Why Safe Sex Is Easier Said Than Done

I scrolled through my contacts, found his name, took a deep breath, and pressed call. Pacing on the sidewalk, my palms getting sweatier by the minute, I rehearsed what I wanted to say, but it was useless by this point because he was going to pick up any sec—

“Hi.”

I struggled through mundane small talk, but finally broke out with the real reason for my call: to talk about sex, or more specifically, sexual history.

Sure, it’d been a few months since we’d slept together, but, at the time, neither of us had initiated that conversation — you know, the one about past partners, risky behavior, condom use, and sexually transmitted infections (STIs). It’s the conversation we all should be having but rarely do. Not only did we not talk about these things, but we didn’t use protection either. I know, I know.

I figured it was time I owned up to my mistake. It was time for some due diligence. After our conversation, I felt a lot more comfortable. I went in for testing not too long after for full confirmation, and I didn’t have any positive results for any STIs. But that still didn’t stop me from wondering why I didn’t insist on protection in the first place.

The Limits Of Statistics

At the time of the phone call, I was in graduate school for public health. Naturally, STI statistics were swirling around in my head. I could easily rattle off data about chlamydia, gonorrhea, syphilisHIV (especially new trends) — the list goes on. (For you number junkies out there, check out Sexually Transmitted Disease Surveillance for comprehensive STI statistics plus helpful charts and graphs.)

I knew I was putting myself at risk that night. What I didn’t know was why I would do that to myself. There I was, a walking brochure for an STI clinic, but I couldn’t even follow my own advice.

I got to thinking about all this again when I read a National Health Statistics Report that came out last week. It looked into behaviors that put people at increased risk for getting HIV (for example: injection drug use, male-to-male sex, having 5 or more partners in the past year, having another STI). The study interviewed people ages 15-44 from the general population . There’s a lot of solid data, but what hit home was one line in particular. It’s buried in the very last table of the report, but when I saw it, I paused.

I stared at the percentages that showed whether a person used a condom the last time he or she had sex — this is often used as a rough proxy for a person’s condom use in general. For those who had at least one high risk behavior in the past year, about half of men and a third of women used a condom during their last sexual encounter.

A lot lower than any sex ed counselor or doctor would hope, right?

I called Ralph J. DiClemente, professor of behavioral sciences and health education at the Rollins School of Public Health at Emory. I wanted to find out why, despite the ubiquitous idea of “safe sex,” so many of us fail to follow through.

When Complexity Trumps Rationality

“There are lots of things we know to do to improve our health,” DiClemente pointed out. He explained that many of us know that we shouldn’t smoke, drink and drive, or text and drive for that matter. We know we should be exercising regularly and eating plenty of fruits and vegetables every day. “But for whatever reason we don’t do them,” he said. “People are really complex organisms; we are not as rational as we like to present ourselves.”

He went on to explain that a lot of our safe sex education treats us as rational beings. We’re taught a “repertoire of responses.” But DiClemente explained, “Sex takes place in a hot space — you’re excited, emotional. Emotions supercede the intellectual rationalism that we like to think people have.”

“Sex takes place in a hot space — you’re excited, emotional. Emotions supercede the intellectual rationalism that we like to think people have.”

We could have talked for days about all the contributing reasons why people do or don’t do what they do. But a few reasons stood out to me; I think they get pushed to the side when we talk about why people engage in unprotected sex. We’re so quick to blame a person for being “irresponsible” without understanding the nuances of their interpersonal relations or the powerful influence of society.

Here are five reasons (just some of many) why it’s often difficult to initiate a sexual history conversation prior to having sex or to insist on using condoms.

High Hopes: ”If you want to engage in a conversation about sex, you’re presuming the person wants to have sex with you,” DiClemente told me. He said it could easily be “ego deflating” if, well, that’s just not the case. He explained how the possibility of hurt feelings can create a barrier, with questions like, “Aren’t I attractive and interesting? Don’t you like me?” hanging in the air.

Danger To Reputation: But what if you manage to get over that initial hurdle of the fear of a bruised ego? Say you initiate the conversation or bring out a condom. DiClemente pointed out this is especially problematic for women. “In many cases it’s the male partner who applies the condom; it’s the male partner who has the condom. If a woman has a condom, is she seen as ‘loose’ or promiscuious? It shouldn’t be that way, but it’s a perceptual issue. If we want people to be safe, they have to carry around the tools to make them safe and not rely on others.”

