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Condom Prophylaxis

Kondom from Wikipedia
Latex condom
Image: Wikipedia

A condom is a sheath usually made of rubber that is rolled onto an erect penis before sex to block cum from entering your sex partner's body.

According to a 2000 report by the National Institutes of Health (NIH), consistent use of latex condoms reduces the risk of HIV/AIDS transmission by approximately 85% relative to risk when unprotected. Analysis published in 2007 from the University of Texas Medical Branch and the World Health Organization found similar risk reductions of 80-95%. In March 2013, a U.S. CDC released a report finding that only one in six gay men used condoms consistently for anal sex and that 100% condom use for anal sex is only 70 per cent effective in stopping HIV. The CDC study also stated that intermittent use of condoms has no effect on reducing HIV rates. However, this number has been disputed as too low, due to the study's mathematical extrapolation from various research.



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Kondom from Wikipedia
18th century animal-gut condom in the British Museum. This would be rinsed out, soaked in water or milk and reused. The pink ribbon is to tie it on.
Image: @WhoresofYore Twitter

A Brief History of Condoms

Condom-like devices that fit on the penis have been used for contraception for many hundreds of years in China and Japan, possibly even the Roman empire, but there are few records. Since the 19th century, condoms have been one of the most popular methods of birth control in the world. Use as contraception has been the reason condoms were prohibited or restricted by religious authorities. However, it was sexually-transmitted disease prevention that spurred the invention and popular use of condoms.

The first uncontested description of condoms being used as prophylaxis is in 1564 — a treatise called De Morbo Gallico (The French Disease) by Gabriele Falloppio. Falloppio's treatise described an experimental trial of condoms that demonstrated protection against syphilis. These condoms were linen sheaths soaked in a chemical solution and allowed to dry before use. The sheaths were sized to cover the head of the penis, and were held on with a ribbon. Syphilis was first documented in Europe in the 1490s as causing severe symptoms with boils, sores and often death within a few months.

Condom (and manual) from 1813
Condom (and manual) from 1813. Click to enlarge.
Photo: Wikipedia

During the Renaissance condoms were made out of leather from lamb intestines and bladder softened by treatment with sulfur and lye. As early as the 17th century the French aristocracy used them widely. Madame de Sevigne, writing in 1671, dismissed the use of condoms as "armour against enjoyment and a spider's web against danger." By the 18th century the condom market was growing rapidly, sold at pubs, barbershops, chemist shops, outdoor markets, and even at the theatre throughout Europe and Russia, and had been introduced to Japan and somewhat in America. Condoms were still at this point used only by the upper classes.

Giacomo Casanova tests his condom for holes by inflating it. Published 1872.
Giacomo Casanova tests his condom for holes by inflating it. Published 1872.
Image: United States Library of Congress

By the 19th century condoms were promoted as contraception for the poor, although there was much controversy and many laws impeding the promotion of condoms — mostly for religious reasons — and for being a method wholely controlled by the man. But by the second half of the 19th century, syphilis rates in America soared, some historians cite the American Civil War as the cause. Many hospitals refused to treat syphilis patients due to the stigma the disease carried. Sex education was introduced in schools, but abstinence — not condoms — was promoted. Sexual diseases were still thought to be punishment for sexual misbehaviour.

The German military were the first to promote condom use for its soldiers at the end of the 19th century. And even though the U.S. Army conducted experiments that concluded that condoms reduced sexual disease infections, the United States and Britain were the only countries that did not provide condoms for their soldiers during World War I. Freud opposed condom use because they cut down sexual pleasure, some feminists opposed condoms because they were controlled by men, The Church of England condemned condoms for being unnatural contraception and the Bishop of London complained about the huge number of condoms littering the streets and parks, especially after holidays. In some European countries condom use was outlawed for civilians even though they were given to the army.

Colourful Condoms

In 1844 Charles Goodyear patented his new invention — a way to process natural rubber so that it was elastic called "vulcanization." The first rubber condom was invented in 1855 which had great advantages over traditional sheepskin condoms. They could stretch and did not easily tear. Condoms had a thick seam as they were made of strips of rubber wrapped around a cock-shaped mould and then sealed using chemicals.

