Comes in all sizes: custom-fitted condoms as a potential sexual health intervention among heterosexual men in Cape Town Open Access

Guillen Jr., Jose Enrique (2015)

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Background: South Africa has one of the highest levels of HIV prevalence in the world, with incidence among key demographics rising. Despite free condom distribution programs, condom utilization may be declining. Issues of condom fit are correlated with breakage, slippage and non-use. Custom-fitted condoms have been shown to reduce condom failure, but no research has been conducted to determine whether heterosexual men in South Africa would be more likely to use condoms if they were custom-fitted.

Objective: To explore issues of condom non-use, and assess overall interest in custom-fitted condoms as a sexual health intervention, among heterosexual men in Cape Town, South Africa

Methods: A survey focusing on condom experiences and opinions was conducted in Cape Town, South Africa (n = 124). Demographics and sexual experiences were analyzed for associations with: condom use at last sex (CUALS), recent condom failures, history of condom failure, perfect use of condoms, preference for brand-name over free condoms, and a higher likelihood of using condoms, were custom-fitted options were available. Further multivariate analyses were conducted to examine the relationships between multiple exposures and selected outcomes.

Results: A high percentage of participants reported CUALS (68%), which was inversely related to relationship level (p < 0.004). Condom errors/failures were also common (58%). Almost a third (31%) reported condom failure within the previous 30 days. Condom dissatisfaction was high, and 24% reported they would be too embarrassed to use free condoms. The majority, 73%, supported more condom sizes.

Uncircumcised men were more likely to report recent condom failures compared to circumcised men (p < 0.004). Men reporting a history of condom failure were more likely to report a higher likelihood of using condoms, if custom-fitted options available (p < 0.007).

Conclusions: Participants reported a high prevalence of condom failure, especially among uncircumcised men, and high dissatisfaction with current condom options. Most participants expressed a desire for additional sizing options, and would be more willing to use condoms, were custom-fitted condoms available. Our data suggests that the introduction of additional condom sizing options could positively affect condom utilization among heterosexual males in South Africa.

Table of Contents

Table of Contents

Chapter I: Introduction. 8

Objectives and Aims. 8

Background. 9

Significance and Implications for Global Health. 12

Chapter II: Literature Review.. 14

HIV/AIDS in South Africa. 14

Condom Use in South Africa. 20

Condom Fit as a Function of their Use. 25

Gaps in literature. 27

Chapter III: Manuscript 29

Abstract 31

Introduction. 32

Background. 33

Methods. 37

Results. 43

Discussion. 66

References. 73

Chapter IV: Recommendations. 76

1. Rebrand Choice condoms. 76

2. Targeted education for high risk groups. 77

3. Realigning sexual health as non-stigmatized, and gender neutral 78

References. 79

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