UNFPAState of World Population 2004
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HOME: STATE OF WORLD POPULATION 2004: Preventing HIV/AIDS
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Preventing HIV/AIDS

Impact and Response
Linking HIV Prevention and Reproductive Health Programmes
Condoms
Voluntary Counselling and Testing
Key Challenges

Condoms

Both male and female condoms are key components of prevention efforts among the sexually active. Programmes can encourage the use of condoms to protect against unintended pregnancy and other STIs as well as HIV, and inform clients that nonbarrier contraceptives do not prevent HIV transmission. Correct and consistent use are critical: in a Uganda study, none of the 350 women who reported consistent condom use became HIV positive, but incidence was significant among women who reported inconsistent use.(20)

But the challenges to wider condom use are significant. There are massive shortfalls in supply compared to current needs, frequent stock-outs, and limited resources for programming to instil safer sexual behaviours. Pervasive myths, misperceptions and fears about condoms also inhibit their use.

Ensuring a steady, affordable supply of highquality condoms involves forecasting needs, procurement, logistics management and quality assurance. Promotion of condom use also requires an understanding of people’s needs and preferences, and of the sociocultural environment of communities and countries.

THE FEMALE CONDOM. Introduced in the 1990s, the female condom has added to women’s limited choice of means of protection. Wider use has been hampered by its price, which is 10 times higher than a male condom.(21) While evidence suggests that the female condom can be reused up to seven times if properly washed with disinfectant, WHO currently recommends one-time use until more data are available on the safety of reuse.(22)

More than 19 million female condoms have been supplied in more than 70 countries. Brazil, Ghana, Namibia, South Africa, Zambia and Zimbabwe all have large programmes. A study in Costa Rica, Indonesia, Mexico and Senegal found that the female condom is most acceptable where men already support family planning and perceive that their peers would support use of the method, where sex workers already have skills in negotiating safer sex, and where the female condom is considered preferable to the male condom.(23) This suggests that “marketing should focus on women who can successfully negotiate female condom use with their partners, as well as encouraging men to accept the device.” (24)

Research in this area continues, and there are indications that a new generation of less-expensive female condoms could be available within a few years.

DIFFICULTIES NEGOTIATING CONDOM USE. Data from the United Republic of Tanzania show that HIV/AIDS prevalence is greater among married, monogamous young women than among sexually active unmarried women. Married women, particularly young women, often cannot negotiate condom use even if they know their husband now has or previously had multiple partners; they are more able to do so if condom use is widely accepted as an important component of overall protection.

24 COMBINING FAMILY PLANNING AND HIV PREVENTION IN ZAMBIA

A project in Lusaka, Zambia, that provides condoms for HIV prevention recently expanded to offer other contraceptives requested by clients, because family planning services were inadequate. Condom use remained high. In fact, programme staff found that users of other types of contraception were more likely to use condoms as well, and that condoms users were twice as likely to start using other forms of contraception when offered. “All we had to do to increase contraceptive use was to make it easy to get,” said the director of the project.

To advertise these new services, according to the director, couples who came to the centre were recruited to be outreach workers. “We paid them to go to their friends and spread the word about what we were doing. We also distribute invitations to the centre door to door, and about one third of the people who receive them come in.” See Sources

Research in South Africa found that women who used a condom the last time they had sex were almost twice as likely as women who did not use one to know that condoms prevent HIV.(25) Women most likely to use condoms were also young, more educated and lived in urban areas. Women with casual partners were four times more likely and women with regular, non-marital partners were twice as likely to have used a condom than women who last had sex with their husbands.

Family planning and antenatal care providers need to assist clients in developing communication and negotiation skills to use with their partners so that they may adequately protect themselves from HIV transmission.

DUAL PROTECTION. Providers should be familiar with dual protection, a strategy for preventing both transmission of HIV or STIs and unintended pregnancy, through the use of condoms alone, the use of condoms combined with other methods for extra protection against pregnancy (dual method use), or the avoidance of sexual activities considered highrisk. The dual protection message can be expanded to include the safeguarding of fertility through STI prevention and control, a particularly relevant message for young women who have not begun childbearing.(26)

MICROBICIDES. Microbicides to protect women against HIV transmission are under development but are several years off. For those who lack the ability to negotiate condom use, introduction of a microbicide would greatly increase their ability to protect themselves against infection. The Global Campaign for Microbicides estimates that a product could be available as early as 2007 and that 2.5 million HIV infections could be averted over three years if a microbicide that is 60 per cent effective were used in developing countries.(27)

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