Johns Hopkins University School of Medicine, Baltimore, MD.
U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD.
J Acquir Immune Defic Syndr. 2021 Mar 1;86(3):329-338. doi: 10.1097/QAI.0000000000002559.
BACKGROUND: Effective condom use is a critical intervention to limit the spread of HIV and other sexually transmitted infections, particularly among individuals in high-risk networks who practice anal sex. We characterized condom failures in cisgender men who have sex with men and transgender women in Nigeria. SETTING: The TRUST/RV368 cohort provided condoms, compatible lubricants, and safer sex education to men who have sex with men and transgender women at community-engaged health centers in Abuja and Lagos, Nigeria. METHODS: Participants completed structured interview questions about condom usage and failure every 3-6 months. Robust Poisson regression models with generalized estimating equations were used to estimate relative risks and 95% confidence intervals for prespecified factors potentially associated with condom failure in the previous month. RESULTS: From September 2013 to September 2019, 2221 of 2737 participants (81.1%) reported condom use for anal sex with a male partner in the last month, and 305 (13.7%) reported condom failure during this time. Multivariate analyses demonstrated an increased risk of condom failure at postenrollment visits, as well as in participants who reported frequent Internet use, 2 or more casual sexual partners, and 2-4 main sexual partners. Those who cohabited with a woman had reduced risk. CONCLUSIONS: Condom failure was common in this population despite freely available condoms, compatible lubrication, and education. Increased risk of condom failure over time could reflect message fatigue a ceiling for effective condom use, or new uptake of condoms by inexperienced users.
背景:有效的 condom 使用是限制 HIV 和其他性传播感染传播的关键干预措施,特别是在进行肛交的高风险网络中的男男性行为者和跨性别女性中。我们描述了尼日利亚的男男性行为者和跨性别女性中 condom 失败的情况。 地点:TRUST/RV368 队列在阿布贾和拉各斯的社区参与式健康中心向男男性行为者和跨性别女性提供 condom、兼容润滑剂和安全性行为教育。 方法:参与者每 3-6 个月完成关于 condom 使用和失败的结构化访谈问题。使用广义估计方程的稳健泊松回归模型来估计与上个月 condom 失败相关的潜在因素的相对风险和 95%置信区间。 结果:从 2013 年 9 月到 2019 年 9 月,在 2737 名参与者中,有 2221 名(81.1%)报告在上个月与男性伴侣进行肛交时使用了 condom,有 305 名(13.7%)报告在这段时间内 condom 失败。多变量分析表明,在随访期间和报告经常使用互联网、有 2 个或更多偶然性伴侣以及 2-4 个主要性伴侣的参与者中, condom 失败的风险增加。与女性同居的参与者风险降低。 结论:尽管有免费的 condom、兼容的润滑剂和教育,但在这个人群中 condom 失败仍然很常见。随着时间的推移, condom 失败的风险增加可能反映了信息疲劳、有效 condom 使用的上限,或者新的缺乏经验的使用者开始使用 condom。
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