Promoting Condom Use *

David A. Gershaw,Ph.D.

Condoms are a major means of preventing STDs (Sexually Transmitted Diseases) especially the HIV (Human Immunodeficiency Virus) infection that causes AIDS. Still, some people may be very upset about condoms being discussed in this publication. Some may be upset because condoms are also contraceptives, and they are against contraception. Others may be upset because they associate condom use with extramarital sexual intercourse. Why would I risk upsetting these people by writing about condoms?

First, public health officials have gone on record about condoms. If (1) you are going to engage in sexual intercourse, and (2) you are not in a mutually faithful relationship where both of you are free of infection condoms are the best way to avoid most STDs, especially AIDS.

Our reaction toward AIDS is like the reaction toward syphilis. Known centuries ago, syphilis was an incurable disease, carried in the blood, and passed on through sexual activity and childbirth. Like AIDS, syphilis was associated with strong negative cultural values, including the view that it was punishment for sexual immorality.

About 1850, latex condoms were mass produced for the first time. However, problems in promoting condom use were increased by the Comstock Act passed by Congress in 1873. This act broadened the definition of obscenity to include information related to the "prevention of conception." Because condoms were used to prevent conception, they were now classified as obscene. As with AIDS, the threat of the terrible effects of syphilis was used to encourage a "just say no" policy.

During World War I, the United States Army advocated abstaining from sex to prevent syphilis and other STDs rather than promoting the use of the condom. However, only 30% of the troops actually abstained from sex. According to army records, they lost almost seven million days of active duty because of STDs.

In contrast, in World War II, the army learned from past experience. Post exchanges were required to stock condoms, and lectures were routinely given on preventing STDs. At least the armed forces had learned something "merely discouraging an activity does not necessarily make it unattractive or mean that it will stop."

After World War II, antibiotics were discovered providing a cure for syphilis. This led to a drop in the use of condoms. Even though physicians realized that condoms helped to prevent STDs, it was easier and more cost effective to treat infected individuals with antibiotics. Therefore, the use of condoms was not promoted. The use of condoms diminished, especially after birth control pills became popular.

As far as sex is concerned,
the media screams,
"Go, go, go!"
Some adults warn,
"Just say no,"
But the majority just say...

In the last decade, with the appearance of AIDS, the condom is greatly needed again as a line of defense. Condoms are relatively low-priced, easy to use, and relatively reliable (if used correctly). While condoms prevent many STDs and unwanted pregnancies, they only rarely have negative physical side effects.

The health values of condom-protected intercourse are overshadowed by unrealistic views about sexuality. Clinging to the incorrect, age-old fear that promoting condoms for adolescents will lead to greater sexual activity, many adults ignore the unprotected sexual activity that is already occurring. Because teenagers have varying amounts of sexual experience, we need to provide them with more than one alternative. Although abstaining is an effective alternative, it is not feasible for teenagers who are already sexually active. Our goal in promoting condoms is not to encourage irresponsible sexual activity, but to prevent the needless suffering and death of our children.

Historically, negative images have been associated with almost any activity viewed as sexual. This links the condom with scenes of promiscuity, immorality, disease, and risk-taking. With these negative images, adolescents find it very uncomfortable to obtain and use condoms. Most sexually active teens would find them easier to use, if we associated condoms with more positive values caution, responsibility, and caring for your partner.

Condoms are only part of the solution in preventing the spread of AIDS. Adolescents who choose to be sexually active (whether we want them to beactive or not) need education, so they know the risks involved and the effective options available. Rather than saying nothing, this article is to educate my readers even if it may offend some of them.

* Adapted from Ronald Valdiserri's article, "Promoting Condom Use to Prevent HIV Infection: Lessons from History," SIECUS Report,Nov./Dec., 1988, pages 10-12.

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