POPULATION REPORTS
Courtesy of TFGI

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CONTENTS

          Chapters
  1. The Condom Gap: A Health Crisis
  2. Sexual Behavior and Condoms
  3. Knowledge of Condoms and AIDS
  4. How Effective Are Condoms?
  5. New Condoms for the New Millennium
  6. Improving Access
  7. Promoting Condoms
  8. Policies for Condom Use

HIGHLIGHTS

Population Reports is published by the Population Information Program, Center for Communication Programs, The Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202-4012, USA


Volume XXVII, Number 1
April, 1999

Series H, Number 9
 Closing the
    Condom Gap

The need for condoms is growing as HIV/AIDS and other sexually transmitted infections (STIs) spread. Making condoms more accessible, lowering their cost, promoting them more, and helping to overcome social and personal obstacles to their use would save many lives and reduce the enormous consequences and costs of STIs and unintended pregnancies.

Every sexually active person should always use condoms unless in a mutually monogamous relationship. An estimated 24 billion condoms should be used each year, but actual use is much less, at an estimated 6 to 9 billion each year.

To avoid AIDS, more and more unmarried people are changing their sexual behavior. Some are avoiding sex entirely, while others have started using condoms. In surveyed countries 5% to 33% of never-married men say they have started using condoms to avoid AIDS. But many others have not adopted safe sexual behavior. Rates of condom use are lower within marriage than among the sexually active unmarried. Yet many married couples need condoms, too, both for family planning and for protection against STIs.

Narrowing the Gap

Narrowing the gap between condom need and use is a major public health challenge. Worldwide, at least 33 million people are living with HIV/AIDS, and another 14 million have died. An estimated 16,000 new infections occur every day. About 6 of every 10 new HIV infections are to women, and many newborns contract the virus from infected mothers.

Efforts to increase condom use are a good social, economic, and health investment. More condom use would reduce rates of HIV infection and slow the spread of AIDS so that emphasis could shift from dealing with the consequences of AIDS to meeting other health needs.

Why Don't More People Use Condoms?

Despite the AIDS epidemic, many people practice risky sexual behavior—even when they know that condoms prevent infections. It is unlikely that all sexually active people will always use condoms when needed. Powerful social norms encourage men to take sexual risks, such as visiting commercial sex workers, and at the same time discourage condom use. Traditional gender roles keep women from talking about sex or asking for condoms. Wives may know that their husbands have sex outside marriage but cannot suggest condoms for fear that their husbands might abuse or reject them.

There are other obstacles to condom use. Some people know little about condoms, dislike them, cannot afford them, or cannot obtain them easily. Others believe, wrongly, that they face little or no risk of pregnancy or STIs. Unmarried young people are particularly at risk: Many face social pressures to have sex and have difficulty getting condoms.

What Programs Can Do

Condoms prevent infections and pregnancy--but only when people use them correctly and consistently. Communication campaigns can help make condom use, not sexual risk-taking, the social norm. Reproductive health programs also must address the issues of trust, negotiation, and communication between partners that are important to condom use and essential to safe sexual relationships.

Condoms should be made accessible to all and provided not only through health clinics and retail shops but also in hotels, bars, grocery stores, and vending machines. Programs can reach out to more groups who need condoms, including youth, unmarried men, and commercial sex workers.

Especially, programs can offer condoms at subsidized prices in retail outlets through social marketing. In the developing world social marketing supplied about 900 million condoms in 1997.

Access and promotion go hand in hand. Condom promotion can improve the image of condoms, portraying them as fun, reliable, and important. Counseling and the mass media can foster safe sexual behavior and teach condom negotiation skills.

Particularly because of AIDS, most countries need to do more to encourage condom use. Governments, health programs, manufacturers, donor organizations, retailers, and health care providers must work together to assure that condom supplies, information, and services meet the growing need.


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