Of HIV infection condoms and sexuality education [letter]

There are many programs in southern Africa that place great emphasis on the use of condoms to prevent the spread of human immunodeficiency virus (HIV); this approach is associated with several problems. First condoms do not cover the lesions found in human papillomavirus (HPV) infection the main cause of carcinoma of the cervix. Second the determinants of condom use are not understood; in spite of counseling every 6 months only 123 of 563 mature couples with 1 partner known to be HIV positive agreed to use condoms consistently. Fewer than 50% of high risk persons in the First World use condoms. Third the emphasis on condom use assumes young people who are likely to become involved in a promiscuous lifestyle actually want that lifestyle; an American survey in Atlanta showed that 84% of the girls participating in a teen services programs wanted information on "how to say no." Fourth explicit sex education linked to a condom "safe sex" message presents promiscuity in a positive light and invites experimentation; an increase in sexual activity among students was found in 6 of 7 studies of sex education programs. Fifth the message assumes sexual decisions are based on cognitive reasoning rather than values and emotions; forming mature value systems is more important than explicit sex information. Sixth the message has been unsuccessful in the highly literate population of the United States where information on HIV is readily available; in a group of teenage males the proportion of those having had coitus rose from 60% in 1988 to 84% in 1991 but the use of condoms dropped from 56% to 44% as they grew older. Seventh any message that threatens the value placed by traditional peoples on virginity being retained until marriage will widen the generation gap. Eighth sexual risk taking reduces the prognosis for a secure long-lasting marriage with intact fertility and a happy healthy family.