Skip to main site content.

Sexual health

Weighing the Sheen effect: How worried are women about H.I.V. these days?

By Sarah Elizabeth Richards on December 18, 2015

When news of actor Charlie Sheen’s HIV-positive status broke a month ago, it was a rare reminder of the still-lurking danger of the virus that causes AIDS. The announcement put the issue of condom use on women’s radars, causing many to confide to girlfriends, “I wonder if I should start being more careful.”

“Whenever one of these celebrity stories comes out, there’s always more interest in the immediate medical issue,” says Nathaniel DeNicola, MD, ob-gyn at University of Pennsylvania Clinical Practices. “I had a few more patients ask me about condom safety that week, but that [piqued interest] also happened when Kim Kardashian had problems with her placenta.”

Although there are some reports of a “Sheen Effect” pushing up sales of at-home HIV tests, it’s too soon to know if more women have changed their sex practices as result. But the renewed focus on the issue highlights how women’s attitudes about HIV and condom use have changed since the era two decades ago when campus safe-sex counselors scared the bejeezus out of us with the message: “Use condoms or die.”

Condoms are still recommended as the best precaution against sexually transmitted diseases, however they’re less popular than ever. According to the most recent figures from the Centers For Disease Control’s National Health Statistics Report, just 15 percent of U.S. women who use contraception relied on condoms with a male partner from 2011 to 2013. The biggest drop was among women who were not married or cohabitating. In a report looking at the decrease in condom use among never-married women (divorcees got their own category), reliance on partners’ condom use decreased from 32 percent in 1995 to 22 percent in 2006–2010.

Following his announcement that he is HIV positive, Charlie Sheen sits on the set of the NBC Today show to be interviewed by Matt Lauer on November 17, 2015. (REUTERS/Mike Segar)
Following his announcement that he is HIV positive, Charlie Sheen sits on the set of the NBC Today show to be interviewed by Matt Lauer on November 17, 2015. (REUTERS/Mike Segar)

Marie Claire editor Whitney Joiner questioned whether condom-free intercourse might even be the norm among her small sample of 30-something New Yorkers in her essay “Am I the Last Women Using Condoms?” “There’s this feeling that if we’re already in our thirties and we haven’t gotten an STD by now, we’re probably not going to,” explains Joiner, also co-founder of The Recollectors, a storytelling site and community for people whose parents were lost to AIDS. “People see AIDS as a tragedy that happened a long time ago and moved to Africa. After the cocktail changed AIDS from a death sentence, people thought ‘We don’t have to worry about it anymore’.”

We still have to worry. Although the rates of new infections have remained steady recently, there are still about 50,000 new cases annually, and women make up 25 percent of those. New generation anti-retroviral medications have made it possible to reduce your viral load to possible undetectable levels so that the risk of transmission is significantly lowered (a confidence booster that prompted Sheen to admit to having unprotected sex with two people.) The challenge: One in eight people living with HIV don’t know they’re infected, according to the CDC. And 61 percent of newly infected people who were aware of their status hadn’t started treatment. “The good news is that medical advances have made HIV a chronic disease for most people,” says DeNicola. “I remember in 1991 when Magic Johnson announced he got it, we all thought he was going to die any month.”

So why are more women foregoing condoms these days? Apparently, it’s not just men who disdain the prophylactics. In a study published in the Journal of Sex Research in October, researchers from the University of California at Berkeley asked 38 young black and Latina women why many preferred the withdrawal method. “One woman called condoms rubbery and painful and said they interfered with the pleasure of sex,” explains co-author Anu Manchikanti Gomez, assistant professor at the School of Social Welfare. “Many women started using the pullout method because they wanted to feel closer to partners, didn’t worry about STD’s and would be okay if they become pregnant.”

Oraquick is an at-home HIV testing kit. (Angel Franco/The New York Times)
Oraquick is an at-home HIV testing kit. (Angel Franco/The New York Times)

Also, more women are opting for long-term intrauterine devices or implants, which have increased five fold since 2002 and have a miniscule risk of pregnancy, compared to condoms, which have a 15 to 18 percent failure rate. Only one in 10 women simultaneously use condoms and another kind of contraception. “The reality is that it’s hard enough for women to use one method,” explains Gomez, adding that women tend to weigh their priorities: Bullet-proof pregnancy protection or minimizing risk of disease. “For some women, contracting HIV would be a worse outcome than getting pregnant,” she says.

Women aren’t necessarily being reckless, say experts. They just might be going about protecting themselves in a different way than past generations by relying more on testing to make safe-sex decisions. “Patients have become more comfortable getting tested for everything,” says DeNicola. STD and HIV screenings are often a part of one’s annual exam, even for those who don’t report being exposed to diseases, he says.

Also, African-American women, who account for 70 percent of new infections among heterosexual females, have been inundated with messages that they are at risk, says Gomez. “Black women are more likely to report talking with a doctor in the last year about HIV and are also more likely to have ever had an HIV test outside of blood donation than white women,” says Gomez.

In the meantime, there’s a movement to make a better condom. Two years ago, the Bill and Melinda Gates Foundation started giving $100,000 grants to researchers intent on reinventing the rubber. Until then, condoms are still the cheapest and most widely available method of contraception, especially for people who don’t have access to better birth control.

And condoms are still critical for first-time coitus before both partners have time to get tested — especially when you hear statistics like 45 percent of men and 63 percent of women who’d recently slept with a “new acquaintance” hadn’t used a condom, according to a 2010 survey of the sexual behavior of nearly 6,000 people ages 14 to 94 by researchers from the Center for Sexual Health Promotion at Indiana University’s School of Health. (That includes older people who weren’t worried about pregnancy.)

“We should be having open conversations before having sex about when your partner has been tested and what safe sex practices they practice. Don’t worry if your new hookup thinks it’s overkill, urges Jaime Chandra, communication manager and sexual health instructor at the Feminist Women’s Health Center of Atlanta “Your life is worth it,” she says. “You always can get laid later by someone better.”


How H.I.V. affects women in the United States

Elizabeth Taylor ran a “secret underground” HIV medication network

Fewer HIV tests and free clinics lead to rise in New York City’s STD rate

Woman who has been HIV-positive for 23 years has no symptoms