In 1912, a polish inventor Julius Fromm developed a new way to manufacture condoms using a dipping method with a glass mould. The rubber was made liquid by adding gasoline which created "rubber cement." Latex (rubber suspended in water) was invented in 1920. Latex condoms were stronger, thinner, less hazardous to manufacture and had a shelf-life of five years compared to three months for old rubber condoms. By 1930, a fully automated condom manufacturing line was patented, and small manufacturers using labourers were eventually put out of business. Schmid condoms gained popularity during the great depression because they were the old rubber cement condoms which could be used with oil-based lubricants and were reusable, so delivered better value. By the end of the 1930s, U.S. Food and Drug Administration began to regulate the quality of condoms sold in the United States due to increased attention on quality concerns.

1935 - Testing condoms. WhoresofYore
1935 – Testing condoms.
Photo: @WhoresofYore, May 2016

In 1939 there was a huge syphilis and gonorrhea outbreak. During World War II condoms were not only distributed to soldiers on all sides, there was active promotion of condom use — films, posters, lectures. This World War II era U.S. public health poster for the army (below) clearly demonstrates the connection between war and large increases in sexually-transmitted disease infections. "Fool The Axis" refers to "The Axis of Evil" — fascism — depicted by nasty charicatures of Italian Prime Minister Benito Mussolini, Japanese General Hideki Tojo and German Chancellor Adolf Hitler. Each dictator is covered with boils sporting banners that read "Gonorrhea," "Chancroid" and "Syphilis" respectively. Mussolini is carrying a doll with a skull and crossbones on her dress presumably to represent prostitutes, while Tojo and Hitler are carrying huge syringes.

Fool the Axis - Use Prophylaxis, John Wyeth and Brother Inc. Philadelphia, 1942
"Fool the Axis - Use Prophylaxis"
Image: John Wyeth and Brother Inc. Philadelphia, 1942. Artist: Arthur Szyk

In Britain from 1950-1960, 60% of married couples used condoms for contraception. From 1955-1965, 42% of Americans of reproductive age relied on condoms for birth control. After 1960, the birth control pill became the most popular contraceptive followed by condoms. Condoms were promoted to developing countries in response to world-population crises. By 1970, hundreds of millions of condoms were being used each year in India alone. Laws against condom sales in Ireland were lifted in 1978. The 1950s ban on condom commercials on television in the U.S. ended in 1979.


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Safe Sex! by Keith Haring
"Safe Sex!"
Image: Keith Haring, 1987

Protect Yourself: Use a Condom

In the 1980s, AIDS was recognized as sexually transmitted and condom use was promoted by grassroots AIDS activists and public health departments. Some of the earliest safe sex education promoting condom use was created by sex workers. In 1984 The Australian Prostitutes Collective (APC) in New South Wales (with branches in Sydney and Melbourne) began outreach programs, distributing condoms and AIDS and STI educational materials. The programme was funded from membership fees and by donations. In 1985, APC became the first sex-worker organization in the world to receive government funding for AIDS education.

Ik doe het met
"Ik doe het mé"
Image: The Red Thread, 1987

In 1987, The Red Thread sex worker organization in Amsterdam got money from the condom manufacturer, Durex to print tens of thousands of stickers with the slogan: "Ik doehet mé" ("I do it with"). The same year in Canada, the Prostitutes' Safe Sex Project produced the pamphlet, "How to Have Safer Sex."

Condom sales grew annually. Durex manufactured the first polyurethane condoms (Avanti) in the 1990s. Female condoms were invented by Dane Dr Lasse Hessel (called the "Femidom") and launched worldwide in 1991. In 2004, the government of India purchased 1.9 billion condoms for distribution at family planning clinics. It was estimated that developing countries needed 18.6 billion condoms in 2015.

Official U.S. Army Public Health Center Anti-HIV Poster c. 2002
Official U.S. Army Public Health Center Anti-HIV Poster c. 2002


  • How to Have Safer Sex, Prostitutes' Safe Sex Project (PSSP) c. 1988
    First produced in 1988 by Danny Cockerline for PSSP with some support from the AIDS Committee of Toronto.
  • The Right Way To Use A Male Condom, U.S. Centers for Disease Control and Prevention, March 24, 2016
    PDF page of instructions with graphics on how to put on and take off a condom.

Protégez-vous: Use a condom animation

Protégez-vous. AIDES
February 2010 (Run-time: 1 min. 38 sec.)

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Smash the prostitution racket. Prostitution spreads venereal disease.
"Smash The Prostitution Racket" c.1940s from the American Social Hygiene Association, New York City
Image: Social Welfare History Archives

Prophylaxis Laws and Sex Work

Prostitutes have long been blamed for the spread of sexually-transmitted disease — syphilis in particular. Public health laws have often targeted sex workers in attempts to prevent STDs. There's a long history of registration and routine mandatory testing.

