Does Condom Use Promote Behavioral Disinhibition? Empirical Evidence from Rakai, Uganda

Saifuddin Ahmed, Johns Hopkins University
Ronald H. Gray, Johns Hopkins University
Tom Lutalo, Rakai Project
David Serwadda, Makerere University
Noah Kiwanuka, Rakai Project
Godfrey Kigozi, Uganda Virus Research Institute, Rakai Project
Maria Wawer, Johns Hopkins University

There is a growing concern that condom use may lead to behavioral disinhibition offseting much of the potential benefit from their use in preventing HIV and STDs. Using longitudinal data, this study examines the association between condom use and subsequent high-risk sexual behaviors in Rakai, Uganda. During 1995-2000, condom use with any partner increased significantly from 17% to 27%, and from 37% to 60% with casual partners. Consistent condom use remains low, but increased almost 2.5 folds from 3.6% to 9%. Individual level trajectories of high risk behaviors show that the risk of having multiple partners increased significantly over time among inconsistent condom users (time-trend OR: 1.08; 95% CI 1.04-1.12), but remained static for consistent condom users and declined among non-users (OR: 0.94; 95% CI: 0.91-0.96). The study suggests that condom users may engender a sense of protection against HIV which may deter persons from adopting safer sexual behaviors.