Condom Use

Sex and Gender-based Analysis of this topic

Definition
Condoms are widely available and inexpensive contraceptives that also provide the best available barriers to sexually transmitted infections (STIs), such as Chlamydia, gonorrhea, syphilis, and HIV [1]. Preventing STIs is critical because viral and incurable infections (as well as the occurrence of bacterial STIs) have been steadily increasing in Canada [2]. Condoms are the only barrier protection against HIV transmission during vaginal and anal intercourse [1]. Male condoms are most commonly available and used for mutual protection in vaginal and anal intercourse and are sometimes used by partners for oral sex. When used correctly, male condoms are 87%-98% effective in preventing pregnancy. Female condoms have been available for some time in North America and are the most effective women-controlled prevention against STIs.
 
 
Sex Issues
Fewer than half of women report using condoms as their primary form of contraception, although 31% of women aged 18-19 and 34% of women aged 20-24 reported using condoms as their birth control of choice [3]. Young males (15-24) were less likely to report using a contraceptive. About one-third of young adults in Canada have had sex with more than one partner in the past year [2, 4]. In Canada, fewer than 35% of women at any age between 15 and 49 who were at high risk for STIs (users with more than one sexual partner in the past 12 months) reported using a condom during the last time they had sexual intercourse [3]. In every age group, women were less likely to report using a condom during last intercourse than were men. For females, but not for males, earlier first intercourse was associated with reduced likelihood of using condoms [2, 4].
 
 
Gender Issues
Condoms as the primary choice for contraception declines as women get older, which presumably coincides with women being in more stable relationships where the risk of disease transmission is lower. Despite their effectiveness as contraceptives and in preventing STIs and HIV/AIDS, many women considered high risk for STIs do not use condoms, particularly after the age of 25 years. Women may not be able to negotiate safer sex and condom use because men decide whether or not a male condom is used. Power differences and potential or real threats of violence may prevent women from protecting themselves [5, 6]; condom use can often be a point of contention between partners [7]. Female condoms are available in Canada but have not been well received by women because they are difficult to use and expensive [8].
 
 
Diversity
Young women with more education and more income were more likely to report regular use of condoms. Condom use declines dramatically with age. In 2005, younger women were most likely to report using a condom and the rate decreases with every age group [3]. Women over 30 years with more than one sexual partner in the past year were half as likely to use condoms as women aged 15 to 29 years [2, 4]. Older women may be more likely to believe that they are not at risk from unprotected sex. Fewer women used condoms in 2002 (18%) than in 1995 (25%) [9]. The decline in condom use was not accompanied by increased abstinence nor was it balanced by corresponding numbers of women and their partners testing for STIs. However, the prevalence of sexually transmitted infections - including Chlamydia, gonorrhea, syphilis, and HIV/AIDS - has increased [2, 4, 9]. A survey of injecting drug users found that women varied in their use of condoms, depending if their sexual encounters were with regular partners, casual partners or paying clients [10]. Women in the sex trade, women who engage in survival sex and others who are vulnerable to poverty and violence are disproportionately likely to acquire HIV although specific rates of condom use in these populations is unknown.
 
Equity
Women with more education have a greater likelihood of using condoms during high-risk encounters, particularly women with at least some post-secondary education [3]. Researchers have found that young women and men were less likely to engage in risky behaviour if they were motivated to pursue their education [11]. As noted, women’s ability to negotiate condom use can be compromised by threats of violence and other power differences with their partners. An “Invisible Condom”, an applicator with spermicidal gel, has been tested [12]. Early testers found both the gel formulation and the applicator were acceptable by women and their male sexual partners. As it is possible to use the applicator and gel without a sexual partner appearing to notice, it may be an effective contraceptive and preventative for women whose male partners refuse to wear a male condom [13].
 
 
Critique
Survey data available on contraceptive use, and condom use specifically, are limited, despite the fundamental importance to individual and population health. The Canadian Community Health Survey asked about contraceptive use among 15-24 year olds but only asked high-risk survey respondents under 50 years of age about condom use [14]. Given that condom use declines with age, while the risks of unprotected sexual intercourse remain unchanged across the life span, it would be valuable to ask about unprotected high-risk sex among all respondents [2, 4]. Other limitations to the survey include that respondents may only have replied about male condom use, “sexual intercourse” was not defined in the question, and respondents who are asked about personal behaviour may not be fully forthcoming about high risk behaviour [15].
 
 
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