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Aim: The overall aim of this paper is to examine sexually active young people’s behavioral expectations of condom use. Methods: We collected data at nine youth clinics and one sexually transmitted infections (STI) clinic in Sweden. We included participants whom had been sexually active during the past 12 months: A total of 1022 participants between the ages of 15 and 31 were included. We analyzed the data separately, for different types of sexual practices and types of sexual partners. Multinomial logistic regression was used to analyze age and gender differences for discrepancies. Results: The behavioral expectation of condom use differed, depending on the type of sexual practice and the type of partner. For all types of sex, the overall pattern showed that the participants were most likely to use a condom with a casual unknown partner, followed by a casual known partner, regular partner and lastly, a main partner. Our results also demonstrated that there is a discrepancy between the behavioral expectation of condom use and the self-reported condom use. The lowest discrepancy was for oral sex, especially with a main partner, and the largest discrepancy was for anal sex and vaginal sex with a casual partner. Conclusions: Our results imply that the participants had a greater expectation of condom use than actually occurs, especially for casual unknown partners. There is a lack of knowledge about the risks associated with oral sex, which is evident in the results of the participants’ behavioral expectations of condom use under those conditions.

Despite large investments in prevention, the spread of sexually transmitted diseases (STIs) continues to be a severe problem in Sweden, especially among young people. In Sweden, condoms are recommended for use in tan-dem with another contraceptive in new or casual sexual relationships. Con-dom use to prevent STI transmission differs from its contraceptive in that it must be used in a much larger scale in order to serve as an adequate protec-tion. Here we address questions if—and how—condom use differs between a broad categorization of sexual relationships and sexual practices than what commonly are used in this type of study. Detailed data on the sexual behav-ior of participants during the previous 12 months were collected at nine youth clinics in the Västra Götaland region of Sweden. Participants were sexually active women and men between 15 and 26 years old who visited these clinics for a STI test. Overall, condom use was low irrespective of type of partner and type of sex. Approximately 20 percent of the participants nev-er used condoms during the preceding 12 months. For vaginal sex, the par-ticipants were more likely ‘always’ to use condoms with casual known part-ners as compared to casual unknown partners. If participants had a main or regular partner, they were more likely to use condoms ‘sometimes’ rather than ‘never’ compared to if they had a casual unknown partner. All sexual practices followed this basic pattern. There were few age and sex differ-ences. It is important to understand that young people visiting youth clinics in Sweden—despite efforts to promote condoms use—have unprotected, oral, vaginal, and anal sex, with both known and unknown partners. More effective programs must be developed in Sweden to promote condom use in relationships where the partners are not monogamous as in casual contacts and non monogamous regular contacts (e.g. ‘fuck buddies’).

The aim of this paper was to examine common factors that affect condom use for sex (anal, oral and vaginal) with casual partners both known and unknown. Data were collected through in-depth interviews at one STI clinic in Stockholm, Sweden, with 29 people (14 men, 14 women and one transgendered person) aged 21-32 years participating in the study. Open questions were asked about the participant’s background, reason for STI test, reasons for condom use, reasons for condom non-use, and their definition of sex. The interviews were audio recorded and transcribed. Data were ana-lyzed according to thematic analysis. The results show that there are several reasons why people do not use a condom. Women encounter resistance from men when they suggest a condom, and often have strategies for avoiding threatening or unpleasant situations. For men, alcohol is a common reason for non-use. This is mostly connected to the effect alcohol has on their sen-sation and their erection. These findings suggest that condom use is a com-plex issue and that there are often underlying reasons why people do not use a condom. To help people be better condom users, we need to identify these underlying reasons and help patients deal with them.