In 2015, Australian GPs reported a troubling spike in rates of sexually transmitted infections (STIs). Diagnoses of HIV, chlamydia and even syphilis saw an unprecedented increase.
Over the past few decades, contraception use increased slowly. It seemed the effects of HIV awareness campaigns, Healthy Harold and more open conversations about sex were finally paying off.
What healthcare professionals hadn’t bet on then — with increasing awareness of STIs and increasing awareness around contraceptive options — was that condoms would suddenly become uncool. Yet in 2014, the annual Kirby Surveillance Reports, which monitor Australian sexual health trends, found that declining condom use was leading to the increases in STI rates.
Historically, physical or ‘barrier’ protection has primarily been for the purpose of contraception. Jamie* says she uses condoms largely because she “can’t take hormonal contraceptives because of contraindications”. Conversely, Rithika says that she consistently uses physical protection because she feels “uncomfortable thinking about more invasive forms of contraceptive,” and she “can’t be fucked taking the pill”.
Perhaps, then, the drop can be attributed to the fact that more comprehensive awareness of sexual and reproductive health has also led to awareness of alternative forms of contraceptives.
Though the pill isn’t new, its use is often at least partially accompanied by physical protection given the tendency of users to forget to take it. Awareness of alternative and more effective forms of contraception that only need to be taken every few years — like injections, Implanon and IUDs — has meant more people have been able to use hormonal contraceptives without worry, or the need to supplement with condoms.
Harry*, for example, says that his condom use changed quickly when his girlfriend began to use the contraceptive implant rather than the pill. “I guess I really wouldn’t know first hand, but I know she was often unsure if she had taken the pill for that day and when it was effective,” he says. “It meant that we still had to use condoms pretty often.”
Despite changes in contraceptive use, physical protection still remains the only way to prevent STI transmission.
What has stood out is that condom use in the queer community is much more common than elsewhere. It seems that historic pushes for awareness of the importance of physical protection, as well as the memory of the AIDs epidemic, have had long lasting impacts.
Adrian says that his use of condoms is largely influenced by high school sex education, but also because of the spectre of AIDS.
“I think using protection feels a lot more relevant to me because I’m gay and the AIDS epidemic has such a horrible impact of the queer community — particularly men who have sex with men,” says Adrian. In not using protection, “I’m kind of letting down the activists who worked so hard to make treatment available during the height of the AIDS epidemic when the government didn’t care about people with AIDS”. Importantly, HIV transmission is still a real possibility. When asked why he always uses condoms, Sam* who also identifies as gay tells me, “because AIDs looks pretty bad”.
It seems, though, that a person’s culture is among the most important factors determining whether someone will use a condoms or not. According to Rahul*, condoms are seen as unnecessary by his straight male friends. “People don’t think getting HIV is likely, and if a girl is using birth control, then they don’t think they have anything to worry about,” he says. A number of heterosexual people Honi talked to agreed that condoms “just seem uncool”.
In the queer community, condom use also cannot be taken for granted. The advent of PrEP — a new drug that greatly reduces the risk of contracting HIV — has led to some health experts worrying that it may lead to a decrease in rates of condom use.
The work of sexual education campaigns and activists has led to robust awareness of STIs and the importance of protection. The worry, then, is that cultures that dismiss the importance of sexual protection threaten the relatively low rates of STI transmission at the moment. If condoms don’t make a come back, syphilis will.
*Names have been changed.