Reports on HIV/AIDS: 1990

OCTOBER 5, 1990, MMWR, Vol 39, No. 39, pp. 685-689
Editorial Note: Because the San Francisco STD clinic emphasizes health education
and distributes condoms free of charge, the participants in this study may have
overstated their use of condoms despite being assured of confidentiality. This study
focused on patients' last episode of sexual intercourse because less recall was
required and because patients who used condoms at that time were less likely to be
diagnosed with an STD on the day of the interview. Nonetheless, the interpretation of
these findings may be limited by recall and reporting bias.
In this study population, overall reported condom use was low. Although infrequent use of condoms can be expected in an STD-patient population, substantial
differences were reported in condom use between whites and minorities. These data
also indicate lower condom use among women who had sex with "steady" partners
than among those with casual partners-a finding consistent with studies among
homosexual male partners (4), female prostitutes (5), and women attending reproductive health clinics (6).
Patient reports of condom use decreasing sexual pleasure are consistent with
other reports among homosexual men and IV-drug users (7,8), although in this study
the association of this variable with not using a condom was statistically significant
only among women. Other factors associated with lower condom use reported in this
study included lack of partner endorsement of condoms and use of alcohol or other
drugs at the time of sexual intercourse, which are consistent with findings in other
population groups (7-9).
Condom breakage generally has been reported in association with anal intercourse
among homosexual men. In the STD-patient population in this report, a large
proportion of heterosexual men and women reported condom breakage during
vaginal intercourse; this finding is consistent with a previous study of heterosexual
men and women attending a genitourinary medicine clinic in London (10). In San
Francisco, however, the breakage rates were higher than those reported by prostitutes in a prospective study in Australia (0.5% breakage during anal intercourse; 0.8%,
vaginal intercourse) (11 ). Factors related to condom breakage may include improper
use, improper storage, or poor manufacture.
Data from this study and another ongoing study of patients' sex partners will be
used by the San Francisco Department of Public Health and collaborating organizations to develop and evaluate interventions to increase condom use.
References
1. CDC. Condoms for prevention of sexually transmitted diseases. MMWR 1988;37:133-7.
2. San Francisco Department of Public Health. Syphilis and congenital syphilis in San
Francisco. San Francisco Epidemiol Bull 1990;6:1-6.
3. Winkelstein WW, Wiley JA, Padian NS, et al. The San Francisco men's health study: continued decline in HIV seroconversion rates among homosexual/bisexual men. Am J Public
Health 1988;78:1472-4.
4. van Griensven GJ, de Vroome EM, Tielman RA, et al. Effect of human immunodeficiency
virus (HIV) antibody knowledge on high-risk sexual behavior with steady and nonsteady
sexual partners among homosexual men. Am J Epidemiol 1989;129:596-603.
5. Hooykaas C, van der Pligt J, van Doornum GJ, van der Linden MM, Coutinho RA.
Heterosexuals at risk for HIV: differences between private and commercial partners in sexual
behaviour and condom use. AIDS 1989;3:525-32.
6. Aral SO, Soskolne V, Magder LS, Bowen GS. Condom use by women seeking family
planning services [Abstract]. Vol 2. VI International Conference on AIDS. San Francisco, June
20-24, 1990:267.

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