A self-administered, anonymous questionnaire examining opinions and experiences of using Reality, the "female" condom, for anal sex was completed by a convenience sample of 100 men who have sex with men (MSM). Eighty-six percent of respondents said they would use Reality again; 54% would rather use Reality than penile condoms. Acceptability was higher among MSM who were HIV positive, in nonmonogamous relationships, or who had serodiscordant partners. Negative experiences included: difficulty inserting (33%), irritation (17%), bunching up (12%), unpleasant texture (10%), and noise (9%). Breakage was reported three times in 334 episodes of use. Although no available data compare preferences and efficacy of Reality to penile condoms, Reality is a welcome alternative for some MSM who have difficulty consistently using penile condoms and probably reduces HIV transmission compared with unprotected anal sex. Research to more definitively assess Reality as a risk reduction method for MSM is greatly needed.
PIP: Men who have sex with men (MSM) in gay male communities do not always use condoms when having anal sex. Reasons for such risky behavior include men's objections to the lack of spontaneity demanded from condom use, decreased sensation, and condom breakage. Reality, a polyurethane pouch designed to line the vagina, was developed mainly to provide women with a contraceptive and STD prevention option. A removable inner ring and fixed outer ring keep the device in place. Some MSM use Reality when having anal sex. 750 free Reality kits were distributed by the STOP AIDS Project in San Francisco at venues frequented by MSM. Kits included 2 female condoms, instructions, a self-administered questionnaire on the users' experiences with Reality, and a stamped return envelope. 108 surveys were returned, with 100 MSM reporting use of Reality during the past 6 months in 147 episodes of insertive and 187 episodes of receptive anal sex. 86 men reported that they would use Reality again, and 54 said they would rather use Reality than conventional male condoms. Generally most liked about Reality were its heightened sensitivity and spontaneity, while insertion difficulties and high cost were the factors least liked. Acceptability was higher among MSM who were HIV-positive, in nonmonogamous relationships, or who had serodiscordant sex partners. Negative experiences included difficulty inserting (33%), irritation (17%), bunching up (12%), unpleasant texture (10%), and noise (9%). Breakage was reported 3 times in 334 episodes of use. Reality appears to be a welcome alternative for some MSM who do not consistently use penile condoms. Although use of the method probably reduces HIV transmission compared to unprotected anal sex, more research is needed to definitively assess its effectiveness as a risk reduction method for MSM.