How often do condoms fail? A cross-sectional study exploring incomplete use of condoms, condom failures and other condom problems among black and white MSM in southern U.S.A.

OBJECTIVES: To compare the occurrence of risk-inducing condom events (condom failures and incomplete use) and the frequency of their antecedents (condom errors, fit/feel problems and erection problems) between black and white men who have sex with men (MSM), and determine the associations between risk-inducing condom events and their antecedents.
METHODS: We studied cross-sectional data of 475 MSM who indicated using a condom as an insertive partner in the previous 6 months enrolled in a cohort study in Atlanta, Georgia, USA.
RESULTS: Nearly 40% of black MSM reported breakage or incomplete use, and they were more likely to report breakage, early removal and delayed application of a condom than white MSM. Only 31% and 54% of MSM reported correct condom use and suboptimal fit/feel of a condom, respectively. The use of oil-based lubricants and suboptimal fit/feel were associated with higher odds of reporting breakage (p=0.009). Suboptimal fit/feel was also associated with higher odds of incomplete use of condoms (p<0.0001).
CONCLUSIONS: Incomplete use of condoms and condom failures were especially common among black MSM. Our findings indicate that condoms likely offered them less protection against HIV/sexually transmitted infection when compared with white MSM. More interventions are needed, particularly addressing the use of oil-based lubricants and suboptimal fit/feel of condoms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.