By Matthew Hodson | Executive Director, NAM @Matthew_Hodson


Every now and then I face the accusation that I am anti-condoms. This is nonsense.

There are a host of good reasons to support condom use. Condoms are relatively cheap and accessible, their physical presence means that you know with certainty when they are being used and they offer protection against other STIs in addition to the protection that they offer against HIV. What’s to object to?

As someone who campaigns for better health, specifically sexual health, if more people used condoms more often, I’d be delighted.

But condoms are not morally superior to other methods of HIV prevention. Just as with PrEP, PEP, monogamy, foreswearing all penetrative sex or total abstinence, there are benefits and drawbacks - and different people will have different views on those benefits and drawbacks.

I challenge those reasons that people give for promoting condom use which are poor, unhelpful or inaccurate. Condoms do not offer better protection against HIV than other methods. Their ability to prevent HIV transmission isn’t as good as PrEP’s; they are unnecessary for HIV prevention if someone is undetectable.

Condoms’ traditional role at the heart of HIV prevention is no reason to reject additional prevention tools. It doesn’t invalidate all the times that people adopted a ‘use a condom every time’ approach just because we now have alternative means of protection. It doesn’t disrespect those who died with AIDS just because we’ve increased our prevention armoury.

Yes, of course we should be considering STIs and looking at ways that we can reduce their incidence and impact. Condoms are a valuable tool for that. Another valuable tool is ensuring that people get screened regularly, like people on PrEP do, so that if they have an STI they can be diagnosed and treated as quickly as possible, reducing opportunities for further transmission. We need to recognise that STIs, such as gonorrhoea, are often transmitted by oral sex. Personally, I’ve never had sex with someone who insisted on condoms for a blowjob - and I can’t imagine I ever would.

Any ambivalence I have towards condom use as an HIV prevention strategy is prompted solely by the fact that so many people who have adopted it also fail on it.

It’s vital that discussion of sexual health acknowledges the key element of sexual pleasure. The quest for pleasure motivates the vast majority of sexual acts. A method of prevention which inhibits sexual pleasure, as condoms do for some (but not all) people is not going to have the widespread, consistent adoption required to end the epidemic.

We know this to be true because even in the grimmest days of the epidemic, before there was effective treatment and AIDS was killing us in droves, condom use was not universal. I know, I was there.

Love, lust, drink and drugs would fog our perceptions of risk. Many whose avowed strategy was ‘use a condom every time’ didn’t.

Since that time condom use has declined. Gay and bisexual men didn’t stop using condoms because of PrEP. In large part, gay and bi men stopped using condoms when people stopped dying of AIDS.

I’m in favour of any HIV prevention strategy that works. I will fight for those who choose condoms just as I will fight for those who choose PrEP or any other effective method of prevention. Your best prevention strategy is the one you can make work for you.


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