When may a couple stop using condoms? [letter]

In vitro studies and theoretical considerations suggest that the proper use of condoms provides a barrier to the sexual transmission of the human immunodeficiency virus (HIV). Yet the indications for condom use particularly among heterosexuals have not been clearly defined. Heterosexuals engaging in sex with many different partners and in high-risk settings e.g. with prostitutes or in sex clubs would be wise to use condoms. Couples in longterm monogamous relationships whether married or not most likely need not use condoms. Among the latter the risk appears to be exceedingly low at this time and it is neither practical nor reasonable to expect that all such couples should forego the pleasures of unfettered sexual expression to reduce this infinitesimal risk. The problem lies between these 2 extremes. There is for example the man or woman who meets a new sexual partner at a singles bar and (appropriately) uses a condom during their 1st sexual contact. The question arises as to what point the couple may stop using condoms if the relationship survives the 1-night stand phase and continues for weeks or months or years. The risk of transmission from an infected partner is increased due to the longer duration of exposure and it may be reasonable for the couple to undergo testing for anti-HIV antibody and stop using condoms only if both partners are found to be seronegative. This is only 1 example of the need to define the indications for condom use. Precise recommendations should be developed and continually revised as the changing epidemiologic situation indicates.