Use of Reality® Condoms for Anal Sex by HIV-Seronegative US Gay/Bisexual Men at Increased Risk of HIV Infection

Background: Assess use of the Reality® "female condom" during anal sex by gay/bisexual men at increased risk, user characteristics, and extent and types of reported problems.

Methods: Self-administered questionnaire completed by 2,272 study participants who reported anal sex at the Month 18 follow-up visit for a prospective cohort in 6 US cities (Boston, Chicago, Denver, New York, San Francisco, Seattle) analyzed by descriptive statistics, chi-square tests, multiple logistic regression.

Results: A total of 148 (7% of the cohort) reported using the device in the prior 6 months for receptive (97, 4%) or insertive (97, 4%) anal sex, including 46 (2%) who tried it for both. San Francisco and Seattle cohorts had the highest rates of use (respectively 16% and 7%, compared with 1% to 4% in the 4 other cities). Most men who tried the device used it more than once in the prior 6 months; 19%, 2X; 39% > 3X. Among 47 receptive users who cited problems, main concerns were pain or discomfort (n=18), inserting the device (n=11) and keeping it in place if the inner ring is removed before insertion (n=6); a few reported bleeding. Among 35 insertive users who cited problems, main complaints were that the device was not pleasurable (n=12), difficult to keep in place (n=8), or insert (n=4). Nevertheless, 72% of those who used the device for receptive anal sex and 85% of men who used it for insertive anal sex said they were very/somewhat likely to use it in the future. Men who had more frequent anal sex (> 1X/month) were far more likely to have used the device than men having anal sex less often (O.R.=3.74, 95% C.I. 2.27, 6.15, controlling for factors significant on crude, but not adjusted, analysis [city, partner number, drug use]).

Conclusions: Willingness to consider future use of Reality® among the more sexually active men who have tried it, despite reported problems, suggests that this device may offer a feasible alternative barrier method, but problems inherent in the design developed for vaginal use (discomfort associated with the inner ring, difficulty inserting and retaining without the inner ring) suggest that a redesigned product would be preferable for anal sex. Reports of possible rectal trauma (bleeding) particularly warrant further study.

Michael Gross
Abt Associates Inc.
4800 Montgomery Lane
Bethesda, MD 20814