Reports on HIV/AIDS: 1990

OCTOBER 5, 1990, MMWR, Vol 39, No. 39, pp. 685-689
Among men, the likelihood of using a condom at last intercourse was lower for
those who reported 1) they had used alcohol or other drugs at last intercourse
(RR= 1.3; 95% Cl= 1.1-1.5); 2) they would not use a condom if they were "in love"
with their partners (RR=1.2; 95% CI=1.1-1.5); 3) they experienced difficulty in
communicating with their partners about condoms (RR= 1.3; 95% CI=1.1-1.5); and
4) their partners did not want to use condoms (RR= 1.4; 95% Cl= 1.1-1.8).
Among women, condom use at last intercourse was lower for those who 1) were
black (RR= 1.3; 95% CI= 1.1-1.6); 2) reported that condoms decrease sexual pleasure
(RR = 1.5; 95% CI= 1.2-1.8); 3) reported that they would not use a condom if they were
"in love" with their partner (RR= 1.3; 95% CI=1.1-1.5); and 4) reported that their
partners were unwilling to use condoms (RR= 1.5; 95% CI=1.1-2.0).
Several variables were not statistically associated with condom use, including
patients' prior STD history, age, income, education, total number of sex partners,
perceived risk for HIV infection, knowledge about HIV transmission and condom
effectiveness, peer endorsement of condoms, and acquaintance with someone with
acquired immunodeficiency syndrome (AIDS); whether patients engaged in vaginal
or anal intercourse; and whether patients exchanged sex for money or drugs.
Based on multivariate analysis controlled for age, race, income, number of sex
partners, and other variables (Table 2), condom use was lowest among men who had
used alcohol or other drugs at their most recent sexual intercourse and men who
stated that their partners did not want to use condoms. Condom use was lowest
among women who reported that their partners did not want to use condoms,
believed condoms reduce sexual pleasure, reported having had sex with a steady
partner, or were black.
Overall, 30 (27%) of 113 men and 41 (31%) of 132 women who had used condoms
during the previous 12 months reported at least one episode of condom breakage.
Rates of condom breakage in the previous 2 months were calculated as the proportion of times condoms broke while being used during vaginal or anal intercourse.
The breakage rates for condoms during vaginal and anal intercourse were 4.3% and
4.2%, respectively. However, condom use was reported for only 24 episodes of anal
intercourse.
Reported by: C Lindan, MD, S Kegeles, PhD, N Hearst, MD, P Grant, D Johnson, Center for AIDS
Prevention Studies, Univ of California, San Francisco; G Bolan, MD, San Francisco Dept of Public
Health; GW Rutherford, /ll, MD, State Epidemiologist, California Dept of Health Svcs. Div of
Sexually Transmitted Diseases and HIV Prevention, Center for Prevention Svcs, CDC.
TABLE 2. Logistic regression analysis of characteristics associated with failure of
patients at a sexually transmitted disease clinic to use condoms - San Francisco,
October-December 1989
Men Women
Characteristic Odds ratio (95% CI*) Odds ratio (95% CI)
Drug/alcohol use at last
sexual encounter 3.6 (1.2-11.1) 1.5 (0.6-3.3)
Lack of partner endorsement 2.9 (1.1-7.7) 2.4 (1.0-5.6)
Belief that condom use
decreases sexual pleasure 1.4 (0.5-4.3) 3.0 (1.3-7.1)
Black race 1.6 (0.6-4.8) 3.7 (1.5-9.1)
Steady sex partner 1.1 (0.3-3.5) 2.6 (1.0-6.9)
*Confidence interval.

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