The use of condoms is another central piece of the fight against HIV transmission. For those using them as a method of family planning, it can be even more important as injectable hormonal birth control has been found to increase the risk of HIV infection (Heffron et al., 2012). Unfortunately, the public health message to be faithful or to use a condom can equate the concept of condom use with unfaithfulness or promiscuity, thus increasing the stigma associated with condom use. Additionally, an understanding of the risk and how condoms can reduce it is often insufficient; self-efficacy in their use is an important piece (Rimal, Bose, Brown, Mkandawire, & Folda, 2009).
Many countries have had to face issues about the use of condoms to spread the prevention message. Worldwide, problems remain with access to, and willingness to use, condoms and water-based lubricants. For example, there has been difficulty in countries such as Kenya and Uganda with condom availability and promotion (“Condoms continue,” 2013; UNAIDS, 2012a). Uganda has been accused of “bowing to U.S. pressure to emphasize abstinence over condom use” (“Condoms continue,” ^2, 2013). Much of the money coming to Uganda from the United States is through pro-abstinence organizations, which can also be anti-condom. Some Ugandan teachers reported that they were instructed by US contractors not to discuss condoms (Human Rights Watch, 2005).
Religious leaders, including Catholics and Pentecostals in Uganda, and Christians and Muslims in Kenya, have campaigned against the use and promotion of condoms, fearing that they will promote immorality (“Condoms continue,” 2013; “Muslim clerics,” 2008). In Kenya and Uganda, campaigns to promote condom use in the case of infidelity were very controversial, despite high rates of infidelity and infections in this manner. These campaigns were viewed as promoting cheating and contrary to the “Be Faithful” message (“Kenya condom advert,” 2013;
“Ugandan HIV campaign,” 2013). Stores in certain areas of Kenya refused to carry condoms, stating they promote infidelity (“Muslim clerics,” 2008). Use of condoms has declined sharply in Uganda since 2005, and it is believed that this, combined with the high level of stigma against MSM and sex workers, is driving the rising HIV prevalence rate (“Condoms continue,” 2013).
In some cultures, the value of a woman depends on how many children she can bear, greatly limiting the incentive to use a condom, as it would inhibit conception (Plusnews, 2003). In India, it has been found that the association of condoms with family planning reduced the likelihood that married women would use them, even though married women are considered a risk group due to the extramarital sexual activity of their husbands (Bhattacharya, 2004). In Malawi, AIDS was originally said to stand for “American Invention Depriving Sex” and was viewed as a US family planning plot, family planning being contrary to indigenous cultural values (Lwanda, 2005).
In India, the social stigma associated with condom use acts as a barrier to their purchase. Therefore, one intervention set up “condom depots” in offices, banks, and marketplaces where people could simply pick up condoms. Therefore, they were easily accessible and no one could be identified as using them. They were found to be 30 times more effective at distributing condoms than condom vending machines (Tamboli, 2010).
In China, there was a stigma against condom use: Those who use condoms must be promiscuous. However, this is being overcome and the sale of condoms in China has boosted the profits of the makers of Durex condoms; sales in China grew 46% in a year (Ford, 2010). Mechai Viravaidhya, an internationally known Thai AIDS activist and politician, worked in Thailand to de-stigmatize condoms by sponsoring contests to blow up condoms and having police officers pass them out in traffic in his “Cops and Rubbers” program (D’Agnes, 2001).