The effectiveness of condoms, as of most forms of contraception, can be assessed in two ways. Perfect use or method effectiveness includes people who use condoms properly and consistently. Actual use or typical use effectiveness are all condom users, including those who use condoms improperly, inconsistently, or both (Campbell, Foulis, Maimane & Sibiya, 2003). Condoms may be combined with other forms of contraception (such as spermicide) for greater protection. They are widely recommended for the prevention of STI`s and have been shown to be effective in reducing infection rates in both males and females. While not a hundred percent effective, condoms are effective in reducing the transmission of HIV, genital herpes, genital warts, syphilis, chlamydia, gonorrhea, and other diseases. Beck (2002) noted that condom use is the best available strategy to prevent HIV infection. However, since many people choose not to use condoms where the risk of HIV exists, alternatives to condom use for HIV prevention are needed. Using condoms should be shared by both partners. This
77
presupposes that females must be empowered to step out of traditional roles and take the initiative in sexual encounters (Barnett & Whiteside, 2002).
According to Campbell (2003) the following needs to be done in order to encourage the use of condoms. Firstly, countries (particularly those with high HIV infection rates) need to review existing policies and laws governing the manufacture, importation, exportation, sale, distribution, advertising and use of condoms. Countries facing foreign exchange and balance-of-payment problems impose a high import duty on condoms. This effectively prevents widespread condom use because of high costs. Condom use in these countries is thus low and inconsistent. Currently, it must be noted that getting hold of condoms is easier than in the past as in most countries with high HIV infection rates they are available free of charge in many places such as public toilets, clinics and even municipal libraries.
In earlier international studies, women have had more positive attitudestowards using condoms than men have, while men have had fewerdifficulties in buying and carrying a condom. Women are embarrassedto buy condoms and were afraid that their partners might think they are promiscuous. Mashego (2004) reported that, negative attitudes towards condom use, stemmed primarilyfrom beliefs about having natural sex (that is, sex without using any form of contraception). The desirability of using condomsappears to be influenced by factors such as trust in your partner and the nature of the relationship. Lack ofknowledge or skill in the use of condoms may also influencebeliefs about their effectiveness and the resulting choice ofcontraceptive methods
78
Mashego (2004) and France-Press (2004) state that in African society there is much ignorance and misinformation about proper condom use and related topics. They further note that individuals need to understand the role of condoms for preventing Aids transmission. It is stated that the image (or profile) of condom use needs to be improved. For instance, perceptions of condom breakage can be addressed by educating individuals about the storage and handling of condoms in ways that minimize product deterioration (Mashego, 2004 & France-Presse, 2004). They must be promoted and branded as a preventive measure against disease, not against pregnancy, in Africa.
Condom use is also associated with sex workers and disease. Condom use must be promoted as a way of escaping negative health consequences.
Taylor (2006) reported that using condoms or insisting that a partner use a condom may be seen as implying that the partner has an STI or is unfaithful or that the person insisting on the condom use is unfaithful. One way of encouraging discussions on safe sex issues and negotiating condom use is by normalizing the use of condoms among sexually active individuals. It must be noted that nearly half of all pregnancies are unplanned, suggesting that condom use should be a higher priority for women.
According to Boer and Emons (2004) research indicates that young unmarried men are more reluctant than women to suggest the use of condoms. For men, the reluctance has to do with the idea of reduced sexual pleasure but also the tendency to view condoms primarily as contraception rather than a means of infection control. Despite the advantages of using condoms, there are a number of factors that prevent individuals
79
using them. For example, negative attitudes towards condom use, not taking into account personalrisk, using alcohol or drugs, low self-confidence and reliance on other contraceptive methods, have been the most common reasons put forward for not using condoms (Kalichman, 2000). Despite wanting sex research has indicated that many men are shy about putting condoms on in front of a sexual partner. It is likely that this is because of communication barriers in society about issues relating to sex and HIV infection. Another reason given for non condom use is that as it has been much publicized that condoms do not provide absolute protection high-risk groups for HIV infection explain their non-compliance in condom use by stating I will get sick anyway (Nel, 2003).