from Safer Sex: Information for Counselors (Part XV)

Condom Failure Rates

(Arranged Chronologically - Reverse Order)

The effective prevention of HIV by female condom (Femidom).

Park JS ; Kim CK
Int Conf AIDS. 1994 Aug 7-12;10(2):288 (abstract no. PC0531).

As part of a widely implemented prevention strategy, condom use exemplifies the empowerment of individuals and interaction between people who want to protect themselves and others against HIV infection. The serious consequences of condom failure has placed added emphasis on condom quality. Correct condom use can be learned and practiced with the result being more condom use with less breakage. The newest female barrier, Female Condom (Femidom) could protect against HIV transmission. Female Condom is a lubricated polyurethane bags with a soft ring. As sexually transmitted diseases are a high risk factors in HIV transmission, then the use of Female Condom has an obvious indirect value in HIV control. Comparative studies have been initiated whether female condom will be as good as better than male condom in directly ffecting HIV transmission. Female Condom is a choice for HIV prevention as well as a useful method of contraception.

Estimated condom failure and frequency of condom use among gay men.

Thompson JL ; Yager TJ ; Martin JL
Am J Public Health. 1993 Oct;83(10):1409-13.

OBJECTIVES. Condoms are designed to bar transmission of the human immunodeficiency virus (HIV), but they sometimes fail. This paper explores the effect of experience with condoms on condom failure among gay men. METHODS. Risk of condom failure (breakage or slippage) on a single occasion is estimated for four sexual acts reported over 12 months by a sample of gay New York City men (n = 741). The estimation procedure assumes that each episode in which a condom is used is an independent event. Evidence is offered to support this assumption. RESULTS. Risk of condom failure in a single episode was fairly high, particularly in anal intercourse, for men who had engaged in each act only a few times in the previous year. It declined rapidly with experience (e.g., to below 1% for receptive anal intercourse after about 10 episodes in the previous year). Condoms failed less often in oral than anal sex, but estimated risk of failure also decreased with experience. CONCLUSIONS. Gay men should be especially cautious the first few times they use a condom; after moderate experience, however, they may expect a low risk of condom failure.

Adolescents and condom use.

Joffe A
Am J Dis Child. 1993 Jul;147(7):746-54.

Increasing condom use among adolescents is an essential component of a public health strategy aimed at decreasing rates of sexually transmitted infections and the spread of human immunodeficiency virus infection. This article reviews current data about the contraceptive and prophylactic characteristics of condoms. Data about current levels of use among adolescents and factors demonstrated to affect such use are also summarized. Except where data are scanty or nonexistent, the research studies are limited to those focusing primarily on adolescents and, occasionally, college students. Based on these data, suggestions for increasing condom use among adolescents are presented.

A meta-analysis of condom effectiveness in reducing sexually transmitted HIV [see comments]

Weller SC
Soc Sci Med. 1993 Jun;36(12):1635-44.

Before condoms can be considered as a prophylaxis for sexually transmitted human immunodeficiency virus (HIV), their efficacy must be considered. This paper reviews evidence on condom effectiveness in reducing the risk of heterosexually transmitted human HIV. A meta-analysis conducted on data from in vivo studies of HIV discordant sexual partners is used to estimate the protective effect of condoms. Although contraceptive research indicates that condoms are 87% effective in preventing pregnancy, results of HIV transmission studies indicate that condoms may reduce risk of HIV infection by approximately 69%. Thus, efficacy may be much lower than commonly assumed, although results should be viewed tentatively due to design limitations in the original studies.

The effectiveness of condom use among homosexual men [letter]

de Wit JB ; Sandfort TG ; de Vroome EM ; van Griensven GJ ;
AIDS. 1993 May;7(5):751-2.

How often do condoms break or slip off in use?

Richters J ; Donovan B ; Gerofi J
Int J STD AIDS. 1993 Mar-Apr;4(2):90-4.

Men attending 3 sexually transmissible disease clinics and a university health service in Sydney were given a questionnaire asking how many condoms they had used in the past year and how many broke during application or use or slipped off. Respondents were 544 men aged 18 to 54 years. Of these, 402 men reported using 13,691 condoms for vaginal or anal intercourse; 7.3% reportedly broke during application or use and 4.4% slipped off. Men having sex with men reported slightly higher slippage rates than those having sex with women. Breakage and slippage were unevenly distributed among the sample: a few men experienced very high failure rates. A volunteer subsample reported 3 months later on condoms supplied to them: 36 men used 529 condoms, of which 2.8% broke during application or use and 3.4% slipped off. Many of these failures pose no risk to the user, especially those occurring during application, as long as they are noticed at the time, but failure may discourage future use. Research is needed to identify user behaviours related to breakage.

