, Tim R. H. Read, Catriona S.
Bradshaw.
Validation: Lenka A. Vodstrcil, Tim R. H. Read, Catriona S. Bradshaw.
Visualization: Rosie L. Latimer.
Writing – original draft: Rosie L. Latimer.
Writing – review & editing: Rosie L. Latimer, Lenka A. Vodstrcil, Christopher K. Fairley, Vin-
cent J. Cornelisse, Eric P. F. Chow, Tim R. H. Read, Catriona S. Bradshaw.
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... Stealthing has received significant media attention in recent years, but has been the focus of relatively little academic research (Ebrahim 2019). A recent Australian prevalence study suggested that 32% of women attending a sexual health center had ever experienced stealthing (Latimer et al. 2018), with sex workers being three times more likely than other women to have been victimized. Within the literature, stealthing has been explored mainly in the context of male same-sex relationships (Klein 2014), and in the context of how the legal system can respond to it as a consent issue (Brodsky 2017;Clough 2018). ...
... Both RCA and stealthing are clearly harmful to women's health and wellbeing (Grace 2016;Grace and Anderson 2016;Latimer et al. 2018); consequently, our intention is not to create a hierarchy of harm. Rather, we suggest that it is important to distinguish between these behaviors for two main reasons. ...
Article
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The aim of this qualitative study was to understand and differentiate between women’s experiences of “stealthing” (non-consensual condom removal) and reproductive coercion and abuse (RCA) which is defined as any deliberate attempt to control a woman’s reproductive choices or interfere with her reproductive autonomy. These two experiences are often conflated within the literature, yet little is known about whether this understanding reflects women’s lived reality. We recruited female participants from a large Australian metropolitan hospital who self-identified as having experienced a partner interfering with contraception or trying to force them to get pregnant or end a pregnancy against their wishes. Fourteen women (predominantly white, educated and employed) participated in an in-depth interview. Interviews were transcribed verbatim and a process of thematic narrative analysis was undertaken, focusing on the meanings women assigned to their experiences and the differences and similarities across the stories. Analysis revealed that stories about stealthing were characterized by disrespect and selfishness, whereas RCA stories highlighted control with intent. The concepts of intent and control can therefore be understood as central to defining RCA and differentiating it from stealthing. It seems likely that stealthing is primarily a form of sexual violence, as it lacks the specific reproductive intent that characterizes RCA. These findings have important implications for how RCA and stealthing are addressed and measured in research and responded to in practice.
... However, given that the majority of these methods require the cooperation of the male partner, this places young women at risk of coercive practices. Although few have explored non-consensual removal of a condom during sex in the Australian context (also called 'stealthing'), current data suggest that this is an experience reported by Australian women (Latimer et al. 2018;Tarzia et al. 2020). Ensuring women maintain reproductive autonomy when using less effective and predominantly male-driven methods of contraception without coercion or stealthing is vital; how best to do this is likely complex and warrants further exploration. ...
Article
Rates of oral contraceptive pill use have declined over the past decade in Australia. While some women use highly effective methods, others rely on less effective methods such as condoms, withdrawal and fertility awareness. We aimed to understand motivations for relying on these methods among young women in Australia. Women aged 18-23 years who reported using less effective methods and participated in the Contraceptive Use, Pregnancy Intention and Decisions (CUPID) study formed the sample for this analysis. Using thematic analysis, we analysed 140 free-text comments. Findings suggest that less effective methods were used when they were assessed as being best suited to current reproductive needs. These methods were perceived as offering benefits that hormonal and more invasive methods did not, and participants were largely satisfied with them. By contrast, some less effective method use was driven by a lack of choice or alternative options, previous bad experiences with hormonal methods, a lack of appropriate information about alternatives and difficulty accessing other methods. It is therefore essential to move beyond 'LARC-first' contraceptive counselling approaches to ensure young women are provided with accurate information regarding all contraceptive options available (including how to negotiate their use) and how to use them to their greatest efficacy.
... However, removing a condom during sexual intercourse without the partner's consent is not exclusive to heterosexual relationships. According to some international studies [39][40][41] , this is called "stealth breeding". ...
