AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #281 - Characteristics associated with condom use problems during anal sex among men who have sex with men (MSM): findings from the Safe City Project Study
Authors: Presenting Author: Dr Laura D'Anna - California State University, Long Beach
Additional Authors: Dr. Andrew Margolis, Dr. Lee Warner, Dr. Olga Korosteleva, Dr. Lydia O'Donnell, Dr. Cornelis Rietmeijer, Dr. Jeffrey Klausner, Dr. Kevin Malotte,
Aim: Condom use problems including breakage, slippage, or partial use (delayed application or early removal) jeopardize condom effectiveness, even when condoms are used consistently. Our research aims were to: 1) assess the prevalence of condom use problems among MSM seeking services in urban U.S. STD clinics; 2) identify participant and partner characteristics, condom use behaviors, and condom use knowledge, self-efficacy and partner support associated with condom use problems; and 3) examine how these characteristics are related to experiencing condom breakage/slippage or partial use during anal sex.
Method / Issue: Patients (n=1609) attending STD clinics in 3 cities (Denver, Long Beach, San Francisco) between June 2004 and May 2005 were enrolled in a study evaluating the behavioral effects of a video-based waiting room intervention modeling couples overcoming barriers to safer sexual behaviors. Two surveys were conducted (enrollment and 3-months) measuring behaviors during the previous 3 months. Up to 3 partnerships where anal sex occurred were considered at both assessments. Two anal sex behaviors (receptive and/or insertive sex by the respondent) were considered for each partnership. Bivariate analysis was conducted using chi-square. Two models were fitted, modeling the probability of condom breakage/slippage and condom partial use. The models were developed using the generalized estimating equations (GEE) approach to account for possible correlations among the multiple partnerships of each study participant, multiple condom uses among individuals, and two time intervals.
Results / Comments: At baseline and follow-up, a total of 263 men (median age=32 years) reported having anal sex at least once in the preceding 3 months. A total of 990 partnerships were included in the analysis; the respondent was the insertive partner in 58.5% of these partnerships. Condoms were used 100% of the time within 454 partnerships (45.9%), <100% within 114 (11.5%), and never within 422 (42.6%) partnerships. Among all partnerships where condoms were used (n=568), 21 (3.7%) reported both errors, 25 (4.4%) reported only breakage, 67 (11.8%) reported only partial use, and 455 (80.1%) reported no errors. The breakage and partial use rates per condom used were 3.4% and 11.2%, respectively. Partner specific condom use self-efficacy was the highest possible in 38.4% of partnerships. Multivariable analysis revealed the following characteristics associated with increased odds for condom breakage/slippage: drunk/high during sex (OR=2.0; CI: 1.0-3.8), and for partial use: lower self-efficacy for condom use (OR=1.44; CI: 1.0-2.1), respondent had an STI (OR=3.9; CI: 1.3-11.5), partner had an STI (OR=2.3; CI:1.3-4.0), Hispanic ethnicity (OR=2.0; CI:1.0-3.9) and <100% condom use (OR=3.3; CI:1.9-5.6). Respondent behavior (insertive or receptive) was unrelated to condom use problems.
Discussion: Condoms were used consistently in 45.9% of all partnerships and correctly in 80.1% of partnerships when condoms were used, which may reflect successful HIV/AIDS prevention efforts targeted to MSM. However, findings suggest that MSM may benefit from interventions designed to increase self-efficacy for condom use with a particular focus on the behaviors of inconsistent and partial condom use. Future research should explore the relationships between partnership characteristics and behaviors, and condom use knowledge, self-efficacy, and partner support as they relate to non-condom use among MSM.
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