Incorrect condom use and frequent breakage among female sex workers and their clients

Our objective was to assess if female sex workers (FSWs) and their potential male clients in Cotonou, Benin, know how to use male condoms correctly. From April to June 2000, 314 FSWs and 208 men were interviewed, and asked to demonstrate on a wooden penis how they usually use male condoms. In all, 27.6% of both women and men tore the condom envelope on the notch; 89.3% of the women versus 75.4% of the men easily found the correct side; 17.3% of the women versus 28.3% of the men held the top of the condom to avoid air entering; 91.4% of the women versus 75.6% of the men correctly unrolled the condom. Taking all the four criteria together, only ∼11% of participants performed a correct condom use demonstration. FSWs frequently reported condom breakage, which was significantly associated with incorrect condom demonstration (P = 0.04). Correct condom use is suboptimal in these heavy consumers of male condoms in Benin. Condom breakage is frequent and is associated with incorrect use.