Condom failure in South Africa [letter]

It was with great interest that we read the recent editorial by Dr Khumalo in which she expressed concern regarding potential condom failure in Africa. The issue of condom failure is certainly important and we were most alarmed by the lack of prevalence data on condom failure in South Africa. In her literature search Dr Khumalo did not find any research on the prevalence of condom failure in Africa aside from that in pregnant women. We have been conducting HIV/AIDS behavioural surveillance research at a large public health clinic that provides sexually transmitted infection (STI) services in Cape Town and have collected data that can help shed light on this urgent problem. In anonymous behavioural surveys collected from 1729 men and 470 women receiving STI services we have found that 41% of men and 37% of women have experienced condom failure defined as a broken torn or slipped-off condom. In a subsample of 202 patients who reported condom failure 12% had used oil-based condom lubricants thatare known to degrade latex such as hand creams vaseline or oils. In another separate subsample of 214 patients who had experienced condom failure 7% reported having practised dry sex although we do not know if the dry-sex practices were directly associated with condom failure. These rates of 30 - 40% of persons experiencing condom failure are similar to those reported in the US studies cited by Dr Khumalo. Our behavioural surveillance data confirm that condom failure is prevalent in at least some high-risk populations in South Africa and may be of particular concern in the populations at highest risk. The causes of condom failure remain undocumented as we found only a minority of cases potentially attributable to improper use of lubricants or dry-sex practices. As stated by Dr Khumalo there are interventions that reduce condom failure and there are now brief counselling interventions that increase condom uptake and proper use in STI patients tested in South Africa. We must also remember that condoms succeed in preventing pregnancy STI and HIV infection far more often than they fail. We therefore applaud Dr Khumalos call for more research as well as evidence-based guidelines that include skill-building techniques for improving correct and consistent use of condoms. (full-text)