Promoting protection and pleasure: amplifying the effectiveness of barriers against sexually transmitted infections and pregnancy

The global burden of morbidity and mortality associated with sexually transmitted infection (STI) and unwanted pregnancy is a prominent global public-health issue. For example HIV/AIDS and other STI cause 12.9% of the burden of disease in disability-adjusted life years. Unsafe sex is the second highest cause of the global burden of disease. Therefore an urgent need exists to amplify effective use of evidence-based measures to diminish this burden including barrier methods that protect against both STI and pregnancy (male and female condoms). The limited effect so far of public-health campaigns to promote effective use of these barrier methods might be attributable in part to scare tactics that emphasise adverse consequences of sexual acts. Promotion of pleasure in use of male and female condoms--alongside safer sex messages--can facilitate consistent use of condoms and boost their effectiveness to protect against STI and pregnancy. Therefore the effect of public-health initiatives that emphasise positive outcomes of use of male and female condoms as barrier methods and positive results of practising other forms of safer sex need to be investigated. Such work includes the potential for safer sex to contribute to good health and hygiene in general (and a healthy sex life in particular) to reduce anxiety about risk of STI and pregnancy and quite simply to make sex more pleasurable. In this Viewpoint we discuss the potential for increasing condom uptake and safer sexual behaviours by promoting pleasurable aspects of condom use in public-health campaigns. (excerpt)