Rural Center for AIDS/STD Prevention

RAP Time

(Volume 2, No. 8, August 7, 1998)

Issue Contents

College Men in Georgia Report Incorrect Condom Use During Vaginal Intercourse

A study of 47 young men reporting condom use in the past month indicated that at least 13 percent of 270 total condom uses resulted in potential exposure to HIV/STD and pregnancy because of breakage, slippage, or failure to use condoms throughout intercourse.

In the last month, 33 percent of consistent users were potentially exposed to risk during condom use. One of every 10 condoms used by these men resulted in potential risk. Problems with condom use occured equally among men reporting consistent and inconsistent condom use.

Description of the Sample and Methodology
Men were recruited from two universities in Georgia. Men having used at least five condoms and also using condoms in the past month were eligible for the study. Average age was 22 years, with 51 percent, 43 percent, and 6 percent of the sample being white, black, and Asian-American, respectively. Subjects were asked to report the number of times they had vaginal intercourse and had used condoms in the past month and year. Subjects were classified as either consistent condom users (100% of all acts of vaginal intercourse) or inconsistent users (less than 100%). Subjects were also asked about the frequency of ten problems related to condom use.

Outcomes of the Study
The majority (91.5%) reported using condoms for both disease and pregnancy prevention. About two-thirds of the sample reported using a condom at the last vaginal intercourse. Among all condom users, the mean number of condoms used in the last month was 5.7. Consistent and inconsistent condom users reported an average of 6.6 and 8.8 acts of vaginal intercourse in the past month, respectively. Problems found related to HIV/STD risk:

  • 17 percent reported at least one occasion of starting intercourse without a condom and then stopping to put on a condom. This error occurred in about eight percent of the 270 cumulative episodes.
  • About 13 percent reported at least one occasion of a condom breaking during intercourse (about 4% of cumulative uses).
  • About nine percent reported removing the condom before ending intercourse (about 3% of cumulative uses).
  • About six percent reported that the condom fell off during intercourse or withdraw (about 2% of cumulative uses).
  • About 32 percent reported placing the condom on the penis upside-down and then flipping the condom over and using it (about 13% of cumulative uses).
  • About 23 percent reported loss of erection before or after the condom was put on (about 12% of cumulative uses). Implications for Prevention The effectiveness of condom use against HIV/STD is contingent upon correct use. Common mistakes reported in this study suggest emphasis areas for programs designed to increase condom use among young men.

SOURCE: Warner, L., et al. (1998). Assessing condom use practices: Implications for evaluating method and user effectiveness. Sexually Transmitteed Diseases, 25, 273-277.

Negative Emotions Lead to Unsafe Sex for HIV-Positive MSM

Research of 155 HIV-positive men attending an out-patient HIV clinic revealed a correlation between negative emotional states and unsafe sex. Subjects were predominately low-income (75%), black (60%), and exclusively homosexual (48%).

Negative emotions included tension-anxiety, depression-rejection, anger-hostility, confusion-bewilderment, anger-arousal, and anger directed inward. Average levels of each negative emotion were significantly higher for men having unprotected anal intercourse with their most recent male partner. For men reporting a female as their most recent partner, negative emotions did not predict unprotected sex.

Use of drugs/alcohol before sex increased probabilities that men experiencing negative emotions would fail to practice safer sex. Additionally, men experiencing depression-dejection were more likely to believe their partner was responsible for insisting on safer sex.

SOURCE: Marks, G., Bingman, C. R., & Duval, T. S. (1998). Negative affect and unsafe sex in HIV-positive men. AIDS and Behavior, 2, 89-99.

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Women Report that Partners Not Barrier to Condom Use

Male partners of low-income women are unlikely to be a source of fear about requesting condom use. More than 400 women in a current relationship with a male sex partner were asked questions about perception of their power and control over sexual decision making and use of condoms for HIV/STD prevention.

Average age of the sample was 24 years, with most being black (85%), low-income (68%), and reporting a history of STDs (65%). Most women viewed sexual decision making with their partner as either balanced or tipped slightly in their favor. Eighty-seven percent of the women indicated at least 50 percent control or more over decisions to use condoms, with 48 percent indicating total (100%) control.

More than 80% of the women had ever asked their male partner to use a condom. Most (85%) of these had not experienced objections to condom use by their current partner.

SOURCE: Cabral, R. J. et al. (1998). Women at risk of HIV/STD: The importance of male partners as barriers to condom use. AIDS and Behavior, 2, 75-85.

Syphilis at Lowest Level Since Reporting Began in 1941

Syphilis rates began to decline in 1991, resulting in the disease being at the lowest level since reporting began in 1941. Although syphilis remains an endemic disease in parts of the South, rates in this region have declined 80% since 1990.

SOURCE: CDC. (1998). Primary and secondary syphilis—United States, 1997. MMWR, 47, 493-497.

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Does Nonoxynol-9 Prevent STDs?

Medical literature on the effect of spermicides containing nonoxynol-9 was reviewed. Results indicated that nonoxynol-9 containing spermicides have an appreciable protective effect against gonorrhea and chlamydia infection. However, insufficient data exist to judge their effect on HIV transmission.

SOURCE: Cooke, R. L., & Rosenberg, M. J. (1998). Do spermicides containing nonoxynol-9 prevent sexually transmitted diseases? A meta-analysis. Sexually Transmitted Diseases, 25, 144-150.