HIV infection in European female sex workers: epidemiological link with use of petroleum-based lubricants. European Working Group on HIV Infection in Female Prostitutes.

AIDS. 1993 Mar;7(3):401-8.

OBJECTIVES: To assess the prevalence of and risk factors associated with HIV infection in European female sex workers, particularly sexual risk factors. DESIGN: Multicentre cross-sectional study performed in nine European countries. METHODS: Female sex workers voluntarily enrolled between September 1990 and November 1991. Face-to-face interviews were conducted in various settings (health care, prostitute organizations, outreach) to collect information on over 150 behavioural, health and sociodemographic variables. Enrollment of intravenous drug users (IVDU) was limited to a maximum of 25% of the total sample. The HIV-1 and HIV-2 antibody status of blood or saliva samples was tested using enzyme-linked immunosorbent assay and confirmed by Western blot. RESULTS: Eight hundred and sixty-six (91.6%) of the 945 interviewees provided blood (n = 824) or saliva (n = 42) samples. HIV seroprevalence was 5.3% [44 HIV-1-positives and two HIV-2-positives (from Lisbon)] overall, 31.8% (35 out of 110) in IVDU and 1.5% (11 out of 756) in non-IVDU [odds ratio (OR), 31.6; P < 0.001]. Lack of condom use (P = 0.002, test for trend) and previous ulcerative sexually transmitted disease (OR, 3.6; P = 0.06) were associated (on logistic regression) with HIV infection in both IVDU and non-IVDU. Previous hepatitis B (OR, 13.8; P = 0.02) and needle-sharing (OR, 4.1; P = 0.04) were associated with HIV infection in IVDU, and low education level (P = 0.02, test for trend), previous transfusion (OR, 9.1; P = 0.003), origin from sub-Saharan Africa (OR, 5.4; P = 0.05) and use of petroleum-based lubricants (OR, 15.2; P = 0.001) in non-IVDU. CONCLUSIONS: HIV prevalence remains relatively low among non-IVDU prostitutes in Europe. While intravenous drug use remains the most important risk factor for HIV, petroleum-based lubricants (used by 10% of women in this study) may be a risk factor for HIV among European female sex workers; over 80% of those interviewed always used condoms with clients.

The effectiveness of condom use in heterosexual prostitution in The Netherlands.

de Graaf R ; Vanwesenbeeck I ; van Zessen G ; Straver CJ ;
AIDS. 1993 Feb;7(2):265-9.

OBJECTIVES: To assess the extent to which condoms are used effectively in commercial heterosexual intercourse. Data on the number of condoms that had broken or slipped off, the sexual technique during which this had occurred and the perceived cause of failure were collected. The use of non-water-soluble lubricants and non-fortified condoms during anal intercourse, and the demand for a greater variety of condom sizes were also examined. SUBJECTS AND METHODS: One hundred and twenty-seven female prostitutes and 91 male clients from different parts of The Netherlands were interviewed face-to-face between July 1990 and March 1991. RESULTS: Of those who used condoms during vaginal intercourse, 49% of the prostitutes had experienced condom breakage in the previous 6 months, and 16% of the clients in the previous 12 months. The breakage rate was 0.8% for prostitutes and 1.5% for clients. Condom quality was seldom reported as the cause; breakage was generally attributed to human factors, such as rough or prolonged intercourse, incorrect handling of the condom or the use of insufficient lubricant. Prostitutes also identified penis size as a cause. Condoms slipping off before or after ejaculation was reported less frequently than breakage. Thirteen per cent of clients and 36% of prostitutes expressed a need for either smaller or larger condoms. Of the prostitutes, 9% used oil or vaseline as a lubricant. CONCLUSIONS: In view of the low rate of condom failure in heterosexual prostitution in The Netherlands, the potential spread of HIV by this means is small. The use of a greater variety of condom sizes may further reduce the failure rate. Few prostitutes remain ignorant about the adverse effects of oil-based lubricants on condoms.

Aspects of comfort and safety of condom. A study of two thousand intercourses among volunteer couples.

Boldsen JL ; Jeune B ; Madsen PC
Scand J Soc Med. 1992 Dec;20(4):247-52.

In nearly 2,000 intercourses 14 different types of condoms were tested by 80 heterosexual and seven homosexual volunteer couples. The test couples were generally quite experienced in the use of condoms. It appears that the condoms rarely (1.3%) ruptured or slipped off during the actual intercourse. This means that emphasis must be put on consistency and skill in the use of condoms rather on technical improvements in the promotion of condoms as a means of preventing the spread of sexually transmitted infections like HIV. Lubricated condoms and condoms that were not too small were preferred by both users and their partners. Other condom properties were significant but of minor concern for the participants of the study.

