FOLLOWING from the article on unsafe condoms and other unsafe sex accessories by Ditmore and Neth in your November 2006 journal, (1) I would like to point out that the practice of unsafe use of good quality condoms is also an issue that needs to be addressed.

In a study among 47 sex workers

that I recently concluded in 2005 in Sri Lanka, almost hall the women (44.7%) said they had experienced breakage of condoms during their professional life. (2) This seemed very high considering the fact that the average number of years they had been in the sex trade was 5.4 years (SD 5.62). Upon further inquiry, it became clear that the condom breakage was due not to accidental damage or the poor quality of condoms bur the result of purposeful condom damage on the part of clients. Sex workers said that they soon come to know when a condom is broken as they can feel it. Condom breakage, they said, was often preceded by the man slipping his penis out of the vagina, seemingly inadvertently, and manually re-inserting it. During the re-insertion the man would purposely damage the condom with his fingernails. This was not inadvertent but an attempt to deceive the sex worker. When the sex worker realised the condom had been broken, she would stop sexual activity to get the client to put on another one. A few of the women also said they verbally abused clients who did such things.

This practice is yet another example of men's unwillingness to wear a condom during intercourse even when they know that it is risky to have penetrative sex without one. The reasons why men do not want to wear condoms include not only the belief that sex is less pleasurable with a condom and the perception that a condom is an unnecessary cost, but also the high incidence of partial impotence among middle-aged men and perhaps the sense of it being aggravated while performing with a condom on.

Condoms remain the sole effective method of prevention of HIV and all efforts should be made to enhance their effectiveness. Sex workers therefore need to know that some clients tend to break condoms purposely, and that they should be observant when a man moves his hand towards his penis during intercourse.

(1.) Ditmore M, Neth C. Unsafe condoms and other unsafe sex accessories. Reproductive Health Matters 2006;14(28):171-73.

(2.) Jayawardena H. An assessment of the profile of female sex workers in Colombo and their risk behaviour related to HIV/AIDS. MSc Thesis, Faculty of Graduate Studies, University of Colombo, Sri Lanka, 2005.

Hemamal Jayawardena

Research Fellow, Harvard School of Public Health

Boston MA, USA