The Bay Area Reporter - July 2, 1999
Mike Salinas

Scientists with the San Francisco Department of Public Health (DPH) recently completed a lengthy research project evaluating condom failure, hoping to find ways to reduce its frequency by better understanding its causes. After studying the habits and practices of 2,500 men who had anal sex with other men in six American cities, researchers found that gay men are better at handling rubbers than they were in the 1980s, but the problem of condom failure is far from over.

According the senior author of the study, Dr. Susan Buchbinder, "over 16 percent [of respondents] reported they'd had at least one condom break or slip off in the six months before entering the study. That came out to an average of just over two failures for every 100 condoms used."

The good news, Buchbinder said, is that researchers identified three main factors that led most frequently to condom failure. Their report, published in the April 15 issue of the Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, found that the biggest risks come from inexperience, alcohol and drug use (especially methamphetamine use); and non-water based lubricants.

Joe Wright, a health educator for the HIV Research Section of the DPH, suggested to the Bay Area Reporter that men who do not yet have good condom techniques should practice û alone or with others û to lessen the risk that comes with unfamiliarity. "Masturbating with condoms is good," he said.

Also, as Buchbinder pointed out, "Men who used methamphetamines or alcohol [are statistically] more likely to have condom failures." Both speed and alcohol tend to delay orgasm, leading to longer sessions of sexual activity and increased strain on the condom; they also may cause men to lose their erections, leading to situations where the condom slips off altogether.

Finally, Buchbinder said, "Men who consistently use water-based lubricants had fewer problems." Oil-based lubricants like Vaseline and Crisco cause latex to break down and completely dissolve in less than a minute. In contrast, water-based lubricants like KY and Wet actually help preserve the integrity of condoms by decreasing friction.

Emergency evacuation

Wright acknowledged to the B.A.R. that scientists still don't have an answer for couples who have found, too late, that a condom didn't protect them from each other's body fluids.

In those situations, Wright suggests the top, or the insertive partner, "follow the classic advice for reducing risk, not just of contracting HIV, but all sexually transmitted diseases: urinate afterwards and wash off.

"If you haven't ejaculated, you might want to do that."

For the other partner, who might have seminal fluid in his body, Wright suggests having a bowel movement, if possible û but not if it leads to muscle strain.

"It might help, but probably not if you have hemorrhoids," he said. "And all the experts I've spoken with say you don't want to douche. You don't want to do anything to irritate the mucosal membranes of your anus."

He also suggested that anyone who is extremely concerned about potential HIV transmission could seek advice from the Post-Exposure Prophylaxis (PEP) program at San Francisco General Hospital. The program offers people who are at risk for very recent infection the option of taking antiretroviral therapy for six months as a potential guard against HIV establishing itself.

"And of course," Wright said, "this shows the need for microbicidal lubricants." Those compounds, containing anti-HIV chemicals as a supplementary barrier to transmission, are currently undergoing preliminary testing, but only for heterosexual vaginal sex. Prospects are uncertain for research in a population that is more likely to practice anal sex. But with 2 percent of condoms failing in gay sex situations, the tests can't come too soon.
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