During World War II, for example, the German army set up army brothels. By 1942, the Wehrmacht was running over 500 so-called "Wehrmachtsbordellen." Under the responsibility of the local Medical Office of Health, the prostitutes were checked for diseases twice a week. Each army brothel had a prophylactic station that soldiers reported after brothel visits and where V.D. treatment drugs were administered.

How PrEP (Pre-Exposure Prophylaxis) is introduced in the sex industry workplace is not simply about Truvada — or even other ARV-based prevention technologies such as vaginal rings and long-term injectables soon to be available. Policies for prescribing PrEP for sex workers could have implications for HIV prevention in the workplace with regard to labour and privacy rights. They could set precedents for future HIV-prevention technologies including vaccines not yet invented.

Sex workers around the world already have faced condom-use enforcement, HIV testing within the workplace — even periodic presumptive treatment where groups of workers are presumed to have disease and are treated without positive test results. Today, there examples of prostitution laws that enforce prophylaxis use.

98 per cent of all procurable women have venereal disease
"98% of all procurable women have venereal disease" c.1940s
poster: Special Service No. 9, M Franklyn

In July 2017, a new law will come into force in Germany, Law for the regulation of the prostitution industry as well as for the protection of persons engaged in prostitution (Gesetz zur Regulierung des Prostitutionsgewerbes sowie zum Schutz von in der Prostitution tätigen Personen) which makes ammendments to Germany's Prostitution Act 2002. This new regulation includes fines for not using condoms. Section 32, paragraph 1 is replaced with:

"unter Hinweis auf die Gelegenheit zum Geschlechtsverkehr ohne Kon- dom, auch wenn der Hinweis in mittelbarer oder sprachlich verdeckter Form erfolgt,"

"Having regard to the opportunity for sex without a condom, even if the reference is in indirect or linguistically disguised form."

Some states in Germany have brought in their own regulations. Mandatory condom use is already in place in Bavaria and Saarland.

WWII German bordello permit
WWII German Bordello Entry Permit c. 1940s "Entry to the brothel is permitted only with this ID card! "Name of prostitute" featured bottom right.


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Prostitution Reform Act, New Zealand

We Are Professional About Preventing AIDS
"We Are Professional About Preventing AIDS"
Poster: New Zealand Collective of Prostitutes, 1989

In 2003, the Prostitution Reform Act decriminalized prostitution in New Zealand. Section 9 of the Act, called, "HIV and STI Testing and Treatment Policies" states:

"A person must not provide or receive commercial sexual services unless he or she has taken all reasonable steps to ensure a prophylactic sheath or other appropriate barrier is used if those services involve vaginal, anal, or oral penetration or another activity with a similar or greater risk of acquiring or transmitting sexually transmissible infections."

New Zealand Prostitutes' Collective (NZPC) is opposed to sections 8 and 9 in the Prostitution Reform Act that states that all reasonable steps must be taken to use a condom or other barrier for vaginal, anal, or oral sex. According to NZPC, this is discriminatory legislation that may result in sex workers being targeted, and having to suffer the consequences of a conviction for sex-work related activity, which is in conflict with the concept of decriminalisation. Health promotion is the most effective way to address safer sex issues with sex workers, who may not be strong in the area of safer sex practices. Brothels usually have policies and practices that uphold the right for sex workers to insist on condoms being used.

In New Zealand this law has been used against clients and, recently, against one migrant sex worker who had only been in New Zealand three weeks. It has also been suggested as a lesser charge when a sex worker has been sexually assaulted or raped.

Posters and leaflets were developed by the Ministry of Health in consultation with NZPC when the PRA first passed in 2003, and these can been seen online at

While sex workers use these leaflets and posters to convince clients who are insistent about wanting unprotected sex to use a condom, a house policy saying the same thing would be just as effective.


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UNAIDS 100% Condom Policy

By 2003 100% Condom-Use Programs (100% CUP) were being implemented or planned in several countries in Asia, Latin America and Africa. UNAIDS and other key agencies promoted 100% CUP as a "best practice" as a result of claims made about the role of 100% CUP in reducing national HIV epidemics.

In a letter published in The Lancet, June 2003, Network of Sex Work Projects (Bebe Loff, Cheryl Overs and Paulo Longo) noted that the program was developed without consultation with sex-work advocates and they questioned the extent to which it infringed on sex worker rights and the validity of UNAIDS claims that the program empowered sex workers. They also suggest that the enlistment of police and other local authorities as part of the surveillance mechanisms through which the program attempted to enforce universal condom coverage has potentially created new methods of abuse in environments already prone to corruption.

