USAID: HIV/STI Prevention and Condoms
The U.S. Agency for International Development (USAID) has been a leader in HIV prevention and is fully committed to a balanced approach to the "ABCs" of HIV prevention - abstinence, being faithful/partner reduction, and correct and consistent condom use for those most at risk for transmitting or becoming infected with HIV. Condom use can reduce significantly the risk of HIV infection and, in conjunction with other behavior changes such as delayed sexual initiation and partner reduction, is a key component of effective HIV prevention programs.
The Effectiveness of Condoms in Preventing Sexually Transmitted Infections
Abstinence from sexual intercourse or maintaining a mutually monogamous relationship between partners known to be uninfected is the surest way to avoid transmission of HIV and other sexually transmitted infections (STIs). Outside of those conditions, condoms have been an important and successful intervention in many places for sexually active people, particularly when targeted at commercial and other casual sexual encounters. While no barrier method is 100 percent effective, correct and consistent use of latex condoms can reduce the risk of transmission of HIV, some other STIs, and of unintended pregnancy.
HIV: While laboratory research has demonstrated that latex condoms provide an essentially impermeable barrier to particles comparable in size or smaller than STIs, including HIV, studies have shown that correct and consistent use is essential to realize the full benefits provided by condoms in reducing the risk of HIV infection. The body of research demonstrating the effectiveness of latex condoms in reducing sexual transmission of HIV is both comprehensive and conclusive. Scientific studies of sexually active couples, where one partner is infected with HIV and the other partner is not, have demonstrated that the consistent use of latex condoms reduces the likelihood of HIV infection by 80 to 90 percent. However, failure to use condoms correctly with every act of intercourse, or to some extent slippage and breakage of the condom, has been shown to increase the risk of HIV transmission. In fact, some studies have shown that inconsistent condom users may face the same risks of HIV infection as non-users.
Other STIs: Correct condom use can provide a barrier protecting the areas of exposure to genital secretions in both sexes. Gonorrhea, chlamydia and trichomoniasis, like HIV, are transmitted by genital secretions. However, these STIs are more easily transmitted than HIV and inconsistent condom use offers little to no protection from these STIs. Scientific studies do provide evidence that latex condoms, when used consistently and correctly, can reduce the risk of gonorrhea and chlamydia infection in both women and men. Additional research is needed to assess more accurately the degree of risk reduction latex condoms can provide to women and men for trichomoniasis and other STIs transmitted by genital secretions.
Genital ulcer diseases (such as genital herpes, syphilis, and chancroid) and human papillomavirus (HPV), which is the main cause of cervical cancer, are transmitted primarily through contact with sores/ulcers or with infected skin in areas that may or may not be covered by a condom. Research studies have shown that correct and consistent condom use can help reduce the risk of herpes and syphilis infection. Correct and consistent use of latex condoms may reduce the risk of chancroid and the other genital ulcerative diseases only when the infected area or site of potential exposure is protected. While there is some data suggesting that the partners of condom users may have a lower rate of cervical cancer, more research is needed to assess whether and to what degree latex condoms may reduce the risk of acquiring HPV, including the few types that are associated with cervical cancer.
Condoms’ Contribution to HIV Prevention Success
The potential impact of condom promotion on the spread of HIV has been demonstrated in Southeast Asian countries in which prostitution has contributed substantially to new HIV infections. In recent years, several countries have succeeded in increasing consistent condom use among prostitutes and their clients. For example, Thailand slowed its explosive HIV epidemic by promoting "100 percent condom" use in brothels. As a result of this policy and an accompanying public information campaign, as well as improved STI treatment services, condom use among prostitutes increased to more than 90 percent, reported visits to prostitutes by men declined by about half, HIV infection rates among military recruits decreased by about half, and the cases of five other STIs decreased by nearly 80 percent among brothel workers.
USAID’s Support for Condom Promotion
Condom promotion is an approach that uses private sector advertising and commercial distribution to make condoms more accessible. These programs distribute high-quality condoms at affordable prices through traditional outlets such as health clinics and pharmacies, and through non-traditional outlets such as bars, hotels, and brothels. Such programs combine condom sales with media campaigns that use culturally appropriate educational messages to promote condom use and other forms of risk reduction. USAID projects also assist governments and organizations in logistics management, including purchase, storage, and distribution, in order to ensure an adequate supply and efficient distribution of condoms. Although it is imperative that USAID address the extraordinary health risks for society associated with prostitution and intravenous drug users by promoting the adoption of safer behaviors and encouraging condom use with casual and high-risk partners, this does not mean that USAID in any way endorses or supports prostitution or drug use.
Successful Examples of Targeted Condom Promotion Programs
Cambodia has also succeeded in reducing HIV prevalence through increased condom use and a large reduction in visits to prostitutes - 76 percent of police reported paying for sex in 1997 versus 32 percent in 2001. USAID support has played an important role in establishing a nation-wide condom distribution program.
Senegal: Along with abstinence and partner reduction, targeted condom promotion and distribution have been central components in Senegal's successful HIV prevention program. Condoms are distributed during AIDS-related public events, as well as to prostitutes, peer educators, and patients with sexually transmitted infections. In addition to providing condoms, a USAID-supported condom marketing program distributes condoms through pharmacies and non-traditional sales outlets.
May 2005
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