Article
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Resumo Este artigo aborda o fenômeno da violência nas trajetórias afetivo-sexuais de jovens gays cisgênero, pertencentes a camadas populares da região metropolitana do Rio de Janeiro, Brasil. A literatura brasileira sobre violência contra homens gays, geralmente, tem como foco a discriminação sofrida por esta população, mas pouco se problematiza a violência que eles sofrem nas relações familiares devido à sua orientação sexual, ou ainda, em suas relações ditas como “namoro” ou “ficar”. Com o objetivo de discutir a presença de violências durante a trajetória afetivo-sexual dos jovens, este estudo qualitativo realizou entrevistas em profundidade a partir de um roteiro semiestruturado. Os resultados mostraram que há múltiplas faces de violência que ocorrem durante a infância e adolescência nas relações familiares, perpassando nos seus relacionamentos afetivo-sexuais na adolescência e juventude, incluindo violências sexuais, físicas, psicológicas e institucionais. As redes de apoio dos jovens são limitadas, como exemplo, a poucos amigos e ao acesso de blogs na internet. Nenhum profissional de saúde foi citado pelos jovens como fonte de ajuda. Destaca-se também a necessidade de debater a prevenção da violência e promoção da saúde destes jovens, ampliando o olhar para as várias formas contemporâneas de se relacionar intimamente.
... Stealthing is another gender-related facilitator of unprotected sex, which highlights the unequal power relations between men and women today. Stealthing occurs more frequently to women than men, as demonstrated both in this and previous [45] research. Survivors of stealthing explain that it feels like a violation of trust and a denial of autonomy [25]. ...
Article
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University students tend to have greater sexual health knowledge than the general public, yet condom use among this group continues to be a public health concern because effective condom use could reduce sexually transmitted infections and, for heterosexual women, unwanted pregnancies. We report findings from a small, qualitative study of condom use among sexually active heterosexual university students in the UK. In interviews, students shared their views about condom use and sometimes their personal experiences too. This paper identifies some of the meanings attributed to condom use in the accounts of nine heterosexually active 20–25 year-olds. Participants explained that when they felt comfortable communicating with their partners, they were more likely to use condoms, and those with negative sexual experiences or under social or psychological pressure were less likely to use them. The findings highlight issues of trust and power between men and women in heterosexual relationships, and describe contexts for dishonest sexual practice, including the traditional notions of femininity that were linked to condom use by this group. The issue of stealthing arose in one woman’s account of her experience and in several others’ reports of what occurs commonly. Stealthing, the secretive removal of a condom by a (usually male) partner during sexual intercourse without a partner’s knowledge or permission, produces non-consensual unprotected sex. We present stealthing as a product of the sexual double-standards described and as a form of interpersonal violence (IPV) and, among these heterosexual partners, as a form of gender-based violence. This study provides a glimpse into university students’ decision-making regarding condom use and highlights how gendered inequalities shape heterosex, in particular, communication about safer sex, that in some cases, compromise women’s decisions about (safer) sex.
... [11][12][13] The meaning of chemsex engagement does not take into account the subculture and multifactorial issues surrounding the phenomenon of chemsex; for example, gay online dating culture and the fine line between consensual and non-consensual sex (NCS) are tightly linked to chemsex engagement and have become a more discussed topic in recent years. [14][15][16] Chemsex engagement often takes place at home during sexualised parties with a small number of men who have met through dating applications or websites. [17][18][19] A qualitative study reported that giving a notion of consent in a chemsex environment (characterised by sexually thrilling and loss of sexual desire control) felt difficult for some men. ...
Article
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Background Chemsex (drug use to enhance sex) has emerged among men who have sex with men (MSM). Non-consensual sex (NCS) is hypothesised to occur frequently under the influence of chemsex, however data are scarce. In this cross-sectional study, it was aimed to assess whether NCS is associated with chemsex. Methods We offered a survey about chemsex in the past 6 months (crystal methamphetamine, mephedrone and/or gamma-hydroxybutyrate/gamma-butyrolacton use) and NCS (sexual experiences beyond one’s limits or unpleasant sexual experiences) in the past 5 years to Amsterdam-located gay dating platform users. Associations were assessed using χ² test, Fisher’s exact test and multivariable logistic regression. Results Of 891 participants, 30.6% (273 of 891) engaged in chemsex; 21.2% engaging and 16.7% not engaging in chemsex reported any NCS experiences (p=0.109). Among MSM who reported any NCS experiences, chemsex engagers reported being touched against one’s will less often compared with non-engagers (22.4% vs 39.8%; p=0.036). Yet, chemsex engagers reported passing out and not remembering what happened during drug use more often (41.4% vs 8.7%; p<0.001). The level of suffering from NCS experiences did not differ between chemsex engagers and non-engagers (p=0.539); and was rated by most participants with no suffering at all or low suffering (77.1%). In the multivariable regression analyses, chemsex engagement in the past 6 months was associated with NCS (adjusted OR 1.46; 95% CI 1.01 to 2.11). Conclusions A substantial proportion of MSM (regardless of chemsex engagement) reported NCS in the past 5 years. In multivariate logistic regression analysis, chemsex engagement was associated with an NCS experience. Among participants who reported NCS, suffering related to NCS however, did not differ between chemsex engagers and non-engagers. Sexual healthcare professionals need to address chemsex and NCS during consultations involving MSM and refer men for specialised help if deemed necessary.
