                        AIDS NEWS SERVICE
                   Michael Howe, MSLS, Editor
                     AIDS Information Center
                VA Medical Center, San Francisco
                     (415) 221-4810 ext 3305
                         January 6, 1995

              Safer Sex: Information for Counselors
                            (Part XV)

                      Condom Failure Rates
           (Arranged Chronologically - Reverse Order)

1
AU  - Park JS ; Kim CK
TI  - The effective prevention of HIV by female condom (Femidom).
AB  - As part of a widely implemented prevention strategy, condom
use exemplifies the empowerment of individuals and interaction
between people who want to protect themselves and others against
HIV infection. The serious consequences of condom failure has
placed added emphasis on condom quality. Correct condom use can be
learned and practiced with the result being more condom use with
less breakage. The newest female barrier, Female Condom (Femidom)
could protect against HIV transmission. Female Condom is a
lubricated polyurethane bags with a soft ring. As sexually
transmitted diseases are a high risk factors in HIV transmission,
then the use of Female Condom has an obvious indirect value in HIV
control. Comparative studies have been initiated whether female
condom will be as good as better than male condom in directly
ffecting HIV transmission. Female Condom is a choice for HIV
prevention as well as a useful method of contraception.
SO  - Int Conf AIDS. 1994 Aug 7-12;10(2):288 (abstract no. PC0531).

2
AU  - Thompson JL ; Yager TJ ; Martin JL
TI  - Estimated condom failure and frequency of condom use among
gay men.
AB  - OBJECTIVES. Condoms are designed to bar transmission of the
human immunodeficiency virus (HIV), but they sometimes fail. This
paper explores the effect of experience with condoms on condom
failure among gay men. METHODS. Risk of condom failure (breakage or
slippage) on a single occasion is estimated for four sexual acts
reported over 12 months by a sample of gay New York City men (n =
741). The estimation procedure assumes that each episode in which
a condom is used is an independent event. Evidence is offered to
support this assumption. RESULTS. Risk of condom failure in a
single episode was fairly high, particularly in anal intercourse,
for men who had engaged in each act only a few times in the
previous year. It declined rapidly with experience (e.g., to below
1% for receptive anal intercourse after about 10 episodes in the
previous year). Condoms failed less often in oral than anal sex,
but estimated risk of failure also decreased with experience.
CONCLUSIONS. Gay men should be especially cautious the first few
times they use a condom; after moderate experience, however, they
may expect a low risk of condom failure. 
SO  - Am J Public Health. 1993 Oct;83(10):1409-13.

3
AU  - Joffe A
TI  - Adolescents and condom use.
AB  - Increasing condom use among adolescents is an essential
component of a  public health strategy aimed at decreasing rates of
sexually transmitted infections and the spread of human
immunodeficiency virus infection. This article reviews current data
about the contraceptive and prophylactic characteristics of
condoms. Data about current levels of use among adolescents and
factors demonstrated to affect such use are also summarized. Except
where data are scanty or nonexistent, the research studies are
limited to those focusing primarily on adolescents and,
occasionally, college students. Based on these data, suggestions
for increasing condom use among adolescents are presented. 
SO  - Am J Dis Child. 1993 Jul;147(7):746-54.

4
AU  - Weller SC
TI  - A meta-analysis of condom effectiveness in reducing sexually
transmitted HIV [see comments]
AB  - Before condoms can be considered as a prophylaxis for
sexually transmitted human immunodeficiency virus (HIV), their
efficacy must be considered. This paper reviews evidence on condom
effectiveness in reducing the risk of heterosexually transmitted
human HIV. A meta-analysis conducted on data from in vivo studies
of HIV discordant sexual partners is used to estimate the
protective effect of condoms. Although contraceptive research
indicates that condoms are 87% effective in preventing pregnancy,
results of HIV transmission studies indicate that condoms may
reduce risk of HIV infection by approximately 69%. Thus, efficacy
may be much lower than commonly assumed, although results should be
viewed tentatively due to design limitations in the original
studies. 
SO  - Soc Sci Med. 1993 Jun;36(12):1635-44.

