PurposeTo determine, among a sample of young black male (YBM), whether female application of male condoms for penile–vaginal intercourse would be associated with higher or lower rates of breakage or slippage. A secondary aim was to investigate if higher rates of breakage or slippage were associated with increased odds of acquiring chlamydia and/or gonorrhea.MethodsA cross-sectional study of 412 YBM, aged 15 to 23 years, was conducted in three US cities located in the Southern United States.ResultsAmong YBM reporting frequent female application of condoms, 43.5% reported one or more instance of breakage or slippage, compared with those reporting less frequent female application (27.2%, P = .003). Among YBM reporting one or more event of breakage or slippage, 25.4% tested positive for chlamydia and/or gonorrhea. In contrast, among those not reporting breakage or slippage, 17.2% tested positive (P = .047).ConclusionsFindings suggest that educational and behavioral interventions should seek to improve young women's skills relative to condom application and use. Further studies could also investigate whether intervention efforts should encourage some YBM to be responsible for their own condom application

Crosby, Richard A.

Graham, Cynthia A.

Milhausen, Robin R.

Sanders, Stephanie A.

Yarber, William L.

English

PubMed

Southampton (e-Prints Soton)

  Condom application errors        Condoms are More Effective When Applied by Males: A Study of  Young Black Males in the United States [Submitted as a Brief Communication]  Richard A. Crosby, PhD1,2,7 Robin R. Milhausen, R  PhD,2,4,7 Stephanie A. Sanders, PhD,2,6,7 Cynthia A. Graham, PhD,2,3 William L. Yarber, HSD5,7  1 College of Public Health, University of Kentucky, Kentucky, U.S.A. 2 The Kinsey Institute for Research in Sex, Gender, and Reproduction, Bloomington, Indiana, U.S.A. 3 Department of Psychology, University of Southampton, Southampton, United Kingdom 4 Department of Family Relations and Applied Nutrition at the University of Guelph, Guelph,       Ontario, Canada 5 School of Public Health – Bloomington, Indiana University, Bloomington, Indiana U.S.A. 6 Department of Gender Studies, Indiana University, Bloomington, Indiana, U.S.A. 7 Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, Indiana, U.S.A.   Short title: Condom application errors      Counts: text = 1,323; abstract = 166 Correspondence: Richard Crosby, PhD, College of Public Health, 111 Washington Ave.  Lexington, KY  40506-0003; telephone: 859-257-5678 (ext 82039) /FAX: 859-323-2933/e-mail: crosby@uky.edu.   Condom application errors                                                                                                                                                                                                                           2 Key Words: Condoms, young men, sexually transmitted diseases, sexual behavior   Condom application errors                                                                                                                                                                                                                           3  Abstract Purpose: To determine, among a sample of young black men (YBM), whether female application of male condoms for penile-vaginal intercourse would be associated with higher or lower rates of breakage/slippage. A secondary aim was to investigate if higher rates of breakage/slippage were associated with increased odds of acquiring Chlamydia and/or gonorrhea. Methods: A cross-sectional study of 412 YBM, ages 15 to 23 years, was conducted in three U.S. cities located in the Southern U.S. Results: Among YBM reporting frequent female application of condoms, 43.5% reported one or more instance of breakage/slippage, compared with those reporting less frequent female application (27.2%, P=.003). Among YBM reporting one or more event of breakage/slippage, 25.4% tested positive for Chlamydia and/or gonorrhea. In contrast, among those not reporting breakage/slippage, 17.2% tested positive (P=.047). Conclusion: Findings suggest that education and behavioral interventions should seek to improve young women’s skills relative to condom application and use. Further studies could also investigate whether intervention efforts should encourage some YBM to be responsible for their own condom application.   Condom application errors                                                                                                                                                                                                                           4 Introduction In the United States, young Black males (YBM) continue to be disproportionally likely to acquire sexually transmitted infections (STIs), including infection with Human Immunodeficiency Virus (HIV).1-3 The problem is exacerbated in the Southern US.4 The consistent and correct use of male condoms is a primary method preventing disease acquisition/transmission among YBM.5-7 Previous studies, however, have documented various errors occurring during application may lead to breakage or slippage of condoms.8-20 Whether these errors are more common when female partners apply condoms has been addressed in only one study. That investigation was of low STI-risk college students and it found that 28% of 102 women applying condoms (over a three-month recall period) reported breakage/slippage.18  The purpose of this study was to determine, among a sample high-risk YBM, whether female application of male condoms for penile-vaginal intercourse (PVI) would be associated with higher or lower rates of condom breakage/slippage. The association between breakage/slippage and testing positive for laboratory-confirmed Chlamydia and gonorrhea was also tested.  Methods Study Sample YBM were recruited for participation in an NIH-funded randomized controlled trial of a safer sex intervention program designed for young Black males. Only the baseline data from that trial were used for this secondary study. Recruitment occurred in clinics that diagnose and treat STDs. Inclusion criteria were: self-identification as Black/African American, 2) ages 15 to 23 years, 3) having engaged in penile-vaginal sex at least once in the past two months, 4) not   Condom application errors                                                                                                                                                                                                                           5 knowingly HIV-positive. Recruitment occurred from approximately 2010 through 2012, in a primary site (New Orleans, LA) and two secondary sites (Baton Rouge, LA and Charlotte, NC). The study enrolled 702 eligible young men, with a participation rate of 60.4%. For this secondary analysis, only those having sex with females and using condoms in the past two months were included (N=396).   