Research on Condom Use

Condom use is often seen as a tipping point in the success of HIV-AIDS education and prevention. This section describes the literature on the effectiveness of condoms in the prevention of HIV and AIDS.

Here are the facts, to date:

Consistent condom use is the most effective way to reduce exposure to HIV and other sexually transmitted diseases among sexually-active individuals. Two major, international health agencies (World Health Organization and UNAIDS) are standing by recommendations for condom use as a means to prevent transmission of HIV/AIDS and other sexually transmitted disease (STDs).

There are no marketed microbicides or vaccines (with the exception of the Hepatitis B vaccine) for the prevention of sexually-transmitted diseases.

Latex condoms have demonstrated significant protection against diseases transmitted via penile-vaginal intercourse. STDs studied are: HIV infection, gonorrhea,chlamydial infection, [including gonococcal and chlamydial pelvic inflammatory disease (PID)], syphilis, chancroid, trichomoniasis, genital herpes caused by herpes simplex viruses (HSV)1 and 2, and genital human papillomavirus (HPV) infection and HPV diseases.

Resistence to Condom Use

One of the most controversial issues in prevention education is the varying responses towards use of condoms. The body of literature on the subject points to cultural and religious taboos; psychological implications (such as illusions of safety); views about condom effectiveness; increased risk behaviors correlating to promising research on treatment; and issues of male aversion. We shall address these responses below.

Condom Use

In the United States, where condom availability is pervasive, only 58% of sexually active youth use condoms.

Young people give the following reasons why they do not use condoms: a) embarrassment; b) a belief that it may affect sexual performance; c) concerns that a partner may be suspicious if a young man puts on a condom; d) an unrealistic optimism in one's personal risk of contracting HIV and other STDs.

The reason for unrealistic optimism may be due to several factors, not the least of which is a sense that by understimating one's risk, a young man or woman can reduce the anxiety. It may seem to be counter-intuitive at first, but the greater the anxiety the young people feel, some studies show, the less chance there is that they will use a condom, for they fight fear by building up a psychological wall of protection. Such denial of vulnerability is not uncommon; many populations avoid uncomfortable emotions associated with health problems, an issue that is surely exacerbated in settings where health care options and treatment facilities are limited.

In developed countries, the introduction of more sophisticated drug therapies in HIV Positive treatment may be contributing to a rise of infections and risk-taking behaviors. Young people may rationalize that AIDS is treatable.

Role models (movie stars and sports figures) have engaged in a public relations campaign to restore pride and dignity to HIV-infected people ("I am Positive"). While such a campaign may be essential to ensure civil rights and active participation in society, an unintended consequence may be the elevation of one's HIV-Positive diagnosis as a status symbol.

Addressing Resistance to Condom Use - 2 Studies

There are several HIV-AIDS programs designed to change behavior. Some focus on facts where little information is available. Others try to infuse frightening messages about HIV-AIDS. Still others integrate the personal elements (showing the effect of knowing someone with AIDS on one's own behavior, for example).

Each HIV-AIDS program must be designed with evaluation techniques that use consistently accurate appropriate dependent and independent variables and analyses that can quantify the connection between education programs and changes in behavior.

As was shown in the Topic: "Resistance to Condom Use," attempts have been made to reduce feelings of invulnerability so that young people do not engage in unprotected sex. The key is to integrate factual material with personal identification and engagement in order for the lessons to run deep.

Two studies have been conducted with young people to determine the clues and strategies for helping them change their behavior. We have chosen to focus on these two approaches to HIV-AIDS education because they integrate personal engagement and good teaching. We stress that the creative presentation of programmatic materials is as important as the factual presentation of materials.

In the first approach, researchers focused on whether or not young people really "knew" about a person's HIV status, based upon a look at photographs and that person's brief statement about his/her sexual history. Many students were unable to produce an accurate score of HIV Negative and HIV Positive people. This study was based upon the idea that a student's sudden confrontation with his or her failed perceptions would change behavior. In this case, such a change would result in not relying on appearance and a statement from a potential partner. Protection would then take place as a matter of course.

It has been suggested that the study using photographs take on longitudinal elements by following the lives of young people pictured in the photographs for several months or years. In this way, several variables can be studied, including: a) a longer term analysis of the staying power of the exercise itself - is it continuing to work? b) a reinforcing of the point, such that subsequent groups of students participating in the photo-identification project could see the deterioration in the lives, over time, of those infected by HIV. A seemingly bright and beautiful face one day then turns into the face of disease.

In the second approach, researchers focused on negative health events as a compelling way of demonstrating a willingness to use condoms. In such cases, young people spoke about the STDs contracted. In addition, a 20-minute video was shown. Studies have shown an initial commitment to use protection, though it is not entirely clear whether or not the pressures surrounding participation in the study itself may not have had an effect on young people, who may feel pressured to provide the "appropriate," rather than the truthful, answer.

Both approaches were followed up by questionnaires at three and six months asking whether or not the young people had been sexually active in the intervening time and the degree to which they intend to use condoms.

FINDINGS & FOLLOW-UP

The intention of both studies is to reduce feelings of invulnerability and increase condom use. Both approaches showed demonstrable effects in reducing feelings of invulnerability and increasing the intention to use condoms. The results of this "stand-alone" intervention may be limited to some degree. The message remains. The teenagers' lack of ability to guess accurately the health of those in the photographs translated into a sense that: a) they may be wrong; b) the picture they viewed could, perhaps, one day be of them.

Future studies are being tested to overcome obstacles to condom use that extend beyond the perceptions of teenagers - availability in numbers and ease of access, social stigmas, myths about condoms, for example.

The post study is as important as the study itself, for the questionnaire itself is explicit about questions directed to young people about their own sexual behavior. These private issues are public insofar as the young people are participating in such a study and the follow-up surveys, which acknowledge their sexual activity. (We do not know what the drop-out rate is to determine the degree to which fear of such questions may have frightened some participants away.)

A conclusion that can be made, however (based upon a larger body of research in adolescent psychology) is that threatening or frightening images or programs showing the connection to and consequences of a particular behavior (in this case, unprotected sex) have been marginally effective, but short term. Recent studies have shown success in mitigating cigarette smoking amongst teens by showing dirty lungs, but the effects do not last because such messages are not personalized. Even more, some young people resist such messages as authoritarian and, therefore, go in the opposite direction - toward greater risk taking.