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While the importance of using condoms to prevent HIV infection is stressed in South Africa, education around how to use them is lacking.
A review recently published in the journal Sexual Health shows that an alarming number of people worldwide aren’t using condoms properly.
When it comes to birth control, for example, condoms are 98 percent successful at preventing pregnancy if used properly. In practice, however, they’re only up to 15 percent successful at preventing pregnancy.
The World Health Organisation says condoms aren’t preventing infection with HIV and sexually transmitted diseases either.
The most common mistakes people make when using condoms are putting them on during sex and not before, removing them before intercourse is over, not squeezing the tip to leave space for semen and failing to inspect the condom for damage before use.
Researchers from the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University reviewed 16 years of research from SA, the UK and US on condom errors going back to 1995. The researchers, led by Stephanie Sanders, found a list of 15 mistakes that alarmingly large percentages of people commonly make when they use condoms.
For example, between 17 and 51 percent of people surveyed said they had put on a condom during intercourse.
Because fluids aren’t only exchanged during ejaculation, this negates the condom’s ability to reduce the risk of HIV infection.
Meanwhile, 82 percent of women and 74 percent of men did not check condoms for damage before use and almost half (48 percent) of women and 41 percent of men reported failing to squeeze air out of the tip of the condom before intercourse.
Mistakes were also made in the way people put on condoms. Some 23 percent said they unrolled the condom before putting it on rather than unrolling it on the penis. Up to 40 percent of participants had experienced a condom breaking and up to 19 percent had had one leaking.
Improper condom use, including the wrong kind of lubricant or storage, can contribute to these problems.
Sex educator Patty Brisben says condom breakage is often caused by using the wrong type of lubricant.
Lubricant can make sex more pleasurable, especially after pregnancy or menopause when vaginal dryness is common, but many women feel too embarrassed to buy it.
Instead they use baby oil or Vaseline, or whatever lubricant they have on hand. You need to take care when using lubricant with latex condoms because oil-based lubricants can damage them, says Brisben.
“Before buying a lubricant, make sure the packaging clearly states that it’s water-based,” she adds. “If you’re uncomfortable buying lubricant in a shop, you can shop for it online.”
In SA it’s not just the incorrect use of condoms that is a problem, though. Cultural norms can be a barrier to safe sex, too.
“We chronically underestimate how complicated condom use can be. It involves the use of a condom, while negotiating condom use and sex with a partner all at the same time,” says Richard Crosby, who co-authored the Kinsey Institute for Research in Sex, Gender and Reproduction study.
Negotiation around condom use isn’t straightforward, particularly in sub-Saharan Africa, where many women lack power in their relationships with men.
“Using or not using a condom is not simply a question of safer sexual behaviour; it is the outcome of a negotiation between potentially unequal partners,” says Rachel Mash, co-author of a review published in the African Journal of Primary Healthcare and Medicine.
Mash and her colleagues Bob Mash and Pierre de Villiers from the Division of Family Medicine and Primary Care at Stellenbosch University found that women were reluctant to ask their partners to use condoms for several reasons. Foremost was a concern that men would interpret bringing condoms into the bedroom as a lack of “real” love, intimacy and trust. Many women were also afraid that their partners would respond violently and force them to have unprotected sex.
Men, on the other hand, feared that if women took charge of birth control, their partners would become promiscuous, that they would lose their role as head of the family and that others might ridicule them.
Myths surrounding HIV also play a key role in resistance to condom use. The idea that condoms don’t work is widespread in some religious communities, as is the belief that they promote “immoral” behaviour.
It’s still thought that HIV can be cured, too, whether by using vitamins, supplements or traditional medicine or by a man having unprotected sex with a virgin.
About 60 million people worldwide are HIV positive. Of those, 5.5 million live in SA, which is home to only 0.7 percent of the world’s population. To date HIV has killed more than 20 million people, and 1.2 million people in sub-Saharan Africa died of Aids-related illness in 2010.
A study published in the British Royal Society’s Interface journal recently has some good news, though. The number of new cases of HIV in SA a year has halved since 1999. The biggest reason for this, according to researchers, is that condom use is on the increase.
They found that the proportion of SA men aged 16-24 who reported using condoms the last time they had sex had leapt from 20 percent in 1999 to 75 percent in 2009.
South Africans need continuing education around the facts about HIV and using condoms correctly if the rate of new HIV infections is to keep dropping. - The Star