100 per cent condom use programmes
Sex-worker rights perspective on 100% condom-use programmes
Photo: Carol Jenkins, July 2002


  • HIV/AIDS and the Social Consequences of Untamed Biomedicine: Anthropological Complicities, Graham Fordham, Routledge 2015
  • "Can health programmes lead to mistreatment of sex workers? Bebe Loff, Cheryl Overs, Paulo Longo, The Lancet, Vol. 361, June 7, 2003
  • "Cambodia's 100% Condom-Use Program." 100% CUP Draft Report, December 23, 2002
    "The policy framework for the Cambodian 100% CUP is contained in the following Ministry of Health documents: Strategy and Guidelines for Implementation of 100% Condom Use in Cambodia; Policy for HIV/AIDS and STI Prevention and Care in the Health Sector in Cambodia; Guidelines for the Implementation of STI Services, Policy, Strategy and Guidelines for HIV/AIDS Counseling and Testing; and The Outreach Program: Strategy and Guidelines for Implementation."
  • "Sex worker rights perspective on 100% condom-use programmes." AIDS 2002 Barcelona, ACT UP New York, July, 2002
    "According to Carole Jenkins, HIV Advisor to USAID, 'the bottom line is that affected and vulnerable communities have to have a voice in the design, implementation, monitoring and evaluation of programmes. Practically speaking, when/if someone accuses a programme of abuse or misconduct, the only safeguard you have is the real and democratic participation of the affected communities.'"

Caught Between the Tiger and the Crocodile
Video: Caught Between the Tiger and the Crocodile
Asia Pacific Network of Sex Workers, 2007

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No on Prop 60, by Jiz Lee
"No on Prop 60"
Image: Jiz Lee on FaceBook

Condom Laws & U.S. Adult Film Industry

California law has required condom use in adult films since 1992. However, the law is rarely enforced. In 1998, veteran male porn actor tested HIV-positive after allegedly hiding his positive status for two years and infecting several co-stars.

In 2004, a male adult performer tested HIV-positive followed by three fellow female performers and film production shut down for a month. The Los Angeles County Department of Health Services (LACDHS) launched an investigation into the four work-related HIV-transmission cases. The California State Assembly Committee on Labor and Employment published a report Worker Health and Safety in the Adult Film Industry, which recommended policy makers and the adult film industry implement "combination prevention" to control HIV transmission.

No on Prop 60, Cristi Ann
"No on Prop 60"
Image: Christi Ann on Twitter
In 2009, a positive HIV test for a performer (known as "Patient Zero") sparked a legal battle between the California Department of Occupational Safety and Health and AIM Medical Associates over performers' rights to medical privacy. In August 2011, a HIV-positive test result again shut down the porn industry. Adult film studios required performers to submit to mandatory STI testing every 14 or 28 days. As a result, the Free Speech Coalition launched an online database to keep track of performers' test results.

A study by Los Angeles County Department of Public Health and the Johns Hopkins Bloomberg School of Public Health was released claiming that L.A. porn stars showed higher rates of STDs than Nevada prostitutes. During the four-month study conducted in 2010, 28% of the 128 performers who participated were diagnosed with an STI. Gonnorhea was the most common with most infections being oral. Anal gonnorhea infections detected were asymptomatic. In summer of 2012 the porn industry experienced a syphilis outbreak with as many as nine U.S. industry-related syphilis cases. It was believed that outbreak first began among Eastern European adult performers in Budapest which involved more than 100 individuals. The outbreak in Los Angeles halted film production for two weeks and prompted the Free Speech Coalition to recommend all L.A. adult performers be treated with antibiotics — prophylactically and tested for syphilis using the rapid plasma reagin test which screens for antibodies.

No on Prop 60, Chellie DD
"No on Prop 60"
Image: Chellie DD on Twitter

In March 2012, Los Angeles became the first city in the nation to require male adult film actors to wear condoms on all film shoots that receive a city permit. November 7, 2012, Measure B (also called the "Safer Sex in the Adult Film Industry Act") was passed in Los Angeles County by a vote of 56%. The ballot measure was spearheaded by AIDS Healthcare Foundation (AHF), who claimed that as many as 22 HIV infections believed to be tied to the adult film industry were reported in two outbreaks in Los Angeles since 2004. After voters in Los Angeles County approved the condom requirement in 2012, the number of permits for adult films in Los Angeles dropped dramatically, from 485 in 2012 to 40 in 2013. Meanwhile, the number of general permits for all film productions in Clark County, including Las Vegas, jumped more than 50%, from 226 in 2012 to 343 in 2013.

