Garbology for research on condom use

Recently I completed a systematic review of research explaining patterns of condom use in five East African countries. The most basic conclusion is that researchers failed to answer this vital question. The most informative projects employed ethnographic participant-observation, and future researchers should emphasize this methodology – as opposed to the current focus on surveys, on which people demonstrably lie in large numbers. All of this is detailed in my comprehensive report, which is freely available online.

Nonetheless, participant-observation has its weaknesses, and one of these is in producing stats. Numerical evidence of trends is important for understanding whether a public-health program is working, and it’s something that policymakers and journalists expect. Since asking people directly about their sex lives yields disastrously unreliable answers, less-direct methods are needed.

Monitor distribution?

One such method is to monitor the distribution of condoms in a given area, whether via sales or giveaways. This wouldn’t work for mosquito nets, because people in East Africa commonly divert them to other uses, but condoms appear to have only one use (and not as water balloons). The drawback is that corrupt officials divert free condoms in bulk from local storehouses to vendors in other regions. Similarly, a study from Uganda (Kajubi et al. 2005) assumed that every condom distributed was used, but one (probably corrupt) distributor claimed absurd success, resulting in unlikely frequencies of copulation. Sales figures seem more likely to be accurate, but they wouldn’t apply to the many people who rely on free condoms. In addition, the extent to which distributed condoms are used is unknown.

Excavating trash

Another, potentially better approach has been employed before but seemingly forgotten. This is to systematically excavate garbage for evidence of condom use. Playfully named garbology, the archaeology of trash is a serious, well established technique for measuring aspects of behavior that people can’t or won’t enumerate accurately. Anthropologist William Rathje originated the field, as he describes in Rubbish!: The Archaeology of Garbage. Researchers have studied trash, whether from individual households or municipal landfills, in diverse cities such as Tucson, Toronto, New York, and Mexico City.

A common item in descriptions of garbology is finding used condoms. Some writers might include such details to disgust the reader, but my point is that researchers have already handled this type of material rather routinely. In fact, Rathje’s book notes that the number of condoms in landfills increased markedly after AIDS became news in the United States. I’m not certain that condoms themselves are the best items to count, since they might be left elsewhere. But trash excavators could count condom wrappers just as easily.

What might we learn from systematically counting condoms in a trash pile? We could:

• Discover trends in condom use among the people whose trash is being examined.
  • In addition to conducting overall counts, researchers could correlate condoms to events, such as holidays, or to other items in the pile, such as beer bottles.
• Verify the trends generated in surveys of people or of distributors.
• Examine used condoms to understand how effectively they’re being employed.
  • This vital topic is entirely unstudied. What percentage of condoms break? Are removed before ejaculation? Have holes cut in the end to allow fluids through? (It happens.)

The garbology approach has limitations. The most obvious is that researchers can’t link condom use to individuals and their attributes, as is de rigueur in the existing – but unreliable – literature. This is one reason that ethnographic participant-observation is still needed to explain the trends observed.

Nonetheless, the potential payoffs from employing garbology, along with participant-observation, are great:

• More-reliable data
• Insights into important issues that currently are off-limits

Surely it merits a pilot project in sub-Saharan Africa.