Wait And See: DiClemente also mentioned how some people don’t want to “jeopardize the relationship before starts.” He explained how some folks take the “wait and see approach” with budding relationships, so they delay talking about sexual history and about how condoms are going to fit into the picture in the here and now. That gray area, that time before there are labels, those first few dates — you barely know the person, and you’re going to have to pepper them with sexual health questions? No wonder people are reluctant.

Monogamy: But say you get to the point where you’re dating someone exclusively. You still want to use condoms, but DiClemente brought up a good point: “Condoms bring up the issue of infidelity.” If the partner you care about is going to accuse you of being unfaithful, it makes it mighty hard to negotiate condom use. And now that you’ve found a significant other, do you compromise the relationship because he or she will learn more about your sexual history?

Sex, Sex Everywhere: The above four reasons are all very individually or interpersonally based, but what I think is really important is the fact that we live in a hypersexualized society. DiClemente pointed out how advertisements for everything from toothpaste to whiskey involve a sexual component: “What we do as a society values attractiveness, sex appeal, sex.” He went on,”The bar is set really high, but most of us will never attain that status, go over that bar. But we’ll try.” It is in that dogged trying that we may fail to have those important pre-sex conversations or practice safe sex at all. Living up to an image is never easy.

Lessons Learned

After I hung up the phone with DiClemente, I realized that I’d fallen into all those traps. It’s hard for the rational voice to drown out all the other voices in my head. Like DiClemente said, emotions tend to win out.

It’s not easy to find someone with whom you feel comfortable talking about these things. And DiClemente agreed, “Finding a partner who is receptive, open, not offensive about it, willing to engage in a candid conversation – it’s difficult to find an appropriate, suitable, and attractive mate. That’s been going on forever.”

What I realized is the search is worth it. I’m currently in a monogamous relationship, and — for the first time, really  — my partner and I have had honest, extended discussions about safe sex. Being able to talk freely about these things is the biggest breath of fresh air I’ve had in years. It was a challenge being able to come to this point, but it was most certainly worth it.

Resource: Looking to get tested for HIV and other STIs? Find a clinic near you.

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  • you

    did everybody just forget the married population? dumb numbers are dumb.

  • yep, you betcha

    I thought the message was going to be that there is no such thing as safe sex – but I got the message that sex can be safe – and we are just not taking advantage of precautions.  

    Condoms might reduce the rate of HSV transmission but herpes transmission happens through skin-on-skin contact and not necessarily that part of the skin that is covered by a condom.  Genital herpes can be present anyplace that we one might describe as the “boxer short” area of one’s skin. From the waist, on the lower abdomen, thighs,buttocks, etc. 

    75% of the people who have herpes don’t know it – they’ve never had a symptom or have misidentified a symptom.  An honest, considerate person could easily infect you. 

    Unless there are warts present, I don’t there is a way to detect HPV in men.   HPV is commonplace in women – and men are the source of the virus in heterosexual women.   

    Lastly, HPV and HSV can both move from the genitals to the mouth, the mouth to the genitals during oral sex.   Safer oral sex would involve using a dental dam then.   

    • nota

       Thanks, I was going to make these points. Genital herpes presents no symptoms in a large portion of carriers and the virus can be shed in many ways besides intercourse. Lots of people have no idea they even have it unless they have a blood test. And the fact that HPV can cause cancer in both the reproductive organs and the mouth, throat, etc. is very frightening. These cancers are apparently on the rise.

  • Flack

    The study cited focused on people 15-44, but there’s another segment of U.S. society that’s also having a big problem with STDs - the 50-and-ups. I’m an early-50s man who split up with my ex-wife several years ago and recently started dating again. I met a nice lady of similar age online and ending up sleeping with her. A few weeks later, she called me and told she had tested positive for herpes (she got it from an old boyfriend who had come into town and slept with her once). She and I had unprotected sex. Why? To be honest, after 20+ years of monogamy, I was totally out-of-practice with the dating scene and didn’t think about it (I was just thrilled to be having sex again). As it turned out, I wasn’t infected. But my doctor said STDs are becoming a big problem with older people like myself who are re-entering the social world after long-term marriages (those of us who used to call STDs ”VD”). Meeting people online is incredibly easy, but you know so little about them. Lesson learned for me – be careful out there folks!

