Factors associated with condom breakage among men who have sex with men in three Indian states: findings from a bio-behavioural survey

Condoms have been proven to be effective in prevention of HIV and STIs. Using data from a bio-behavioural survey (2009-10), we examined the extent of condom breakage and factors associated with the breakage among men who have sex with men (MSM) in three Indian states. We analyzed data for 3,812 MSM identified from cruising sites, selected using time location cluster sampling. Of the total MSM who ever used a condom, 16.8% reported condom breakage in the previous month in the three states: 22.2% in Maharashtra, 13.2% in Andhra Pradesh and 28.3% in Tamil Nadu. Results from the multivariate analysis show that MSM were much more likely to report condom breakage if they were above 25 years of age (AOR: 1.31; C.I-1.10, 1.55), consumed alcohol (AOR: 1.40; C.I-1.12, 1.74) and had any STI (either syphilis/NG/CT-AOR:1.54; C.I-1.08, 2.20). No significant association was observed between condom breakage and exposure to HIV prevention intervention and use of oil/water based lubricants. Condom breakage rate is high among this sample of MSM and younger MSM especially need to be provided targeted information about proper use of condoms and to avoid breakage. Data suggest alcohol use may be related to condom breakage and hence prevention interventions need to address alcohol abuse.