OXFORD, Miss. (AP) 鈥� It鈥檚 hard to miss the overflowing bowl of condoms at the entrance of the gym.
Some University of Mississippi students walking past after their workout snicker and point, and the few who step forward to consider grabbing a condom rethink it when their friends catch up, laughter trailing behind them. Almost no one actually reaches in to take one.
Though officials say they refill the bowl multiple times a day, and condoms are available at multiple places on campus, Ole Miss students say the disinterest is indicative of changing attitudes.
are , but the teens and young adults who are sexually active aren't using condoms as regularly, if at all. And people ages 15 to 24 made up half of new and in 2022.
The downward trend in condom usage is due to a few things: medical advancements like and ; a fading fear of ; and in high schools.
Is this the end of condoms? Not exactly. But it does have some public health experts thinking about how to help younger generations have safe sex, be aware of their options 鈥� condoms included 鈥� and get tested for STIs regularly.
鈥淥ld condom ads were meant to scare you, and all of us were scared for the longest time,鈥� said Dr. Joseph Cherabie, medical director of the St. Louis HIV Prevention Training Center. 鈥淣ow we鈥檙e trying to move away from that and focus more on what works for you.鈥�
A shift in attitudes
Downtown Oxford was thrumming the day before the first football game of the season. The fall semester had just started.
Lines of college students with tequila-soda breath waited to be let in dim bars with loud music. Hands wandered, drifting into back pockets of jeans, and they leaned on one another.
It鈥檚 likely that many of those students didn鈥檛 use a condom, said Magan Perry, president of the college鈥檚 Public Health Student Association.
鈥淯sing a condom is just a big, 鈥榰h, no,鈥欌�� the senior said.
Young women often have to initiate using condoms with men, she said, adding that she鈥檚 heard of men who tell a sexual partner they鈥檒l just buy emergency contraception the next day instead.
鈥淚鈥檝e had friends who go home with a guy and say they鈥檙e not having sex unless they use a condom, and immediately the reaction is either a reluctant, 鈥極K, fine,鈥� or 鈥業f you don鈥檛 trust me, then I shouldn鈥檛 even be here,鈥欌�� Perry said. 鈥淭hey鈥檙e like, 鈥榃ell, I鈥檓 not dirty, so why would I use them?鈥欌��
Women have long had the onus of preventing pregnancy or STIs, Cherabie said, and buying condoms or emergency contraceptives 鈥� which are often in a locked cabinet or behind a counter 鈥� can be an uncomfortable experience and 鈥渋nserts a certain amount of shame.鈥�
Annie Loomis, 25, a student at the University of Washington, said dating apps and casual sex are making it hard for people to know what a 鈥渉ealthy sexual relationship鈥� looks like when it comes to intimacy and respect.
鈥淚f you say, 鈥楬ey, I want you to wear a condom鈥� and they say, 鈥榥o, I don鈥檛,' you're not having sex. It should be that simple,鈥� Loomis said. 鈥淏ut it's not.鈥�
If pregnancy risk has been the driving factor for condom usage among heterosexual couples, the fear of contracting HIV was the motivation for condom use among men who have sex with men.
But as that fear has subsided, so has condom use, according to that focused on a population of HIV-negative men who have sex with men.
Grindr, a popular gay dating app, even lists condom use under 鈥渒inks鈥� instead of 鈥渉ealth.鈥� Things like that make Steven Goodreau, an HIV expert at the University of Washington who led the study, worry that the change in attitudes toward condoms is trickling down to younger generations.
Goodreau believes the promotion of pre-exposure prophylaxis (PrEP), a drug that prevents HIV, is overshadowing condoms as a prevention strategy. A doesn鈥檛 mention condoms, and .
The Centers for Disease Control and Prevention acknowledges that condoms are still an effective tool that can be used 鈥渁longside newer prevention strategies.鈥�
鈥淲e know that condom use has declined among some groups, but they still have an important role to play in STI prevention,鈥� said Dr. Bradley Stoner, director of the CDC鈥檚 Division of STD Prevention. 鈥淐ondoms can be accessed without navigating the health care system, can be used on-demand, are generally affordable and most importantly 鈥� they are effective at preventing HIV and STIs when used consistently and correctly.鈥�
Medical advances allow for more options
Pleasure 鈥� for both men and women 鈥� has long been an undeniable factor for the lack of condom use, according to Dr. Cynthia Graham, a member of the Kinsey Institute team that studies condoms.
But more so, have expanded the options for both STI and pregnancy prevention.
Young cisgender women have been turning to contraceptive implants like intrauterine devices and birth control pills to keep from getting pregnant. And researchers say that once women are in committed relationships or have one sexual partner for a significant amount of time, they often switch to longer-term birth control methods.
Ole Miss junior Madeline Webb said she and her partner seem like outliers 鈥� they have been seeing each other for four years, but still use condoms. They also share the responsibility of buying condoms.
鈥淧eople see condoms as an inconvenience 鈥� but they do serve a purpose even if you鈥檙e on birth control because there is always a chance of an STD,鈥� Webb said.
A new drug on the market could mean even more STI prevention options for men and possibly women.
Doxycycline post-exposure prophylaxis, or doxy PEP, can be taken within 72 hours after unprotected sex and can help prevent chlamydia, gonorrhea and syphilis. It has to be prescribed by a doctor. Trials are still being conducted for women, but the drug is gaining traction among men who have sex with men and transgender women.
