Journal Article

Factors associated with condom failure in a longitudinal cohort of men who have sex with men and transgender women in Abuja and Lagos, Nigeria

Background
Effective condom use is a critical intervention to limit the spread of HIV and other sexually transmitted infections (STIs), particularly among individuals in high-risk networks who practice anal sex. We characterized condom failures in cisgender men who have sex with men (MSM) and transgender women (TGW) in Nigeria.

Setting
The TRUST/RV368 cohort provided condoms, compatible lubricants, and safer sex education to MSM and TGW 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 (RRs) and 95% confidence intervals (CIs) for pre-specified factors potentially associated with condom failure in the previous month.

Results
From September 2013 to September 2019, 2221 (81.1%) of 2737 participants 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 post-enrollment visits, as well as in participants who reported frequent internet use, two or more casual sexual partners, and 2-4 main sexual partners. Those who cohabited with a woman had reduced risk.

Conclusion
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 or a ceiling for effective condom use, or new uptake of condoms by inexperienced users.