Increasing Consistent Condom Use By Young Men
10 July 2000
MINISTER OF YOUTH AFFAIRS
Increasing Consistent Condom Use By Young Men
1. This paper discusses the issue of increasing consistent condom use by young men. In particular the paper outlines the following:
access to condoms
consistency of use
effective use of condoms.
2. Previous work by the Ministry of Youth Affairs (see appendix for background summary) has led us to focus on working with other agencies on developing methods to encourage young men to:
delay the onset of sexual
take contraceptive responsibility and practise safe sex, if sexually active
seek diagnosis and treatment if exposed to a sexually transmitted infection (STI).
3. One of the priority areas identified was increasing young men’s access to condoms. Increasing access to condoms is possibly the simplest and most cost effective strategy to improve sexual and reproductive health by providing protection from pregnancy and STIs. Increased access must, however, be accompanied by mechanisms to encourage consistent and effective use.
Access To Condoms
4. Currently condoms can be purchased over the counter from retail outlets such as pharmacies, supermarkets and petrol stations. Condoms can also be purchased at bars and restaurants from condom vending machines in the toilets. However, for many young men cost is a barrier. Research has shown that free condoms are obtained at a greater rate than those at low cost .
5. Free condoms are available for young people. Pharmac fully subsidises several brands of latex condom. They are available by prescription at general practitioners but there may be a consultation fee and a prescription part charge. Free condoms can also be obtained from organisations such as the Family Planning Association (FPA), student health clinics and sexual health clinics. Free condoms are often available at events such as concerts and dance parties . Typically sexual health educators contracted by schools from other organisations will distribute condoms in the school classroom. However, it is not known how widespread this practice is.
6. Although, there are means of accessing free condoms, young men do not appear to taking advantage of these . There may be a variety of possible reasons for this, including:
lack of knowledge about where to access condoms
embarrassment and confidentiality issues
lack of sexual health clinics and FPA clinics in rural areas.
7. To increase the rate of young people obtaining condoms, research suggests it is important that access to condoms is confidential, free and does not require parental consent. Of all condom availability programmes operating in schools in the United States, the rate of condoms obtained was highest from baskets or bowls and school-based health clinics . In contrast vending machines had a lower rate. This may be an anomaly given the small number of schools employing this method. Two other factors suggested for this effect were the locations of the machines and the costs associated . Research indicates that increasing access does not increase sexual activity among young people .
8. A Ministry of Youth Affairs’ consultation, carried out by Youthline, with young men aged 15-20 found strong support for making condoms more widely available, especially in schools. This support was strongest amongst the 15-16 year olds. There was almost unanimous support for making condoms available free of charge.
“A lot of people are still embarrassed to go and purchase condoms. So if they were free more young people would use them.”
Incidence And Consistency Of Use
9. Research is not clear on whether or not simply increasing access to condoms increases the incidence and consistency of use. Other barriers appear to be affecting young men. These include:
lack of planning ahead
using drugs and alcohol
a belief that condoms are unreliable and defective
a belief that condoms diminish sexual pleasure
a belief by young women that condoms are not acceptable to their partners
a belief that taking the pill is sufficient.
10. A small New Zealand study showed that young men have misconceptions and misunderstandings about the effectiveness of condoms. Some of those interviewed did not take any responsibility for STIs and pregnancy prevention, believing that these are caused by young women being provocative and promiscuous. Some believe that responsibility for contraception and safe sex rests with women . In addition some young women may lack control in their relationships, lack confidence and have poor communication with their partners which means they are not in a position to demand safer sex practices ..
Promoting consistent use
11. Research consistently points to the importance of peer acceptability: the belief that condoms are popular and are used by other young people. Other important factors are the belief that condoms allow ‘spur of the moment’ sex, make males responsible and are easy to use and that their partners will appreciate the use of condoms .
12. Young men are more likely to use condoms consistently if they believe in their efficacy. In addition, concerns about AIDS and STIs appear to be a greater motivator to use condoms than pregnancy . Similarly, knowledge of STIs is associated with a greater likelihood of using condoms . However, knowledge alone is not sufficient. Psychosocial factors such as attitudes and beliefs appear to be most important in predicting consistent condom use .
