CONDOM NEGOTIATION AND HIV

HIV/AIDS remains a disease of great public health concern worldwide. In regions such as sub-Saharan Africa (SSA) where women are disproportionately infected with HIV, women are reportedly less likely capable of negotiating condom use. Confidence to negotiate safer sex practices is very crucial especially today when the Acquired Immune Deficiency Syndrome (AIDS) due to Human Immunodeficiency Virus (HIV) is rampant. In the global warfare against HIV/AIDS, research underscores the importance of communication between sexual partners concerning condoms use. This is based on the fact that communication between sexual partners about condom use is associated with increased use of condoms.

More importantly and probably beyond communication, it is established that those who convince or persuade their sexual partners to use condoms are more likely to actually use them than those who do not.

A condom– if used correctly and consistently– guarantee more than 90% effectiveness at preventing heterosexual acquisition and transmission of HIV. Family planners also acknowledge condoms as players of an imperative role in reducing the risk of unintended pregnancies, with their effectiveness estimated at 85-98% and 79-95% for male and female condoms respectively. Therefore, promotion of condom use has been and continues to receive considerable attention in fighting the HIV/AIDS pandemic [8], and this is very important particularly in sub-Saharan Africa (SSA) where unprotected heterosexual contact involving an infected partner is a major pathway for HIV transmission.

Although evidence showing an increased use of condoms over the past decade exists, negative attitudes towards condom use reign mainly due to factors such as fertility desires and sexual conformity of women as a way to accomplish their economic status. Furthermore, barriers to condom use incline towards cultural definition of a good sex and perceptions of sex from a procreation standpoint. In addition, research shows that rejection of condom use is due to several reasons including assertions that it reduces sex enjoyment, uncomfortable to use, they come off inside a woman and that they pedal promiscuity. Other barriers such as doubt in the efficacy of condoms, myths, physical side-effects and others have also been reported. On the other hand, marital status greatly affects condom use. In non-marital relationships, condom use is high and chunkily intended for preventing sexually transmitted infections (STI) especially HIV/AIDS. In contrast, condom use and marital intimacy are incompatible, since bringing the two together may be thought of as confessing infidelity. Evidence shows that other than preventing a pregnancy, condom use within marriage suggests lack of trust between partners and consequently betrays the intimacy that is necessary within a marital relationship. Married women will most likely use condoms if they know or suspect that their partners are infected with HIV or other STIs.

Condom use among unmarried women may be affected by the type of partner. Relationships in which sugar daddies or large amounts of material assistance are involved, condom use is less likely. Also, condom use tends to be higher in the beginning of a relationship, but drops in subsequent contacts as the relationship extends, even if the HIV status among the partners may be unknown.

Gender inequality in the HIV/AIDS burden has been reported in SSA, thus a need for gender-specific efforts in combating the HIV/AIDS. Evidence shows that in 2007, women accounted for 61% of all adults living with HIV in SSA, and 75% of young people infected were girls [13]. The extent of HIV infection tends to be higher among women than men. It has been established that the biological make-up of the female genitalia together with cultural frameworks within which sex occurs, exposes women more to the risk of contracting HIV than their male counterparts.

 

Negotiation Skills about using condom

It might not be easy to negotiate with your partner about using condoms. Here are some tips, which may be helpful:

Select an appropriate time :

It is difficult to talk about using condoms when you are "in the heat of the moment". A better way is to bring up the subject in a frank and honest manner when you are relaxed together, like over lunch or while taking a walk.

Give a clear message :

Tell your partner about your need and expectation, making the message clear and to the point. Let your partner know that you care about health and encourage him/her to do the same. For example you may say, "I want to have sex with you, but I won't unless we use protection." Or "I have decided to use condoms because I don't want to risk getting sexually transmitted infections or getting pregnant."

Make condom use fun :

With a bit of creativity, you and your partner can make it fun to use a condom. Try a variety of different condoms, experiment with the size, shape, texture and thickness and look for different colours and flavors until you find the ones that you both prefer. Also, putting on a condom can be made part of your foreplay: for instance, just before putting on the condom, spread some lubricant on the head of the penis and gently massage the penis to get sexually aroused. Keep in mind that your health and your life are more important than a few moments of embarrassment.

What if your partner says "NO" ?

Common excuses for not using condoms:

• "Don't you trust me?"
• "It's like having a shower while wearing a raincoat!"
• "I am already using other contraception."
• "It spoils the mood."
• "I thought we loved each other."

We tend to want to please the person we care about, so being firm may not be easy. If your partner resists or pressurizes you, you need to repeat the message and use more "I" statements. For example:

• "When you say this, I feel upset. Although I do trust you, I don't trust your previous partner(s). I think it's better that we use a condom."
• "When you say that putting on a condom is like having sex with a raincoat on, I feel frustrated because we both know the risks of not using a condom. I just want us to include condom use in our sexual activity. There are so many condom styles, let's choose one together!"
• "When you only care about contraception, I still feel worried as there are other risks to think of and I would like us to use a condom as well."
• "When you say the condom will spoil your mood, I feel cross because it seems like you are using that as a threat. I don't enjoy sex when I don't feel safe and I'd like us to think about all this before we do anything."
• "When you complain about using condoms, I feel upset because I really care about you and I was preparing for something that concerns us both. I think it's time for us to talk about our relationship."

Act on your decision :

Following through on your decision is a continuous process that may not be easy, but once you have decided "No condom, No sex", you must act according to your resolution in spite of your own sexual feelings and/or pressure from your partner.

Culled from:

1.    Exavery et al. BMC Public Health 2012,12:1097, http://www.biomedcentral.com/1471-2458/12/1097

2.    Red Ribbon Centre, http://www.rrc.gov.hk