title: Why do condoms break? A study of female sex workers in Bangalore, south India.
abstract: OBJECTIVE
  The purpose of the study was to obtain a better understanding of the relative importance of personal factors, male partner factors and situational factors, in determining condom breakage in a population of female sex workers (FSWs) in Bangalore.
  
  
  METHODS
  The authors conducted a cross-sectional study that included a face-to-face interview and condom application test, with 291 randomly selected FSWs in Bangalore, India, in early 2011.
  
  
  RESULTS
  Ninety-seven per cent of respondents noted condom use at last sex; 34% reported a condom breakage in the last month. Combining individual, situational and partner aspects of condom breakage into one logistic regression model and also controlling for client load, the authors found that partner and situational factors were dominant since the only significant predictors of condom breakage included being a paying client (adjusted odds ratio 4.61, 95% CI 1.20 to 17.58, p=0.025), the condom being too small for the penis (adjusted odds ratio 2.29, 95% CI 0.97 to 5.40, p=0.056) or too big for the penis (adjusted odds ratio 4.29, 95% CI 1.43 to 12.80, p=0.009) and rough sex (adjusted odds ratio 6.39 CI 3.55 to 11.52, p<0.001).
  
  
  CONCLUSIONS
  Condom use among Bangalore FSWs is now very high. However, condom breakage is still a not uncommon event and puts women and their clients at unnecessary risk of infection. It may be difficult to eliminate the problem completely, but every effort should be made to discuss with sex workers the findings of this survey that point to possible personal markers of risk seen in the univariate analysis and to highlight the importance of avoiding rough sex and of ensuring the condom fits the client.
authors.affiliation: CHARME-India Project, IT Park 5 floor, #1-4 Rajajinagar Industrial Area, Behind KSSIDC Admin Office, Rajajinagar, Bangalore 560 044, India. jbradley@uresp.ulaval.ca
authors.forename: Janet
authors.initials: J
authors.lastname: Bradley
authors.forename: S P
authors.initials: SP
authors.lastname: Rajaram
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.forename: Marie Claude
authors.initials: MC
authors.lastname: Boily
authors.forename: B M
authors.initials: BM
authors.lastname: Ramesh
authors.forename: Shajy
authors.initials: S
authors.lastname: Isac
authors.forename: Anil
authors.initials: A
authors.lastname: Lobo
authors.forename: G Chandrashekhar
authors.initials: GC
authors.lastname: Gowda
authors.forename: R
authors.initials: R
authors.lastname: Pushpalatha
authors.forename: Kaveri
authors.initials: K
authors.lastname: Gurav
authors.forename: Sunil
authors.initials: S
authors.lastname: Kumar
authors.forename: Reynold
authors.initials: R
authors.lastname: Washington
authors.forename: Michael
authors.initials: M
authors.lastname: Pickles
authors.forename: Michel
authors.initials: M
authors.lastname: Alary
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D060386:Sex Workers; D012725:Sexual Behavior; D012747:Sexual Partners; D055815:Young Adult