- The Washington Times - Friday, November 8, 2002

Most public health professionals say condoms are the best technology science has to offer when it comes to preventing the spread of sexually transmitted disease.
But the much-promoted condom which has its detractors may be facing yet another opponent: "prevention fatigue," or a general weariness of the safe-sex message.
Last year, the Centers for Disease Control and Prevention's National Center for HIV, STD and TB Prevention cited prevention fatigue as a key reason homosexual men were becoming "increasingly complacent" about HIV prevention and condom use.
This spring, in an open letter to the public about syphilis outbreaks in homosexual communities, the AIDS Project in Los Angeles said prevention fatigue was a problem that could be cured with new "comprehensive sexual health promotion."
"Blaming gay men for their 'prevention fatigue' seems misguided, especially if we simply recycle the same old narrowly conceived condom-use messages ," the AIDS Project said.
While "condom fatigue," as it is called in Canadian research circles, most often has been linked to homosexual populations, there is also concern that teens and college-age people are stopping their use of condoms as they become older or more sexually experienced.
Safe-sex proponents say some condom data have been encouraging: The latest Youth Risk Behavior Surveillance Survey (YRBSS) shows that 58 percent of sexually active teens used condoms in 2001, up from 53 percent in 1993.
The latest National Survey of Family Growth (NSFG) also shows an explosion of condom use among teenage girls during their first sexual experience: In 1982, 23 percent of girls ages 15-19 said they used a condom "at first sex"; in 1995, 63 percent of girls said they used a condom.
However, these same studies show condom use falls with time: The YRBSS, for instance, showed that in 2001, 68 percent of sexually active ninth-graders used condoms but only 49 percent of sexually active 12th-graders used condoms.
When the NSFG asked teen girls in 1988 and 1995 what they used for contraception at their "most recent sex," 26 percent and 28 percent, respectively, said they used condoms.
"Getting people to think about their own personal health needs especially in a prevention mode is always difficult, whether it's convincing people to wear a condom or convincing people to brush their teeth," said Chicago Department of Public Health spokesman Tim Hadac, who started seeing "condom fatigue" several years back.
"I've seen [condom fatigue] for a long time," said pediatrician Dr. Meg Meeker, author of the new book, "Epidemic: How Teen Sex Is Killing Our Kids."
"I have given out many condoms and a lot of birth control, and absolutely, kids will try things once go on birth control for a month or two or use a condom once or twice," she said.
But as they continue with their sexual activity, Dr. Meeker said, they start feeling demoralized, out of control or depressed and stop using condoms or birth control. "In short, they don't care as much about who they are," she said. And, in her experience, "holding off" from sex is a more positive, powerful message for teens.
Condoms have long evoked mixed feelings. Rubber condoms were created in the 1840s and latex ones appeared in the 1880s. In 1861, the New York Times ran the first U.S. condom ad, for "Dr. Power's French Preventatives."
But condoms often were condemned as immoral, and groups such as the American Social Hygiene Association tried to prohibit condom use during the early 1900s, said an article written by Jon Knowles, public information director at Planned Parenthood Federation of America, and posted on the organization's Web site.
Condoms also were disliked because they reduced physical sensations, were awkward to use and were associated with prostitution.
In fact, the 1960s sexual revolution "almost put an end to condom use," wrote Mr. Knowles. An abundance of casual-sex partners reduced the need for prostitutes, the only STDs (gonorrhea and syphilis) were curable, and birth-control pills and the intrauterine device (IUD) addressed pregnancy fears.
The discovery of AIDS in the 1980s led to a condom revival after it was identified as the best technological barrier to the deadly virus.
Today absent AIDS vaccines and over-the-counter STD germ-killers condoms reign as the best tool to stop STDs, and their future may be brighter. An estimated 6 billion condoms now are distributed each year worldwide, but population analysts say 24 billion condoms could be distributed. Condom markets in some countries are growing 15 percent a year, the Economist reported in 1999.
Condom fatigue, however, may have been born in 1995, when homosexual porn star Scott O'Hara wrote an article called "Exit the Rubberman," in which he said, "I'm tired of using condoms and I won't. " Mr. O'Hara, who had HIV, died of complications from lymphoma in 1998.
His statement marked a rebellion against the 1980s AIDS mentality, which viewed condom use as a "virtual communal duty," homosexual author Michael Scarce wrote in a widely read 1999 article in POZ magazine, published for people with AIDS and HIV.
"Men don't want to face a lifetime of wrapping themselves in latex," one homosexual man explained to Mr. Scarce.
Research may also be contributing to condom fatigue with less-than-stellar findings about the device's effectiveness.
The National Institutes of Health (NIH) released a study last year that found condoms offered 85 percent risk reduction for HIV-AIDS and some risk reduction for gonorrhea in men, but insufficient evidence about its impact on other STDs. More research is needed, the NIH study said.
The NIH study, plus other new studies, show "safer sex isn't nearly safe enough," the Medical Institute for Sexual Health concluded in a just-released report on condom effectiveness.
The way to promote condoms is not to say "use this or die," but make them a part of everyday life, said Stephen Mare, director of sales and marketing for Global Protection Corp. (GPC), a condom maker and distributor in Boston.
GPC, for instance, addresses consumers' dislike for the feel of condoms with a product that is ultrasensitive and disarms the fatigue issue with condoms that glow in the dark, he said. These brands "refresh" the condom's image, Mr. Mare added.
A "much bigger problem" than condom fatigue is "the frustration" people have with the restrictions in abstinence-only education, said Barbara Huberman of Advocates for Youth, which leads a safe-sex campaign called "Rights. Respect. Responsibility."
Studies show that if young people believe they should use condoms because they are effective, and they feel supported in these decisions by their friends, community or parents, they are more likely to use condoms, said Ms. Huberman.
The "three R's" campaign, she said, sends "a positive message" that when young people receive good sex education and access to health services, "they will act responsibly."

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