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  • Title: Assessing condom use practices. Implications for evaluating method and user effectiveness.
    Author: Warner L, Clay-Warner J, Boles J, Williamson J.
    Journal: Sex Transm Dis; 1998 Jul; 25(6):273-7. PubMed ID: 9662759.
    Abstract:
    BACKGROUND: Consistent and correct condom use remains important to human immunodeficiency virus (HIV) prevention. Although many studies evaluate consistent condom use, few examine how condoms are used during intercourse. GOALS: Assess how user practices affect exposure to risks of pregnancy and infection during condom use. STUDY DESIGN: A cross-sectional survey on condom behaviors in the past month was conducted among 98 male students attending two Georgia universities. RESULTS: Altogether, 35 of 270 total condom uses (13.0%, 95% confidence interval, 7.4-18.5) resulted in potential exposure to sexually transmitted disease and/or HIV infection or pregnancy. Both consistent and inconsistent users were similarly likely to report potential exposures during condom use. CONCLUSION: These findings suggest condom problems occur among both consistent and inconsistent users. Future studies of condom effectiveness must distinguish whether condoms were used both consistently and correctly. A cross-sectional study conducted among US male college students investigated how condom use practices affect exposure to risks of pregnancy and sexually transmitted infections, including HIV. Although previous studies have suggested men have problems using condoms effectively, none has systematically quantified the problems that occur. Through advertisements posted at two universities in Georgia, 98 male students (mean age, 22.3 years) who reported ever-use of 5 or more condoms during vaginal intercourse were enrolled. To minimize subject recall bias, the analysis was restricted to the students who had used condoms in the month preceding the study. These 47 students used a total of 270 condoms in that month. The most common use problems that carried no risk of direct penile-vaginal contact were using a condom that had been put on inside out and then flipped over (13.0%), loss of erection (12.2%), allergic reaction or irritation (2.2%), and complete unrolling of a condom before use (0.7%). The frequencies of the four problems that posed a direct risk of contact were as follows: starting intercourse without a condom and then stopping to put one on (7.8%), breakage during intercourse or withdrawal (4.1%), starting intercourse with a condom and then removing it and resuming intercourse (2.6%), and complete condom slippage during intercourse or withdrawal (1.5%). 16 men (34%) potentially exposed themselves and their partners to risks of pregnancy and infection. Assuming that multiple problems may have been experienced during the same condom encounter, a minimum of 35 (13%) of total condom uses were associated with these risks. These exposure levels are likely even greater among less experienced, less educated men.
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