Thursday, April 08, 2004

Sure, You're Safe

According to the American Social Health Association (via CNN), after all these years of public service announcements, most Americans still don't have a clue about safer sex.
The majority -- 84 percent -- of the survey respondents said they take necessary steps to prevent catching an STD, but 82 percent of the sexually active participants said they never use barrier protection when having oral sex. Almost half said they go without condoms when having vaginal sex. [...]

More than 90 percent of respondents said they believed their current or recent sexual partner was disease free. But a third of them never discussed STDs with their partners and only half said their partners had been tested.
The interesting aspect of this survey is the disconnect between people's beliefs and their behaviors. Some large percentage of them are having unprotected sex with a partner who has not been tested for STDs, and yet they believe they're taking all the necessary steps to avoid infection. Sounds like crazy stuff, but it's actually perfectly consistent with research showing that the number one risk factor for unprotected sex, among the general population, is being in love.

The message that most Americans appear to have picked up from STD education is that you should wear a condom with a new partner, someone you don't know very well, someone you're not sure you can trust. A large majority of people use a condom for the first sexual encounter in a relationship, but the percentage of people who use condoms for the second, third, and fourth encounter - and so on - decreases linearly. As couples grow to love and trust each other, they generally stop using condoms. Rational people include a step where they go and get tested together, or trade doctor's notes, but for the majority of the population that step appears to be optional. Instead, people seem to develop a general sense that their partner is "safe," which leads them to believe that sex with their partner must also be safe. They let down their emotional barriers, and so using a physical barrier seems untrusting or unnecessary.

In retrospect, you can see how a lot of safer-sex education materials might unwittingly lead people in that direction. Prevention messages tend to address safer-sex discussions and decisions as things that happen when a relationship begins - or in the context of casual sexual encounters. There's an undertone of "you can't trust this person; you don't necessarily know where they've been" to a lot of safer-sex messages, so it's unsurprising that people discard those recommendations when they do conclude that they can trust their partner.

I don't think I've ever seen a pamphlet or ad directed at the general public that talked about how established couples can decide whether or when to stop using condoms. And yet, it's unreasonable to expect lifetime condom use in established relationships. If nothing else, some people are going to get married and decide to have babies. Marriage isn't exactly protection against STDs, but there's a general expectation that married couples don't use condoms unless they're using them for birth control - in the absence of a general expectation that couples who are sexually active prior to marriage should get a whole panel of STD tests.

We've done a decent job, culturally, of teaching people that condoms are basic and expected elements of casual sexual encounters. But until we do a better job of teaching people how to integrate safer-sex protections into loving and committed relationships, we're going to continue to get survey results just like these.