  • http://twitter.com/zalel Nicky McCatty

    I really don’t get how it can be so hard. How often does sex rear its head, so to speak, without any warning? I’ve had unsafe sex fewer than 10 times in my whole non-monogamous life, and that’s certainly not ’cause I never got drunk nor otherwise chemically enhanced. Perhaps, if I were a woman and only carrying teeny clutches while scantily dresssed on weekend nights, that mighta happened a few more times (but not many). But really, how can any man make that excuse? 

  • Iris Adler

    Aayesha – thank you for this important post. Well done, well researched. It will be helpful to many.

  • Privacy

    It’s not clear why the author was calling months later to discuss history. That’s almost mean. In this situation wouldn’t you go for testing first and then call to notify only about positive results? It’s not clear that this was a current relationship.

  • Trena G

    This article is unnecessary because everyone already knows this. 

  • thoughts

    You forgot another VERY important reason people don’t practice safe sex. In general, people now consider sex and pregnancy to be separate issues because with birth control we have a lot more control over that than in the past. But that’s a really stupid way to look at things. Sex naturally leads to pregnancy. And birth control is never 100% reliable. So if you’re thinking about sex, take a couple minutes and think about whether or not that person would abandon you if you got pregnant and whether or not that person would be a good father or mother. Because if you use no protection (or even if you do!), you still might have a baby together and be stuck dealing with that person for the rest of your life. Think hard about that.

  • Andy Morris

    I don’t see much point in “The Conversation” the answer would still be “Use A Condom” until 1.you’ve been together awhile 2.you trust them not to cheat or at least tell you before they have intercourse again with you and 3.both of you go get tested! “The Conversation” is not at all an acceptable way to determine whether or not to use a condom, you just met this person? newsflash! people lie! AND they could easily not know that their ex-husband was seeing hookers on the side or even shooting smack occasionally, more people than you think lead double lives. 

  • Duana

    “That gray area, that time before there are labels, those first few dates — you barely know the person, and you’re going to have to pepper them with sexual health questions? No wonder people are reluctant.”  
    I think the key words are “you barely know the person”.  Willingness to have sex with those we don’t even know is itself a huge part of this issue.

    • Joy2b

      I’ve never understood why waiting the 3 months for a test to be really accurate is a big problem.

    • Joy2b

      I’ve never understood why waiting the 3 months for a test to be really accurate is a big problem.

  • Glitter Dick

    If you’re not mature enough to initiate a discussion about safe sex with a potential (or current) sexual partner then you are not mature enough to be having sex in the first place.

    • nykelly

      I dislike that platitude because it neglects that emotional maturity and physical maturity are too different states.

      • Mikka

        No, it doesn’t. If you aren’t emotionally mature enough to discuss sex, you aren’t emotionally mature enough to have it. People are often physically mature enough for sex long before they’re fully (emotionally and physically) mature enough.

        • Drew Van Zandt

          I can agree with the statement, but I’ll still point this out: It’s a useless statement nonetheless.  Is there something that makes you think someone is not emotionally mature enough to discuss sex, not emotionally mature enough to HAVE sex, and SOMEHOW MAGICALLY emotionally mature enough to 1) Understand that and/or 2) actually listen to you when you say it?

          It puts this statement squarely into the “useless platitudes” category, if not in the “dangerously optimistic” category. Telling someone they aren’t mature enough to have sex is REALLY REALLY DUMB if you think they’re not mature enough to have sex, because it’s as likely to have the opposite effect as it is to help…and I’m being very generous, I think, in saying it’s just as likely to have the opposite effect.  My experience suggests a much less than 50% chance of it working.

        • mplo

          Good point well taken, Mikka.  Too many people have all the physical equipment for sex, but aren’t emotionally equipped to handle sex and its possible consequences.   For decades, our society has been breeding adolescents whose imaginations far surpass their emotional and physical maturity. When sex is added to that, it’s a rather hideous combination.

    • janesafool

      Hello Dad? Well thats just a stupid and pedantic thing to say to a young person. How careful were you? Or are you still young? It’s really hard to think rationally when you’re attracted. Don’t undermine this young woman’s view and words. Wish I’d read this in my 20′s and hoping I’ll hang on to it for my daughters to read.

    • Kristengoodell

      What a totally unhelpful comment.  Congrats to you, Glitter Dick (btw – seriously?!) on being immune to all of the forces in the entire article.  You can continue to blame people that use suboptimal judgement, or you can investigate the issue to find out what the problem might be and figure out how to make it easier for people to do the right thing.

