Dave Hill on the death of the condom culture

Where have all the rubbers gone? The question, unconnected with the provision of classroom equipment, might seem unnecessary. Long past are the days when purchasing prophylactics involved pharmacists reaching furtively under counters or coded barbershop exchanges about "something for the weekend".

Today, condoms are everywhere. You're waiting for your piles prescription and a rank of gleaming boxes speaks of ribbed shafts, fruit flavours and "Xtra Pleasure for Him and Her". You're in the supermarket perusing frozen peas, knowing that a phalanx of French letters is just an aisle or two away.

But does this brazen visibility, now established so thoroughly, necessarily mean that the condom is doing the good work for which it emerged from the shadows in the first place? The joint may be jumping with johnnies, but what effect has that had on the perils they are designed to prevent? Does the condom culture, so central to the promotion of safe sex, have quite the force it did when it emerged in the early 80s in response to Aids?

The signs are not encouraging. For example, if the new ubiquity of the everyman of contraception has had a limiting effect on rates of teenage pregnancies it hasn't been enough to knock the UK off the top of the European league. Moreover, the latest data on HIV infection and other sexually transmitted infections [STIs] make it tempting to conclude that condom use is going radically out of style. Figures from the public health laboratory service (PHLS) for last year showed 2,868 new HIV diagnoses, with more likely to be added as information continues coming in. This represents a 7% rise on 1999 - which was itself a 10-year high. Other STIs are also being diagnosed in larger numbers. At the end of last year the PHLS also reported big rises since 1995 in diagnoses of genital warts (up 20%), syphilis (up 54%), gonorrhoea (up 55%) and, most spectacularly, genital chlamydia (up 76%).

This data should be handled with appropriate care. Chlamydia was almost unknown to the general public until a few years ago, but has been vigorously targeted by providers of sexual health services and information - hence the huge rise in its diagnosis figure may partly reflect increased amounts of testing.

Similarly, many of the new HIV diagnoses have been of people who were infected some years ago but have only recently come forward for testing, perhaps encouraged in some cases by the emergence of drug treatments which slow the development of the virus. None the less the PHLS view is that "the rises in acute STIs are likely to be associated with increasing unsafe sexual behaviour particularly among young heterosexuals and gay men".

The basic prevention message remains the same: use a condom. So why does rejection of them appear to be strengthening, especially among certain social groups?

Again, there is a need for circumspection. For example, Will Nutland, a health promotion manager at Terrence Higgins Trust Lighthouse, cites research showing that while there is some evidence that gay men are having more unprotected analintercourse, there is also evidence that many of those who do so are aware of their own and their sexual partners' HIV status and proceeding accordingly: if both partners are HIV positive, a condom becomes redundant, as it does if both are free from the virus.

But while this shows that the connection between condom use and the incidence of infection is not straightforward in all respects, no one doubts that the safe sex message in general is at least as important as ever, or that the virtues of the condom must remain integral to it. As Nutland points out, one effect of more successful HIV treatment has been to enlarge the pool of people surviving with the virus and therefore representing a possible source of infection. And Gwenda Hughes, a senior scientist at the communicable disease surveillance centre in Colindale, stresses that the increased diagnoses of syphilis and gonorrhoea seem very directly connected to unsafe sex practices. Hughes also emphasises the invisibility of chlamydia - "70% of cases show no symptoms" - and the very serious consequences it can have for women: infertility, ectopic pregnancy, chronic pelvic pain.

As ever, it is the young who are at the greatest risk from STIs, especially girls and young women in their late teens, and men in their early to mid-20s. So how can the young be taught to love the condom more? It may not be easy. Nutland is frank in saying that those brave 80s efforts to promote condoms as sexy were doomed to have a limited effect: "In the real world most people just don't think they're sexy at all." From another perspective Greg Falola, a Merseyside youth worker specialising in male sexual health and behaviour, says that a lot of those he works with are put off by the bog-standard models they can get for free, and put off by the price of more exotic varieties: "It means they never get to use a condom that they like."

Behind such practical realities lies a deeper problem too: the connections between certain styles of heterosexual masculinity, social disadvantage and the allure of risk. In one of his projects Falola asked a group of Wirral lads to tell him the things that make a man manly. They listed big money, a big car, and getting lots of notches on their bedposts. Of these, only the last is ever likely to be theirs. As Falola observes: "To them being manly means being big and brave and taking risks. It isn't hard to see how that kind of thinking transfers into their attitudes to condoms and safe sex."

Thanks to guardian.co.uk who have provided this article. View the original here.


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