Sex in Asia

Humans have used primitive condoms like oiled silk, fish bladders, and lamb intestines as birth control for centuries. Early condom use is depicted in Ancient Egyptian images and cave paintings in France. Dating as early as the 16th century, condoms were used for both birth and disease control. The modern condom was born with the advent of industrialised rubber. It was initially made with rubber that was stitched together, then produced using a mould, and further refined to the latex condom on the market today.

Condoms play an important role in our society and we rely on rubber to produce them. Globally condoms are the preferred barrier method contraceptive and are important for birth control. They help control population growth, and reduce the pressure our population places on Earth’s resources to support us. Condoms also save lives — short of abstinence, condoms are the best way to prevent sexually transmitted infections, including HIV, an untreatable and prevalent virus.

Although the rubber tree is native to Brazil, commercial plantations in the country have never been successful. The rubber tree has thrived in Asia since it was introduced, first to the Indian Subcontinent, then to Southeast Asia. Surprisingly, condoms are an important industry in this region. The world’s largest condom manufacturer, Karex, is based in Malaysia. In 2017, the company produced seven billion condoms, and generated US$82 million in revenue. Condoms are an important export for Asia, constituting part of the US$700 million worth of pharmaceutical rubber products leaving the continent.

The modern condom would not be possible without the innovation of vulcanisation. Created in 1839, vulcanisation is a chemical process that makes natural rubber latex strong, durable, and long-lasting. Vulcanised rubber is the basis of a range of rubber products, such as latex gloves, shoe soles, rubber tyres, pipes, belts, and condoms that make up the global rubber industry. Vulcanisation revolutionised rubber, making these products indispensable since the 1890s. The demand for rubber products, especially tyres, is continually growing and rubber growing regions are under pressure to supply ever-increasing volumes of latex — the sap of the rubber tree.

Global rubber production has more than doubled over the last two decades. The pressure to produce more rubber falls on Asia, with most of the world’s rubber produced in just six countries: Thailand, Indonesia, Vietnam, India, China, and Malaysia.

Rubber grows best in low, flat, tropical areas. Existing rubber plantations in suitable growing areas are being replaced by profitable palm oil plantations, and new rubber plantations are increasingly planted in sub-optimal ranges. Rubber grown outside the suitable range faces greater risks of crop failure, like dry and cold stress, and environmental damage, like soil erosion and poor water quality. These areas are also likely to produce low latex yields at best, and complete crop failure at worst.

Rubber growing communities are economically dependent on their rubber crops and are vulnerable to global market changes and crop failure. Rubber plantations in Xishuangbanna, China’s rubber region, regularly suffer cold damage due to plantation altitude and slope, and are at risk of reduced yield. In 2010 these same plantations suffered a loss of US$26.35 million due to drought.

The new plantations in Xishuangbanna often encroach on primary rainforest and key biodiversity areas. Between 2005 and 2010, 516 square kilometres of key biodiversity areas and 610 square kilometres of protected areas became rubber plantations. A total of 2,500 square kilometres was converted from natural forest cover to rubber plantation. Xishuangbanna is home to a significant proportion of the nation’s biodiversity. Despite accounting for only 0.2 percent of China’s total area, Xishuangbanna hosts 36 percent of bird species and 22 percent of mammal species found in China. The conversion of tropical seasonal rainforests to rubber plantations has eliminated important habitats for the Asian elephant and tiger, which do not live anywhere else in China.

Rubber is winning the competition for agricultural space in Asia because it is lucrative, which impacts food production and security. The growing demand for rubber is not only replacing important rainforests and threatening biodiversity, but also extending into other agricultural areas. Since the most suitable rubber growing areas are already cultivated by rubber or oil palm, thirsty rubber plantations are proliferating into food cropland. Thirty percent of new plantations in Southeast Asia replace food crops, especially rice. This trend exacerbates existing food and water insecurity. If these resources were diverted from rubber to rice paddies, malnourishment would be significantly reduced especially in Indonesia, Thailand, and Vietnam.

