title: 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.
authors.affiliation: Center for Health Care Innovation, California State University, Long Beach, CA, USA. ldanna@csulb.edu
authors.forename: L H
authors.initials: LH
authors.lastname: D'Anna
authors.forename: A D
authors.initials: AD
authors.lastname: Margolis
authors.forename: L
authors.initials: L
authors.lastname: Warner
authors.forename: O A
authors.initials: OA
authors.lastname: Korosteleva
authors.forename: L
authors.initials: L
authors.lastname: O'Donnell
authors.forename: C A
authors.initials: CA
authors.lastname: Rietmeijer
authors.forename: J D
authors.initials: JD
authors.lastname: Klausner
authors.forename: W
authors.initials: W
authors.lastname: Nomura
authors.forename: C K
authors.initials: CK
authors.lastname: Malotte
mesh_terms: D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D004868:Equipment Failure / Q000706:statistics & numerical data*; D018023:HIV Seronegativity; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012725:Sexual Behavior; D014481:United States / Q000453:epidemiology; D014504:Urban Health