Spotlight Center on HIV Prevention Today


CDC Analysis Puts Numbers on Condom Effectiveness for Gay Men

December 22, 2014

Consistent condom use during anal sex prevents 70% of HIV infections among men who have sex with men (MSM) in the U.S., according to an analysis by Centers for Disease Control and Prevention (CDC) researchers that was published ahead of print on Dec. 2 in the Journal of Acquired Immune Deficiency Syndromes.

In "Condom Effectiveness for HIV Prevention by Consistency of Use among Men Who Have Sex with Men (MSM) in the U.S.," data from two large studies were examined to determine the effectiveness of condoms in reducing HIV transmission among MSM who reported "always" using condoms during anal sex, compared with those who reported "sometimes" or "never" using condoms.

In the analysis, which had been presented earlier at the 2013 Conference on Retroviruses and Opportunistic Infections (CROI), the CDC researchers found that "among MSM reporting any anal sex with an HIV-positive male partner, we found 70% effectiveness with reported consistent condom use (compared to never use) and no significant protection when comparing sometimes use to never use."

The study used existing data sets from two HIV prevention trials that enrolled HIV-uninfected MSM in the U.S. Researchers asked participants about their sexual behaviors and conducted HIV testing every six months over a number of years.

Notably, the study observed low rates of consistent condom use. Only 16% of participants reported "always" using condoms during anal sex with male partners (of any HIV status) throughout the entire study period, despite having received sustained behavioral interventions.

"Our findings of strong but partial effectiveness for consistent condom use, minimal effectiveness for inconsistent condom use, and low rates of consistent condom use over 1-2 years, even among persons receiving high quality risk-reduction counseling, may contribute to a better understanding of the persistent rates of HIV infection among MSM in the U.S., despite current levels of condom use promotion and provision," the study concluded.

Researchers did not explain how some participants contracted HIV despite reporting they "always" used condoms. However, they said self-reports of condom use were not validated, so it is possible some participants failed to report instances of condomless sex. Participants who reported injecting drugs before or during the trial period were excluded from the study.

While MSM represent approximately 2% of the U.S. adult population, researchers explained they accounted for 62% of all newly diagnosed HIV infections.

Yet few studies have looked at the effectiveness of condom use among this population. The most widely used estimate of condom effectiveness (80%) was based on studies among heterosexual people with HIV-positive partners.

"Given that the proportion of new HIV infections in the U.S. annually is greatest for MSM, it is important to have robust and accurate estimates of the effectiveness of condoms and other prevention methods that are specific to this population," the researchers explained.

They said the difference between heterosexual and MSM estimates was not statistically significant, but recommended using the new MSM estimate of 70% for discussions and models involving anal sex among MSM, rather than continuing to use the heterosexual estimate of 80%.

"From a public health perspective, these data suggest the need to further intensify efforts to educate HIV-uninfected MSM and improve their ability to accurately assess both their risk of HIV acquisition and the effectiveness of their current use of condoms (consistently or inconsistently) during anal sex," the study authors wrote.

"These data also suggest a need to provide access to additional highly effective HIV prevention tools and strategies, including more frequent HIV testing (including testing as couples) and daily oral antiretroviral pre-exposure prophylaxis (PrEP) when indicated," they added.

Katherine Moriarty is a consultant and freelance writer, based in Vancouver. She has 10 years of experience in the intersecting fields of public health and community development, with a focus on bloodborne virus policy and programming.

Copyright © 2014 Remedy Health Media, LLC. All rights reserved.

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Reader Comments:

Comment by: Dr. Elizabeth Mwanukuzi (Harare. Zimbabwe) Wed., Jan. 21, 2015 at 3:43 am UTC
this emphasizes the fact that MSM get infected with HIV because only 16% of them use condoms consistently, not because they are a marginalised group of society.
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Comment by: Get Real (London) Tue., Jan. 13, 2015 at 8:15 pm UTC
I hate to say it (and I do to all neurotic people I meet who are OCD about getting STDs)...If you are so worried about transmitting it/getting transmitted then simply abstain and don't have sex!

...otherwise, just accept that there is no 100% in life and you just have to do your best, don't let it control your life and just get on with living as best you can..

The statistics are that 1 in 3 people will get cancer, 1 in 6 will get dementia by 80 and so on. Perhaps it would be better if we lived in a sealed plastic bag with pure filtered oxygen pumped into it and we never had any actual body contact with anyone ever.
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Comment by: Dan (Mexico) Fri., Jan. 9, 2015 at 1:13 am UTC
70% is a very low effectiveness rate! I am very surprised because I have been told that condoms are 99% effective. How did the other 30% got the infected? Was it through anal sex or other behaviors?? I find this research very poor but at the same time scary because I have a relationship with an HIV positive person and I rely on condoms
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Comment by: Gary (Long Beach, CA) Thu., Jan. 8, 2015 at 4:07 pm UTC
When will researchers stop trying to relate high quality condom counseling (vs. low quality counseling) to consistent condom use compliance? The bottom line is that condoms do not feel good to either person so they aren't always used, are not always available, and do break.
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Comment by: Pissed off Thu., Jan. 1, 2015 at 11:02 am UTC
We were told they were 100% effective. If any caveat was given, it was "if use properly and there is no break". If we insisted we'd used condoms, we were called liars and told to take responsibility for our "mistake". We were movked as "immaculate infections". Now we're supposed to keep believing? If I were negative, I wouldn't get within a mile of any quoted statistic. Clearly the "experts" have no idea what they're talking about.
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Replies to this comment:
Comment by: pissed on (hart. ct.) Wed., Jan. 21, 2015 at 5:20 am UTC
i find it interesting that they tell everyone recieving oral is no risk .how many have been infected because of this is this truly the way to end this doctors actually ridiculed me and made light of the my sucks going through ars and having your drs ---- on you.then tell you you must have done something else.they tell you symptoms dont matter when you know what you are feeling and what it is.aren't the people who know the ones who have it.who cares what they can or cant make happen in mice.

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