HIV-prevention interventions that include information about condoms do not inadvertently lead to earlier sexual debut, more frequent sexual activity, or more sexual partners, according to a new meta-analysis of 174 studies published in the March 2006 edition of the Journal of Acquired Immune Deficiency Syndromes . Conducted in order to assess whether condom-related interventions inadvertently undermine sexual risk-reduction efforts by increasing the frequency of sexual behavior, the study reviewed the influence of HIV risk-reduction interventions on individual’s number of sexual encounters, number of partners, and abstinence.1

Researchers from the University of Connecticut and Syracuse University , with a grant from the United States National Institutes of Health (NIH), are the first to address together the questions of whether condom-based interventions affect the overall frequency of sexual behavior and whether interventions designed to reduce sexual frequency are the most effective. The meta-analysis looked at 174 studies published between January 1989 and May 2003 involving 206 separate interventions. The interventions consisted of 116,735 participants, an equal amount of whom were men and women, and 54% of whom were black. The majority of the studies (80 percent) were conducted in the United States and most (70 percent) were conducted in medium to large cities.2

The researchers found that, overall, interventions which provided condoms to study participants had no effect on the number of sexual partners, the total number of times participants had sex, or whether participants who were previously abstinent became sexually active. “This finding,” wrote the researchers, “should provide reassurances that increased numbers of sexual occasions, larger number of partners, and more likely sexual activity are not [unintentional] effects of providing condoms or training in condom use skills and interpersonal negotiation still.”3

The study also concluded that including more information on condoms, messages about why condom use is important, and behavioral skills training is more likely to have a positive effect on reducing the frequency of sexual activity compared to interventions that do not include these three components. In fact, when they specifically examined interventions that had improved condom use, they found that these also reduced numbers of sexual partners and the number of times participants had sex. The researchers noted that, “this finding suggests that risk-reduction interventions work, at least in part, by engaging intrinsic motivation for self-protection.” In addition, “this suggests that negotiating a safe sexual relationship with a partner requires skill. Individuals who lack the ability to skillfully decline a partner’s advances may be at greater risk for unintended sexual advances, including unprotected sex.”4

The researchers conclude that, “although condom use has been touted as the primary and most beneficial sexual risk-reduction outcome,” an approach that combines condom use with “key elements of behavioral theory” may be most successful at reducing sexual frequency and number of partners.

“This study confirms that discussing condoms with people and showing people how to use condoms will not in fact make people have sex sooner, increase the number of partners they have, or even increase sexual activity with existing partners,” said William Smith , vice president for public policy at SIECUS. “While myths related to condom education are quite pervasive, this study confirms that they are ultimately unfounded.”

References

1. Natalie D. Smoak, PhD, et al, “ Sexual Risk Reduction Interventions Do Not Inadvertently Increase the Overall Frequency of Sexual Behavior: A Meta-analysis of 174 Studies with 116,735 Participants,” JAIDS: Journal of Acquired Immune Deficiency Syndromes, March 2006, 41(3):374-384.
2. Edwin J. Bernard, “Condoms for HIV prevention do not lead to earlier sex, more sex, or more partners, meta-analysis concludes,” aidsmap, 24 March 2006, accessed 12 April 2006, <http://www.aidsmap.com/en/news/34FE2167-2DE0-4B2A-B2D0-319230755C1E.asp>.
3. Ibid.
4. Ibid.