Preventing HIV/AIDS

Comprehensive Condom Programming: A Strategic Response to HIV and AIDS

Comprehensive condom programming integrates various activities including male and female condom promotion, communication for behaviour change, market research, segmentation of messages, optimized use of entry points (in both reproductive health clinics and HIV prevention venues), advocacy and coordinated management of supplies. The goal of condom programming is to reduce the number of unprotected sex acts, which will, in turn, reduce the incidence of unintended pregnancy and sexually transmitted infections.

Strategic condom programming recognizes the complementarity between male and female condoms. It takes advantage of a variety of entry points -- not just clinics, but also, for example, barber shops, pharmacies and youth centres. It requires the collaboration of the private and public sector. And it demands a consistent and affordable supply.

Comprehensive condom programming is a key institutional priority for UNFPA, because condoms, both male and female, are recognized as the only currently available and effective way to prevent HIV – and other sexually transmitted infections – among sexually active people. Moreover, within UNAIDS, UNFPA is the lead agency for all aspects of condom programming.

Both supply and demand are critical

Creating demand for condoms by convincing people at risk of sexually transmitted infections to use them routinely is an important part of the equation for preventing the spread of HIV and other sexually transmitted infections. But in many places, people who want to use condoms are unable to obtain them.

An estimated 13 billion condoms per year are needed to help halt the spread of HIV and other sexually transmitted infections, according to UNAIDS. The reality falls short.  In 2004, some 2.1 billion condoms were provided by bilateral donors, UNFPA and social marketing organizations. In that year, sub-Saharan Africa, the region with greatest HIV prevalence and the largest share of donor support, received about 10 condoms per man of reproductive age (15-59). Brazil, China and India are self-sufficient in condoms. But for many other developing countries, the gap between condom needs and donor support means paying for imported condoms with funds needed for food, medicine and other necessities.

Highlights from the UNAIDS Position Statement on Condoms and HIV Prevention

  • Condom use is a critical element in a comprehensive, effective and sustainable approach to HIV prevention and treatment.
  • The male latex condom is the single, most efficient, available technology to reduce the sexual transmission of HIV and other sexually transmitted infections.
  • Condoms must be readily available universally, either free or at low cost, and promoted in ways that help overcome social and personal obstacles to their use.
  • HIV prevention education and condom promotion must overcome the challenges of complex gender and cultural factors.
  • Condoms have played a decisive role in HIV prevention efforts in many countries.
  • Increased access to antiretroviral treatment creates the need and the opportunity for accelerated condom promotion.

An effective element in reducing infection

Condoms have helped to reduce HIV infection where AIDS has already taken hold and curtailed the broader spread of sexually transmitted infections. They have also encouraged safer sexual behaviour more generally.

Thailand's efforts to de-stigmatize condoms and its targeted condom promotion for sex workers and their clients dramatically reduced HIV infections in these populations and helped reduce the spread of the epidemic to the general population. A similar policy in Cambodia has helped stabilize national prevalence, while substantially decreasing prevalence was observed among sex workers. In addition, Brazil's early and vigorous condom promotion among the general population and vulnerable groups successfully contributed to sustained control of the HIV epidemic. Increased condom use is believed to be a contributing factor in the decline in HIV prevalence reported in Zimbabwe between 2003 and 2005.

Gender dimensions of condom use

Physiologically, men are more likely to transmit HIV to women than vice-versa. Although condoms can provide effective protection against HIV infection, and female condoms are agreed to increase women's empowerment, several issues impact upon the use of both male and female condoms. Cost, availability and perceptions of risk are important factors. Power relations between men and women, including the relative social and economic status of partners, influence the extent to which condom use can be successfully negotiated.

Accepted notions of masculinity and femininity also come into play. For instance, in many cultural settings, young women are supposed to be sexually innocent and may therefore be reluctant to carry or suggest using condoms. Since condoms are also associated in many contexts with illicit or extra-marital sex, married women are often powerless to request their partner to wear a condom despite suspecting that he may be infected with HIV, for fear of reprisal at the implied accusation of being unfaithful.

Myths, misperceptions and fears on male and female condoms

UNFPA and WHO have produced a publication that addresses commonly held condom myths, misperceptions, fears and negative attitudes that act as barriers to correct and consistent condom use around the world. Myths and misperceptions were collected from regional and country programme managers and health care providers and the most commonly occurring myths and misperceptions are addressed in this publication.

Assuring high quality and low cost

Condoms must be procured according to the quality assurance procedures established by WHO, UNFPA and UNAIDS. Condoms are manufactured utilizing the highest international standards and then stored in a dry environment away from direct heat sources to ensure safety and efficacy.

Manufacturing standards have also been established by the International Organization for Standardization, the Comité Européen de Normalisation, and the American Society for Testing and Materials. These standards are mainly concerned with the safety and integrity of the condoms and establish minimum acceptable quality levels.

WHO, UNFPA, and UNAIDS work with manufacturers, testing laboratories, researchers, donors, international agencies and program managers to establish an internationally accepted specification, quality assurance and procurement procedure for male latex condoms. In accordance with these quality assurance procedures, all donor procured condoms are quality controlled and tested for safety and efficacy during the manufacturing process and before they enter a country's distribution network. Their ultimate effectiveness depends on user behaviour in opening the package, applying the condom, sexual activity, lubrication, and number of times an individual condom is used.

Low cost is also essential for government distribution and social marketing of condoms. As the largest public-sector procurer of condoms in the world, UNFPA is able to negotiate the lowest prices possible. Developing countries are the suppliers for virtually all of the male condoms procured by UNFPA.

Key Publications