13. Effectively using contraception and practising safe sex often requires communication, negotiation skills and assertiveness. Research has shown that the level of confidence in ability to refuse unprotected sex and demand the use of a condom is related to increased consistent condom use. The young men interviewed for Youth Affairs felt they needed more skill in these areas.
14. In terms of seeking advice from someone, New Zealand research suggests that young people are most likely to go to their mothers or their peers if they needed advice or help with anything to do with sex or birth control/contraception and are least likely to go to their teachers . This is true for both young men and young women.
15. There is very little research about parents’ involvement in promoting condom use specifically. However, research suggests that parent-child communication about birth control can lead to better contraceptive practices. Communication and disapproval of teen sex can also delay the age of onset of sexual intercourse .
16. Not all parents, however, are willing or able to talk openly to their children about sexuality issues. In addition, parents may be unaware that their children are sexually active. Parents that may be least able to support and guide their children are those whose children may be at the highest risk. U.S research indicated that young people who are at risk of poor sexual and reproductive health are more likely to have parents:
who have low levels of education, are
poor, and have experienced a divorce or separation or never
married, and were teenage mothers
whose child-rearing practices are poorer and who provide less support or supervision .
17. The children of these parents may have the most to gain from parents being supported with information about young people’s sexual and reproductive health. We might assume then that progress could be made in developing information resources to support and encourage parents to become an effective and accurate first information source for their children on issues of sexuality that could include condom use.
Effective Use Of Condoms
18. New Zealand research has highlighted the fact that young men’s skill in using condoms is often inadequate. As well as increasing the risk of pregnancy and STIs this is an important barrier to consistent use. The group who tended to experience most problems with condom use were younger, less experienced in using condoms and often had a history of slipping and breakage.
19. Young men should be encouraged to practise using condoms prior to intercourse and be given practical information such as how to dispose of condoms and what to do if it breaks or comes off. Not only does this provide valuable information; it can help to normalise the issue. A United States study found that sex education was associated with an almost 80% decrease in the risk of condom breakage among young men who used condoms frequently .
20. Expert practitioners involved in this area suggest that a common cause of difficulties is a lack of lubricant and strongly advocate lubricant being provided with condoms. At this stage lubricant is not subsidised .
High Risk Groups
21. Those engaging in health risk behaviours (eg. drug and alcohol abuse) and STIs risk behaviour (eg. multiple partners) are the least likely to use condoms . Research suggests that for young people who use condoms every time they engage in sexual intercourse this behaviour is resistant to change. It is, therefore important to establish these behaviours early before high risk behaviours begin .
22. Overall research comparing ethnic groups indicates that in New Zealand Maori are most at risk of poor sexual and reproductive health outcomes.
23. Young men in detention also represent a high risk group. At present young men’s health is assessed on entering detention, and they are treated for any medical conditions (including STIs). However, once in detention, sexually active young men do not have access to condoms. There is no policy to ensure that young men in detention are encouraged to develop the intention and are equipped with the skills, abilities, and knowledge required for them to adopt sexually healthy behaviours either in detention, or after release.
24. Currently there are a number of issues that need to be addressed to improve government’s response in this area.
i. The Education Act requires that approximately every two years principals consult with the school community about the health education curriculum of which sex education is a part. After consultation, the principal presents a written report to the board of trustees that outlines the proposed programme. The board then directs the principal about the components of sex education to be included in the curriculum (see appendix for further information). The Act also allows parents to withdraw their children from sex education classes. Therefore young people may be missing important elements of sexuality education such as safe sex and contraception.
This is the only area of the curriculum where law requires consultation, and where the principal does not have the final say over what is taught. It is worth noting that no parental consent is required if a young person chooses to access the same information from other sources such as the Family Planning Association or their local GP.
ii. In 1996 the government implemented a Sexual and Reproductive Health Strategy. Although funding has been allocated to Pacific Peoples programmes, attention to Maori sexual and reproductive health has been limited. The focus is also on young women and needs to consider issues for young men.
iii. There are limited ways of accessing free condoms. Those methods that do exist are not those highly preferred by young men. Regulations are under consideration to allow nurse prescribing and these should include prescriptions for condoms. However, this not likely to occur until 2002.
iv. Youth in detention cannot access condoms or other information to encourage them to take responsibility for safe sex and contraception.
v. Lubricant is not subsidised by Pharmac yet health providers stress the importance of providing lubricant with condoms to reduce the risk of breakage.