Effectiveness of latex condoms as a barrier to human immunodeficiency virus-sized particles under conditions of simulated use [see comments]

Carey RF ; Herman WA ; Retta SM ; Rinaldi JE ; Herman BA ;
Sex Transm Dis. 1992 Jul-Aug;19(4):230-4.

Condoms were tested in an in vitro system simulating key physical conditions that can influence viral particle leakage through condoms during actual coitus. The system quantitatively addresses pressure, pH, temperature, surfactant properties, and anatomical geometry. A suspension of fluorescence-labeled, 110-nm polystyrene microspheres models free human immunodeficiency virus (HIV) in semen, and condom leakage is detected spectrofluoro- metrically. Leakage of HIV-sized particles through latex condoms was detectable (P less than 0.03) for as many as 29 of the 89 condoms tested. Worst-case condom barrier effectiveness (fluid transfer prevention), however, is shown to be at least 10(4) times better than not using a condom at all, suggesting that condom use substantially reduces but does not eliminate the risk of HIV transmission.

Failure rate of condoms among gay men.

de Wit J ; de Vroome E ; van Griensven G ; Sandfort T
Int Conf AIDS. 1992 Jul 19-24;8(2):D416 (abstract no. PoD

OBJECTIVES: The purpose of this study is to assess the failure rate of condoms used during anogenital contact among gay men, specified for type of condom and type of lubricant. Characteristics of men who experienced condom failure are also investigated. METHODS: Respondents were 671 gay men participating in the Amsterdam Cohort Study. In datawave 10 (October 1990-May 1991), questions were asked about condom use in the previous six months. Attitudes and social norms with respect to condom use were also assessed. RESULTS: Anogenital sex was practiced by 277 participants of whom 242 men had used condoms. Valid data on condom use were obtained from 239 men. In sum, the use of 2447 condoms was reported, of which 51 tore and 40 slipped off. The observed failure rate was 3.7%. Vaginal condoms failed more often than anal condoms (4.6% vs 3.1%). With water-based lubricants, the failure rate was lower than with oil-based lubricants (1.7% vs 10.3%). When no lubricant was used the failure rate was 6.1%. Vaginal condoms were at least once used by 41 participants (17.1%). Oil-based lubricants were used at least once by 26 participants (10.8%) and 59 men (24.7%) did not use lubricants or used saliva. Condom failure was experienced by 47 users (19.7%). Bivariate logistic regression analysis showed that men who experienced condom failure had a less positive attitude (O.R. = 1.67, 95% C.I. = 1.05-2.59) and social norms towards condom use (O.R. = 1.65, 95% C.I. = 1.05-2.34). CONCLUSIONS: Vaginal condoms, which were found to have a higher failure rate than anal condoms, were utilized by a substantial portion of condom users. In addition, often no or oil-based lubricants were used, practices that also increase condom failure. Data suggest that adequate use of lubricants might even be a more important factor in preventing condom failure than type of condoms used. Although the results indicate that improving the use of condoms among gay men is important, it was also noted that condom failure in this cohort decreased from 8% in 1986 to 4% in 1991.

Comparison of condom breakage during human use with performance in laboratory testing.

Russell-Brown P ; Piedrahita C ; Foldesy R ; Steiner M ;
Contraception. 1992 May;45(5):429-37.

This paper combines results from a study of the determinants of condom quality and use conducted by The Population Council in two countries in the Caribbean with results from a condom breakage study conducted by Family Health International (FHI) in the United States. The studies, conducted two years apart, compared the breakage rates of condoms from the same lot during human use to their performance in laboratory test results. Breakage rates of 12.9% for Barbados, 10.1% for St. Lucia and 6.7% for the United States compared to passing ASTM laboratory tests suggest that existing laboratory tests as used with the current pass/fail standards are either not sufficiently sensitive or not well-defined to reliably predict condom performance during human use. The study also suggests that user behaviors and practices may be a factor in condom breakage. If the condom is to be an effective method against unplanned pregnancy and STD/HIV infection, and if consumer confidence is to be retained, condom breakage during sexual intercourse must be reduced.

A study of the relationship between tensile testing of condoms and breakage in use.

Gerofi J ; Shelley G ; Donovan B
Contraception. 1991 Feb;43(2):177-85.

The ability of the condom wall to maintain its integrity throughout sexual intercourse is critical to its role in halting the spread of major sexually transmissible pathogens including the human immunodeficiency virus. There are three principal in vitro performance tests applied to condoms: a test for freedom from holes, an inflation test, and tensile testing. In this study we subjected condoms that had broken in use to tensile tests in order to determine any correlation between their in vivo and in vitro performance. Condoms which had broken in use showed similar tensile properties to those which had not. All passed all tensile test criteria. Thus, the inclusion of tensile testing in National Standards for condoms is not sufficient to insure strong products.

