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Table 4 Exemplary quotations illustrating major themes and sub-themes

From: Risk evaluations and condom use decisions of homeless youth: a multi-level qualitative investigation

Relationship/Partner level
Theme Example quotes
Emotional factors • “No, we haven’t really felt the need to (use condoms) since we got tested together and we both came back negative and neither one of us has cheated on each other so there’s no chance of either of us having anything.” -- 18 year old female describing how developing trust between her and her partner led to unprotected sex
• “…we use condoms just because I'm not entirely sure where he's been.” -- 21 year old female described how lack of trust of her partner influenced her to continue to use condoms with him
• “I was cool with her…I'd been with her for a while.” -- 21 year old male describing how knowing his partner for a long time influenced a feeling of familiarity, leading to unprotected sex
• “…sometimes you get that feeling that the person – you kind of just know they’re the right person for you.” – 18 year old female explaining not using condoms with her long-term partner with whom she developed an emotional bond
• “Because I think he sees me as a long-term relationship, and he wants to have kids already.” – 18 year old female respondent describing how emotional closeness with her partner lead to unprotected sex in order to become pregnant
• “Like, we’re trying but we’re not. We’re like in the middle, you know?” – 21 year old male describing how closeness to his partner lead to ambivalence towards pregnancy and, as a result, unprotected sex
Relationship type • “It was just a random person. I didn't know him.” 21 year old female describing why she used a condom with a partner who was a stranger.
• “I don’t just want to go and fuck any random person…There’s too much risk, because I don’t know where they’ve been at and I don’t know their history and I don’t know what girls they’re being with. But he’ll sit there and tell me what girls he’s been with, who he’s been with and if I know them, then I know more of the background, disease-wise and even if we don’t use a condom, it’s like he knows he won’t bust in me because I told him I don’t want that shit.” – 17 year old female describing her risk reduction strategy of having casual sex with a good friend rather than someone she does not know
• “Because he’s not my man, he’s not my boyfriend.” – 14 year old female explaining why she uses condoms with a partner who is not her committed boyfriend
• “When I have a…very good girlfriend, very good woman, then yeah, we may not use a condom.” – 20 year old male explaining that he would only have unprotected sex with a serious partner
Perceived partner preferences • “And then it kind of just became like, this one boy used them and this one preferred not to, so we didn't.” – 22 year old female respondent describing how she relies on her partners to decide to use condoms or not
• “The only times I don’t (use condoms) is when she says not to, when she says she doesn’t want me to.” – 21 year old male respondent describing how his use of condoms or not was due to his partner’s decisions
• “. . .she just offered the condom. She was like, ‘Here.’ I was like, ‘Alright.’ I have no problem with it. If anything, I think she’s helping me.” -- 17 year old male respondent describing how using a condom at the insistence of his partner and how he appreciates her decision to use protection
• “Most of the time, we don't use protection. And I tell him not to cum inside of me, but he'll still do it. And I've tried using condoms, but he won't let me.” –17 year old female explaining that she wants to use condoms but her boyfriend does not want to use them and does not use withdrawal even though she asks him to do that.