25. Sexual and reproductive health is a complex issue and condom use is only one aspect that needs to be considered. However, increasing availability and encouraging consistent and effective use is possibly the most effective method of reducing the risk of unplanned pregnancies and STIs.
26. Increasing availability of condoms to young men may increase usage. Research suggests that making condoms available without cost and without having to engage with another person will lead to the most condoms being obtained. Having health providers proactively enquiring about contraceptive needs during consultations on other matters could also prove effective. Further work is required to establish the circumstances in which condom vending machines would be effective.
27. A Youth Health Strategy, discussed in Labour’s manifesto, needs to address the poor sexual and reproductive health of many young people, particularly for Maori and Pacific Peoples and consider the above barriers to improving the current situation. Youth Affairs is arranging a meeting with the Ministry of Health and the Health Funding Authority to scope issues relating to a Youth Health Strategy.
28. There are multiple barriers to young men consistently using condoms. One of the most effective methods of encouraging use is changing norms of high risk sex amongst peers. Sexuality education programmes need to be aware of these issues and build them into programmes. As well as removing social barriers, educators need to incorporate the technical aspects of building young men’s skill in effectively using condoms. Promoting the use of lubricant may also improve effective condom use.
Rationale for Young Men’s Sexual and Reproductive Health Project
There are three key reasons for Youth Affairs carrying out work on young men’s sexual and reproductive health. Firstly, young people in New Zealand appear to have poor sexual and reproductive health compared to other similar countries:
Zealand has one of the highest rates of teenage births of
any industrialised country
New Zealand has a high abortion rate with 2962 terminations carried out on 11-19 year old women during 1997
we do not have complete data on the incidence of sexually transmitted diseases (STDs), however, the data that is available is concerning: 297 under-15 year olds and a further 6546 15 to 19 year olds were first-time patients at STD clinics during 1997 .
Secondly, there is lack of initiatives that focus on the particular needs of young men. The Government Sexual and Reproductive Health Strategy was developed to address teenage pregnancy, abortion and STDs and focuses primarily on young women. Good sexual and reproductive health cannot be achieved by treating one gender in isolation. Young men’s sexual behaviours have a major impact on their own health and that of young women.
Thirdly, the project fits within priorities set by government. Specifically, the project builds on youth development work being lead by Youth Affairs, including work on young men and risk-taking behaviour. Youth Affairs in also involved in supporting work on improving teen parent access to education and training.
Priority Work Areas
Based on research and consultation the project has focused on developing methods to encourage the following behaviours in young men:
delayed onset of sexual
contraceptive responsibility and safe sex
diagnosis and treatment seeking if they have been exposed to a sexually transmitted infection (STI)
Youth Affairs selected four areas on which to focus its attention. These were selected based on research, consultation with sexual and reproductive health experts and consultation with a group of young men and women and include:
developing key messages to encourage
young men to delay the onset of intercourse and for sexually
active young men to use condoms
investigating mechanisms to improve condom availability
maximising the potential impact of the sexuality components of the Health and Physical Education Curriculum on young men
encouraging the development of programmes and services for young people in detention.
Youth Affairs has prioritised two of the four key areas identified to ensure limited resources are used effectively and will support other agencies in leading the other two areas. Youth Affairs believes it is best placed to progress work on developing key messages for young men and increasing the availability of condoms. In all areas input and active support from other agencies will be required.
Legal Requirements for Schools Regarding Sex Education
The law requires school principals to consult communities about health education of which sex education is a part . Schools develop a draft programme for the health education curriculum (including sex education) that is presented to the school community. Consultation can be by any means agreed by the principal and board of trustees. It should allow maximum input by the community.
The purpose of the consultation is to:
“identify the broadly agreed
health needs of the students
establish broadly agreed goals
reach broad agreement on the scope and treatment of health education” .
Consultation is not required to include the students themselves or teachers at the school, although the Ministry of Education recommends this.
Within six months of the consultation the principal is required to present a written report to the board of trustees. The board then directs the principal about the components of sex education to be included in the curriculum. The policy is finalised and feedback given to the community. The programme is implemented and can not be altered until the board receives another written report from the principal.
Consultation is carried out approximately every two years. It must take place no longer than 18 months after the health programme was last approved.