Barriers to condom use.

OBJECTIVE To identify barriers to condom use. METHODS Data were extracted through MEDLINE from papers published between 1993 and 2007. Surveys, reviews, clinical studies and comments were included in this review. The impact of cost, moral, social, personal and psychological factors were taken into consideration. RESULTS Several factors were associated with non-use of a condom during sexual intercourse. Their cost often posed a barrier to condom use for the poor, even in developed countries. In many communities, moral values, ethnic and religious factors also played a role. Among other social factors, gender inequality, lack of a dialogue among partners with regard to condom use, and the stigma attached to the condom could all lead to unprotected sexual intercourse. Personal factors such as aversion to the condom, consumption of alcohol or use of drugs prior to sexual intercourse, and anxiety and depression all were negatively associated with condom use. CONCLUSION Their cost evidently poses a barrier to the use of condoms by the poor. Beside social stigmas and personal reluctance, prevailing moral norms and religious interdicts also adversely affect use of these devices in many communities. Because of their disastrous consequences in the domain of public health each of these barriers must be effectively addressed.