Article
RESUMO Objetivo: Identificar a prática de stealthing entre jovens universitários e as associações entre o perfil desses jovens e a prática do stealthing. Método: Estudo transversal realizado em um campus universitário de um município no interior paulista. A coleta de dados foi online pelo RedCap, entre maio e setembro de 2018, por meio de questionários com dados de identificação, características sociodemográficas e de saúde sexual e reprodutiva. Os dados foram analisados pelo IBM-SPSS, versão 17.0. Resultados: Participaram do estudo 380 estudantes, com idade entre 18 e 24 anos, a maioria sem exercer função remunerada, advindos(as) de ensino particular, sem religião e solteiras(os). Em sua maioria, eram do sexo biológico feminino e se identificavam como mulheres cisgênero e heterossexuais. Quanto ao stealthing, 1,33% dos participantes tinham realizado e 11,44% já tinham sofrido essa prática. Houve associação significativa entre ter sofrido stealthing e as variáveis sexo biológico feminino (p = 0,000) e se identificar como mulher (p = 0,000). Conclusão: A ocorrência do stealthing é maior entre os que sofreram essa prática do que entre aqueles que a praticaram. Ter sofrido stealthing está associado a ser do sexo feminino e se identificar como mulher.
Article
Objective: To identify the practice of stealthing among university students and the associations between the profile of these young people and this practice. Method: Cross-sectional study carried out at a university campus in a city in the countryside of Sao Paulo. Data collection was carried out online by RedCap between May and September 2018, through questionnaires with identification data, sociodemographic characteristics and sexual and reproductive health. Data were analyzed by IBM-SPSS, version 17.0. Results: A total of 380 students participated in the study, aged between 18 and 24 years old, most of them unpaid students, coming from private education, not having a religion and being single. Most of them were biologically female and identified as cisgender and heterosexual women. As for stealthing, 1.33% of the participants had performed it and 11.44% had already undergone this practice. There was a significant association between having been stealthed and the variables female biological sex (p = 0.000) and identifying as a woman (p = 0.000). Conclusion: The occurrence of stealthing is higher among those who have been stealthed than among those who have done it and having been stealthed is associated with being female and identifying as a woman.
Article
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This paper explores how gay, bisexual, and queer men (GBQM) discuss “stealthing,” the removal (or alteration) of condoms and ejaculation during penetration without consent, in a barebacking (or condomless sex) online forum. Considerations of stealthing have largely been framed as a legal problem based on the notion of consent or the lack thereof. However, such examinations may be oversimplistic, failing to recognize how GBQM negotiate and understand sexual consent and stealthing. Mobilizing “sexuality-assemblages” frameworks, this article explores the relationship between GBQM and their physical, social, and technological contexts in shaping articulations of sexual consent and stealthing. Examining online discussion board postings from a popular barebacking website, I argue that views about stealthing’s moral acceptability emerges through various relations involving more-than-human entities. Some GBQM conceptualize stealthing as morally unacceptable when considered through liberal/contractual consent and HIV criminalization, where the materialities of condoms (their alteration or removal) and HIV status (lying about or not disclosing) play crucial roles. However, stealthing may be morally acceptable for others, especially in anonymous sexual spaces, like bathhouses, where there is a culture of silence. Consent is perceived to be passively given in these spaces because the normative idea of consent as a communicative exchange is constrained. The article highlights the ways in which sexual scenarios and environments are implicated in the remaking of alternative conceptualizations of sexual morality and “consent.”
