It’s a Wrap – Condoms Reduce Risk
A good friend of mine (a retired sailor) laughs at me and says he can’t believe I actually get paid to run around telling sailors and Marines to wear a condom. He’s got a point. Don’t they already use condoms? Well... if only that was true. The fact is that only half of unmarried male sailors and Marines and only one-third of unmarried female sailors and Marines say a condom was used the last time they had sex.
Do sailors actually even need condoms? Well, in 2012, there were 5,000 sailors and Marines diagnosed with chlamydia, gonorrhea or syphilis, and another sailor or Marine was diagnosed with human immunodeficiency virus about every four days. About one in five enlisted female sailors and Marines aged 21-35 say they had an unplanned pregnancy in the last 12 months. Condoms might have helped prevent these outcomes.
Do condoms work? Well... in general, yes – condoms reduce, but don’t eliminate risk. Correct use (before any penetration) and consistent use (every time) of male latex condoms reduces the risk of sexually transmitted infections including HIV. How effective are they? Condoms provide different levels of protection for various sexually transmitted infections. They are likely to provide greater protection against infections transmitted only by genital fluids (like gonorrhea, chlamydia, trichomoniasis, and HIV infection) than against infections that are transmitted primarily by skin-to-skin contact, which may infect areas covered by a condom (like genital herpes, human papillomavirus infection, syphilis, and chancroid). So although there is a range of effectiveness, clearly sex with a condom is much less risky than without one.
There are three challenges to using a condom: (1) knowing how to use them; (2) being comfortable and confident negotiating condom use with a partner; and (3) having easy access to condoms. With any given sailor or Marine, we should not take for granted that any of these conditions has been met.
Some people have never actually been shown how to use a condom. Although 99 percent of Americans are aware of condoms, about one in three unmarried young American adults say they know little or nothing about condoms. I speak in many Navy medicine settings, and I am continually surprised by how many Navy doctors seem to have never demonstrated this skill for anyone in their life.
And using condoms is the easy part. Negotiating condom use is actually the more difficult skill. What should a person say? What if they reject me? What if my partner says, ‘no’? Many young people do not know how to initiate this conversation. Women worry about asking men to use a condom. Yet, among American male 20-somethings, when asked, “What would your reaction be if a girl asked you to use a condom,” 83 percent would “gladly do it” and only 6 percent would not. In 2010, the largest national survey of Americans’ sexual behavior found that adults using a condom for intercourse were just as likely to rate the sex positively in terms of arousal, pleasure and orgasm as sex without a condom.
Condom access. Condom distribution programs have been shown to reduce sexually transmitted infections. Remember – some adults are embarrassed about using condoms. While men report less embarrassment than women, studies have found that both groups often used the same strategies when making their purchase. For example, they sought out a clerk of the same sex. Both men and women report trying to conceal the condoms or buying additional items to distract attention. Men and women alike said they scanned the store for other customers while purchasing the condoms; women were more likely to wait for other customers to leave. We must devise a strategy that targets the segment of our population we believe to be at risk. It should enable people to discreetly access condoms without asking for permission or being observed. Retail stores can position condoms in a place where the customer does not need to ask for assistance to select them. Restroom dispensers are another good example.
Condoms are not the whole solution to the silent epidemics of sexually transmitted infections and unplanned pregnancies in our country. Abstinence, mutual monogamy and long-acting reversible contraceptives must also be part of our public health strategy. But condoms remain the quickest, least expensive, most easily implemented intervention available for people who decide to have sex outside of long-term, mutual monogamy.
Some suggestions:
Sexual health promotion efforts should not be perceived as just “pushing condoms.” Wherever you make condoms accessible, include a message stating that abstinence and monogamy can eliminate risk, and condoms reduce risk.
Every clinician, counselor or educator who speaks with patients about sexual health should have condoms available for people who want to try them. Have a variety of condoms in stock for patient education. Just having samples visible may generate patient questions and productive discussions.
Teach health care providers to speak with their patients about correct and consistent condom use. Many clinicians are not comfortable or experienced at this. Consider making this an in-service training for providers.
Be prepared for occasional misuse of “free” condoms. For example, a bowl of free condoms may disappear from a clinic and reappear as “balloons” taped to the ceiling of a barracks hallway. Help leaders understand that this is to be expected and may be used as an opportunity to educate. Rather than limiting access and punishing perpetrators, engage them as partners in promoting sexual health among their peers.
Don’t forget that many military members acquire their sexually transmitted infections (including HIV) while in the U.S. – condom access and sexual health education isn’t just a “deployment” concern.
For women who decide to have sex, help them know that it is OK for them to carry condoms and insist on their use. It is their right and responsibility to protect their health.
My Vision: For people who are not in a long-term, mutually-monogamous relationship, I believe we need to achieve a new cultural norm in which sex without a condom is as crazy an idea as driving without a seat belt. We can help – help them know how to use a condom, how to negotiate condom-use with a partner -- and we can make it easier to get condoms.
Really, it’s a wrap. Condoms reduce risk. So let’s all get to work making condom use normal and easy. Check out our condom page.
The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, nor the U.S. Government.
This story originally appeared on Navy Medicine Live.