In roughly 13 billion acts of sexual intercourse worldwide last year in which condoms were needed, only about 6 billion were used, according to an estimate in Population Reports, a journal published by the Johns Hopkins School of Public Health.
The study assumes that every man needs a condom for every act of intercourse outside of marriage and in 9 percent of marriages where they are normally used.
The low condom use, particularly at a time when acquired immune deficiency syndrome is on the rise in the United States among young heterosexuals, could cause a tremendous amount human misery, said the report, "Condoms -- Now More Than Ever."
"The problem is critical. Many more condoms must be used to prevent AIDS and protect against pregnancy, especially among young people and in developing countries," Dr. Phyllis D. Piotrow, director of the Hopkins Center for Communication Programs, said yesterday.
This country needs "to promote condoms openly, vigorously and any way it can," and that is not happening today, said Laurie Liskin, one of the report's four authors.
"It's my feeling that people don't use condoms in this country as often as they should because they haven't really been told in a straightforward way they should use condoms," she said.
"Instead, they've been getting mixed signals and they've been coming from the White House on down."
During World War II, condoms were used widely, and sexually transmitted diseases were controlled. The U.S. military saw condoms "as a drug against a serious health problem," Liskin said. "Morality did not enter into it one bit.
"They weren't squeamish about it. They recognized that men in the military were sexually active, that they were going to go to prostitutes, so they might as well make sure the men didn't harm themselves in the process."
In 1987, six years into the AIDS epidemic, Dr. Everett G. Koop, the former U.S. surgeon general, promoted the use of condoms and sales shot up sharply, between 20 percent and 50 percent.
"The extraordinary thing that happened was that condoms became news items and suddenly we were allowed to talk about condoms on prime-time television and we hadn't done that before," Liskin said.
"Now, we have to go to the next step in this country. We have to have the same kind of sexy, appealing, interesting, persuasive advertising for condoms that we have for any other consumer product."
The report recommends 30 specific ways to recommend the use of condoms, which, for the most part, remain unpopular even though latex condoms have been found to be very effective when used properly.
The recommendations urged that:
* Condoms be made a top public health priority, with distribution through as many outlets as possible including stores, places of work, schools and all government offices that serve the public.
"They should be as easy to get as a package of gum," Liskin said.
* In the United States, the entertainment industry should depict condom use as normal, acceptable behavior and condom users as smart, sensible people.
* In many developing countries condoms cost about 25 cents each, which is out of reach of many consumers. Nearly half of this cost can be duties and taxes.
To arrive at their estimates, the Hopkins researchers used data from several dozen surveys of sexual behavior to get a total annual worldwide requirement of 13 billion condoms.
The estimate of 6 billion condoms actually used was derived from 1989 world production figures of 6 billion to 6.5 billion.
Some sexually active young people are using condoms more often, the report noted. In the United States, a 1988 national survey of sexually active male adolescents in metropolitan areas found that nearly 60 percent had used condoms at their last sexual intercourse, compared with 21 percent in 1987.
With the spread of AIDS, researchers have particularly focused on condom use in high-risk groups in developed countries -- homosexual men, prostitutes and users of intravenous drugs.
In the United States, the latest evidence suggests that younger homosexual men and adolescents are not using condoms as much as older men. Many female prostitutes in developed countries are insisting that their customers use condoms but do not do so with their non-paying sexual partners.