Since the HIV epidemic in the 1980s, sexually transmitted diseases including but not limited to HIV, have been a significant issue across the Asia-Pacific region, and condoms are still the best prevention method. At-risk groups, such as men who have sex with men, sex workers, intravenous drug users, and transgender people, are facing growing rates of HIV infection. AIDS related deaths continue to take lives.

Within the cultural, religious, and social contexts of many countries in Asia, the activities of these at-risk groups are illegal, or considered shameful or wrong. Condoms are associated with ‘immoral’ behaviours such as premarital sex, homosexuality, and prostitution. These people often face social stigmas that create barriers to the sexual education and protection that they need. Low levels of condom use amongst these groups can be attributed to poor HIV literacy.

Despite sexual stigma and traditions, Mechai Viravaidya, or Mr. Condom as he is affectionately known, has been instrumental in demonstrating the effectiveness of condoms against both unplanned pregnancies and HIV in Thailand.

Beginning in the 1970s, Mr. Condom began to promote condoms as a family planning tool, especially to families living in rural locations. He used humour to break down traditional barriers and enable public conversations about sex, and ensured condoms were readily available. He also introduced financial incentives for families using family planning techniques. His efforts saw a reduction in the national population growth rate from 3.2 percent in 1974 to less than one percent in 2000.

When the HIV/AIDS epidemic struck Thailand in the 1980s, Mr. Condom stepped up again to promote condoms to reduce transmission of the deadly illness. He mobilised the resources of the Thai military and focussed his efforts towards at-risk groups, such as sex workers and their clients in red light districts. His work was so effective that Thailand was one of the first countries in the world with a declining rate of new HIV incidences. The World Bank estimates that Mr. Condom’s anti-AIDS measures contributed to saving 7.7 million lives in Thailand. Mr. Condom has left such a lasting impact on the country that a ‘Mechai’ is the colloquial term for a condom in Thailand.

How did Mr. Condom navigate the traditions and ‘sex taboos’ of Thailand to ensure that condoms were widely accepted? He distributed condoms across the country, so that they were as readily available as vegetables in the market. He also included Thai traditions and religion into his campaign to promote the condom. Condoms that had been blessed by Buddhist monks using holy water were considered acceptable, and women felt they could adopt them as a family planning method. If these methods are applied across other countries in Asia, particularly those in which traditions restrict access to condoms, HIV incidence rates are sure to decline.

The Indonesian Government has been publicly criticised by Islamic groups for ‘promoting promiscuity’ through its condom use campaign, targeted towards at-risk groups which constitute the majority of HIV incidences. The Philippines is one of the only countries in which the rate of new HIV infections is increasing year on year. Almost ninety percent of new infections are amongst the largely discriminated gay community. The conservative Catholic Filipino society may contribute to this discrimination and limited access to condoms and sexual health testing.

The taboos associated with sex and contraception are so far-reaching that academic literature and research about condom use is limited. There is a surprising lack of publicly available data on worldwide condom usage, perceptions, and trends, which may be attributed to the uncomfortable silence surrounding sex and contraception. This data is important for understanding the true scale of the condom discussion. In the same way that public dialogue about safe sex can serve to educate the most vulnerable communities and improve public health, public data can improve policies and outcomes in preventing HIV infections.

As we become more aware of climate change and our impact on the environment, the condom presents a different point of discussion. While rubber is largely used to make car and aeroplane tyres, which are implicitly associated with greenhouse gas emissions and climate change, it also supports another essential daily product—condoms. Despite the negative impacts of cultivating rubber, and the waste generated by condom use, condoms are an irreplaceable part of society today and should be promoted in our public health efforts.

One thing is for certain. Data about condom use helps us understand the scale and impact of condom waste. As a single use item designed not to degrade, condoms have an environmental impact that should be assessed. Without reported figures, we can only roughly estimate the amount of condoms entering landfills and waterways around the world.