Structural and psychosocial determinants of condom nonuse among people living with HIV: a qualitative approach

This descriptive qualitative study analyzed the meanings attributed to condom use and nonuse among adults living with HIV who are receiving antiretroviral treatment in Mexico. Through in-depth interviews with forty-four adults, the narratives were situated from an ecological perspective, considering individual, relational, community, structural, and epidemiological factors. The findings show that the decision not to use condoms is mainly driven by subjective processes related to pleasure, perceptions of a partner's health, normalization of risk, and resignation in the face of the diagnosis. Among women, gender mandates hinder the negotiation of sexual care, while among men, a narrative of autonomy linked to desire prevails. Social and sexual networks reinforce patterns that discourage protection, especially in contexts involving substance use or economic exchange. Public policy discourses - such as those promoting preventive medications or emphasizing an undetectable viral load - are often interpreted subjectively, weakening risk perception and self-care. Structural factors such as exclusion, precariousness, and gaps in access to information and services further complicate the situation. The study underscores the need for interventions that integrate biomedical and psychosocial perspectives, incorporating the meanings that shape sexual decision-making and addressing the sociocultural conditions that sustain them.