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Open Access Research article

Towards condom skills: a cross-sectional study of the association between condom proficiency, condom problems and STI risk amongst MSM

Lisa Goodall1*, Daniel Clutterbuck1 and Paul Flowers2

Author affiliations

1 Chalmers Centre, 2A Chalmers Street, Edinburgh EH3 9ES, UK

2 School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK

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Citation and License

BMC Public Health 2012, 12:747  doi:10.1186/1471-2458-12-747

Published: 6 September 2012

Abstract

Background

Condom use problems are common amongst Scotland’s men who have sex with men (MSM). To date condom errors have been associated with the likelihood of sexually transmitted infections in heterosexual sexually transmitted infection (STI) clinic attendees but not in MSM and direct evidence of a link between condom problems and STI acquisition in MSM have been lacking. This study investigated the possibility of an independent association between condom proficiency, condom problems and STI acquisition in MSM in Scotland.

Methods

An exploratory observational design employed cross-sectional surveys in both STI clinic and community settings. Respondents completed self-report measures of socio-demographic variables, scales of condom proficiency and condom problems and numbers of different partners with whom men have had unprotected anal intercourse (UAI partners) in the preceding year. Self-report data was corroborated with clinical STI diagnosis where possible. Analysis included chi-squared and Mann–Whitney tests and multiple logistic regression.

Results

792 respondents provided data with an overall response rate of 70% (n = 459 clinic sample, n = 333 community sample). Number of UAI partners was the strongest predictor of self-reported STI acquisition over the previous 12 months (p < 0.001 in both clinic and community samples). Demographic characteristics were not associated with self-reported STI diagnosis. However, condom proficiency score was associated with self-reported STI acquisition (p < 0.05 in both samples). Condom problem score was also associated with self-reported STI diagnosis in the clinic (p = 0.001) but not the community sample. Condom problem score remained associated with self-reported STI diagnosis in the clinic sample after adjusting for number of UAI partners with logistic regression.

Conclusions

This exploratory study highlights the potential importance of targeted condom use skills interventions amongst MSM. It demands further research examining the utility of condom problem measures in wider populations, across prospective and experimental research designs, and a programme of research exploring their feasibility as a tool determining candidacy for brief interventions.

Keywords:
Condom skills; Men who have sex with men; Sexually transmitted infections; Condom problems; Condom proficiency; Condom measures