Why do men who have sex with men practice condomless sex? A systematic review and meta-synthesis

BMC Infectious Diseases

Table 4 Contribution of individual review items to final synthesized themes and sub-themes (N = 39)

Number	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20
Number	Li et al. 2010	Moen et al., 2013	Peterson et al., 2003	Taggart et al., 2017	Campbell et al., 2013	Mustanski et al., 2014	Ostergren et al., 2011	Neville et al., 2016	Schnarrs et al., 2012	Tadele, 2010	Li et al., 2016	Beoughe et al., 2012	Harawa et al., 2006	Valente et al., 2019	Chakrapani et al., 2013	Adam et al., 2010	Adam et al., 2000	Adams et al., 2009	Balán et al., 2009	Boulton et al., 2010
Individual-level
Physical discomfort
Physical pain		×				×	×		×		×		×					×	×
Reduced sexual pleasure	×	×	×			×	×	×	×	×		×	×	×	×	×			×	×
Lack of HIV/STI-related knowledge		×	×			×		×	×	×	×	×	×		×	×	×	×		×
Substance use			×				×		×	×			×	×		×	×		×	×
Psychological factors
Fluke thinking										×		×		×	×					×
Negative emotions	×										×					×	×			×
Vengeful perspective															×				×
Interpersonal-level
Condom stigma
A symbol of distrust	×		×	×		×	×	×			×	×			×	×	×	×		×
A symbol of HIV/STIs prevention	×	×	×		×	×	×	×		×	×	×			×	×	×	×	×	×
A symbol of violating the traditional cognition of sex	×	×	×	×			×								×	×		×	×
Feeling embarrassed to initiate condom related communication		×	×		×	×				×					×				×	×
Environmental/structural-level
Socioeconomic factors
Situational unavailability			×		×	×	×		×		×			×	×	×	×	×		×
Unaffordability of condoms		×	×			×	×				×		×	×					×
Power imbalance in the relationship											×		×	×	×					×

Number	21	22	23	24	25	26	27	28	29	30	31	32	33	34	35	36	37	38	39
Number	Diguez et al., 1996	Eisenberg et al., 2011	Giano et al., 2019	Harawa et al., 2010	Harper et al., 2016	Hospers et al., 1994	Hubach et al., 2014	Klassen et al., 2019	Kong, 2008	Malebranche, 2009	Musinguzi et al., 2015	Middelthon, 2001	Siegler et al., 2014	Starks et al., 2017	Zhang et al., 2018	Wang et al., 2005	Zou, 2008	Ofreneo et al., 2020	Rwstar et al., 2019
Individual-level
Physical discomfort
Physical pain			×								×					×	×
Reduced sexual pleasure	×	×	×	×	×	×	×	×			×	×	×	×	×	×
Lack of HIV/STI-related knowledge			×		×		×	×	×	×	×				×	×	×		×
Substance use	×		×			×	×	×			×		×		×		×
Psychological factors
Fluke thinking	×							×									×
Negative emotions						×				×
Vengeful perspective				×
Interpersonal-level
Condom stigma
A symbol of distrust	×	×	×	×		×	×	×	×	×	×	×	×	×	×	×	×	×
A symbol of HIV/STIs prevention		×	×	×		×		×		×	×			×	×	×	×	×	×
A symbol of violating the traditional cognition of sex								×						×					×
Feeling embarrassed to initiate condom related communication	×	×							×		×						×		×
Environmental/structural-level
Socioeconomic factors
Situational unavailability	×	×		×	×		×	×		×	×		×	×		×	×		×
Unaffordability of condoms				×		×			×		×					×	×		×
Power imbalance in the relationship			×					×							×

ISSN: 1471-2334