Sexual Health – Why Not Condoms?

In Canada, 75% of HIV positive women have been infected through heterosexual contact while 26% have been infected through injection drug use.1

Condoms are not only about birth control. They reduce risk of sexually transmitted infections including HIV. Yet studies have shown that most women living with HIV have been infected through heterosexual sex, and most often through a spouse or a regular partner.2

Married women can find it difficult to discuss condom use with their husbands. The same is true for women who are not married. The topic may bring up sensitive issues, including questions about loyalty and trust. Many women and men might think condoms have no place in a long-term relationship, except as birth control.

The service providers at ACT (AIDS Committee of Toronto), always encourage condom use as the most effective and available way to have safer sex and reduce HIV transmission. We also recognize that many women cannot insist on condom use all of the time.

  • A wife might be reluctant to require condom use in her marriage.
  • A woman might feel unable to ask her husband or male partner if he is having sexual relationships with other people outside of the relationship.
  • A man using injection drugs could be involved with partner(s) who do not know if he is sharing needles or not.
  • Violence and other forms of abuse in the home could mean that it isn’t safe to even raise the subject.

A woman can be blamed for bringing HIV into a relationship. And punished for it.

A third of all women have experienced sexual assault. Many currently live in violent relationships. Based on past and current experiences, women can be afraid for themselves or for their children.

Sometimes, the most vulnerable people are least likely to ask that condoms be used, or to discuss sexual health concerns with spouses or partners. This is true for escapees of conflict situations, women who use drugs, older women, sex workers, survivors of childhood sexual assault or women who live with abuse now. Some fears might be about:

  • blame
  • rejection
  • abandonment
  • deportation
  • discrimination
  • loss of economic support or income
  • loss of reputation in the community
  • having children taken away
  • physical violence or emotional abuse
  • the reaction of family members

There are, of course, other reasons why women might not want to talk about condom use or HIV infection with their partners. Some people do not know where to start. The facts about HIV aren’t widely known. And sexual health education is lacking for young and old alike. A long-term approach to HIV prevention among women means addressing the social and economic issues, gender inequalities and harmful gender norms that put women at increased risk for HIV. It means working with both women and men.

Showing women how to use both female and male condoms is central to the reduction in HIV rates. Making condoms easily available in your agency – without judgment – also helps a lot. A service provider who understands that condom use is not always possible can open the door to exploring other options to improve sexual health. This door can lead to new ways of thinking about relationships – and about self.

Our page on risk reduction describes some other strategies women can use to take care.

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1HIV/AIDS Epi Updates, Surveillance and Risk Assessment Division, Centre for Communicable Disease and Infection Control, Public Health Agency of Canada, July 2010
2Love Sex and Abstinence: A Positive Woman’s Perspective, Luisa Orza, in Exchange: On HIV Sexuality and Gender, Autumn 2006