Condom Use Waning Among Younger Adults: Public Health Watch Report

After the number of HIV/AIDS cases reached epidemic proportions in the United States during the 1980s, the concept of “safe sex” seemed to achieve near-universal acceptance among the general public.

“Protection” (wearing a condom, for men) meant more than preventing unwanted pregnancy—it was a matter of staying healthy or even alive.

Now, though, there are indications that condom use may be waning among younger, sexually active individuals, and we are already seeing the consequences. According to the US Centers for Disease Control and Prevention’s (CDC) annual report, Sexually Transmitted Disease Surveillance, released earlier this month, the overall incidence of sexually transmitted diseases (STDs) has now increased in each of the past 3 years (2014, 2015, and 2016), with the number of cases of relatively rare infections such as early syphilis (27,814 cases in 2016) and congenital syphilis (628 cases in 2016) rising at alarming rates (up 17.6% and 27.6% from 2015, respectively).

Knowing this, it is now incumbent upon the public health community to determine the causes of these disturbing figures and identify means of reversing them.

The ongoing opioid abuse/misuse crisis in the United States arguably plays at least some role as a causative factor in the increasing rate of STDs and poor adherence to safe-sex practices, at least based on the limited research published on the topic to date. A 2015 study of women enrolled in addiction treatment programs, for example, found that more than 90% had at least 1 “unprotected” sexual encounter (no condom use) in the 3-months prior to enrollment, while a 2009 report found that “cocaine use, alcohol use, and opiate use diagnoses” were associated with increased risk for “having multiple partners, trading sex for drugs, [or] having anal sex,” among other high-risk behaviors.

However, it’s possible that the reasons behind poor adherence to safe-sex practices are more nuanced than that. In an essay published last December 2016 in Esquire, writer Dave Holmes cautioned gay men, in particular, against having a false sense of security in the age of pre-exposure prophylaxis (PrEP). Although PrEP can and will keep people from becoming HIV-positive, it does not mitigate all risk for all STDs. He urged readers (gay, straight, and/or other) to “take a tip from [his] generation and throw on a condom.”

Unfortunately, not all young, sexually-active adults are taking his advice. A “millennial sex survey,” conducted by condom manufacturer SKYN and published in Men’s Fitness, found that fewer than 60% of 18- to 24-year-olds regularly use condoms during sexual encounters. A survey at Duke University, the results of which were published online by the school newspaper, found that just 66% of sexually-active students at the school regularly used condoms. Meanwhile, more than 40% of sexually-active teens don’t use condoms, according to the CDC.

At issue may be the perception that the purpose of condoms is to prevent unwanted pregnancies, as opposed to disease prevention, according to experts quoted in a Readers’ Digest article published in September. In addition, Holmes, in his essay in Esquire, implies that there also may be a feeling among younger adults that advice about safe-sex practices is really an admonition about sexual experimentation in disguise—and that they may respond defensively and tune out the message. He writes, “Recent outbreaks of syphilis, gonorrhea, and chlamydia seem to indicate that younger people are feeling freer to engage in higher-risk activity without condoms... In an era where a simple message like ‘You still need to practice safe sex’ can be shrugged off with accusations of slut-shaming, it’s hard to get the point across effectively…”

Clearly, new actions are needed to make safe sex “cool” again, and that may mean reinforcing the idea that sexual experimentation is okay... if it’s done safely.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.