Correlates of Condom Failure in Men Who Have Sex With Men in Kenya, Malawi, and South Africa: Findings From the HIV Prevention Trials Network 075 Study

Abstract

Background: Research on condom failure among African men who have sex with men (MSM) is rare; therefore, we sought to identify multilevel correlates of condom failure. Methods: Using logistic regression, we identified the associations of various participant, partnership, and sexual interaction characteristics with condom slippage and breakage among African MSM participating in HIV Prevention Trials Network (HPTN) 075, a 1-year, multinational, prospective cohort study (2015-2017). Results: Of 401 participants, 387 (96.5%) reported at least one sexual interaction in which condoms were used. Condom slippage was reported in 194 (10.2%) of the 1908 sexual interactions reported by participants and breakage in 223 (11.7%) interactions. Both slippage and breakage were reported less frequently by participants in ongoing intimate relationships compared with those who were not (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.29-0.95; OR, 0.57; 95% CI, 0.34-0.93). Slippage and breakage occurred more frequently when sex happened under the influence of substances (OR, 1.67; 95% CI, 1.13-2.46; OR, 2.08; 95% CI, 1.48-2.93) or when sex was forced (OR, 3.18; 95% CI, 1.68-6.02; OR, 2.39; 95% CI, 1.41-4.04). Having experienced homophobia was also associated with slippage and breakage (OR, 1.32; 95% CI, 1.04-1.68; OR, 1.35; 95% CI, 1.10-1.65). Conclusions: Ongoing condom failures suggest the importance of continued condom education of African MSM, addressing circumstances that promote or hinder optimal use, and increasing their control in sexual interactions. Experienced homophobia might as a distal factor also contribute to condom failure.