Study Procedures   After providing assent, research assistants asked young men less than 18 years of age for their permission to contact one parent or guardian to obtain consent for study participation. All other young men provided written informed consent. The study protocol was approved by the institutional review boards at all participating sites.   Upon enrollment young men were instructed in the use of a laptop computer to complete an audio-computer assisted self-interview (A-CASI) lasting approximately 30 minutes. The A-CASI was completed in a private area, with the research assistant being nearby in case participants encountered technical problems or had questions about wording. Subsequently, young men were asked to donate a urine specimen that was used for STD testing. Specimens were shipped to Quest Diagnostics and tested using the Aptima COMBO 2 Assay, a target amplification nucleic acid probe test that utilizes target capture for the detection and differentiation of ribosomal RNA (rRNA) from Chlamydia trachomatis and Neisseria gonorrhoeae. All participants were compensated $50 for their participation.  Measures  One A-CASI questions asked, “In the past two months, how often did your partner put the condom on you?” Response alternatives were provided on a 5-point scale ranging from 1) “never” to 2) “some of the time,” 3) “about one half of the time,” 4) “almost every time,” and   Condom application errors                                                                                                                                                                                                                           6 5) “every time.” For this study, “frequent female application” was defined as 50% or more of all penile-vaginal sex events occurring in the past two months.   Subsequent A-CASI questions assessed whether condoms had broken during PVI, slipped off during PVI, or slipped off during withdrawal (again, using the same 2-month recall period). Having one or more of these events occur was counted as a condom failure. Data Analysis   Contingency table analyses were used to determine the bivariate association between the measure of whether females frequently applied condoms and condom failure. Subsequently, three variables were tested to determine whether they might confound the association between female application and breakage/slippage: having multiple partners (defined as two or more) during the recall period, frequency of having penile-vaginal sex during the recall period, and frequency of condom use during the recall period. Age, education, and recruitment site were included as control variables, regardless of their bivariate association with breakage/slippage. A hierarchal logistic regression model was created to include any of the three significant confounding variables and the three control variables in block 1, with block 2 containing the variable representing whether frequent female application of condoms occurred. Next, contingency table analysis was used to determine whether breakage/slippage was associated with laboratory-confirmed diagnosis of Chlamydia and/or gonorrhea. Significance was defined by an alpha value of .05.  Results  Characteristics of the Sample  Mean age was 19.7 years (SD=1.9). Exactly 50% reported current school enrollment (high school or beyond) and 94.7% reported currently being recipients of one or more financial   Condom application errors                                                                                                                                                                                                                           7 public assistance programs. All YBM self-reported a history of one or more STIs. The mean number of condom-protected acts in the past two months was 8.47 times (standard deviation = 18.46). Of 396 YBM providing valid urine specimens, 19.4% tested positive for Chlamydia and/or gonorrhea.  Findings Just over one-fifth of the sample (20.9%, n=83) was classified as reporting that female partners frequently applied condoms for PVI. Nearly one-third (31.3%, n=124) reported at least one event of breakage/slippage. Among those in the frequent female application group, 41.0% experienced one or more instance of breakage/slippage. In contrast, among men not reporting frequent female application, 28.8% experienced breakage/slippage (P=.03).  In testing the three possible confounding variables, only one was associated with breakage/slippage: Among those having multiple partners, 37.7% reported breakage/slippage versus 23.9% among those having one partner (P = .003). Frequency of PVI did not differ by breakage/slippage (11.55 times among those with no breakage/slippage versus 12.46 for those reporting one or more instances of breakage/slippage, t = .48, df=378, P=.63). Similarly, frequency of condom use PVI did not differ by breakage/slippage (7.49 times among those with no breakage/slippage versus 8.91 for those reporting one or more instances of breakage/slippage, t = .96, df=375, P=.34). In a multivariate analysis controlling for age, education level, recruitment site, and whether participants had multiple partners during the 2-month recall period, the adjusted odds ratio was 1.82 (95% CI=1.07-3.11, P=.027), indicating that those reporting frequent female application were about 80% more likely to also report breakage/slippage.   