The Latex Condom: Recent Advances, Future Directions

Introduction: Why a Monograph on Latex Condoms?

See Also:

Condoms in various forms have been with us for centuries. The use of barriers covering the penis to protect against disease dates back to at least 1350 BC, and for pregnancy prevention at least to the 16th century AD. Since the 1930s, latex condoms have been available to prevent both pregnancy and sexually transmitted disease (STD), but in most parts of the world they have never been widely used. When forms of contraception that were not coitally dependent became available in the l960s and 1970s, the use of condoms declined. Beginning in the l980s, however, the worldwide epidemic of STDs, including HIV/AIDS, prompted a renewed interest in latex condoms, which, to date, remain the most effective method of preventing disease transmission during sexual intercourse.

The rediscovery of condoms for disease prevention has led to an explosion in research and technical knowledge during the past decade and the first substantial modifications in manufacturing of condoms since the l930s. Along with the technical improvements in the product, research has contributed to a better understanding of the behaviors that influence whether and how condoms are used, and the extent to which user behaviors and technical product attributes interact to determine effectiveness. Sadly, the great improvements in condom design and reliability are not widely known. Consumers and service providers alike continue to lack confidence in the condom's ability to prevent pregnancy and disease.

While perceived unreliability is often a problem, a host of other issues present greater barriers to overall acceptability of condoms. Many people do not believe they are at risk of STD/HIV. Others do not like the feeling of a condom or worry about their partner's reactions to suggesting condom use. Some are embarrassed by, or lack skills in, adding condom use to sexual activity. Communication between sexual partners is minimal in many cases, contributing to non-use and higher STD rates. Also, cultural and political norms often reinforce negative perceptions of condoms and tend to limit their availability. The most important obstacle to more widespread and consistent use of condoms, however, appears to be that consumers do not like them.

The aim of this monograph is to draw together the wealth of information that now exists on multiple aspects of latex condom manufacturing, quality assurance, performance in human use, acceptability and user behaviors -- and the interrelationships among these issues. The monograph focuses on the product, its attributes and how attributes affect human use. Providing a comprehensive review of all the behavioral and programmatic issues that relate to condom use is beyond the scope of this monograph. We briefly review the major issues regarding behavior change and condom acceptability, focusing on the interaction between people and product. We explore the remaining gaps in knowledge about latex condoms, describe several non-latex alternatives for men and women that are in development or have recently become available, and propose research priorities for the future. We hope that researchers, manufacturers, regulatory officials and public health professionals who promote and provide condoms will find the information in these pages useful.

The impetus to produce a monograph on latex condoms came from an experts meeting convened by Family Health International (FHI) in May l996. The meeting brought together representatives from research, industry, regulatory agencies and the donor community to assess needs and set priorities for future research on latex condoms. In particular, the experts scrutinized the issue of whether laboratory measures of condom reliability can predict condom performance in human use. The consensus of the meeting was that relating laboratory-based measurements of quality assurance with human use remains problematic. Even so, we know a great deal about the technical merits of latex condoms and an ever-increasing amount about consumer use behaviors.

The experts proposed a publication that would summarize state-of-the-art information from the various disciplines involved in the production, quality assurance, behavioral research and promotion of latex condoms. This would be a first step in determining future research needs, while also serving to address the gaps in knowledge regarding condoms. Since a significant portion of the work that is reported here has been carried out by FHI, its presentation is influenced by the perspectives that have evolved at FHI. We also acknowledge the importance of the work on condoms done by others and trust that we have adequately represented their contributions in this volume. While we summarize the research findings of other groups, these results do not necessarily reflect the views of FHI.

Beginning in the mid-1980s, FHI, with support from the U. S. Agency for International Development (USAID), undertook a program of research to apply the same scientific rigor to the study of condoms that had been applied to the study of other contraceptive methods. The research carried out by FHI and other agencies, such as the Program for Appropriate Technology in Health (PATH), has provided new information on the physical characteristics of the latex condom and on behavioral aspects that influence whether and how condoms are used.

During the past decade, manufacturers of latex condoms have continued to make improvements in the product based on new insights provided by the growing body of research on a wide range of issues and based on changes in purchase specifications of major buyers. Condoms now on the market are manufactured more consistently, have better formulations of latex, have incorporated a wide range of design modifications to improve both acceptability and functionality, and are subjected to pre-marketing quality assurance. Improvements in packaging have minimized potential damage to the product prior to use. Currently available condoms, if packaged and stored correctly, will maintain their quality for five years or more. If used consistently and correctly, they rarely fail and are highly effective in preventing pregnancy and sexually transmitted disease.

In the chapters that follow, we first examine recent research on the effectiveness of latex condoms in preventing pregnancy and STDs. Since understanding why people do or do not use condoms is critical, we devote Chapter 2 to consumer attitudes and preferences, summarizing what is known about product acceptability issues. Behaviors and characteristics of condom users are often primary factors in condom effectiveness, as demonstrated by the studies summarized in Chapter 3. Chapter 4 discusses recent advances in the manufacture of latex condoms, focusing on improvements in latex formulation, packaging and reducing health-related problems related to latex and other allergies.

In Chapter 5, we move into the more technical area of product testing and standards for condom production, and what these standards mean for assuring product quality. Chapter 6 discusses the thorny issue of whether laboratory testing can predict condom performance in human use. Chapter 7 describes new non-latex products, such as the recently marketed polyurethane female condom and non-latex condoms for men that are now in development. Finally, Chapter 8 synthesizes the major messages in the monograph, presenting 10 reasons why we should have confidence in condoms, 10 priority areas for future research, and essential public health messages for condom users.

Substantial strides have been made over the past decade in improving understanding of condoms and their use. This synthesis of new information and knowledge, combined with suggestions for future research, could lead to further improvements in latex condoms and to increased consumer acceptance of the condom. Increased product reliability and acceptance may, in turn, lend a higher level of confidence among the millions of people worldwide who either use or should use condoms to protect their health. It might also assist public health professionals in discouraging behaviors that lead to condom failure and encouraging behaviors that enhance product performance. The public health benefits of correct and consistent condom use are clear. Public health officials and service providers have an urgent responsibility to reinforce confidence in condoms as a contraceptive method and to promote their use for disease prevention.

by JoAnn H. Lewis

Return to table of contents