Condom use problems during anal sex among men who have sex with men (MSM): Findings from the Safe in the City Study

Abstract

Our research aims were to: (1) assess the prevalence of two condom use problems: breakage or slippage and partial use (delayed application or early removal) among men who have sex with men (MSM) seeking services in urban US STD clinics; and (2) examine the association between these condom use problems and participant, partner and partnership characteristics. Analysis was restricted to HIV-negative MSM who reported having anal sex at least once in the preceding 3 months and who completed both the baseline and 3 month follow-up assessments. Two models were fitted using the generalized estimating equations (GEE) approach. A total of 263 MSM (median age=32 years) reported 990 partnerships. Partnerships with no condom use 422 (42.6%) were excluded. Thus, 207 MSM and 568 partnerships were included. Among condom users, 100% use was reported within 454 partnerships (79.9%) and <100% within 114 (20.1%), and 21(3.7%) reported both condom use problems, 25 (4.4%) reported only breakage, 67 (11.8%) reported only partial use, and 455 (80.1%) reported no errors. The breakage or slippage and partial use rates per condom used were 3.4% and 11.2%, respectively. A significantly higher rate of breakage or slippage occurred among non-main partnerships. Characteristics associated with increased odds for condom breakage or slippage were: lower education level (OR=2.78; CI: 1.1–7.5), non-main partner status (OR=4.1; CI: 1.5–11.7), and drunk or high during sex (OR=2.0; CI: 1.1–3.8), and for partial use: lower education level (OR=2.6; CI: 1.0–6.6), perceived partner sexually transmitted infections (STI) risk (OR=2.4; CI: 1.3–4.2), and inconsistent condom use (OR=3.7; CI: 2.0–6.6). A high percentage of MSM partnerships reported no condom use and among condom users, a sizable proportion did not use them consistently or correctly. MSM may benefit from interventions designed to increase proficiency for condom use with a particular focus on the behaviors of inconsistent and partial condom use.

Keywords:

• condom use problems
• consistent condom use
• men who have sex with men
• sexual partnerships

Acknowledgements

The Safe City Project Study was funded by the United States Centers for Disease Control and Prevention. The preparation of this manuscript was supported in part by Award Number P20MD003942 from the National Institute on Minority Health and Health Disparities. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention, the National Institute on Minority Health and Health Disparities, or the National Institutes of Health.