Communication about Risk “If they stutter or think about it for a minute, I’d just be like, ‘All right, never mind.’” – 23 year old male describing his strategy for determining partner riskiness by asking them if they have an STD and evaluating their reaction
 “I asked him if he was clean, and he said that he had gotten tested and he seemed like a real person that wouldn't really lie to you.” – 22 year old female describing the reassurance she received from her partner about his lack of an STD
  • “I already knew she didn't have anything…I'd seen her paperwork.” – 22 year old male describing his confidence that his partner did not have an STD because she presented him with results of an STD test
 “It was more just like an offhand…hey…you don’t have anything, right? Are we still going to use these?” -- 22 year old female respondent describing her discussion of condoms with her partner prior to engaging in unprotected sex
  • “She said that she was clean…Thank you, God, I didn’t catch nothing.” --22-year-old male respondent describing his reaction after a family member of a woman with whom he had unprotected sex told him she was HIV+
  • “It’s the papers that prove it.” – 18 year old female describing her attitude towards the need to see documentation from her partners about their STD status to decide to have unprotected sex or not
  • “Are you clean? I can prove it. Look.” 20-year-old male who is tested every 3 months describes how he shows his test papers to each of his new partners and asks for theirs prior to unprotected sex
• “Of course we asked the question, ‘Are you safe?’…And he's, like, I'm safe, you know, are you safe? We kind of took our word for it and then we later got tested and found out we're both safe.” – 22 year old female describing communication with her partner prior to engaging in unprotected sex for the first time
• “I told him this was the ninetieth day so, for me, I'm off birth control so you need to start using a condom or pull out.” -- 18 year old female described what she told her partner about protection after her Depo-Provera shot wore off
• “I was like…‘You can get me pregnant.’ And he was like, ‘I’m not gonna nut in you.’” -- 14 year old female describing her conversation with her partner prior to having unprotected sex after they ran out of condoms.
• “He says it feels better when the guy comes inside the girl, so when he wants to come inside me, he’ll put a condom on, so he can cum in the condom.” – 17 year old female describing communication with her partner over using a condom or engaging in withdrawal
I just automatically do that shit…it just happens.” -- 20 year old male respondent explaining why he did not have a conversation with his partner about using a condom
Perceived partner characteristics • “For the most part, I trust him. But he's also known as a ‘man whore’…And I was pretty concerned about where he had been.” –21 year-old female respondent explaining that she used condoms with her partner because of his reputation
• “There’s only three dudes she slept with in her whole life, and I just happened to know all of them.” -- 21-year-old male respondent explaining his lack of concern about not using condoms with his partner because he knew her sex history
• “If I’m paying like $30 for a hooker then, yes, I’m going to use a condom.” – 20 year-old male respondent who frequently had unprotected sex said that he would not have unprotected sex with a prostitute
• “I know that the women that I mess with…I make sure… I ask them…or check with the homies and shit like that if not.” – 22 year-old male describing a conversations with his friends about a potential sex partner prior to unprotected sex
• “I caught chlamydia twice and it came from really hot girls, both times….I get a little bit uglier girls, I been clean every time.” – 21 year old male explaining how he now engages in unprotected sex with ugly girls because they are less risky
Relationship trajectory and risk • “I started getting more sensual…with our lovemaking… around that time it was around Valentine's Day and since we had been hooking up and seeing each other for a while, like, everything was a little bit more passionate when I tried to approach her.” 22-year-old male said that he and his partner transitioned from consistent condom use to unprotected sex when their sexual relationship became more passionate
  • “It was just kind of like they were getting in the way… They would slip off and then you'd have to put it back on again and then sometimes they'd get stuck inside me and I'm just, like, oh my God.” – 23 year-old female explaining why she and her boyfriend transitioned from always using condoms to never using them
“We just kind of stopped using them…We just kind of stopped randomly.” – 22 year old male describing how he and his partner transitioned from using condoms consistently to not using them at all for no particular reason
“Yeah, just like ran out and then it was like, oh, fuck it. Didn't care.”—20 year-old male describing the event that lead to transitioning from consistent condom use to unprotected sex with his partner because he ran out of condoms and was too “lazy” to go get a new one and did not care about the consequences
• “I run up there and I grab a condom and I come back and I tried and she tried, too. She said, ‘It’s not working.” I was like, ‘Nope,’ and I threw the condom. And she’s like, ‘Oh well, at least you tried to get a condom.’” – 21 year old male describing he and his partner’s attempt to use a condom one time when they first had sex prior to engaging in consistent unprotected sex
• “I guess we were just like really into it, and I didn’t want one on him because I just wanted to like get the feeling better…It doesn’t feel as pleasurable with it on as it does with it off.” – 18 year old female respondent describing an isolated incident of unprotected sex with her partner with whom she typically had protected sex
• “We just wouldn’t have sex.” 22-year-old male who said he consistently used condoms answering a question about what he would do if he and his partner ran out of condoms.