Condom application errors                                                                                                                                                                                                                           8 Among YBM giving valid urine specimens and reporting one or more instance of breakage/slippage, 27.3% tested positive for Chlamydia and/or gonorrhea. In contrast, among those not reporting breakage/slippage, 17.1% tested positive (P=.02). Discussion Findings suggest that, among YBM from the Southern U.S., the practice of having a female partner frequently apply condoms for PVI may heighten the risk of condom failure; as a result, this population may be more likely to acquire an STI. It is also worth noting, however, that the alternative to the female applying the condom may have been that condoms were not used at all, thereby creating even greater risk. This is the first study of YBM to assess whether the frequency of female-partner application of condoms is related to rates of breakage and slippage. If the observed prevalence of female sex partners applying condoms to YBM is indicative of population prevalence, then approximately 20% of YBM may be at increased risk of acquiring an STI.  Findings are limited by the validity of self-report. The use of a convenience sample limits the generalizability of the findings to other populations of STD clinic attendees. Also, the analysis of breakage/slippage on Chlamydia/gonorrhea prevalence is limited by the selection bias inherent in STI clinics (i.e., the sample is limited to YBM not using condoms consistently and correctly). Additionally, although we did control for possible confounding, it is important to note that this study cannot infer causality.  One possible explanation for our findings may be that female partners of YBM have limited opportunities to apply condoms and thus, their skill level may be lacking. Although one implication of the study findings is that interventions efforts should encourage YBM to “take charge” of their own condom application, it is equally important to suggest that education and   Condom application errors                                                                                                                                                                                                                           9 behavioral interventions should provide young women with skills relative to condom application and use.                                                                                                      Condom Breakage   10 Acknowledgement  This study was funded by a grant from the National Institute of Mental Health to the first author, R01MH083621.                                                                                                         Condom Breakage   11 References 1. Cates W. Estimates of the incidence and prevalence of sexually transmitted diseases in the United States. Sex Transm Dis. 1999;26(4): s2-s7. 2. Centers for Disease Control and Prevention (CDC). Condoms and STDs: Fact sheet for public health personnel. 2011; Retrieved June 29, 2011 from http://www.cdc.gov/condomeffectiveness/latex.htm 3. Crosby RA, Bounse S. Condom effectiveness: Where are we now? Sexual Health 2012;9:10-17. 4. Holmes KK, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bulletin of the World Health Organization. 2004;82: 454-461. 5. CDC. Youth Risk Behavior Surveillance – United States, 2009. Morbidity and Mortality Weekly Report. 2010;59(SS05): 1-142. Retrieved June 29, 2011 from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5905a1.htm 6. Sanders SA, Reece M, Herbenick et al. Condom use during most recent vaginal intercourse event among a probability sample of adults in the United States. J Sex Med. 2010;Suppl 5:362-73. 7. Yarber WL, Crosby RA, Graham CA et al. Correlates of putting condoms on after sex has begun and of removing them before sex ends: a study of men attending an urban public STD clinic. Am J Mens Health. 2007;12(3):412-8. 8. Crosby RA. Sate of condom use in HIV prevention science and practice. Current HIV/AIDS Reports 2013;10:59-64. 9. Spruyt A, Steiner MJ, Joanis C, et al. Identifying condom users at risk for breakage and  slippage: Findings from three international sites. Am J Public Health 1998;88:239-244.                                                                                                       Condom Breakage   12 10. Crosby RA, Yarber WL, Sanders SA, et al. Slips, breaks, and falls: Condom errors and problems reported by men attending an STI clinic. International Journal of STDs and AIDS 2008;19:90-93. 11. Crosby RA, Salazar LF, Yarber WL, et al. A theory-based approach to understanding condom errors and problems reported by men attending an STI clinic. AIDS & Behavior 2008;12:412-418. PMID: 17588147 12. Graham CA, Crosby RA, Sanders SA, & Yarber WL. Assessment of condom use in men and women. Annual Review of Sex Research 2006;16:2-52. PMID: 16913286  13. Mertz KJ, Finelli L, Levine WC, Mognoni RC, Berman SM, Fishbein M, Garnett G, St. Louis ME. Gonorrhea in male adolescents and young adults in Newark, New Jersey: Implications of risk factors and patient preferences for prevention strategies. Sex Transm Dis 2000;27:201-207. 14. Crosby RA, Sanders S, Yarber WL, Graham CA. Condom-use errors and problems: a neglected aspect of studies assessing condom effectiveness. Am J Prev Med 2003;24(4):367-70. PMID: 12726876 15. Sanders SA, Graham CA, Yarber WL, Crosby RA. Condom use errors and problems among young women who put condoms on their male partners. J Am Med Womens Assoc 2003;58(2):95-8. PMID: 12744422 16. Sanders SA, Yarber WL, Kaufman EL, Crosby RA, Graham CA, Milhausen RM. Condom use errors and problems: a global view. Sexual Health 2012;9:81-85.  PMID: 22348636 17. Crosby RA, DiClemente, R. J., Yarber, W. L., et al. An event-specific analysis of condom breakage among African American men at risk of HIV acquisition. Sex Transm Dis 2008; 35:174-178. PMID: 18090176                                                                                                       Condom Breakage   13 18. Sanders SA, Graham CA, Yarber WL, Crosby RA. Condom use errors and problems Among young women who apply put condoms on their male partners. J Am Med Women's Assoc 2003;58:95-98. PMID: 12744422 19. Warner L, Newman DR, Fishbein M, et al. Problems with condom use among patients attending sexually transmitted disease clinics: prevalence, predictors, and relation to incident gonorrhea and chlamydia. Am J Epidemiol 2008;167:341-349. 20. Sanders SA, Yarber WL, Kaufman EL, Crosby RA, Graham CA, Milhausen RM. Condom use errors and problems: a global view. Sexual Health 2012;9:81-85.                                                                                                      Condom Breakage   14    