Condom use and breakage among women in a municipal hospital family planning clinic.

Albert AE ; Hatcher RA ; Graves W
Contraception. 1991 Feb;43(2):167-76.

For those who choose to be sexually active, condoms are the best available means of protection against sexually transmitted diseases including the human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). Condoms are also an effective method for preventing pregnancy. Unfortunately, condoms are not 100% effective at preventing pregnancy or the spread of infection, in part because condoms do break. In order to gain insight into condom breakage, a questionnaire was administered to women attending a municipal hospital family planning clinic. Thirty-six percent of the 106 subjects had experienced at least one condom breakage. Condom breakage occurred in approximately 1 out of 100 acts of intercourse using condoms, with a lifetime breakage rate of 10 per 1000 condom uses and a past year breakage rate of 8 per 1000 condom uses. Breakage rates did not differ substantially by age. Five percent of the women's unplanned pregnancies were attributed to broken condoms. The results of this study corroborate previously reported rates. Factors associated with these women's most recent breakage experiences included: vaginal intercourse, minimal foreplay, and breakage prior to ejaculation. Controlled studies will be needed to determine how the condom can be used to reduce the likelihood of breakage.

Burst sheaths [letter]

Fisher M
Br J Gen Pract. 1990 Dec;40(341):520.

Risk of HIV infection among clients of the sex industry in Scotland.

Thomas RM ; Plant MA ; Plant ML ; Sales J
BMJ. 1990 Sep 15;301(6751):525.

Factors related to seroconversion among homo- and bisexual men after attending a risk-reduction educational session.

Silvestre AJ ; Lyter DW ; Valdiserri RO ; Huggins J ; Rinaldo
AIDS. 1989 Oct;3(10):647-50.18

Thirteen homosexual men, volunteers in a study of the natural history of HIV, who seroconverted to HIV after participating in an educational program on HIV prevention, were interviewed about the circumstances leading to their seroconversion. Six men had participated in unprotected anal intercourse with at least one partner whom they believed was HIV-negative. Four men attributed their conversion to mental health problems or to drug and alcohol use. Two men's seroconversions could not be ascertained and one man attributed seroconversion to a condom break. Most men who had learned how to avoid infection, and had successfully done so for a time, had knowingly engaged in unsafe behaviors because of strong emotional responses to certain partners or because of mental health or drug and alcohol-related problems. Skills training for dealing with partners who pressure men to behave unsafely is needed, as is mental health and drug and alcohol counseling for men at risk for HIV infection.

Detection of occlusion vs leak in condom rheological test.

Torres J ; Anabitarte H ; Usieto R ; Noguera E
Int Conf AIDS. 1989 Jun 4-9;5:168 (abstract no. A.544).

OBJECTIVE: The condom is recommended and used as an efficient barrier against HIV and others. In practice, the film of a condom may present irregularities or leaks. This has been resolved efficiently with rigorous sampling plans for leak-detection tests, realized in all standards by conductometric or electronical test (ET). But, as the test is made on a condom in repose and without mechanical tension, eventually existing micro-occlusions or micro-chaps would not be detected as leak. Given that a condom in use in sexual relations is submitted to forces and mecan. deformations, there could appear leaks, invisible in condom without tension, and the protection is then lost. To evaluate this loss of protection vs HIV due to appearance of leaks while using stretching) condom, it is proposed to test with Rheological Test (Pat.Met.). METHODS: We tested with usual test ET and Rheological Test 2 homogeneous lots of 2 different manufacturers, considering the presence of leak at the indication of 50mV(ISO 4074, UNE 53625) and 50mV (Rheological Test RQTS 88.E1.PM1.) RESULTS: With standard method ET (condom in repose) there was no leak found. The Rheological Test detected 1 and 14 leaks in the two manufacturers respectively. CONCLUSION: 1) Condoms can present micro-occlusions or micro-chaps which will be transformed into leaks and holes and they will lose their protection effect against HIV when submitting them in use to forces and deformation. 2) The leak detection tests for condoms with the Rheological Test permit to reject non-safe condoms with micro-occlusions or micro-chaps which would not be detected by usual tests (ET).

Condom failure among homosexual men.

Golombok S ; Sketchley J ; Rust J
J Acquir Immune Defic Syndr. 1989;2(4):404-9.

Following a postal questionnaire survey of 262 homosexual men carried out to investigate condom use during sexual activity, a sample of 97 men who used condoms during anogenital sex was identified. Thirty-one percent of those who had used a condom during anal intercourse reported at least one incident of condom breakage. When looked at in terms of frequency of individual condom use, it was found that 1 in 27 condoms break during this activity. Examination of the reasons for breakage and a review of the literature indicated that physical stress on the condom is likely be a major factor in these incidents.

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