Condom use at last high-risk sex

The percent of respondents who say they used a con­dom the last time they had sex with a non-marital, non-cohabiting partner, of those who have had sex with such a partner in the last 12 months

For each partner listed in the last 12 months, respon­dents are asked whether they used a condom the last time the couple had sex. Other questions allow for the classification of partnerships as cohabiting or non-co­habiting. All those who report at least one non-marital, non-cohabiting partner in the last 12 months (i.e., the numerator of the previous indicator: Percent of popu­lation who had high risk sex in the last year) form the denominator. The numerator is the number of those in the denominator who used a condom the last time they had sex with their most recent non-cohabit­ing partner.

This indicator is calculated as:

(# of respondents who report using a condom the last time they had sex with a non-martial, non-cohabitating partner/ Total # of respondents who report having sex in the last 12 months with a non-marital, non-cohabiting partner) x 100


Self-reported data from survey respondents


UNAIDS general population survey; DHS AIDS Mod­ule; FHI BSS (adult)


If everyone used condoms every time they had sex with a non-marital or non-cohabiting partner, a heterosexu­ally transmitted HIV epidemic would be almost impos­sible to sustain. Although AIDS programs try to reduce casual partnerships, they must also, if they are to suc­cessfully curb the epidemic, promote condom use in the casual partnerships that remain. This indicator tracks changes in condom use in these partnerships.

A rise in this indicator is an extremely powerful indica­tion that condom promotion campaigns are having the desired effect among their principal target market.


Because condom promotion campaigns aim for consis­tent use of condoms with non-regular partners rather than simply occasional use, some surveys have tried to ask directly about consistent use, often using an always/ sometimes/never question. Although this question may be useful in sub-population surveys, it is subject to recall bias and other biases and is not suffi­ciently robust for use in a general population survey. Asking about the most recent act of non-cohabiting sex minimizes recall bias and gives a good cross-sectional picture of levels of condom use. However, since higher levels of condom use with non-regular partners will re­flect increases in overall consistency of use, this indi­cator supports the objective of consistent condom use.


HIV/AIDS

Although women may know the protective effect of condoms, sexual negotiation between partners depends on the balance of power between part­ners, which in most places, weighs more heavily in the man‘s favor.  This has several ramifications. Many women may lack the negotiation skills to ask their partner to use a condom or they may be reluctant to approach the subject because of the association between condoms, illicit sex, and STIs. Some women may be apprehensive about demanding or negotiating condom use (or with­holding sex if partners refuse to use condoms) for fear of partner violence, fear of being perceived as unfaithful or promiscuous, or fear of abandon­ment (which some women may perceive as hav­ing more serious consequences than engaging in unprotected sex) [UNAIDS 1998].

 Many women may not be having "higher risk sex" (defined as having sex with a non-marital, non-cohabitating partner), but they may be ex­posed to HIV infection within a monogamous relationship or a marriage, especially where condom use is rare between marital or regular partners. Cultural norms are lenient with regards to men‘s multiple sex partners œ thus diminishing the protective effect that a monogamous relationship has for women who are unable to control or are unaware of their partner‘s extra-marital relationships (UNAIDS, 1999a).

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