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 U.S. STD clinics; and 2) examine the association between these condom use problems and participant, partner and partnership characteristics. Analysis is 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 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 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.

Consistency of Condom Use During Receptive Anal Intercourse Among Women and Men Who Have Sex With Men

“…We have previously reported inconsistent condom use among MSM who participated in the Safe in the City evaluation for all anal intercourses (insertive and receptive), highlighting HIV/AIDS-related morbidity and mortality and the prevention efforts targeted to this group. 26 Overall, these results suggest that innovative efforts to increase consistent condom use by MSM are needed.…”

“…4,[22][23][24][25] In our previous examination of condom use for receptive and insertive anal intercourse within a sample of MSM sexually transmitted disease (STD) clinic patients, in nearly half (43%) of partnerships condoms were not used, and another 11% involved only inconsistent use. 26 Inconsistent condom use for anal intercourse among MSM has been associated with beliefs that pre-ejaculatory fluid poses no or minimal risk for HIV/STI transmission or that only rectal trauma poses HIV risk resulting in the false sense of security that brief penetration without protection is a safe behavior. 22,23 Furthermore, MSM report heightened perceived risk for HIV/STIs and more consistent condom use within nonmain partnerships.…”

“…22,23 Furthermore, MSM report heightened perceived risk for HIV/STIs and more consistent condom use within nonmain partnerships. 26,27 In the present analysis, we examined individual respondent, partner, and partnership-related factors among women and MSM that influence the decision to use condoms during receptive anal intercourse. Specifically, we (1) determined the prevalence of receptive anal intercourse in a sample of urban US STD clinic patients, (2) assessed differences in condom use consistency for receptive anal intercourse only among heterosexual women and MSM, and (3) examined characteristics and cognitive factors associated with condom use consistency for receptive anal intercourse and how these factors differ for women and MSM.…”

Comparing Sexual Risk Behaviors Between Sexual Minority Men Living With and Without a Chronic Illness/Disability (CID)

“…In the US, sexual minority men (an encompassing term used to describe a group whose sexual identity, orientation, or expressions differ from exclusive heteronormativity, such as gay, bisexual, queer, or men who have sex with men) are engaging in high-risk sexual behaviors that leave them vulnerable to HIV/AIDS, STIs, and other compromised health outcomes (Centers for Disease Control [CDC], [3,6,9]). Sexual minority men living with CID conditions may be especially at risk given their multiple minority status; they are simultaneously denied sexuality, while also being told that heterosexuality is normative and the only acceptable form of sexual behavior.…”

Conductas De Riesgo Y Actitudes Relacionadas Con La Infección Por Vih/Sida en HSH

“…Los estudios desarrollados específicamente en hombres que tienen sexo con otros hombres, determinan que los factores relacionados con el uso inconsistente del preservativo son: mantener relaciones sexuales con una pareja estable (D'Anna et al, 2013), poseer actitudes negativas hacia el uso del preservativo (Mendoza-Pérez y Ortiz-Hernández, 2009), no percibir apoyo de la pareja sexual respecto al uso del preservativo (D'Anna et al, 2013;Wilson, Díaz, Yoshikawa y Shrout, 2009) Los resultados descritos revelan la necesidad de seguir investigando el comportamiento sexual en el colectivo de HSH así como aquellos factores que expliquen la adopción de conductas sexuales de riesgo. Por tanto, el objetivo de la presente investigación es proporcionar información actualizada acerca de las actitudes hacia el preservativo y los comportamientos de riesgo sexual de hombres que tienen sexo con otros hombres.…”