Like it or not, some people can’t or don’t want to use condoms. We investigate some of the reasons and alternative options.
“Tell him if it’s not on, it’s not on!” Remember that campaign? If you’re over the age of 25 and grew up in Australia, perhaps you’re familiar with this or similar messages from years gone by. But does this attitude and approach still hold currency in a brave new world of biomedical prevention?
Our GPs and sexual health experts do an outstanding job of providing recommendations to help us understand how best to protect ourselves. So it’s really no wonder they recommend using condoms to maximise our own protection, even for use in conjunction with other available strategies. Condoms are cheap, readily available and have done a pretty good job of preventing HIV and other STIs for over 30 years. However, the pragmatic truth is that not everyone uses them every time.
Condoms in history
Although there’s some evidence of condom like devices being used for birth control as far back as the 15th century, it wasn’t until the early 1980s that we figured out they could also help prevent the spread of HIV. That’s around about when men who have sex with men first started using them.
“…it’s undeniable that condoms have, and continue to play a hugely important part in keeping the HIV epidemic and several other STIs at bay.”
Whether you love them or hate them, it’s undeniable that condoms have, and continue to play a hugely important part in keeping the HIV epidemic and several other STIs at bay. What they haven’t done is stopped HIV transmissions altogether. So what are some of the biggest reasons why they might not get used?
Reasons why some guys may not use condoms
- Maintaining an erection while wearing a condom simply isn’t doable
- Being in a monogamous relationship
- For allergy sufferers, latex-free condoms exist, though they might not be as readily available
- Having a penis size or shape that causes challenges with condom usage or comfort
- Usage of alcohol or other drugs impairing ability to use a condom properly, or even at all
- A bottom (receptive partner) must rely on a top (insertive partner) to put a condom on and keep it on
- Belief that offering sex without a condom will be more desirable to others
- Being comfortable to not use condoms for HIV prevention when using PrEP as another highly effective strategy
- Mental health conditions involving stress or depression affecting a person’s decision to protect their own wellbeing
- In a BDSM or power play context, submissive partners could have diminished capacity to manage their own protection
- Negotiated safety based on mutual agreements between the people involved
- Being a person living with HIV and having no risk of transmitting the virus by using treatment to maintain an undetectable viral load
- Not being aware of the benefits of condom protection due to lack of knowledge
Gay and bisexual men have a history of being leaders in rallying for availability and adoption of HIV prevention strategies. As a community most affected by the HIV epidemic, encouraging use of condoms played a major part in HIV prevention through the ‘80s and ‘90s. As a means to ensure our survival at the time, it’s possible to see why some people’s attitudes might be damning of condomless sex today.
What’s important to remember is that criticising someone for not using a condom doesn’t help protect them, and is unlikely to support them in changing their behaviour. Ultimately, nobody deserves to get HIV regardless of the circumstances.
“…criticising someone for not using a condom doesn’t help protect them, and is unlikely to support them in changing their behaviour.”
Not using a condom in a situation where we imagine we would ordinarily do so doesn’t mean any of us have failed. It means we’re human. Regardless of sexuality, humans have had a natural desire for intimacy and connection since as far back as we can record. Men who have sex with men have been using condoms for less than 40 years, which is a mere blink of an eye relative to the history of the human race having sex.
Considering advertising from the height of the AIDS crisis spread messages of fear and death, it’s no wonder we sometimes have a complex relationship with sex and condoms. If you’ve ever experienced that certain kind of intense passion to be had in moments of intimacy, maybe you can also relate to how easy it is to let rational decision making slip by the wayside.
And if you find that’s you or someone close to you, we now have even more options to protect ourselves and each other against HIV, and they’re all fully compatible with condoms. Here are some other options you might find more practical, realistic and easy to manage:
If you’re HIV negative, PrEP could be right for you.
PrEP stands for Pre-Exposure Prophylaxis. PrEP is a highly effective HIV prevention strategy involving a program of using prescription medication once a day to protect you against HIV. PrEP allows you to take control of your own health and protection, and it works around the clock regardless of the choices you make.
PrEP involves the daily use of anti-HIV drugs to protect you against HIV before the possibility of exposure to HIV. PrEP needs to be taken on an ongoing basis for as long as you choose to be protected by it.
If you’re wondering if PrEP is right for you or someone else, check out our information on it here.
TasP and Undetectable Viral Load (UVL)
If you’re HIV positive, treatment holds two big benefits.
TasP stands for Treatment as Prevention. TasP is a highly effective HIV treatment strategy involving a program of using prescribed drugs once a day to manage HIV. TasP allows you to take control of your own health and it works around the clock regardless of the choices you make.
TasP involves the use of drugs to suppress the HIV viral load in your body. This is important because maintaining a suppressed viral load that is considered “undetectable” means there is no risk of transmitting the virus to someone else. Treatment works to keep your health maintained and has the added benefit in being a powerful tool to prevent the onward transmission of HIV. TasP is only for people already living with HIV and is used on ongoing basis.
If you’re HIV negative, knowing about PEP and how to get it can help you stay that way in an emergency.
PEP stands for Post-Exposure Prophylaxis. PEP is a one-month course of anti-HIV drugs intended to prevent someone from acquiring HIV after the possibility of an exposure. For PEP to stand a good chance of working it must be taken within 72 hours after exposure.
Use this website to know how and where to get PEP