Estimating the prevalence and predictors of incorrect condom use among sexually active adults in Kenya: results from a nationally representative survey.

With nearly 1.2 million persons living with HIV and 106,000 new infections, Kenya has one of the highest burdens of HIV infection in the world.1 The most recent Kenya National AIDS Strategic Plan calls for providing coordinated, comprehensive high-quality combination prevention options aimed at controlling the epidemic.2 In recent years, Kenya has expanded prevention efforts which now include increased HIV testing and counseling options, widely available voluntary medical male circumcision, and broader use of antiretroviral treatment to achieve viral suppression and thereby reduce HIV transmission. Also, although prevention strategies have expanded over the past 3 decades of HIV prevention programming, promotion of condom use continues to be a fundamental strategy to reduce the risk of acquiring and transmitting HIV and other sexually transmitted infections (STIs).3 Central to an argument that a condom should be used consistently presumes that it should be used correctly throughout the duration of sex. Any breach of use presents an opportunity for HIV transmission. As such, gathering data on the types and prevalence of incorrect condom use is necessary to determine the need for targeted interventions to improve the effectiveness of condom use. A recent systematic review of 50 published articles of condom use errors found a wide range but generally high percentage of condom users reporting incorrect condom use.4 Common errors and problems included not using condoms throughout intercourse (late application, early removal) and condom breakage, slippage, and leakage.4 Although obtaining precise estimates can be challenging due to different recall periods, framing of questions, and populations studied, the literature indicates that the proportion of individuals who experienced incomplete condom use ranged from 13.6% to 51.1%.5–12 Condom breakage estimates ranged from 0.8% to 40.7%5,6,8–11,13–18 and condom slippage during sex between 13.1% and 19.3%.8–10 Reported condom leakage estimates are 7.6% and 12.5% for men and women, respectively.8,9 It is important to note that the range of estimates reflect varying recall periods, and many of these studies were targeted toward specific groups such as STI clinic attendees, university students, and other high-risk populations. In addition, nearly all were conducted in North America and other areas with concentrated HIV epidemics. None were from Africa. In this present study, we used data from a nationally representative population-based study in Kenya in 2012 to estimate the prevalence and independent predictors of incorrect condom use, and the frequency of selected types of condom errors among sexually active adults and adolescents.