Condom failure (slippage or breakage) has been shown to be associated with HIV seroconversion among men who have sex with men (MSM), but predictors of failure have been poorly elucidated. Of 2592 HIV-seronegative MSM participants in the HIV Network for Prevention Trials (HIVNET) multisite Vaccine Preparedness Study who reported condom use for anal sex in the 6 months before enrollment, condom failure was reported by 16.6%, with failure rates of 2.1/100 episodes of condom usage (2.5 failures/100 episodes for receptive anal sex and 1.9/100 episodes for insertive anal sex). In separate multivariate models evaluating predictors of condom failure reported by the insertive and receptive partners, more frequent condom use was associated with a decreased per-condom failure rate and amphetamine and heavy alcohol use with increased rates in both models. Being employed, having private medical insurance, and using lubricants for >80% of anal sex acts were significantly associated with decreased failure rates in the insertive model. Safer sex counseling should particularly target men of lower socioeconomic status, promote proper and consistent use of condoms with appropriate lubricants, and address the impact of drug use, especially amphetamines and alcohol, on condom failure.
PIP: Although the extent of condom use during anal intercourse has increased considerably among men who have sex with men (MSM) in response to the HIV/AIDS pandemic, condom failure through both slippage and breakage limits the effectiveness of such method use. Condom failure is associated with HIV seroconversion among MSM. 16.6% of the 2592 HIV-seronegative MSM participants in the HIV Network for Prevention Trials (HIVNET) multi-site Vaccine Preparedness Study who reported condom use for anal sex in the 6 months before enrollment reported condom failure. The overall failure rate was 2.1/100 episodes of condom use, with 2.5 failures/100 episodes for receptive anal sex and 1.9/100 episodes for insertive anal sex. Almost half of the men were aged 30 years or younger, 25% were non-White, 60.6% attended college, and 85.7% were employed either part- or full-time. Multivariate analysis of reported failures found more frequent condom use to be associated with a decreased per condom failure rate, and amphetamine and heavy alcohol use with increased rates in both models. Being employed, having private medical insurance, and using lubricants for more than 80% of anal sex acts were significantly associated with decreased failure rates in the insertive model. These findings suggest that safer sex counseling should therefore target men of lower socioeconomic status, promote the proper and consistent use of condoms with appropriate lubricants, and address the impact of drug use upon condom failure.