Condom is the best thing (…) Condoms! Best for keeping Eric safe (Eric, 26)
Many young people emphasised the importance, to them personally, of condom use and indicated that they would abstain from sex if they did not have a condom. However, as we see later, condom use was medicated by situational complexities.
Both young men and women agreed that free condoms were widely available at Aboriginal Community-Controlled Health Services (ACCHS), dedicated sexual health services, hospitals and youth support services: “Easily accessible” (Nina, 26) and “Never had trouble getting protection, no problem at all” (Morris, 20). Young people described picking up free condoms opportunistically when visiting health services and proactively when they anticipated they would need them. Despite reporting the widespread availability of free condoms, participants also discussed encountering barriers to access. For example, the supply of free condoms at health services was not always reliable: “(They have) a basket of condoms kept in the clinic but the condoms sometimes run out” (Lizzie, 18).
A few young women reported buying condoms at supermarkets or pharmacies, while other young people reported sharing condoms with friends or partners.
I carry (condoms) everywhere anyway. Also give to friend if any spare (Tim, 18)
Yet, obtaining condoms was a relatively public act, and embarrassment and shame remained an issue for some young people:
Pretty shame, even if I wanted to grab a free condom at TAIHS I still feel too shame (Finn, 18)
It's embarrassing trying to buy condoms at stores, it feels like everybody watching, that's why I just get them off a friend or my boyfriend (Jane, 19)
Some participants also said that they found it hard to anticipate when they would need condoms, as they needed to “know the right time” (Finn, 18). Knowing the right time hints at a particular challenge for condom use raised by several young men in our study - unplanned sex. A small number of participants described instances where they have no condoms with them because they had not anticipate having sex and therefore they had unprotected sex. Perhaps not surprisingly, alcohol was often implicated in these situations. For example, the combination of alcohol and not having a condom was enough to disrupt Fred's resolve to use a condom.
So I like to use condoms when I can get them. I know TAIHS give out free condoms but it is hard to find some or to buy some when you need them (…) Not always easy to get condoms. Protection is very easy word but is hard to do. (…) it is easy to say use the condom but when you are out drinking and forgetting to get a condom you just go ahead and do it right there and then and not bother about protection (Fred, 19)
It may be particularly difficult for homeless (or highly mobile) young people to access condoms as they may not be having sex at home or have local knowledge of where to obtain free condoms. Several young people in our study reported regularly carrying condoms:
I know if you don't use protection you are in trouble. That is why I have start[ed] to carry condoms with me. You never know, aye (…) I carry condoms everywhere anyway (Tim, 18)
One potential downside to carrying condoms is that this can be interpreted by potential sexual partners as consent to sex, something that may put off young women who are worried about their reputation. There was no evidence of this in our study, indeed, young women talked about obtaining free condoms, buying condoms and carrying condoms:
I carry condoms with me all the time (Margaret, 26)
In addition to having access to a condom when they needed one, two other challenges to condom use emerged in our interviews: disparities in men's and women's commitment to consistent condom use; and alcohol and drug use.
Young male partners refusing to use condoms, or indicating a preference for sex without them, was reported by several young women in our study.
Only with my (partner), he doesn't like to use protection (…) I have asked him to use it a few times but he just says no. I would rather he use a condom just to be safe (Karen, 24)
One young woman indicated that it was easier to go along with her partner and seek screening later. That is, potentially dealing with an infection was ‘preferable’ to having to insist on a condom within the dynamics of a sexual interaction. More broadly, young women's choice to engage in sexual intercourse, with or without condoms, was not always truly negotiated. One pregnant young woman, for example, suggested that her ‘choice’ to have sex was limited by her fear of her partner and reliance on him for accommodation.
I'm still sexually active but it is getting a bit uncomfortable you know with the baby and all. I know I was told to be careful from my doctors at TAIHS. But my friend (partner) wants it and I don't want him to be angry with me [Does he gets angry if he does not get it and do you feel scared?] All I want is a place to stay and yes he scares me sometimes (Lizzie, 18)
While none of our male participants indicated that they refused to wear condoms or pressured women into sex, their ambivalence to condoms was evident: “Condoms are not as good as what they [are] made out to be” (James, 25) and “Everyone likes to be or go ‘free willy’ sometimes” (Eric, 26)
It is important to note that a few young men suggested that it was their female partner who needed to be reminded of their personal responsibility for safer sex. However, more commonly the dynamic appeared to be gendered suggesting that many young women still feel responsible for insisting on protection during sex but are often challenged by men's dislike for condoms, refusal to use them, or ambivalence to safer sex ‘in the moment’.