5
AU  - de Wit JB ; Sandfort TG ; de Vroome EM ; van Griensven GJ ;
Kok GJ
TI  - The effectiveness of condom use among homosexual men [letter]
SO  - AIDS. 1993 May;7(5):751-2.

6
AU  - Richters J ; Donovan B ; Gerofi J
TI  - How often do condoms break or slip off in use?
AB  - Men attending 3 sexually transmissible disease clinics and a
university health service in Sydney were given a questionnaire
asking how many condoms they had used in the past year and how many
broke during application or use or slipped off. Respondents were
544 men aged 18 to 54 years. Of these, 402 men reported using
13,691 condoms for vaginal or anal intercourse; 7.3% reportedly
broke during application or use and 4.4% slipped off. Men having
sex with men reported slightly higher slippage rates than those
having sex with women. Breakage and slippage were unevenly
distributed among the sample: a few men experienced very high
failure rates. A volunteer subsample reported 3 months later on
condoms supplied to them: 36 men used 529 condoms, of which 2.8%
broke during application or use and 3.4% slipped off. Many of these
failures pose no risk to the user, especially those occurring
during application, as long as they are noticed at the time, but
failure may discourage future use. Research is needed to identify
user behaviours related to breakage.
SO  - Int J STD AIDS. 1993 Mar-Apr;4(2):90-4.

7
TI  - HIV infection in European female sex workers: epidemiological
link with use of petroleum-based lubricants. European Working Group
on HIV Infection in Female Prostitutes.
AB  - OBJECTIVES: To assess the prevalence of and risk factors
associated with HIV infection in European female sex workers,
particularly sexual risk factors. DESIGN: Multicentre
cross-sectional study performed in nine European countries.
METHODS: Female sex workers voluntarily enrolled between September
1990 and November 1991. Face-to-face interviews were conducted in
various settings (health care, prostitute organizations, outreach)
to collect information on over 150 behavioural, health and   
sociodemographic variables. Enrollment of intravenous drug users
(IVDU) was limited to a maximum of 25% of the total sample. The
HIV-1 and HIV-2 antibody status of blood or saliva samples was
tested using enzyme-linked immunosorbent assay and confirmed by
Western blot. RESULTS: Eight hundred and sixty-six (91.6%) of the
945 interviewees provided blood (n = 824) or saliva (n = 42)
samples. HIV seroprevalence was 5.3% [44 HIV-1-positives and two
HIV-2-positives (from Lisbon)] overall, 31.8% (35 out of 110) in
IVDU and 1.5% (11 out of 756) in non-IVDU [odds ratio (OR), 31.6;
P < 0.001]. Lack of condom use (P = 0.002, test for trend) and
previous ulcerative sexually transmitted disease (OR, 3.6; P =
0.06) were associated (on logistic regression) with HIV infection
in both IVDU and non-IVDU. Previous hepatitis B (OR, 13.8; P =
0.02) and needle-sharing (OR, 4.1; P = 0.04) were associated with
HIV infection in IVDU, and low education level (P = 0.02, test for
trend), previous transfusion (OR, 9.1; P = 0.003), origin from
sub-Saharan Africa (OR, 5.4; P = 0.05) and use of petroleum-based
lubricants (OR, 15.2; P = 0.001) in non-IVDU. CONCLUSIONS: HIV
prevalence remains relatively low among non-IVDU prostitutes in
Europe. While intravenous drug use remains the most important risk
factor for HIV, petroleum-based lubricants (used by 10% of women in
this study) may be a risk factor for HIV among European female sex
workers; over 80% of those interviewed always used condoms with
clients.
SO  - AIDS. 1993 Mar;7(3):401-8.

