Table 1: Summary of the reviewed articles

Author Objectives Design Population Findings Limitations
Crosby et al. [18] To explore the occurrence of self-reported condom use errors among Black MSM and to match the observed frequency with HIV serostatus. Cross-sectional comparative study. n=369 young Black MSM aged between 15-29
Condom slippage and breakage were common among MSM, an issue that is associated with anal sex as opposed to vaginal penetration. Other prevalent condom errors include early removal, condom re-use, and early removal. Slippage and breakage affected 9% and 15% of the HIV-negative men respectively, compared to 16% and 30% of the HIV-positive counterparts. There is a need for repetitive education to enhance proficiencies on correct condom use. Relied on self-reports, which may be marked by recall bias.

Convenience sampling.
Kim et al. [19] To determine the rate of condom failures, particularly breakage, and the allied behavioral and demographic antecedents in the last anal sex. Survey. n=9005 MSM

4% condom breakage rate
The prevalence did not vary between respondents who indicated insertive and receptive anal penetration.
The investigation focused on self-report data on condom failure due to breakage in the last anal intercourse. Thus, it did not offer a clear picture of condom breakage over time.
Remis et al. [37] To test the supposition that a significant percentage of sexual spread is occurring irrespective of condom use among MSM. Structural modeling. MSM in Ontario, Canada. At the time of the investigation, approximately n=92,963 HIV-negative men used condoms in more than 1 million acts of anal intercourse, and 117,1133 others without a condom.
14% of the respondents had HIV at the baseline
By the end of the study, 693 new incidences of HIV among the study population, with more than 50% of them occurring among those who used condoms, 16% and 33% via oral and anal sex, respectively.
Godall et al. [35] To assess the relationship between the frequency of errors/problems in condom use and the occurrence of STIs among MSM in Scotland. Cross-sectional observational study. n=792 of MSM

The multiple number of unprotected anal intercourse (UAI) were the primary measure of STI acquisition.
Awareness of proper condom usage was strongly linked to reduced odds of STI infections and low condom problem scores.
A convenient sampling of MSM attending clinics may not be representative of the community-dwelling respondents.
Lau et al. [22] To explore the frequency of unreliable use of condoms among HIV discordant partners. Cross-sectional study. n=88 HIV discordant couples from a rural village in China. 27.9% recounted inconsistent use of condom protection, mainly due to the inaccessibility of condoms.

Surprisingly, before HIV confirmation, consistent condom use was 24%. This means that HIV diagnosis did not improve constancy.
The data was based on self-reports, which can be impartial due to recall bias.

n=20 respondents provided incomplete information.
Yi et al. [23] To investigate the risk factors for the unsteady application of condoms among MSM. Cross-sectional analysis. n=367 randomly selected MSM from Cambodia. Unlike previous studies, there 62.3% consistent use, but the highest was among male sex workers (78.1%).

However, the population was at increased risk of acquiring HIV due to the use of drugs that caused them to either remove or disregard condoms completely.
The investigation surveyed factors that shape the general use of a condom with no description of the specific forms of sexual positions or types of partners.
Sanders et al. [15] To determine the prevalence of numerous condom use mistakes and difficulties around the world. Systematic review. n=50 articles were reviewed. The most frequent errors:
removal of the condom during intercourse, placing the condom inside out, improper withdrawal, failure to squeeze out air at the tip, use of non-water-based lubricants, and leaving no space at the tip.
Similarly, the commonly reported problems included challenges with fit and feel, failure to erect after wearing the condom, leakage, breakage, and slippage.
A significant number of appraised investigations were carried out in developed countries where the rates of HIV are relatively lower than in evolving nations.
Crosby et al. [24] To evaluate and match condom-use mistakes and problems. Cross-sectional survey. n=260 college students
n=142 females and n=118 males

11% of the respondents recalled using sharp objects to open the condom packet
83% did not change the condom between sexual acts
14% disregarded the condom during intercourse
38% wore the condom after penetrative intercourse has began
Problems comprised of breakage or slippage (28%), and loss of erection when applying the condom (15%) and 10% during the act.
The results are limited by recall bias due to retrospective self-reports
Convenient sampling.
Bradley et al. [25] To investigate the precipitating causes of reported breakage of condoms in the last 30-days among female-sex-workers in South India. Survey. n=1,928 FEMALE SEX WORKERs

(S. India).
11.4% of the surveyed participants recalled of breakage at least once in the past 30-days

Breakage was more likely to happen among participants who were: widowed/divorced/separated, <20-years-old, and used alcohol
The study did not specify the forms of sexual acts when condom breakages occurred.
Crosby R et al. [26] To review self-reported occurrences of condom use-associated errors among young black men. Cross-sectional analysis. n=475 young African American men are attending an urban STI clinic in the U.S. 10-25% of the participants recalled experiencing condom errors in the past two months.
40% used damaged or expired condom
Re-use of condoms
Low-socioeconomic status was associated with the inaccessibility of condoms
Having multiple sexual partners was a predictor of condom breakage and slippage.
The study focused on a single population (young black men). This reduces the possibility of extrapolating the findings.
Zoboli et al. [27] Assess condom application proficiencies among migrants in Italy. Cross-sectional analysis. > 18-year-old male asylum seekers in Italy. The results showed that literacy levels affect the extent of awareness regarding transmission mechanisms of STIs, including HIV, as well as the quality of knowledge. The authors recommended that for condom users need instructions on the best application methods. Only male respondents.
Baćak & Štulhofer [28] To evaluate the incidence and correlates of condom-associated loss of erection, delayed use, slippage, and breakage among 18-25 aged Croatian adults. Population-based national survey. n=1005 (n=510 men and n=495 women) 18-25 years-old Croatian adults

