The Condom Challenge: Too little use, too little access, inadequate availability
Individual and societal obstacles to use
Low perceived risk of HIV infection contributes to low condom use. An eight-country study in sub-Saharan Africa found that low perception of personal risk is the most important reason that people avoid using condoms: men and women tend to trust their marital or regular partners. Even female commercial sex workers are more likely to acquire STIs from their lovers, with whom they have unprotected sex, than from their clients. And many men do use condoms with casual partners because of a higher perceived risk of contracting HIV.
Young people tend to consider themselves invulnerable to risk. In Zambia, for example, youth who have only seen older people die of AIDS believe that HIV infection only occurs among older people. The same study found that youth felt more confident about having sex with partners who did not suggest condom use, because they thought them less likely to have STIs, including HIV.
In many societies, people associate condoms with infidelity and commercial sex; adolescents often consider the discussion of condom use with a partner a signal of distrust. Gender roles and inequalities jeopardize sexual and reproductive health for both women and men.
Programmatic and Policy Barriers to Access
Too many programs fail to adequately promote condoms and to impart the skills and knowledge required to use them effectively. A study among youth in Rwanda showed that fewer than 20 percent knew how to use condoms correctly. In Pakistan, as in India, where condoms have been promoted for family planning for decades, individuals at high risk of acquiring HIV do not know that condoms can protect them against HIV transmission.
Adult bias blocks young people’s access to condoms and information about them.
The promotion of condoms as part of comprehensive HIV prevention programming, including sexuality and sexual health education, is not fully accepted. Drawing on the U.S. experience, there is no evidence that abstinence-only programs delay onset of sexual activity or other sexual behavior.
Limited distribution systems complicate access, especially in rural areas.
Lack of Donor Support, Coordination, are Obstacles to Availability
Many developing country governments are providing and promoting condoms as part of their HIV prevention strategies, but for the poorest countries, assistance from the wealthier developed countries remains the main source of condoms. In other countries, sustainable prevention efforts that include promotion and provision of condoms are hurt by inadequate government commitment. Condom supply and distribution systems are not coordinated or streamlined.
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