Condom Use Among U.S. Men, 1991.

A 1991 study of a nationally representative sample of men aged 20-39 finds that 27% of sexually active men had used a condom in the four weeks before interview. Black men are more likely than white men to report condom use (38% vs. 25%), and men younger than 30 are more likely to do so than are those older than 30 (36% vs. 19%). Among white men, condom use increases with years of education; among black men, however, those with 12 years of education are much less likely to report condom use than are those with more or less than 12 years (28% vs. 43-50%). Condom use is positively related to number of partners. Men who have engaged in anal intercourse, those who have had a one-night stand and those who are bisexual or homosexual are also more likely to report condom use. Among those who reported using a condom in the previous four weeks, 55% of whites and 18% of blacks had done so only for birth control and 7% of whites and 9% of blacks had done so only for protection against infection with the human immunodefic iency virus and other sexually transmitted organisms; the remainder had used a condom for both reasons.

(Family Planning Perspectives, 25:61-66, 1993)

The incidence of sexually transmitted diseases (STDs) rose dramatically during the 1980s. In 1988, an estimated 12 million new sexually transmitted infections occurred in the United States. (1) Increases occurred not only in the incidence of historic venereal diseases such as gonorrhea and syphilis, but also in about 20 other diseases, syndromes and complications of STDs. (2) During the same period, the human immunodeficiency virus (HIV), the virus that causes AIDS, spread rapidly, first among homosexual men and then among heterosexuals. The Centers for Disease Control and Prevention estimates that at least one million Americans are now infected with HIV. (3) Heterosexual transmission is expected to account for an increasing proportion of those who become infected with HIV in the future. (4)

The risk of STD infection can be virtually eliminated by total abstinence from sex; individuals who do not wish to abstain can substantially diminish their risk by engaging in "safer sex" practices, such as limiting the number of people with whom they have sex, avoiding sex with partners they do not know well, choosing partners who have a relatively low risk of being infected, or maintaining a mutually faithful relationship. They can also reduce their risk of contracting and transmitting STDs by taking precautions that minimize the potential for exposure to body fluids through damaged rectal or genital tissue. (5)

Condoms can provide effective protection by blocking the transmission of a wide variety of sexually transmissible organisms. Research has demonstrated that latex condoms help to protect against gonorrhea, syphilis, chlamydial infections, trichomoniasis, herpes simplex, mycoplasmas and HIV. (6) In laboratory experiments, sperm and most disease-causing organisms, including HIV, have not passed through intact latex condoms. (7) Because condoms help prevent STDs, they also help prevent conditions in women that result from STD infection, such as pelvic inflammatory disease (PID), which in turn can lead to ectopic pregnancy and infertility. Condom use may also protect women against cervical cancer, (8) which research has linked to infection with certain types of human papillomavirus. (9)

When the condom is used correctly, it is also a relatively effective method of birth control. But, after more effective methods--oral contraceptives and the IUD--were introduced in the early 1960s, condom use declined. (10) Recently, however, this trend seems to have reversed: Data from the 1988 National Survey of Family Growth show that between 1982 and 1988, the use of the condom increased significantly among women younger than 25 and those who had never been married. (11)

The behavioral response of the American public to the STD epidemic is not well documented. Knowledge about how the spread of these diseases has affected the prevalence of condom use and its variation across population subgroups is particularly limited. Most of the nationally representative data on condom use focus on contraception because they were collected before concern about HIV and other STDs became widespread. Moreover, with a few exceptions, our knowledge about contraceptive behavior is based on information reported by women only. (*)