Another challenge to condom use, described by both male and female participants, was alcohol and drug use. Specifically, intoxication increased the difficulty of following through on intentions to use condoms during sex:
It is easy to say use the condom but when you are out drinking and forgetting to get a condom you just go ahead and do it right there and then and not bother about protection (Fred, 19)
In their accounts of unprotected sex while intoxicated, young people characterised themselves as impulsive and irrational. However, these narratives of unprotected sex often coexisted with descriptions of subsequent rational behaviour in the form of STI screening. We see this, and the two challenges of intoxication and a partner's preference for no condom, in this extract from Ester:
With alcohol and drugs, it would be easier not to use protection during sex, being under the influence of drugs and alcohol and go with the flow, and the fella may not want to use the protection. I would probably go along willingly being intoxicated (…) But still I have to think about the end result and then would have to go for a sexual health check later on (Ester, 26)
Being in a trusting and committed relationship
The second preventive strategy raised by young people focused on trust and a committed relationship. ‘Sleeping around’, or having multiple casual partners, was seen by many young people as a risk for STI and some participants described personal experiences of having multiple partners and contracting an infection: Like before I never have one partner and never use a condom and I had that thing (Chlamydia) (Ester, 26). As such, not sleeping around or having only one partner was often presented as a protective strategy. Just as casual relationships were seen to be risky, the opposite was true for boyfriend-girlfriend, de-facto or married relationships, which were expected to be trusting, monogamous and committed, thereby, inherently safe. Almost a third of participants (similar proportions of women and men) stated that allowing time to get to know a potential sexual partner in order to develop trust were important STI prevention practices:
Develop a relationship first (Ester, 26)
I don't rush into anything, I never rush. It is important not to rush rather know a girl first (Finn, 18)
Once participants felt that they had established trust (which included getting to know the other person and sometimes negotiating a relationship status – i.e. boyfriend/girlfriend – or monogamy), many young women indicated that condoms were no longer a relevant prevention strategy:
I never use condoms, not that important. I trust and know my husband. […] I have never used a condom ever because there was no need for me to use a condom (Natalie, 25)
I'm sexually active at the moment and I don't use protection because I know him (…) I trust my partner that is why I do not use protection (Katie, 26)
Another young woman, Rachel, was currently using and endorsed the importance of condoms, but suggested that if she was in a relationship she would not use condoms because trust should be part of the relationship:
It is important that partner relationships are being based on trust. If I know my partner and trust him then I would not have any problem with not using condoms. I guess it is based on trust and developing that relationship with your partner (Rachel, 23)
It is unsurprising that when young people in our study did talk about using condoms in an established relationship, it was linked with suspicion that a partner was having sex with other people:
I don't remember having an STI, maybe because I use protection all the time, you know. I think too I know what my husband was up to (Katie, 26)
Some young people reported that their trust in their partner had been violated when a partner had cheated. This violation was not just about hurt feelings but potential exposure to infection, and often produced changes in subsequent prevention practices:
I had an STI from this other girl that I was going around with. […] Up until now I don't trust girls (Mark, 26)
I'm now seeing someone new. I'd like to take it slowly. I use protection, he is still someone that I need to get to know gradually. I don't want to make the same mistake like before. (Nina, 26)
The third strategy for preventing infection reported by the young people in our study was STI screening. A quarter of our participants spontaneously spoke about regular checkups, blood tests, sexual health checks. This included monitoring their own and their partners’ STI status through regular screening, and seeking screening when they perceived themself at risk of infection. Young people reported proactively seeking screening both within specific time frames (6 months, 2 years), as well as in more general terms (regular or when I can). Young women, in particular, reported opportunistic screening when attending their regular health provider. It was common for young people's descriptions of regular screening to contain a sense of pride, particularly around being a responsible person and doing the right thing. This was evident when young people described themselves as a ‘good’ patient by having STI screening when their doctor suggested it or when women were proud to have been a ‘good’ expectant mother and sought STI screening.
Every time I go to TAIHS I go for a sexual health. I make sure that everything is clear. I'm now pregnant and I made sure as soon as I found out that I went for an antenatal check and they did screening and all blood tests came back clear (Rachel, 23)
All of the young ones these days are frightened to get a check up for STI, not me, I'm happy to go any time they need me to go for a pap smear (Samantha, age unknown)
Some young people also talked about using screening as a way to establish a partner's sexual health status prior to commencing a sexual relationship. Some young women suggested that they had refused to have sex until their partner had been screened:
I have a partner that I trust obviously. I make sure that he gets a sexual health check first before I sleep with him (Naomi, 26)
We never use condoms, he is clean, I tell him to go for a check up before he touch me (Lydia, 24)