Condom Compliance: Why Aren’t All the Adults Doing It?

by Robin Slaw, Sexual Health Educator/Trainer

(In this article on condom compliance – Robin touches on the necessity of educating youth on the importance of condoms to and some reasons adults may not use them as well as other issues. Condoms are critical to preventing STIs so this article is perfectly timed to coordinate with the Get Yourself Tested campaign and STI Prevention Month – ending in a week.)

Recently, a freshman student asked me why older people don’t use condoms. It’s a good question, isn’t it? How do you explain to a 15-year-old that even though older adults might not use condoms, they should? And, how do you finish that explanation and still manage to get through a 45-minute contraception presentation before the bell rings and you lose your audience?

It’s a conundrum that sexual health educators often face, especially those of us who are invited to present to an entire freshman or junior class of 298 students in 45 minute chunks, in classes of 30 to 60 students, some doubled in size to make sure we are heard by the entire school’s worth of freshmen or juniors.

In this particular class, we spent some time talking about pleasure and condoms, since one reason people are not condom compliant is the complaint about reduced pleasure. One of my colleagues has shared some wonderful work on pleasure and safer sex (you’ll see her lesson in the third edition of Teaching Safer Sex, out by the end of 2010!) We talked about how lubricants can help condoms feel more natural and what kind of lubricants you can safely use with condoms (and perhaps more importantly, what kinds of lubes are not safe for condoms). And we talked about trying different condoms since loose fitting condoms can detract from sexual pleasure. We spent a minute on how older people can sometimes get stuck in out-of-date ideas, or perhaps don’t understand the necessity of using condoms to help prevent disease as well as pregnancy. Then we continued the class with dental dams and female condoms so I could finish the presentation before the bell rang.

The teacher that I worked with during this class was amused by the reactions of some of the students to the idea of looking at condoms in the store. Together, we worked on a plan to send the students out to stores to evaluate condoms for extra credit during the unit on sexually transmitted infections (STIs). These lucky students will have a deeper understanding of the range of condoms and how to use them properly, so when they do become sexually active, they will be prepared to stay safe.

At the end of March, sexual health education advocates went to Washington, D. C. to advocate for comprehensive sexuality education across the country. The standards are radically different across the country. Even in Northern New Jersey, state standards are applied differently in different areas. In some schools, I can demonstrate how to put on a condom correctly, which helps students use condoms effectively. In other schools, I can only talk about condoms, even though I can demonstrate the use of every other type of contraception. In other schools, like the one my daughters attend, they don’t cover contraception, and students don’t even see pictures, let alone get to examine a female condom or a dental dam.

I am left wondering – how will the students who don’t see contraception know what to do when it comes time for them to delay pregnancy? How many of them will become part of the statistics of STIs in high school students in the U.S.? According to the last CDC report on Trends in HIV- and STD-Related Risk Behaviors Among High School Students, about half of all high school students will become sexually active by the time they leave high school, only one third of those students will use condoms consistently, and one in every four sexually active high school students will get a sexually transmitted infection by the time they graduate high school. If we aren’t showing these students how to use condoms, will they know how to stay safe?

The Guttmacher Institute published a study in 1998 that indicates condom distribution in high schools increases the use of condoms for students. The study saw very little change in condom use among students who were already sexually active, but a dramatic increase in the use of condoms for students who initiated sexual activity after condom distribution was introduced to schools. There were no changes to the number of students who initiated first intercourse, nor was there an increase in the number of times students had intercourse. The only net (and positive) effect was better condom compliance for students who were not yet sexually active before the study.

Wouldn’t it be amazing if we could live in a community that taught its students how to use contraception, and then made that contraception easily available? We wouldn’t see increases in sexual behavior; instead, we would see safer students!