This article by Martha Kempner first appeared in TheBody.com here.
If you've ever chosen to forego a condom or had difficulty using them correctly, you are far from alone. Few gay or bisexual men or couples use them every time, despite their power to prevent sexually transmitted infections (STIs). We forget. We make mistakes. And, we take calculated risks.
These days, additional strategies such as pre-exposure prophylaxis (PrEP) and sex with HIV-positive partners who have an undetectable viral load have expanded the palette of HIV prevention options. But there are plenty of times and places where condoms have a key role in HIV prevention among gay and bisexual men, as well as in the prevention of a whole lot of other STIs.
Whether you aim for perfect use and miss or make the decision to skip condoms a few times, you might start to wonder whether imperfect condom use is even worth the trouble. Are condoms an all-or-nothing proposition?
Common sense would suggest that using condoms some of the time is better than never using them at all. Think of each act of sex as a stand-alone equation. Your chance of getting a specific STI depends on a number of factors -- most notably, how prevalent the STI is in your community (in other words, the likelihood your partner has it) and how easily that STI is transmitted (so, the likelihood you will get it if he does). Every time you add condoms to this equation, you reduce the risk of transmission.
But the research on this topic is far more complicated and does not provide as clear an argument for condom use as some public health experts would hope. A recent study on men who have sex with men (MSM) and HIV transmission, for example, found that consistent condom use only reduced HIV risk by 70% -- and inconsistent use reduced risk by a mere 8%. Then again, research on this topic is tricky and prone to flaws.
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