Condoms Count for HIV Prevention

Studies show that young people tend to assess the disease risk of a partner by association, appearance, or other unreliable indicators.^{115 116 117 118 119} This falsely low perception of risk hinders consistent condom use.¹²⁰ In Ghana, condom use was found to be more likely among young men who perceived themselves to be at high risk of HIV infection as opposed to those who did not perceive a risk.¹²¹ Among young people ages 15 to 24 in Mozambique, condom use at last sex for both males and females was more than twice as high among those who assessed their risk correctly (30 percent and 16 percent respectively) as among those who did not (14 percent and 6 percent).¹²²

Young people commonly cite concerns about the effectiveness and quality of condoms—particularly free condoms—as well as concerns that condom use signifies infidelity or having an STI and that condoms reduce pleasure.^{123 124 125} Aspects of masculine sexuality, pleasure, eroticism and emotion must be addressed if condoms are to be promoted effectively.¹²⁶ In a number of studies, trust in a partner is cited as a reason for non-use and young women may sacrifice condom use if it threatens the development of a relationship.¹²⁷

"If a woman offers me a condom, I won’t take her seriously (i.e. marry her.). I don’t think she would be a good model for my kids." Unmarried man, Mexico.¹²⁸

Among adolescents in four sub-Saharan African countries, knowledge about correct use of condoms lags significantly behind awareness about the condom.¹²⁹ One study found that the strongest predictor of knowledge of correct condom use among adolescents of both sexes is exposure to a condom use demonstration. Communication skills building and involvement of male partners have also been shown to increase condom use. A nationally representative survey of young South African women found that those who discussed condom use with their partners were more likely to use condoms for dual protection, and to use them consistently.¹³⁰

Research shows that school-based sexuality programs for young people do not encourage early sexual activity or increase the number of sexual partners.^{131 132}In fact, a 2007 review of sexual education programs found that more than 60 percent of comprehensive programs—those that supported both abstinence and the use of condoms and contraceptives for sexually active adolescents—reduced unprotected sex, and some programs also delayed sexual initiation.¹³³ A systematic analysis of curriculum-based sex and HIV education programs in developing and developed countries found that of the 54 studies measuring program impact on condom use, almost half showed increased condom use; none found decreased use.¹³⁴ In countries with strong youth-friendly sexual and reproductive health services, including easily accessible condoms, the incidence of teenage pregnancy, abortion and STIs are consistently much lower than in countries where these services are not available, according to a UNAIDS and WHO review.¹³⁵

However, studies from Ethiopia^{136 137} and China¹³⁸ have demonstrated that out-of-school status is strongly associated with riskier sexual behaviors and thus greater risk of HIV and unintended pregnancy. An evaluation of an African Youth Alliance (AYA) comprehensive adolescent sexual and reproductive health (ASRH) program in Ghana, Tanzania, and Uganda, which included some activities for out-of-school youth, found that condom and contraceptive use increased substantially for females living in areas where the AYA program was implemented for at least a year.¹³⁹ Improving condom use among young people is critical—data show that if condom use is established during adolescence, it is more likely to be sustained in the long-term.^{140 141}

Please refer to the Appendix for end notes.