In December 2014, two cases of HIV transmission were reported in porn production in Nevada. In January 2015, the health department stated it would take two years to collect data and public comment to consider porn production regulations similar to those for Nevada brothels. Condom use would be required for all sex acts, including oral sex. Adult film performers, like Nevada's licensed brothel workers, would be required to undergo weekly testing for the sexually transmitted diseases chlamydia and gonorrhea, and monthly testing for HIV and syphilis.

No on Prop 60, Julia Ann
"No on Prop 60"
Image: Julia Ann Ann on Twitter

Porn actors aren't prostitutes, said Diane Duke, chief executive of the Free Speech Coalition, an industry trade group that administers strict HIV testing and a database showing pass-fail results. Duke said the database lists 6,000 porn performers since 2011. Porn actors are tested every 14 days.

"In a brothel, you're talking about people coming in from outside," she said. "We have performers on a closed set who go through a testing protocol."

Also sponsored by AHF, Proposition 60 (2016) (a ballot for the State of California) is modelled on LA County's Measure B. In addition to requiring the use of condoms in the production of pornographic films, "Prop 60" would also require adult film companies to obtain a health license and pay for the costs of vaccinations and health tests for sexually transmitted diseases for their performers. This requirement has received much criticism and is said by some to be counter-productive, merely forcing companies that make pornographic films to relocate to other places without this requirement. Prop 60 was defeated November 29, 2016.

Check your condom (law) for safety risks!
Click to enlarge.
Image: #NoProp60


  • "Will California's Prop 60 expose adult film workers to lawsuits? Chris Nichols, PolitiFact California, September 2, 2016
  • "California Officials Vote Against Condom Rules for Porn Productions." Rhett Pardon, XBiz News Report, February 18, 2016
    "Nearly all of the adult entertainment stakeholders said that if S. 5193.1 were to come into play, it would force the business underground and might put an end to the industry's own requirement that actors be tested for sexually transmitted disease every 14 days."
  • "Nevada considering strict condom regulation for porn films," Ken Ritter, Medical Express, January 24, 2015
  • "No condom-free porn? Nevada considers brothel-style regulation: Last month two performers tested positive for HIV following a video shoot." Associated Press, The Guardian, January 24, 2015
    "If porn production is regulated under the same rules, condom use would be required for all sex acts, including oral sex. Adult film performers, like Nevada's licensed prostitutes, would be required to undergo weekly testing for the sexually transmitted diseases chlamydia and gonorrhea, and monthly testing for HIV and syphilis."
  • "Sexually Transmitted Infection Testing of Adult Film Performers: Is Disease Being Missed? Cristina Rodriguez-Hart, MPH et al, Sexually Transmitted Diseases, November 1, 2012
    "Adult film industry performers had a high burden of STIs. Undiagnosed asymptomatic rectal and oropharyngeal STIs were common and are likely reservoirs for transmission to sexual partners inside and outside the workplace. Performers should be tested at all anatomical sites irrespective of symptoms, and condom use should be enforced to protect workers in this industry."
  • "LA County Voters Mandate Condoms for Porn Actors". Samantha Tata, NBC Los Angeles, November 7, 2012
  • "HIV-Positive Performer Shuts Down L.A. Porn Industry." Katie Moisse, ABC News, August 30, 2011
  • Worker Health and Safety in the Adult Film Industry: Post-Hearing Report. Paul Koretz, Chair, California State Assembly Committee on Labor and Employment, July 2004
    "Dr. Coates further testified that in addition to a harm reduction strategy policy makers and the industry should also be re-conceptualizing the issue of safety in adult films to include "combination prevention" as may be necessary in order to control transmission of HIV during the risky situations that define the content of adult films."
  • "HIV Transmission in the Adult Film Industry – Los Angeles, California, 2004." Morbidity and Mortality Weekly Report, September 23, 2005
    "In April 2004, the Los Angeles County Department of Health Services (LACDHS) received reports of work-related exposure to human immunodeficiency virus (HIV) in the heterosexual segment of the adult film industry in California. This report summarizes an investigation by LACDHS into four work-related HIV-transmission cases among adult film industry workers."

No Prop 60
Click to enlarge.
Image: #NoProp60

Last modified: December 9, 2016
Created: September 23, 2016
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