    • Yep, you betcha

      And what does that have to do with anything.   People have sex whether they pass you test or not.

    • notakidanymore

      It’s a good idea, but the whole problem is the neurochemistry that alters people’s emotional and mental state. Especially in young people, every relationship seems to be “The One,” until it isn’t. 

  • David Holzman

    For guys, the female condom is vastly superior to the male condom, because you can actually feel something. It’s also more protective for women, because it covers more of the relevant, uh, real estate.  Unfortunately they are not easy to find, but they are far superior to the male condom.

    • Cici

      I disagree. Male condoms are actually superior, because they are 10% more effective in preventing pregnancy. 

      • jasonchickeson

        One area in which the female condom excels is that women can put them on at any time before intercourse (including before the date) and be protected.

  • Nancy

    Aayesha, thanks for another great and thought provoking post–keep them coming!  This was a great way to talk to my daughter about this difficult issue.  Nancy

  • Anonymous

    thanks – great article and discussion on a vital, challenging subject. first night one time my partner slowed things down to say that she was positive on a common std and safe at present. i saw that as such courageous as well as respectful thing. i never, ever forgot nor took for granted her strength of character. i wondered what I’d have done. i’m down the road a bit now and sense and hope that those coming of age now are better at it than we ever were. it only takes one miss to sidetrack life big time.

  • Matt

    I have never had a problem with this. I’ve had the “condom talk” with everyone I’ve ever slept with, and got STD screenings at the outset of each of my last two relationships just to be responsible. Heck, I and my current girlfriend went to the clinic on the same day and then waited for the results before switching to pill-based birth control.

    Why isn’t everyone doing this?

  • http://www.facebook.com/people/Nikole-Taylor/100002964542844 Nikole Taylor

    Unprotected sex is a scary thing because it just take one time with someone that’s affected to give it to you.  Its too risky.  I rather just have phone sex, 888-471-4468 FREE and risk free.  

    • Mr. B

      that number wants a credit card.  As if I’m going to do that.  NOT.

      • Anonymous

        You didn`t really believe it was free..did you?

    • Guest

      Grumble – stop spamming the local websites! Seen this same comment elsewhere…

  • GKS Answers

    Always wrap it up before playing GuysKeepScore.com.

  • Greg Barron

    Part of the problem is that, at least regarding HIV, doing the “wrong” thing is:

    1) Safe – The odds of contracting HIV from a single act of heterosexual
    intercourse with a randomly selected person in the US are approximately
    1:328,000 assuming a HIV/AIDS prevalence rate of 364 per 100,000 (CDC,
    2004) and a mean transmission rate of 1 in 1000 (Royce, Sen ̃a, Cates,
    & Cohen, 1997).

    2) More enjoyable – Unprotected
    intercourse is reported as being more pleasurable than using a condom
    (Thomsen, Stalker, & Toroitich-Ruto, 2004).

     To make matters ‘worse’, if one stays away from high risk groups you could easily
    reduce the risk of HIV infection to below 1 in 1,000,000. Unfortunately,
    that is a psychologically very compelling argument. Thus the problem.
    Most people do
    not know that the odds of getting HIV through intercourse are only 1 in
    1000 (per act). Good thing too. More information does not always improve
    decision making.

  • lyon

    great article. i got serious about safe sex after i went for my first hiv test – the stress and anxiety waiting for those results isn’t worth taking a chance.

    i’ve gotten all sorts of responses when i insist on condoms – like what do you have that you have to do this – but i always say it’s not what i have it’s what i don’t have and don’t want to get.

    once a guy and i got out of bed at 4 am to walk to a 24-hr drug store to get some. if you’re having sex with me it’s going to be safe sex.

    • Reasonable?

      I think people vary widely in their ability to broach this topic frankly.
      This is a great opportunity for technology.
      Imagine an iphone app, where you invite your partner to answer a few historical questions.  Based on the answers, it would give recommendations like “use a condom” or “get screened for the following STI’s”. 

      • Anonymous

        Trouble is, as we’ve written before, herpes is so widespread and so often asymptomatic that the app would always have to tell you to use a condom. But at least you could blame your iPhone for your insistence!

        • Reasonable?

          Yeah, the point of the app would be to get people over the barrier of the ackward conversation.

  • stephanie

    call me old fashioned, but how can you NOT “feel comfortable talking about these things” when you feel comfortable enough to share your body with someone?