An increase in reported sexually transmitted diseases (STDs), including HIV/AIDS, among adolescents has prompted many communities to take action to protect their youth. One proven method is to provide comprehensive sexuality education along with school based programs that make condoms available to sexually active youth. Numerous national health organizations have adopted policies in support of school condom availability as a component of comprehensive sexuality education.
Condom Availability Programs Are Successful.
- A comparison of public high schools in New York City and Chicago found positive effects of condom availability programs. With the same sexual activity among senior high students in both cities (NYC, 59.7 percent; Chicago, 60.1 percent), sexually active students in New York, where there is a condom availability program, were more likely to report using a condom at last intercourse than were those in Chicago, where condoms are not available in school (60.8 to 55.5 percent).1
- In a two-year study of Philadelphia health resource centers (HRCs) that make condoms available, the percent of students using condoms at last intercourse increased from 52 to 58 percent. In schools with high HRC use, the number of students ever having intercourse dropped from 75 to 66 percent, while condom use at last intercourse rose from 37 to 50 percent.2
- By comparison, in schools reporting lower HRC use, the percentage of sexually active teens decreased from 61 to 56 percent, while condom use a last intercourse rose from 57 to 61 percent. Non-program schools showed an increase in sexual activity among teens, while condom use increased from 62 to 65 percent.2
Condom Availability Programs Do Not Promote Sexual Activity.
- A study of New York City's school condom availability program found a significant increase in condom use among sexually active students but no increase in sexual activity.1
- A World Health Organization review of studies on sexuality education found that access to counseling and contraceptive services did not encourage earlier or increased sexual activity.3
- In Europe and Canada where comprehensive sexuality education and convenient, confidential access to condoms are more common, the rates of adolescent sexual intercourse are no higher than in the United States.4
Sexually Active Teens Face Risks.
- The 1995 Youth Risk Behavior Survey found that 53.1 percent of high school students have ever had sexual intercourse; 20.9 percent of the males and 14.4 percent of the females have had sexual intercourse with four or more people. Only 54.4 percent of sexually active students reported using a condom at last intercourse; 60.5 percent males, 48.6 percent of females.5
- Each year, an estimated 3 million adolescents are infected with STDs, accounting for 25 percent of the estimated 12 million new STDs occurring annually in the United States.6
- In 1997, one-half of all new HIV infections in the United States occurred in people under the age of 25. One in four new HIV infections in the U.S. occurs in people under the age of 22.7
- AIDS is the sixth leading cause of death for among those 15- to 24-years-old.8
- Each year approximately 1 million teenage women in the United States become pregnant.6
- Condom use among adolescents decreases as they mature. Self-reported condom use is at 62.9 percent in the ninth grade, and steadily decreases to 49.5 percent for high school seniors,5 as many young women start using the pill as their birth control method.7
- The percentage of U.S. youth who receive HIV education in school increased 59 percent, between 1989 and 1995, from 54 to 86 percent. During the same period, condom use among sexually active youth in school increased 17 percent.7
Adolescents Lack Access to Contraceptives.
- Adolescents face many obstacles to obtaining and using condoms. Some of these obstacles include confidentiality, cost, access, transportation, embarrassment, objection by a partner, and the perception that the risks of pregnancy and infection are low.6
- A 1996 survey conducted by high school peer educators examined the accessibility of family planning methods in drug and convenience stores in Washington, D.C. and found that:
- Condoms were behind the counter in 83 percent of all convenience stores and 15 percent of drug stores.
- Only 33 percent of the stores had signs clearly marking where the contraceptives were located.
- Adolescent females asking for help in locating and/or purchasing condoms encountered resistance or condemnation from clerks 27 percent of the time, compared to 10 percent for male teens.9
Condoms Are an Effective Method of Protection.
- Latex condoms are highly effective barriers to HIV when used consistently and correctly.10
- The Center for Disease Control and Prevention (CDC) defines consistent use of condoms as using a condom at every act of sexual intercourse. Correct use means using undamaged, unexpired condoms, using only water-based lubricants, careful opening of the package, correct placement and use throughout intercourse, and correct removal of the condom after ejaculation.11
- Studies of condoms in the U.S. have shown less than a 2 percent breakage rate. Most breakage occurs due to incorrect use.11
- A study of 123 couples where one partner had HIV, and the other did not (sero-discordant couples) found that none of the uninfected partners who reported consistent condom use during the study became infected.12
Condom Availability Programs Are Common.