8
AU  - de Graaf R ; Vanwesenbeeck I ; van Zessen G ; Straver CJ ;
Visser JH
TI  - The effectiveness of condom use in heterosexual prostitution
in The Netherlands.
AB  - OBJECTIVES: To assess the extent to which condoms are used
effectively in commercial heterosexual intercourse. Data on the
number of condoms that had broken or slipped off, the sexual
technique during which this had occurred and the perceived cause of
failure were collected. The use of non-water-soluble lubricants and
non-fortified condoms during anal intercourse, and the demand for
a greater variety of condom sizes were also examined. SUBJECTS AND
METHODS: One hundred and twenty-seven female prostitutes and 91
male clients from different parts of The Netherlands were
interviewed face-to-face between July 1990 and March 1991. RESULTS:
Of those who used condoms during vaginal intercourse, 49% of the
prostitutes had experienced condom breakage in the previous 6
months, and 16% of the clients in the previous 12 months. The
breakage rate was 0.8% for prostitutes and 1.5% for clients. Condom
quality was seldom reported as the cause; breakage was generally
attributed to human factors, such as rough or prolonged
intercourse, incorrect handling of the condom or the use of
insufficient lubricant. Prostitutes also identified penis size as
a cause. Condoms slipping off before or after ejaculation was
reported less frequently than breakage. Thirteen per cent of
clients and 36% of prostitutes expressed a need for either smaller
or larger condoms. Of the prostitutes, 9% used oil or vaseline as
a lubricant. CONCLUSIONS: In view of the low rate of condom failure 
in heterosexual prostitution in The Netherlands, the potential
spread of HIV by this means is small. The use of a greater variety
of condom sizes may further reduce the failure rate. Few
prostitutes remain ignorant about the adverse effects of oil-based
lubricants on condoms.
SO  - AIDS. 1993 Feb;7(2):265-9.

9
AU  - Boldsen JL ; Jeune B ; Madsen PC
TI  - Aspects of comfort and safety of condom. A study of two
thousand intercourses among volunteer couples.
AB  - In nearly 2,000 intercourses 14 different types of condoms
were tested by 80 heterosexual and seven homosexual volunteer
couples. The test couples were generally quite experienced in the
use of condoms. It appears that the condoms rarely (1.3%) ruptured
or slipped off during the actual intercourse. This means that
emphasis must be put on consistency and skill in the use of condoms
rather on technical improvements in the promotion of condoms as a
means of preventing the spread of sexually transmitted infections
like HIV. Lubricated condoms and condoms that were not too small
were preferred by both users and their partners. Other condom
properties were significant but of minor concern for the
participants of the study.
SO  - Scand J Soc Med. 1992 Dec;20(4):247-52.


10
AU  - Carey RF ; Herman WA ; Retta SM ; Rinaldi JE ; Herman BA ;
Athey TW 
TI  - Effectiveness of latex condoms as a barrier to human
immunodeficiency virus-sized particles under conditions of
simulated use [see comments]
AB  - Condoms were tested in an in vitro system simulating key
physical conditions that can influence viral particle leakage
through condoms during actual coitus. The system quantitatively
addresses pressure, pH, temperature, surfactant properties, and
anatomical geometry. A suspension of fluorescence-labeled, 110-nm
polystyrene microspheres models free human immunodeficiency virus
(HIV) in semen, and condom leakage is detected spectrofluoro-
metrically. Leakage of HIV-sized particles through latex condoms
was detectable (P less than 0.03) for as many as 29 of the 89
condoms tested. Worst-case condom barrier effectiveness (fluid
transfer prevention), however, is shown to be at least 10(4) times
better than not using a condom at all, suggesting that condom use
substantially reduces but does not eliminate the risk of HIV
transmission. 
SO  - Sex Transm Dis. 1992 Jul-Aug;19(4):230-4.