Article
Reproductive coercion and abuse refers to patterns of controlling and manipulative behaviours used to interfere with a person's reproductive health and decision-making. Unintended pregnancy, forced abortion or continuation of a pregnancy, and sexually transmissible infections all may result from reproductive coercion, which is closely associated with intimate partner and sexual violence. Clinicians providing sexual and reproductive healthcare are in a key position to identify and support those affected. Yet, reproductive coercion and abuse is not currently screened for in most settings and addressing disclosures poses many challenges. This article discusses what reproductive coercion and abuse is, who it affects, how it impacts, and potential strategies to improve identification and response.
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This study was a cross-sectional study aiming at exploring factors predicting HIV preventive behaviors among young men who have sex with men in Bangkok Metropolitan areas by applying the Ecological Model (McLeroy et. al. 1988) as the conceptual framework. Samples were youth males aged between 18-24 years old who resided or worked in Bangkok. The snowball sampling technique was employed with all 386 youth males. Data collection was manipulated by the online self-administered questionnaire, conducted between November and December 2019. Descriptive statistics and Stepwise Multiple Linear Regression were managed for data analysis with p-value at .05. Results reported that the majority of participants had HIV preventive risk behaviors score reaching the risky level at 91.50%. In addition, predicting factors for HIV preventive behaviors among young men who had sex with men including the access to information and policy about HIV infection among YMSM (β = .163, p < .05), the unknown status of sexual transmission disease infection of their partners (β = .138, p < .05), drinking alcohol (β = -.127, p < .05), the disclosure of sexual status to the public (β = .149, p < .05) and knowledge in HIV preventive behaviors among young men who had sex with men (β = .136, p < .05). These findings were able to predict HIV preventive behaviors among young men who had sex with men at 21.2% (R2 = .212, p < .001). Findings delineated the importance of HIV preventive behaviors among young men who had sex with men that they should emphasize on the coverage of multi-level preventive factors, particularly factors at the public policy level. This is performed through the access of information and the policy of HIV prevention in young men who have sex with men, and the intrapersonal factors towards HIV preventive behaviors among young men who have sex with men.
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Background: The fact that youth take sexual risks when they are abroad have been shown in previous studies. However, it is not known if they increased their sexual risk-taking when travelling abroad, compared to the stay in their homeland. Objective: To assess whether Swedish youth increased their individual sexual risk behaviour, defined as having a casual sex partner, when travelling abroad and to examine possible factors that may be associated with increased risk-taking abroad. Design: In 2013, a population-based sample of 2189 Swedes, 18-29 years, was assessed by a questionnaire (45% response rate). Sexuality, duration of travel, parents’ country of origin, mental health, heavy episodic drinking (HED), use of illicit drugs, and socio-demographic background were assessed. Increased risk of casual sex in relation to time spent abroad vs. time spent in Sweden was analysed by a variant of case-crossover design. Factors that could be associated with increased risk of casual sex in Sweden and abroad, separately, were analysed by logistic regression.
Article
‘Stealth breeding’ describes a stealth form of condomless sex between men (known as ‘bareback’). While ‘stealthing’ as a practice of non-consensual condom removal affects both men and women, ‘stealth breeding’ is explored here in the context of sex between men. Despite a growing corpus on bareback – as a practice and increasingly popular genre in gay pornography – scholarship on ‘stealth breeding’ remains scant. This article addresses this by theorising the term in various contexts, namely fantasy, accounts of crimes, and gay pornography. Crucially, I argue against viewing the practice as necessarily connected with the transmission of HIV – known as ‘gift-giving’ – so as to not limit the potentialities and motivations of ‘stealthing’, as is supported by online commentary and important in light of HIV preventative technologies now available. Through textual analysis of online discourse, the article pursues a qualitative, holistic understanding of the stealthing phenomenon from the perspective of those men in favour and opposed to it, pointing to the structures of power and abuse that underpin the term.