- Advocates for Youth National School Condom Availability Clearinghouse has found 418 public schools in the U.S. that make condoms available to students.13
- Condoms are made available through different strategies: school nurse, 54 percent; teachers, 52 percent; counselors, 47 percent; other health workers, 29 percent; principals, 27 percent; other school personnel, 13 percent; bowls and baskets, 5 percent; vending machines, 3 percent; and by students, 2 percent.14
- In 81 percent of schools, some type of parental consent is required before a student can acquire a condom. In 71 percent of the schools, all students have access to condoms, except those whose parents deny permission in writing ("opt-out"). In 10 percent, students have access only with written permission of their parents ("opt-in").14
- In 98 percent of schools with condom availability programs, students may receive counseling. In 49 percent of the schools, counseling is mandatory for condom receipt.14
- Counseling commonly includes information on abstinence, instruction on proper storage and use of condoms, and, in some schools, a demonstration on using condoms.14
The Public and Public Health Groups Support Condom Availability Programs.
- In a 1993 New York City survey of parents of public high school students, 69 percent stated that students should have access to condoms in school.15
- A 1992 Gallup Poll found that 68 percent of adults surveyed thought condoms should be available in the schools, and a separate survey of high-school seniors showed 81 percent agreed.6
- In a 1995 survey of Denver high school students, 85 percent supported condom availability in their school.16
- The Institute of Medicine, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Medical Association have all adopted policies recommending that condoms be made available to adolescents as part of comprehensive school health programs.17,4,6,18
- Guttmacher S, Lieberman L, Ward D, et al. Condom availability in New York City public high schools: relationships to condom use and sexual behavior. Am J Public Health 1997; 87:1427- 1433.
- Furstenberg FF, Geitz LM, Teitler JO, et al. Does condom availability make a difference? An evaluation of Philadelphia's health resource centers. Fam Plann Perspect 1997; 29:123-127.
- Baldo M, Aggleton P, Slutkin G. Poster presentation to the Ninth International Conference on AIDS, Berlin, 6-10 June 1993. Geneva, Switzerland: World Health Organization, 1993.
- American Academy of Pediatrics, Committee on Adolescence. Condom availability for youth. Pediatrics 1995; 95:281-285.
- Kann L, Warren CW, Harris WA, et al. Youth risk behavior surveillance, US, 1995. MMWRCDC Surveillance Summaries 1996; 45(SS-4):1-84.
- Committee on Adolescent Health Care, American College of Obstetricians and Gynecologists. Condom availability for adolescents. J Adolesc Health 1996; 18:380-3.
- Collins C. Dangerous Inhibitions: How America Is Letting AIDS Become an Epidemic of the Young. San Francisco, CA: Center for AIDS Prevention Studies, University of California, 1997.
- Peters KD, Martin JA, Ventura SJ, et al. Births and deaths: United States, July 1995-June 1996. Monthly Vital Statistics Report 1997;45(10, Suppl 2):1-40.
- Advocates For Youth. 1996 Update of Teens' Survey of Stores in the District of Colombia on Accessibility of Family Planning Methods. Washington, DC: Advocates, 1996.
- Centers for Disease Control and Prevention. Condom availability as an HIV prevention strategy. CDC Update; 1997 (February):1-2.
- Centers for Disease Control and Prevention. Facts about condoms and their use in preventing HIV infection and other STDs. CDC HIV/AIDS Prevention; July 1993:1-3.
- de Vincenzi I. A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. New Engl J Med 1994; 331:341-346.
- Advocates For Youth . Unpublished data from the School Condom Availability Clearinghouse. Washington, DC: Advocates, 1997.
- Kirby DB, Brown NL. Condom availability programs in U.S. schools. Fam Plann Perspect 1996; 28:196-202.
- Guttmacher S, Lieberman L, Ward D, et. al. Parents' attitudes and beliefs about HIV/AIDS prevention with condom availability in New York City public high schools. J Sch Health 1995;65:101-106.
- Fanburg JT, Kaplan DW, Naylor KE. Student opinions of condom distribution at a Denver, Colorado high school. J Sch Health 1995; 65:181-185.
- Eng TR, Butler WT, ed., Committee on Prevention and Control of Sexually Transmitted Diseases, Institute of Medicine. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academy Press, 1997.
- American Medical Association. Update on AMA policies on human sexuality and family life education, H-170.974. HOD Policy, 1997. Chicago, IL: The Association, 1997.
Compiled by Keri J. Dodd
February 1998 © Advocates for Youth