Event circumstances level
Theme Example quotes
Drug and alcohol use • “We were drunk, and we were just like in the moment, you know?”—22 year-old female describing why she had unprotected sex with her partner during one event
• “Under the influence or not, I’m still aware of what I’m doing…I know that if I have sex without a condom, there’s still a really good chance that I could end up with an STD or a kid…no matter how drunk I am.”—16 year old male arguing that being drunk does not prevent him from knowing that he needs to use a condom to avoid risk
• “When people tell me, ‘Oh I got drunk. I didn’t mean to do it.’ I’m just like there’s no way.” – 18 year old female describing her attitude towards people who blame having unprotected sex on being intoxicated.
Sexual arousal • “Yeah, at the moment, I just didn’t care. I didn’t care what happened, the only thing I was focused on was bed, naked woman, me, that’s it, you know?” 16 year old male respondent explaining why he atypically did not use a condom
• “…because it was right then and there and she was asking for it so…” -- 21 year old male describing how the sexual arousal of his partner led him to engage in sex without condoms
• “I was into it too much, so it happened.” -- One 21 year old male respondent said that he did not pull out because he was too sexually aroused and was concerned about pregnancy afterwards
Individual level
Theme Example quotes
Concern about pregnancy and STIs • “I have to be in a situation where I feel like I can actually take care of myself, my girl, and my child. And right now we’re not at that level yet.” 22-year-old male describing his use of condoms because of his concern about pregnancy because he was not stable enough in his life to become a parent
• “I am struggling to take care of myself and how the fuck am I going to take care of an infant?” – 21 year old female discussing her concern about becoming pregnant and why she does not have unprotected sex
• “I'm just concerned with every STD. I just wouldn't want to get one. It would be horrible, because you see people suffering with it. And I would just really be ashamed of myself.” – 15 year old female discussing her desire to protect herself because of her concern about getting an STI
• “Because in the past…I have…not used protections and came, but they never seem to get pregnant. So…I kind of don't worry about it so much.” – 22 year old male describing his lack of concern about engaging in unprotected sex
• “Didn’t care. . .life as we know, it’s over.” –18 year-old male’s description of why he often had unprotected sex instead of protecting himself against STIs
• “…you’re just taking the pill for nothing. If God wants you to have a baby, He’ll let you have a baby. If He doesn’t, He won’t let the miracle happen. That’s how I see it. God knows when you’re ready for a baby and when you’re not.” –22 year old female explaining why she does not use contraception and is not concerned about pregnancy
General attitudes about risk and typical patterns of risk engagement and protection • “Hey, if we’re going to have sex, you need to show me some papers if you want to do it without a condom.” -- 14-year-old female described her typical interaction with partners who wanted to have unprotected sex
• “I don’t let them put it in without a condom on…I think guys should always use condoms because it like reduces like spread of whatever. And it makes the people a whole lot safer.” – 21 year old female discussing her consistent approach to asking all partners to use condoms
  • “I'm really all about safety. I'm just a freak about that.” -- 15 year old female discussing the intensity of her concern about preventing risk
“I just automatically do that shit…it just happens.” -- 20 year old male respondent explaining his automatic use of condoms with all partners
• “For me it’s just like the first time rule kinda, you’ve kinda got to put it on.” -- 18 year old female explaining her typical pattern of initially using condoms with new partners but not after the first time
“I usually use them with like new partners…I think I’ve used them with every new partner…usually the first time, or the first few times, but then after that, like, I just sort of stop.” – 22 year old female describing the typical pattern of starting out using condoms with partner but then just stopping using them after the first sex or first several sexual encounters
• “Because I don't like them…Because they'll break. They break! So, they break…you still get pregnant. What's the difference? – 22 year old female explaining that she has never uses condoms because they are unreliable
• “I would never get off with a condom…Because you get no feeling…I ruined it the first time I had sex without a condom.” –21 year old male explaining that he has never used a condom because they inhibit sexual pleasure