Goodall et al. BMC Public Health 2012, 12:747 http://www.biomedcentral.com/1471-2458/12/747 R E S E A R C H A R T I C L E Open Access Towards condom skills: a cross-sectional study of the association between condom proficiency, condom problems and STI risk amongst MSM Lisa Goodall1*, Daniel Clutterbuck1 and Paul Flowers2 Abstract Background: Condom use problems are common amongst Scotland’s men who have sex with men (MSM). To date condom errors have been associated with the likelihood of sexually transmitted infections in heterosexual sexually transmitted infection (STI) clinic attendees but not in MSM and direct evidence of a link between condom problems and STI acquisition in MSM have been lacking. This study investigated the possibility of an independent association between condom proficiency, condom problems and STI acquisition in MSM in Scotland. Methods: An exploratory observational design employed cross-sectional surveys in both STI clinic and community settings. Respondents completed self-report measures of socio-demographic variables, scales of condom proficiency and condom problems and numbers of different partners with whom men have had unprotected anal intercourse (UAI partners) in the preceding year. Self-report data was corroborated with clinical STI diagnosis where possible. Analysis included chi-squared and Mann–Whitney tests and multiple logistic regression. Results: 792 respondents provided data with an overall response rate of 70% (n = 459 clinic sample, n = 333 community sample). Number of UAI partners was the strongest predictor of self-reported STI acquisition over the previous 12 months (p < 0.001 in both clinic and community samples). Demographic characteristics were not associated with self-reported STI diagnosis. However, condom proficiency score was associated with self-reported STI acquisition (p < 0.05 in both samples). Condom problem score was also associated with self-reported STI diagnosis in the clinic (p = 0.001) but not the community sample. Condom problem score remained associated with self-reported STI diagnosis in the clinic sample after adjusting for number of UAI partners with logistic regression. Conclusions: This exploratory study highlights the potential importance of targeted condom use skills interventions amongst MSM. It demands further research examining the utility of condom problem measures in wider populations, across prospective and experimental research designs, and a programme of research exploring their feasibility as a tool determining candidacy for brief interventions. Keywords: Condom skills, Men who have sex with men, Sexually transmitted infections, Condom problems, Condom proficiency, Condom measures Background In common with findings in some other countries [1], cross sectional surveys amongst bar–going gay men in Scotland showed an increase in rates of unprotected anal intercourse (UAI) in the late 1990s [2] followed by a plateau [3], with men under 25 years of age consistently * Correspondence: lisagoodall@doctors.org.uk 1Chalmers Centre, 2A Chalmers Street, Edinburgh EH3 9ES, UK Full list of author information is available at the end of the article showing higher rates of UAI than older men. Whilst pre- vention is usually thought of as encouraging men to use condoms per se, here the issue of the effective use of condoms is examined. Behavioral interventions continue be an essential com- ponent of HIV prevention in MSM [4] but targeting evi- dence based interventions to achieve maximum benefit is challenging. MSM attending clinics exhibit variable levels of sexual risk behavior and the differences in risk behav- ior, when assessed through routine clinical questioning, © 2012 Goodall et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.