With widespread uptake, the drug has the potential to make a significant impact in STI prevention strategies.
鈥淲hen PrEP came out, everyone was excited because it was one less thing to worry about in terms of HIV acquisition,鈥� Cherabie said. 鈥淲ith another thing on board that can help decrease our likelihood of getting other STIs, on top of not having to worry about HIV, it gives our community and patients a little less anxiety about their sex lives.鈥�
And in just a decade, PrEP has become a main preventive measure against HIV and other STIs for men who have sex with men 鈥� though it is disproportionately used by white men.
Condom use now is 鈥減retty much a thing of the past鈥� for men who have sex with men compared to the 1980s and early 1990s during the AIDS epidemic, said Andres Acosta Ardilla, a community outreach director at an Orlando-based nonprofit primary care clinic that .
鈥淧art of what we have to talk about is that there is something enticing about having condomless sex,鈥� Acosta Ardilla said. 鈥淎nd we have to, as people who are working in public health, plan for the fact that people will choose to have condomless sex.鈥�
The fight over sex ed
Despite the relentless Southern sun, a handful of people representing various student organizations sat at tables in the heart of Ole Miss鈥� campus. Students walked past and grabbed buttons, wristbands and fidget toys. One table offered gold-packaged condoms 鈥� for cups to prevent drinks from being spiked.
Actual condoms are noticeably absent. They鈥檙e also absent in the state鈥檚 public schools.
Condom demonstrations are banned in Mississippi classrooms, and school districts can provide abstinence-only or 鈥渁bstinence-plus鈥� sexual education 鈥� both of which can involve discussing condoms and contraceptives.
Focus on the Family, a Christian organization that advocates for teaching abstinence until marriage, is concerned that comprehensive sex education 鈥渆xposes students to explicit materials.鈥� Abstinence-centered education is 鈥渁ge-appropriate鈥� and keeps students safe and healthy, Focus on the Family analyst Jeff Johnston said in an emailed statement.
But Josh McCawley, deputy director of Teen Health Mississippi, an organization that works with youth to increase access to health resources, said the effects are clear.
鈥淭he obvious consequence is the rise of sexually transmitted infections, which is what we鈥檙e seeing right now, which can be a burden on the health care system," he said, "but also there could be long-term consequences for young people in terms of thinking about what it means to be healthy and how to protect themselves, and that goes beyond a person鈥檚 sexual health.鈥�
The shows Mississippi has the highest teen birth rate in the country.
Scott Clements, who oversees health information for the state education department, was hesitant to criticize Mississippi's sex education standards because they're 鈥渓egislatively mandated.鈥�
鈥淚f the legislature wants to make changes to this, we will certainly follow their lead,鈥� he added 鈥� though attempts to pass more advanced sexual education standards have died repeatedly in the Mississippi statehouse over the past eight years.
Nationally, there is for sex education, according to Michelle Slaybaugh, the director of social impact and strategic communication for the Sexuality Information and Education Council for the United States, which advocates for comprehensive sex ed.
Not every state mandates sex education. Some states emphasize abstinence. Less than half of states require information on contraception.
鈥淭here is no definitive way to describe what sex ed looks like from classroom to classroom, even in the same state, even in the same district,鈥� Slaybaugh said, 鈥渂ecause it will really be determined by who teaches it.鈥�
Compare Mississippi to Oregon, which has extensive state standards that require all public school districts to teach medically accurate and comprehensive sexual education. Students in Portland are shown how to put on a condom on a wooden model of a penis starting in middle school and have access to free condoms at most high schools.
Lori Kuykendall of Dallas, who helped write abstinence-focused standards, said condom demonstrations like those in Portland 鈥渘ormalize sexual activity in a classroom full of young people who the majority of are not sexually active.鈥� She also points to increasingly easy access to pornography 鈥� in which people typically do not wear condoms 鈥� is a contributing factor to the decline in condom use among young people.
Jenny Withycombe, the assistant director for health and physical education at Portland Public Schools, acknowledged the standards see pushback in the more conservative and rural parts of Oregon. But the idea is to prepare students for future interactions.
鈥淥ur job is to hopefully build the skills so that even if it鈥檚 been a while since the (condom) demo ... the person has the skills to go seek out that information, whether it鈥檚 from the health center or other reliable and reputable resources," Withycombe said.
Those standards seem to contribute to a more progressive view of condoms and sex in young adults, said Gavin Leonard, a senior at Reed College in Portland and a former peer advocate for the school's sexual health and relationship program.
Leonard, who grew up in Memphis 鈥� not far from Oxford, Mississippi, said his peers at Reed may not consistently use condoms, but, in his experience, better understand the consequences of not doing so. They know their options, and they know how to access them.
Slaybaugh wants that level of education for Mississippi students 鈥� and the rest of the country.
鈥淲e would never send a soldier into war without training or the resources they need to keep themselves safe,鈥� she said. 鈥淲e would not send them into a battle without a helmet or a bulletproof vest. So why is it OK for us to send young people off to college without the information that they need to protect themselves?鈥�
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This story has been corrected to show that Michelle Slaybaugh's title is director of social impact and strategic communication for the Sexuality Information and Education Council for the United States.
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Associated Press videojournalist Manuel Valdes in Seattle contributed to this report.
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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
Devna Bose, The Associated Press
