Sex Transm Infect doi:10.1136/sextrans-2014-051581
  • Behaviour
  • Original article

How often do condoms fail? A cross-sectional study exploring incomplete use of condoms, condom failures and other condom problems among black and white MSM in southern USA

  1. Eli S Rosenberg1
  1. 1Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  2. 2Department of Health Behavior, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
  1. Correspondence to Dr Alfonso C Hernández-Romieu, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Room 444 GCR, Atlanta, Georgia 30322, USA; alfonso.claudio.hernandez{at}
  • Received 3 March 2014
  • Revised 30 June 2014
  • Accepted 5 July 2014
  • Published Online First 30 July 2014


Objectives To compare the occurrence of risk-inducing condom events (condom failures and incomplete use) and the frequency of their antecedents (condom errors, fit/feel problems and erection problems) between black and white men who have sex with men (MSM), and determine the associations between risk-inducing condom events and their antecedents.

Methods We studied cross-sectional data of 475 MSM who indicated using a condom as an insertive partner in the previous 6 months enrolled in a cohort study in Atlanta, Georgia, USA.

Results Nearly 40% of black MSM reported breakage or incomplete use, and they were more likely to report breakage, early removal and delayed application of a condom than white MSM. Only 31% and 54% of MSM reported correct condom use and suboptimal fit/feel of a condom, respectively. The use of oil-based lubricants and suboptimal fit/feel were associated with higher odds of reporting breakage (p=0.009). Suboptimal fit/feel was also associated with higher odds of incomplete use of condoms (p<0.0001).

Conclusions Incomplete use of condoms and condom failures were especially common among black MSM. Our findings indicate that condoms likely offered them less protection against HIV/sexually transmitted infection when compared with white MSM. More interventions are needed, particularly addressing the use of oil-based lubricants and suboptimal fit/feel of condoms.