Failure to Use and Sustain Male Condom Usage: Lessons Learned from a Prospective Study among Men Attending STI Clinic in Pune, India

Abstract

BackgroundSustained or consistent use of condoms by men remains a challenge. A study was carried out to identify factors associated with failure to use condoms consistently by men attending STD clinics in Pune, India.MethodAmong 14137 STI clinic attendees, 8360 HIV sero-negative men were enrolled in a cohort study. The changes in condom usage behavior were studied among 1284 men who returned for first scheduled quarterly follow up, 309 reported consistent condom use at the time of enrollment in the cohort. Data pertaining to heterosexual men practicing high risk behavior were analyzed to identify factors associated with change in condom use behavior using logistic regression model. Demographic, behavioral and biological factors observed to be associated with condom use were fitted in five Cox proportional hazards models to calculate hazard ratios and their 95% confidence intervals to identify independent predictors of failure to sustain condom use behavior.ResultsThe univariate analysis showed that men who were 30 years or older in age (p = 0.002) and those who did not have contact female sex worker (FSW) were more likely to fail to sustain consistent condom use. However both these factors did not show significant association in multivariable analysis. Marital status and contact with Hijra (eunuch) in lifetime were associated with failure to change in their condom use behavior [AOR 0.33 (CI 0.13–0.82; p = 0.017)]. During the follow up of 2 years, 61 events (15.5 per 100 person years, 95% CI 12.3–19.5 years) of ‘failure of condom use’ were recorded despite counseling. Older age, contact with non CSW partner and presence of genital ulcer disease / discharge syndrome were significant predictors of failure to sustain condom use.DiscussionMarried monogamous older men, who report contact with sex worker and present with genital ulcer disease are at risk of failure to use condom after first exposure to voluntary HIV counseling and testing. This is a scenario of primary prevention program. Condom promotion and counseling needs to be reinforced through follow up counseling among this population.

Sexually transmitted infections in male heterosexual Dutch clients who visited German cross-border female sex workers; a 3 year retrospective study

“…There is a well-known relationship between condom use and reducing the risk of getting an STI [20,21]. Though national data is difficult to generalise, due to very different national legislative, administrative and cultural contexts, there are studies that also report on the relationship between decreasing condom use by FSWs and an increasing STI positivity among FSWs [22][23][24][25]. An Italian study assessing condom use among clients of FSW showed that cumulatively, 87 and 85% of vaginal and anal intercourses were respectively reported as regularly protected by condom [26].…”

Etiology of Genital Ulcerative Disease in Conjunction with HIV Infection among Patients Attending the STD Clinic at a Tertiary Care Hospital

“…Being married and monogamous was another factor of failure to sustain consistent condom use behavior among these men who were attending STI clinics in India. A large study in Britain also reported that 80% of sexually active, never married respondents used condoms "to protect against HIV and other STI" in contrast to 1.8% of married respondents (Sahay et al, 2015). Use of condom with regular and non regular partners was 19.5% and 42.1%, respectively.…”

“…Condoms are also often regarded as irrelevant in long-term relationships due to lack of perception of risk among monogamous married men who prefer not to use condoms consistently with their regular partners. Heterosexual transmission is the major mode of HIV transmission in India with most married women living with HIV having acquired it from their spouses (Sahay et al, 2015).…”

Increasing Awareness and Knowledge among Adult Latinos regarding Sexually Transmitted Infections

“…Providing a culturally appropriate education bundle may increase awareness and knowledge of STIs and thus, decrease the vulnerability of this population (Sahay et al, 2015;Trans et al, 2013). Therefore, the purpose of this quality improvement (QI) project is to implement an educational bundle and evaluate its effectiveness in increasing STI knowledge and consistent condom use among adult Latinos seen in an outpatient clinic.…”