HEALTH WATCH: Attitudes inhibit condom use

By Dr Cory Couillard

DESPITE condoms being one of the best ways to prevent pregnancies and sexually transmitted infections (STIs) such as human papilloma virus (HPV) and HIV, their use is still relatively unpopular. 

Despite some success, low rates of condom use occur especially in rural areas and within adolescent marriages. This not only points to a lack of awareness and availability but also people’s beliefs and attitudes towards them.

According to The Lancet, the world's leading medical journal, adolescents who use condoms face discrimination, stigmatization and a lack of trust. Condom use often creates a perception that a potential sexual partner is ‘clean’ or ‘unclean’ – so it is ok not to use a condom if a partner is deemed ‘clean’.

The media is important in changing and improving these attitudes by pushing the message to ‘condomize’, get tested and to abstain.  However, while education is vital, no education campaign will make a difference unless people alter their behaviors.

according to UNAIDS, “focusing only on the individual psychological process ignores the interactive relationship of behaviour in its social, cultural and economic dimension thereby missing the possibility to fully understand crucial determinants of behaviour.”

This points out, in many cases that motivations for sex are complicated, unclear and may not be thought through in advance. Behavioral change has been found to be most effective within the context of adolescent life-skills education that is related to sexual behaviour and reproductive health.

Condom use and safe sex practices are more common in non-steady sexual relationships versus long-term ones. Several studies indicate that marriage increases the frequency of sex but decreases the use of condoms. Low use of condoms in marriage severely restricts a woman’s ability to protect herself from STIs.

Adolescent married girls were found to have higher levels of HIV infection than non-married sexually active girls the same age – demonstrating that marriage is not protective in some settings and can actually increase the risk.

Every year, one in 20 adolescent girls gets a bacterial infection through sexual contact, and the age at which infections are acquired is becoming younger and younger. There are more than 30 different sexually transmissible bacteria, viruses and parasites. They can lead to chronic diseases, AIDS, pregnancy complications, infertility, cervical cancer and death.

The most common conditions they cause include gonorrhoea, chlamydial infection, syphilis, trichomoniasis, chancroid, genital herpes, genital warts, human immunodeficiency virus (HIV) infection and hepatitis B infection.

In pregnancy, untreated early syphilis is responsible for one in four stillbirths and 14% of neonatal (newborn) deaths. Up to 15% of pregnant women in the region test positive for syphilis and interventions could prevent 492 000 stillbirths per year.

The success of antiretroviral therapy in reducing illness and prolonging life has altered the perception of risk associated with HIV. A perception of low-risk and a sense of complacency can lead to unprotected sex through reduced or non-consistent condom use.

According to the World Health Organization (WHO), “condoms, as a proven effective barrier method, can be used as a dual-purpose method for both prevention of pregnancy and protection against HIV and other STIs. For maximum effect any barrier method for contraception or infection prevention has to be used correctly and consistently.”

The promotion of correct and consistent use of condoms – within antiretroviral treatment programmes, and within reproductive health and family planning services – is essential to reduce HIV transmission.

The most effective means to avoid becoming infected with or spreading a sexually transmitted infection is to abstain from sexual intercourse or to have sexual intercourse only within a long-term, mutually monogamous relationship with an uninfected partner.

Dr Cory Couillard is an international health columnist working in collaboration with the World Health Organization's goals of disease prevention and control. Views do not necessarily reflect endorsement