For many people, asking an intimate partner to use a condom suggests a lack of trust (31, 69, 110, 219, 316, 601). Particularly in a long-term relationship, requesting to use condoms could imply distrust rather than caring (82, 259, 335, 341, 437, 504, 519, 521, 570).

Often, a couple will use condoms in the beginning of their sexual relationship but switch to another contraceptive method as trust grows and concerns about STIs lessen (237, 372). Couples should use condoms until they have had a monogamous relationship for at least three months and both partners have tested negative for HIV (569). Because infectiousness is greatest immediately after someone has become infected, the strategy of using condoms for several months with each new partner could substantially slow the AIDS epidemic (412).

Delivery of Improved Services for Health Project/USAID/DMO

The AIDS crisis has brought new attention to issues of trust, negotiation, and communication between sex partners.

Negotiating condom use can be difficult for many women, married or unmarried (172, 601). In Ghana young unmarried women in focus groups often said that negotiating condom use was "hopeless." As one woman said, "The man is already poised for action. I am in his grip and he will do as he pleases" (214). In a Ugandan survey only one-quarter of respondents said that it is acceptable for a married woman to ask her husband to use condoms compared with two-thirds who said that an unmarried woman can ask (62). CSWs may be better able to negotiate condom use with men because the discussion can be unemotional (417, 601).

Communication about sex. People need to learn to talk about sex directly. While some couples discuss sex and cooperate in making the decision to use condoms, much communication is indirect. Most people learn about their partner's sexual needs from a combination of hints and nonverbal "body language" rather than from direct communication (53, 62, 110, 250). Communicating indirectly, however, leaves more room for misinterpretation than does talking.

"Non-talkers" face greater risk for STIs than "talkers" because their lack of communication often prevents effective preventive behavior—especially behavior that requires cooperation, such as condom use (287). For example, analysis of Kenyan DHS data found that the level of contraceptive use was three times as high (at 36%) among couples who frequently discussed sex as among those who did not communicate (381).