Article
Introduction To determine the prevalence of Mycoplasma genitalium and Chlamydia trachomatis in urethra, rectum and pharynx of men who have sex with men (MSM) in China, and to analyse the association between the agents detection and clinical manifestations. Methods 388 MSM were recruited at gay bars in five cities of China from September 2007 to November 2008. Rectal and pharyngeal swabs and first void urine were tested for M. genitalium and C trachomatis by PCR. Bivariate and multivariable analyses were performed to determine the association between the infections and clinical manisfestations. Results The prevalence of M. genitalium infection at urethral, rectal and pharyngeal sites was 17.2% (95% CI: 13.4% to 21.0%), 11.8% (95% CI: 8.4% to 15.2%), and 13.5% (95% CI: 9.9% to 17.1%), respectively. C trachomatis was more commonly detected in rectum (16.0%, 95% CI: 12.2% to 19.8%) than in urethra (9.4%, 95% CI: 6.4% to 12.3%) and in pharynx (0.8%, 95% CI: 0.1% to 1.6%). Urethral M. genitalium infection was significantly associated with urethral discomfort in the past 3 months (AOR: 2.22, 95% CI: 1.09–4.52) and polymorphonuclear leucocyte (PMNL) counts per high-power microscope field (AOR: 2.40, 95% CI: 1.02–5.62). Rectal M. genitalium infection was independently associated with rectal discharge in the past 3 months (AOR: 6.06, 95% CI: 1.59–23.11). For C trachomatis infection, PMNL counts per high-power microscope field (AOR: 4.66, 95% CI: 1.80–12.07) and having receptive anal intercourse with a male in the past 3 months (AOR: 2.27, 95% CI: 1.14–4.54) were associated with urethral and rectal C trachomatis infection, respectively. Conclusion High prevalence of M. genitalium infection was observed among MSM in China at urethral, rectal and pharyngeal sites. M. genitalium infection was significantly associated with urethral and rectal symptoms. C trachomatis was more commonly detected in rectum and more likely to be asymptomatic. Disclosure of interest statement No potential conflicts of interest.
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With the recent media interest in celebrity childhood sexual abuse and rape cases, we think we know what sexual violence is and who 'rape victims' are. But this portrayal is limited. Drawing on in-depth accounts from women who have experienced rape, this book revisits issues of credibility, responsibility and feminism to provide missing details.
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Mycoplasma genitalium and Trichomonas vaginalis are common sexually transmitted infections. In the Netherlands, testing for M genitalium and T. vaginalis is not recommended for first-line sexually transmitted infections screening. Recent reports about the increasing antimicrobial resistance in M. genitalium raise concern about the adequacy of current empirical treatment regimens. It is necessary to have insight in the prevalence of M. genitalium and T. vaginalis in order to evaluate current first-line sexually transmitted infections screening and treatment protocols. During a five-month period, samples sent to two large medical microbiology diagnostic centres in the Netherlands for sexually transmitted infections screening (Chlamydia trachomatis and Neisseria gonorrhoeae) were retrospectively tested for the prevalence of M. genitalium and T. vaginalis using the Diagenode S-DiaMGTV kit. A total of 1569 samples from 1188 unique patients (55.4% female) were tested. M. genitalium was the second most prevalent sexually transmitted infection detected (4.5% of the patients), after C. trachomatis (8.3%). T. vaginalis was detected in 1.4% of the patients, comparable to the prevalence of N. gonorrhoeae (1.3%). Dual infections were only detected in a small number of patients (1.0%). Incorporation of M. genitalium into routine sexually transmitted infections screening should be considered, because of its relatively high prevalence, the consequences of its detection for antibiotic treatment and because of the availability of easy-to-use molecular diagnostic tests. For T. vaginalis, routine screening may be considered, depending on local prevalence and (sub)population. © The Author(s) 2015.
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Recent scientific evidence demonstrates that many young men commonly resist condom use with their female sex partners and that both alcohol intoxication and a history of sexual aggression may increase the risk of condom use resistance (CUR). Using a community sample of heterosexual male non-problem drinkers with elevated sexual risk (N = 311), this alcohol administration study examined the direct and indirect effects of intoxication and sexual aggression history on men's CUR intentions through a sexual risk analogue. State impulsivity, CUR-related attitudes, and CUR-related self-efficacy were assessed as mediators. Results demonstrated that alcohol intoxication directly increased CUR intentions, and sexual aggression history both directly and indirectly increased CUR intentions. These findings highlight the importance of addressing both alcohol use and sexual aggression in risky sex prevention programs, as well as indicate the continued worth of research regarding the intersection of men's alcohol use, sexual aggression, and sexual risk behaviors, especially CUR.