A theory-based approach to understanding condom errors and problems reported by men attending an STI clinic.

An event-specific analysis of condom breakage among African American men at risk of HIV acquisition. Sex Transm Dis

Assessment of condom use in men and women.

Condom effectiveness: Where are we now?

Condom use during most recent vaginal intercourse event among a probability sample of adults in the United States.

Condom use errors and problems Among young women who apply put condoms on their male partners.

Condom use errors and problems among young women who put condoms on their male partners.

Condom use errors and problems: a global view. Sexual Health

Condom use errors and problems: a global view. Sexual Health 2012;9:81-85. Condom Breakage

Condom-use errors and problems: a neglected aspect of studies assessing condom effectiveness.

Correlates of putting condoms on after sex has begun and of removing them before sex ends: a study of men attending an urban public STD clinic.

Disease Control and Prevention (CDC). Condoms and STDs: Fact sheet for public health personnel. 2011; Retrieved

Effectiveness of condoms in preventing sexually transmitted infections.

Estimates of the incidence and prevalence of sexually transmitted diseases in the United States. Sex Transm Dis.

Gonorrhea in male adolescents and young adults in

Identifying condom users at risk for breakage and slippage: Findings from three international sites.

Problems with condom use among patients attending sexually transmitted disease clinics: prevalence, predictors, and relation to incident gonorrhea and chlamydia.

Risk Behavior Surveillance – United States,

Sate of condom use in HIV prevention science and practice.

Slips, breaks, and falls: Condom errors and problems reported by men attending an STI clinic.

Condoms are more effective when applied by males: a study of young black males in the United States

http://dx.doi.org/10.1016/j.annepidem.2014.07.017

Condoms are more effective when applied by males: a study of young black males in the United States

Abstract

Similar works

Full text

Available Versions

Southampton (e-Prints Soton)