Correlates of condom failure in a sexually active cohort of men who have sex with men

Condom failure (slippage or breakage) has been shown to be associated with HIV seroconversion among men who have sex with men (MSM), but predictors of failure have been poorly elucidated. Of 2592 HIV-seronegative MSM particip ants in the HIV Network for Prevention Trials (HIVNET) multisite Vaccine Pr eparedness Study who reported condom use for anal sex in the 6 months befor e enrollment, condom failure was reported by 16.6%, with failure rates of 2 .1/100 episodes of condom usage (2.5 failures/100 episodes for receptive an al sex and 1.9/100 episodes for insertive anal sex). In separate multivaria te models evaluating predictors of condom failure reported by the insertive and receptive partners, more frequent condom use was associated with a dec reased per-condom failure rate and amphetamine and heavy alcohol use with i ncreased rates in both models. Being employed, having private medical insur ance, and using lubricants for >80% of anal sex acts were significantly ass ociated with decreased failure rates in the insertive model. Safer sex coun seling should particularly target men of lower socioeconomic status, promot e proper and consistent use of condoms with appropriate lubricants, and add ress the impact of drug use, especially amphetamines and alcohol, on condom failure.