11
AU  - de Wit J ; de Vroome E ; van Griensven G ; Sandfort T
TI  - Failure rate of condoms among gay men.
AB  - OBJECTIVES: The purpose of this study is to assess the
failure rate of condoms used during anogenital contact among gay 
men, specified for type of condom and type of lubricant.
Characteristics of men who experienced condom failure are also
investigated. METHODS: Respondents were 671 gay men participating
in the Amsterdam Cohort Study. In datawave 10 (October 1990-May
1991), questions were asked about condom use in the previous six
months. Attitudes and social norms with respect to condom use were
also assessed. RESULTS: Anogenital sex was practiced by 277
participants of whom 242 men had used condoms. Valid data on condom
use were obtained from 239 men. In sum, the use of 2447 condoms was
reported, of which 51 tore and 40 slipped off. The observed failure
rate was 3.7%. Vaginal condoms failed more often than anal condoms
(4.6% vs 3.1%). With water-based lubricants, the failure rate was
lower than with oil-based lubricants (1.7% vs 10.3%). When no
lubricant was used the failure rate was 6.1%. Vaginal condoms were
at least once used by 41 participants (17.1%). Oil-based lubricants
were used at least once by 26 participants (10.8%) and 59 men
(24.7%) did not use lubricants or used saliva. Condom failure was
experienced by 47 users (19.7%). Bivariate logistic regression
analysis showed that men who experienced condom failure had a less
positive attitude (O.R. = 1.67, 95% C.I. = 1.05-2.59) and social
norms towards condom use (O.R. = 1.65, 95% C.I. = 1.05-2.34).
CONCLUSIONS: Vaginal condoms, which were found to have a higher
failure rate than anal condoms, were utilized by a substantial
portion of condom users. In addition, often no or oil-based
lubricants were used, practices that also increase condom failure. 
Data suggest that adequate use of lubricants might even be a more
important factor in preventing condom failure than type of condoms
used. Although the results indicate that improving the use of
condoms among gay men is important, it was also noted that condom
failure in this cohort decreased from 8% in 1986 to 4% in 1991. 
SO   Int Conf AIDS. 1992 Jul 19-24;8(2):D416 (abstract no. PoD
5178).

12
AU  - Russell-Brown P ; Piedrahita C ; Foldesy R ; Steiner M ;
Townsend J
TI  - Comparison of condom breakage during human use with
performance in laboratory testing.
AB  - This paper combines results from a study of the determinants
of condom quality and use conducted by The Population Council in
two countries in the Caribbean with results from a condom breakage
study conducted by Family Health International (FHI) in the United
States. The studies, conducted two years apart, compared the
breakage rates of condoms from the same lot during human use to
their performance in laboratory test results. Breakage rates of
12.9% for Barbados, 10.1% for St. Lucia and 6.7% for the United
States compared to passing ASTM laboratory tests suggest that
existing laboratory tests as used with the current pass/fail
standards are either not sufficiently sensitive or not well-defined
to reliably predict condom performance during human use. The study
also suggests that user behaviors and practices may be a factor in
condom breakage. If the condom is to be an effective method against
unplanned pregnancy and STD/HIV infection, and if consumer
confidence is to be retained, condom breakage during sexual
intercourse must be reduced. 
SO  - Contraception. 1992 May;45(5):429-37.

13
AU  - Gerofi J ; Shelley G ; Donovan B
TI  - A study of the relationship between tensile testing of
condoms and breakage in use.
AB  - The ability of the condom wall to maintain its integrity
throughout sexual intercourse is critical to its role in halting
the spread of major sexually transmissible pathogens including the
human immunodeficiency virus. There are three principal in vitro
performance tests applied to condoms: a test for freedom from
holes, an inflation test, and tensile testing. In this study we
subjected condoms that had broken in use to tensile tests in order
to determine any correlation between their in vivo and in vitro
performance. Condoms which had broken in use showed similar tensile
properties to those which had not. All passed all tensile test
criteria. Thus, the inclusion of tensile testing in National
Standards for condoms is not sufficient to insure strong products.
SO  - Contraception. 1991 Feb;43(2):177-85. 

14
AU  - Albert AE ; Hatcher RA ; Graves W
TI  - Condom use and breakage among women in a municipal hospital
family planning clinic.
AB  - For those who choose to be sexually active, condoms are the
best available means of protection against sexually transmitted
diseases including the human immunodeficiency virus (HIV), which
causes acquired immunodeficiency syndrome (AIDS). Condoms are also
an effective method for preventing pregnancy. Unfortunately,
condoms are not 100% effective at preventing pregnancy or the
spread of infection, in part because condoms do break. In order to
gain insight into condom breakage, a questionnaire was administered
to women attending a municipal hospital family planning clinic.
Thirty-six percent of the 106 subjects had experienced at least one
condom breakage. Condom breakage occurred in approximately 1 out of
100 acts of intercourse using condoms, with a lifetime breakage
rate of 10 per 1000 condom uses and a past year breakage rate of 8
per 1000 condom uses. Breakage rates did not differ substantially
by age. Five percent of the women's unplanned pregnancies were
attributed to broken condoms. The results of this study corroborate
previously reported rates. Factors associated with these women's
most recent breakage experiences included: vaginal intercourse,
minimal foreplay, and breakage prior to ejaculation. Controlled 
studies will be needed to determine how the condom can be used to
reduce the likelihood of breakage.
SO  - Contraception. 1991 Feb;43(2):167-76.

