ViewpointCondoms and seat belts: the parallels and the lessons
Section snippets
Seat belts—what does the evidence show?
More than 80 countries have laws that require motorists and passengers to wear seat belts. Most people believe that thousands of lives have been saved. Adams commented that “strength of convictions about what this legislation has achieved is remarkably independent of objective evidence”.1 Figure 1 shows data from the 17 countries that had 80% of the world's cars in the 1970s. Comparison of the 13 countries that passed seat-belt laws with the four countries that did not shows a large excess of
The risk compensation hypothesis
Adams has suggested that drivers who wear seat belts feel safer and drive faster or more carelessly than they would do without seat belts.7, 8 The benefits of seat belts for drivers wearing belts during serious accidents could be offset by increases in the absolute number of accidents, increases in the speed at which accidents occur, and increases in deaths among unbelted road users inside or outside cars. In the 23 months that followed the introduction of the UK seat-belt law, the number of
Condoms—seat belts for sex?
The huge increase in seat-belt use since 1970 has been paralleled by a similar trend in condom use since the rise of HIV. The benefits of condom use to individuals exposed to HIV or sexually transmitted diseases are substantial, well documented, and can be compared with the benefits of wearing a seat belt during a high-speed collision. However, it is hard to show that condom promotion has had any effect on HIV epidemics. The most well-known example is the 100% condom policy in Thailand,13 which
Other examples of risk compensation in sexual health
There is evidence to show behavioural adaptation in response to other interventions that may affect HIV transmission. Two studies have reported that gay men are less worried about HIV infection since treatments have improved, and that they are significantly more likely to report unprotected sexual exposure than in the past.19, 20 Kalichman21 reported that of 327 men surveyed at a Gay Pride festival in Atlanta in 1997, eight (3%) had already used antiretroviral post-exposure prophylaxis and 85
Can sexual risk-taking be managed effectively?
The growth of safety interventions in recent decades rests on the assumption that governments can manage risk successfully. The “success” of seat-belt legislation is held up as a prime example of what has been achieved. Research devoted to behaviour change since the advent of HIV shows a firm belief by governments that sexual health risks can and must be managed. The difficulties of implementing, evaluating, and sustaining changes in sexual behaviour have become increasingly apparent.25, 26 A
Conclusion
Seat belts have not delivered all the safety benefits that were originally expected of them. A theory of risk compensation may explain why the obvious benefits of seat belts do not necessarily translate into benefits when they are used by whole populations. If safety interventions engender compensatory changes of risk behaviour among drivers, it is highly probable that interventions to reduce sexual health risks could also change risk behaviour. There is much preliminary evidence that sexual
References (27)
Seat belt legislation: the evidence revisited
Safety Science
(1994)Post-exposure prophylaxis for HIV infection in gay and bisexual men: implications for the future of HIV prevention
Am J Prev Med
(1998)- Rodgers W. Hansard, 22 March 1979, col...
Seat belts reviewed
Lancet
(1986)Traffic safety and the driver
(1991)The benefit of seat belt legislation in the United Kingdom
J Epidemiol Community Health
(1989)- et al.
Effects of changes in motorisation in various countries on the number of road fatalities
Traffic Eng Control
(1970) - Adams JGU, Risk and freedom: the record of road safety regulation. Transport Publishing Projects,...
Risk
(1995)- et al.
The effects of seat belt legislation on British road casualties: a case study in structural time series modelling
J R Stat Soc
(1986)
Target Risk
Seat belt wearing and driving behaviour: an empirical investigation: report IZF 1991 C-15
Behavioural adaptations to changes in the road transport system: report prepared by an OECD Scientific Expert Group
Cited by (123)
Sexually transmitted infections: challenges ahead
2017, The Lancet Infectious DiseasesCitation Excerpt :All three uses of cART for HIV prevention have been accompanied by concern about their possible unintended negative consequences for sexual behaviour and STIs,422 in an analogy with earlier fears about penicillin and syphilis.8 These concerns have been framed within the risk compensation hypothesis, which was first applied to sexual behaviour to explain why increases in condom use were not reflected in reductions in HIV infection incidence.423 Risk compensation occurs when an intervention prevents an adverse outcome, paradoxically making risk-taking behaviour more attractive; compensatory increases in risky behaviours then result in a failure to reduce the adverse outcome.
Assessment of risk compensation following use of the dapivirine vaginal ring in southwestern Uganda
2022, Sexually Transmitted InfectionsRisk compensation and face mask mandates during the COVID-19 pandemic
2021, Scientific Reports