Few concepts in history have been as simple yet revolutionary as the condom. While early prototypes date back to the Bronze Age, condoms as a tool for public health and sexual safety is a relatively new concept. In 2020, it's difficult to imagine a reality without fishbowls of condoms provided by public officials strategically placed in bars, vending machines stocked with them in dorm basements, and clever Trojan commercials, but it wasn't until the mid-80s, in the wake of the AIDS crisis, that condoms began popping up in national public service announcements and safe sex advertisements. Even now, in many parts of the world and even the United States, condom use is either discouraged or virtually inaccessible despite 1.7 million new HIV acquisitions worldwide in 2019 alone.
Today, on World AIDS Day, we look back at the history of the condom, reflect on just how far we've come, and look ahead at where we need to be.
It's no surprise that early versions of condoms were rudimentary at best. First mentioned in writings from 1000 B.C. (that's around 3,000 years ago), they functioned on the most basic level by using household fabrics and materials like silk papers soaked in oil, leather or other thin hides, and even hollowed out animal horns and turtle shells to act as a blockade. Despite evidence of their use, it's up for debate among historians as to how frequently worn or widespread condoms actually were.
The first definitive moment in condom technology didn't arrive until the 16th century when an Italian physician—who, incidentally, also discovered the Fallopian tubes—first recommended them to the public as a way to stem the spread of syphilis. Despite a flawed design that consisted of tying a cloth to the penis with a ribbon, it was a watershed moment in public and sexual health. In subsequent centuries, we saw vast improvement in condom design and understanding, trading out paper and animal horn for lambskin, intestines, and softened linen. The animal intestine model became the popular version of the condom all the way up to World War I.
The Big Breakthrough
In 19th century America, condom use wasn't common despite spiking sexually transmitted disease rates. Abstinence, what would become an all-too-familiar refrain, was the only promoted solution to rampant syphilis infection rates as all STDs were seen as punishment for moral failings even as World War I saw outbreaks among soldiers. But by World War II, not only were single-use latex condoms mass-produced and freely distributed to soldiers. Ordinary civilians, particularly those of disadvantaged communities, still faced stigma and obstacles to access.
In the 1950s, with the advent of even thinner latex condoms that include the reservoir tip for semen collection we know today, condom sales skyrocketed and it was estimated that 42 percent of American adults used them for birth control. It was the primary form of birth control until the Pill's introduction in the 60s. However, the morality of condoms, and birth control in general, was still up for debate. Even broadcast advertisements for condoms were outlawed, citing indecency.
The AIDS Crisis
The public conversation around condoms took a turn in the early '80s with the discovery of HIV and, subsequently, AIDS. Ignorantly referred to as "gay cancer", the virus' rapid spread primarily through urban populations of gay men turned what should have been a straightforward and robust response to a pandemic into a political, religious, and moral argument. The Reagan Administration's chilling lack of action, peddling an abstinence mantra over any real prevention recommendation, dominated until activist organizations battled for actual sexual health information to be widely distributed.
National condom promotions began broadcasting nationwide while informational mailers were sent to homes. Access to prevention information and condoms, in combination with a few other factors, lead to increased condom use and decreased infection rates. And the ad campaigns continue to help: from 2010 to 2019 alone, new HIV acquisitions fell by 23 percent.
Today, condoms are cheaper, more widely available, and in more varieties than ever before. If you've ever had the singular experience of stepping into a sex store, like the gloriously literal Condomania, and you'll be treated to towering displays showing every kind of ribbed, studded, flavored, colored, textured, patterned, scented, and sized condom imaginable, and often at nominal price points. The problem, though, is that for all of our progress, there are still large swaths of people still disproportionally affected by HIV and AIDS. Black, gay, Latinx, and sex worker communities are all more vulnerable to infection based on lack of information and resources, no or little access to contraception, and disenfranchisement. And while preventative pharmaceuticals like PrEP are life-changing in terms of HIV prevention, studies find it may give a false sense of security to takers leading them to forgo condoms and potentially be exposed to other infections.
Because condoms stand alone with the Pill as the two most revolutionary inventions in the history of sex, we'd be remiss to not discuss sexual health options for those who have uteruses. Just as widespread public ad campaigns and cheap or free access lead to increased condom use and therefore lower STD infection rates, similar pushes would only benefit society. So-dubbed female condoms also protect against HIV and other diseases and have only a slightly higher failure rate than traditional condoms yet are almost never freely distributed outside of clinics. And, of course, the health benefits of birth control pills, from helping to prevent ovarian cancer to dissolving or reducing breast cysts and bone thinning, are widely documented but prescriptions and insurance coverage can be scarce.
Looking back at the history of condoms, it's clear that we should view it as unfinished with significantly more ground to cover than a finite timeline. Today, we're grateful for our progress but hopeful for the future.