One Size Does Not Fit All: Exploring the Condom Use Experiences and Attitudes of Heterosexual Men in Cape Town, South Africa

Purpose                      

Despite widespread availability of free condoms, South Africa continues to experience extremely high HIV prevalence (17.1%) and incidence (4.4% per 100 person-years). However, issues with condom fit result in usage problems, and reduced acceptability. This study explored heterosexual men’s experiences with condoms, as well as their interest in fitted-condoms.

Methodology

Using convenience sampling at city health clinics and truck stops, 133 heterosexual men completed a self-administered survey of condom experiences and attitudes. Data were analyzed for descriptive purposes, and Chi-square tests were used to explore possible correlations for interest in fitted-condoms.

Results

            Respondents came from a variety of racial, religious, and economic backgrounds.

Overall, 67% of participants reported at least one problem with condom fit or function: condom length (22%); width (31%); 53% reported breakage; and 41% reported slippage; 32% reported non-condom use at last sex.

The majority (77%) would prefer condoms to come in more sizes. This preference was sustained regardless of education level (Pearson X²  2.09, p  < .554), race (p < 0.19), religion (p < 0.70), or income (p < 0.07). Moreover, 72% reported they would be more likely to use condoms if they were custom-fitted.

Conclusions

            The results suggest that South African men experience significant problems with condoms, and that demand for novel condom sizes is universally high. Increasing availability of custom-fitted condoms may lead to increased use among heterosexual men, thus potentially reducing the sexual transmission of HIV.