18%, 17%, 13%, and 34% of the respondents encountered breakage, erection loss, slippage, and delayed application, respectively.
Condom breakage was more probably to be recounted by.
There was no information about the type of sexual acts associated with the condom errors.
Crosby et al. [29] The study sought to test the supposition that men commonly incur condom errors with many intimate partners. Cross-sectional. n=271 African-American men aged between 18 and 29 years old, seeking medical care for diagnosed STD at a metropolitan clinic in the U.S. The respondents with ≥3 intimate female partners were highly likely to experience condom mistakes compared to their counterparts with two or fewer partners.
(This information is essential in planning for “triage” for developing educational programs.
Convenient sampling

Reliance on self-reports.
Garofalo et al. [30] To explore ethnic/racial disparities in HIV knowledgebase in MSM aged between 16-20 years and its association with errors in condom use. Cross-sectional analysis. n=344 MSM drawn from continuing longitudinal investigation

White men scored substantially higher than their Black counterparts on HIV knowledgebase.

Increased awareness of HIV transmission mechanisms was allied to fewer errors when using a male condom.
The respondents were sampled from one residential area; thus, the findings may not be representative of other young MSM.
The sample was largely comprised of Blacks.
Crosby et al. [31] To determine the pervasiveness of condom damage, and the specific practices resulting in the breakage among young heterosexual men. Online survey. n=278 young sexually active heterosexual men
31.3% of the respondents recounted experiencing condom breakage in the last three penetrative vaginal sex
The correlates of condom breakage included: men with a recent infection of STI and reported cases of slippage. Other errors allied to condom breakage encompassed of erection loss, failure to remove the air at the receptacle tip, and using sharp objects to open the packet.
Reliance on self-reported data limited the reliability of the findings.
Crosby et al. [32] To evaluate condom usability and the correlation between perceived and actual ability. In addition, the study sought to assess the relationship between the illustrated ability and occurrence of STIs among Black adolescent girls. Survey. n=522 sexually active female adolescents from the African-American communities
26% of the respondents reported a history of STI, while vaginal swabs of 28% of the girls were positive for at least one STI at the time of the study.
Incorrect application of the condom demonstrated by the respondents on the wood model would be associated with the incidence of STIs.
Self-reported measures limited the cogency of the findings.
The results are also restricted to condom application, yet the efficacy of condoms in infection prevention covers other factors including errors of slippage, breakage, or erection loss.
Hall et al. [33] To assess the ability and poise to wear condoms effectively and consistently among young music festival attendees in Australia. Survey
n=288 young adults aged between 18-29 years present at a music carnival

77% of the participants reported being confident in using condoms. The measures of self-assurance in condom use encompassed having >5 intimate partners and being male.
Paying attention to packet instructions was allied to increased confidence
37% breakage
51% and 48% slippage during the act and withdrawal, respectively
High school sex education did not cause any impact on condom errors.
Self-reports and the long recall period (12months) increased recall bias.
Hernández-Romieu, et al. [34] To compute and match the prevalence of incomplete condom use and condom mistakes as well as the regularity of condom inaccuracies, erection, and fit and feel difficulties among African American and Caucasian MSM. Cross-sectional. n=475 MSM who used a condom in insertive sex in the past six months

82% reported using condoms in the past 180days, (77% and 87% White and Black MSM, respectively). 40% of Black reported delayed/late application. There was an ethnic disparity in condom inefficiencies. Although condom use was common among Black MSM, they were more likely to incur errors than their White counterparts. This implies that unequal infection with HIV among Black MSM may be heightened by the regularity of condom errors and failures, mainly slippage and breakage problems. 54% recounted fit/feel problems. Self-reports and a six-month recall period reduced the validity of the findings.
D’Anna et al. [35] To determine the incidence of condom use failures: incomplete use, slippage, and breakage, and their association with the respondent, partner/relationship characteristics among HIV uninfected MSM. Survey. n=1609 MSM STI patients enlisted from a larger trial

There were 100% condom use in 93 main and non-main relationships respectively, and 20% of the participants reported to have not used condoms in the past 90 days.
Delayed use or early removal was the major error, while erratic use was a predictor of incomplete use particularly among MSM with multiple intimate partners.
The survey focused on a single cohort of MSM: HIV negative. Hence, the findings may not be representative of HIV positive MSM.
Giannou et al. [36] To re-evaluate the efficacy of condoms in decreasing the spread of HIV among heterosexual partners. Systematic review /meta-analysis

25 studies involving n=10,676 HIV serodiscordantheterosexual couples. HIV spread was significantly low among partners who consistently used condoms than non-users.
Condom use decreases the danger of HIV transmission by 70%; however, there were several imperfections including slippage and breakage.
Most of the reviewed papers relied on self-reports which are likely to increase the risk of recall bias.