Correspondence

What Heterosexual Adults Believe about Condoms

N Engl J Med 1994; 331:406-407August 11, 1994

Article

To the Editor:

Beliefs about condoms are powerful correlates of condom use among adolescents,1 adults,2 heterosexuals,3 injection-drug users,4 and homosexual men5. However, information on these beliefs is scant. Using data from a probability-based telephone survey of people living in 23 urban areas in the United States with a high prevalence of AIDS (as described by Catania et al.6), we examined the beliefs about condoms held by 5331 heterosexual adults 18 to 49 years of age (59 percent were white, 49 percent male, 42 percent 18 to 29 years old, 47 percent married, and 56 percent college-educated).

Few respondents said that they believed that condom use is immoral (4 percent) or that it makes men look silly (16 percent). Most agreed that condoms are an effective means of preventing sexually transmitted diseases (96 percent) and an effective contraceptive device (83 percent). However, 54 percent believed that condoms might fail during intercourse, and 41 percent complained that they reduce sexual sensation. In addition, 37 percent worried about losing their partner's trust if they suggested using a condom; 35 percent said they felt embarrassed about buying condoms, and 21 percent said they felt uncomfortable about putting them on.

Multiple logistic-regression analysis (Table 1Table 1Beliefs about Condoms among Groups of Heterosexual Adults, According to Multiple Logistic-Regression Analysis.) revealed that distrust associated with condom use correlated with male sex, black race, Hispanic ethnic background, and a lower educational level. The response that condoms frequently fail during sex was more common among blacks, Hispanics who were married or older, and people with less education. Men and less well educated respondents were more likely to believe that condom use reduces sexual enjoyment. Women felt more embarrassed than men about buying condoms. Finally, Hispanic women and those with less education were less comfortable with regard to handling condoms during sex.

On the basis of these findings, we recommend that feelings of distrust be counteracted by the portrayal of condom use as a caring and responsible behavior for men. Instructions that illustrate correct condom use should be widely distributed, especially to blacks, married or older Hispanics, and people with less education. Publicity materials should eroticize condom use, and it should be made easier for women to purchase them by mail and from vending machines. Training and counseling are needed to increase sexual comfort with regard to condom use, especially among Hispanic women and those who have less education.

Although condoms may not provide absolute protection against the human immunodeficiency virus (HIV),2 their consistent use should be promoted rigorously. Such use will slow the spread of HIV and sexually transmitted diseases. The mass media should help in the promotion campaigns. The medical community can also help, since three quarters of Americans visit a doctor every year7.

Kyung-Hee Choi, Ph.D., M.P.H.
Richard Rickman, Ph.D.
Joseph A. Catania, Ph.D.
University of California, San Francisco, CA 94105

7 References

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Citing Articles (12)

Citing Articles

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   Brandon J. Hill, Erick E. Amick, Stephanie A. Sanders. (2011) Condoms and US college-aged men and women: briefly assessing attitudes toward condoms and general condom use behaviours. Sexual Health 8:3, 372
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   J. A. Higgins, S. Hoffman, S. L. Dworkin. (2010) Rethinking Gender, Heterosexual Men, and Women's Vulnerability to HIV/AIDS. American Journal of Public Health 100:3, 435-445
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   Jenny A. Higgins, Amanda E. Tanner, Erick Janssen. (2009) Arousal Loss Related to Safer Sex and Risk of Pregnancy: Implications for Women's and Men's Sexual Health. Perspectives on Sexual and Reproductive Health 41:3, 150-157
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   Mary E. Randolph, Steven D. Pinkerton, Laura M. Bogart, Heather Cecil, Paul R. Abramson. (2007) Sexual Pleasure and Condom Use. Archives of Sexual Behavior 36:6, 844-848
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   Tina R. Norton, Laura M. Bogart, Heather Cecil, Steven D. Pinkerton. (2005) Primacy of Affect Over Cognition in Determining Adult Men's Condom–Use Behavior: A Review1. Journal of Applied Social Psychology 35:12, 2493-2534
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   Laura M. Bogart, Alex H. Kral, Andrea Scott, Rachel Anderson, Neil Flynn, Mary Lou Gilbert, Ricky N. Bluthenthal. (2005) Condom Attitudes and Behaviors Among Injection Drug Users Participating in California Syringe Exchange Programs. AIDS and Behavior 9:4, 423-432
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   BRUCE M. KING, TAMARA M. SCOTT, SUNBLE E. WAJEEH. (2005) FACTORS AFFECTING INDIVIDUALS DISSUADING SEXUAL PARTNERS FROM USING CONDOMS: A COMMENT ON McDERMOTT AND NOLAND ¹. Psychological Reports 96:3, 586-590
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   Mary Sormanti, Leslie Pereira, Nabila El-Bassel, Susan Witte, Louisa Gilbert. (2001) The Role of Community Consultants in Designing an HIV Prevention Intervention. AIDS Education and Prevention 13:4, 311-328
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   Lisa K. Comer, Carol J. Nemeroff. (2000) Blurring Emotional Safety With Physical Safety in AIDS and STD Risk Estimations: The Casual/Regular Partner Distinction1. Journal of Applied Social Psychology 30:12, 2467-2490
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    JANET LEVER. (1999) Using Print Media for STD Prevention: Reflections of a Journalist/Public Health Researcher. AIDS Patient Care and STDs 13:12, 689-693
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    PAUL ROBERT APPLEBY, LYNN CAROL MILLER, SADINA ROTHSPAN. (1999) The paradox of trust for male couples: When risking is a part of loving. Personal Relationships 6:1, 81-93
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    S PINKERTON, P ABRAMSON. (1995) Decision making and personality factors in sexual risk-taking for HIV/AIDS: A theoretical integration. Personality and Individual Differences 19:5, 713-723
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