The degree to which people have taken up the use of condoms during the HIV epidemic varies hugely according to a whole number of different factors. These include the following

• The degree to which people know that an activity carries an HIV transmission risk.
• Whether they think their partner is likely to have HIV.
• Whether they are having casual or commercial sex or are in a steady relationship.
• Whether they are HIV-positive themselves.
• Whether risky sex is linked to using alcohol or drugs, which impair people’s ability to make healthy decisions.
• Whether their behaviour is influenced by chronic mental health problems such as depression, low self-esteem or learned behaviour due to sexual abuse.
• Whether they are in a position to insist on the use of condoms.

The main factors that influence condom use (other than drugs and mental health) can be illustrated by taking, more or less at random, a selection of condom usage figures from different population groups and exploring the differences between them.

KEY

A – US Heterosexuals under 35 – vaginal sex – ‘always or often’ (American Social Health Association, 2004).

B – US Heterosexuals under 35 – new partners – anal sex – ‘always or often’(ibid).

C – San Francisco gay couples, seroconcordant (both HIV-negative) (Guzman 2005).

D – US gay youth, serodiscordant (HIV+/HIV-)(Lightfoot 2005).

E – UK gay men’s sex survey 2003 – ‘no unprotected anal sex’(Hickson 2003).

F – UK gay men’s sex survey 2003 – ‘probably not had serodiscordant unprotected anal sex’(ibid).

G – Thai sex workers and clients (Mechai 2004).

H – Thai teenage boys (Agence-France Presse 2003).

J – Men, Rakai, Uganda – 1994 – wives and girlfriends (Najjumba 2003).

K – Men, Rakai, Uganda – 2004 – wives and girlfriends (ibid).

L – Women, Uganda – ‘ever used’ (ibid).