15
AU  - Fisher M
TI  - Burst sheaths [letter]
SO  - Br J Gen Pract. 1990 Dec;40(341):520.

16
AU  - Thomas RM ; Plant MA ; Plant ML ; Sales J
TI  - Risk of HIV infection among clients of the sex industry in
Scotland.
SO  - BMJ. 1990 Sep 15;301(6751):525.

17
AU  - Silvestre AJ ; Lyter DW ; Valdiserri RO ; Huggins J ; Rinaldo
CR Jr
TI  - Factors related to seroconversion among homo- and bisexual
men after attending a risk-reduction educational session.
AB  - Thirteen homosexual men, volunteers in a study of the natural
history of HIV, who seroconverted to HIV after participating in an
educational program on HIV prevention, were interviewed about the
circumstances leading to their seroconversion. Six men had
participated in unprotected anal intercourse with at least one
partner whom they believed was HIV-negative. Four men attributed
their conversion to mental health problems or to drug and alcohol
use. Two men's seroconversions could not be ascertained and one man
attributed seroconversion to a condom break. Most men who had
learned how to avoid infection, and had successfully done so for a
time, had knowingly engaged in unsafe behaviors because of strong
emotional responses to certain partners or because of mental health
or drug and alcohol-related problems. Skills training for dealing
with partners who pressure men to behave unsafely is needed, as is
mental health and drug and alcohol counseling for men at risk for
HIV infection. 
SO  - AIDS. 1989 Oct;3(10):647-50.18
AU  - Torres J ; Anabitarte H ; Usieto R ; Noguera E
TI  - Detection of occlusion vs leak in condom rheological test.
AB  - OBJECTIVE: The condom is recommended and used as an efficient
barrier against HIV and others. In practice, the film of a condom
may present irregularities or leaks. This has been resolved
efficiently with rigorous sampling plans for leak-detection tests,
realized in all standards by conductometric or electronical test
(ET). But, as the test is made on a condom in repose and without
mechanical tension, eventually existing micro-occlusions or
micro-chaps would not be detected as leak. Given that a condom in
use in sexual relations is submitted to forces and mecan.
deformations, there could appear leaks, invisible in condom without
tension, and the protection is then lost. To evaluate this loss of
protection vs HIV due to appearance of leaks while using
stretching) condom, it is proposed to test with Rheological Test
(Pat.Met.). METHODS: We tested with usual test ET and Rheological
Test 2 homogeneous lots of 2 different manufacturers, considering
the presence of leak at the indication of 50mV(ISO 4074, UNE 53625)
and 50mV (Rheological Test RQTS 88.E1.PM1.) RESULTS: With standard
method ET (condom in repose) there was no leak found. The
Rheological Test detected 1 and 14 leaks in the two manufacturers
respectively. CONCLUSION: 1) Condoms can present micro-occlusions
or micro-chaps which will be transformed into leaks and holes and
they will lose their protection effect against HIV when submitting
them in use to forces and deformation. 2) The leak detection tests
for condoms with the Rheological Test permit to reject non-safe
condoms with micro-occlusions or micro-chaps which would not be
detected by usual tests (ET).
SO  - Int Conf AIDS. 1989 Jun 4-9;5:168 (abstract no. A.544).

19
AU  - Golombok S ; Sketchley J ; Rust J
TI  - Condom failure among homosexual men.
AB  - Following a postal questionnaire survey of 262 homosexual men
carried out to investigate condom use during sexual activity, a
sample of 97 men who used condoms during anogenital sex was
identified. Thirty-one percent of those who had used a condom
during anal intercourse reported at least one incident of condom
breakage. When looked at in terms of frequency of individual condom
use, it was found that 1 in 27 condoms break during this activity.
Examination of the reasons for breakage and a review of the
literature indicated that physical stress on the condom is likely
be a major factor in these incidents.
SO  - J Acquir Immune Defic Syndr. 1989;2(4):404-9.




