Background Condom use consistency is influenced by factors including participant and partnership characteristics, sex acts and cognitive mediators. We aimed to: (1) assess condom use consistency among urban U.S. STD clinic users; (2) examine condom use patterns for anal and vaginal sex within partnerships; and (3) identify characteristics and cognitive factors associated with condom use consistency.

Methods Patients (n = 1609) enrolled in a behavioural sub study of Safe in the City, a video-based STD/HIV prevention intervention, completed baseline and 3-month surveys measuring prior 3-month behaviours. The study population was restricted to 360 heterosexual males and females who reported both anal and vaginal sex with their most recent partner. Partnerships were classified into five mutually exclusive groups (below) according to reported condom use behaviour. Chi-square and Kruskal-Wallis tests assessed associations between condom use consistency and categorical (e.g., race, partnership type) and continuous (e.g., number of anal and vaginal sex acts, condom use beliefs) variables.

Results Of 360 partnerships, 156(43.3%) reported no condom use; 92(25.6%) used condoms for vaginal but not anal sex; 9(2.5%) used condoms for anal but not vaginal sex; 61(16.9%) used condoms for anal and vaginal sex inconsistently (< 100%); and 42(11.7%) used condoms consistently (100%) for both. Main partnership status was associated with increased inconsistent condom use in anal and vaginal sex. Consistent condom use for anal and vaginal sex was associated with the following cognitive mediators: anticipated partner agreement to future condom use, high condom self-efficacy with that partner, and positive condom-use beliefs.

Conclusions Condoms were not used over 40% of the time, and only a small fraction of partnerships used condoms consistently for both anal and vaginal sex. Results suggest that condom use counselling should consider barriers and facilitators unique to anal and vaginal sex, and that improving cognitive mediators may enhance the success of risk-reduction strategies.