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

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Article (peer-reviewed)

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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.