This meta-analysis concludes that structural-level condom distribution interventions are effective in preventing both HIV and sexually transmitted infections. Structural interventions improve the availability, acceptability, and accessibility of male condoms. The analysis shows that structural-level interventions are particularly effective for increased condom acquisition, carrying, and use; abstinence or delayed sexual debut in young people; and reduced incidence of sexually transmitted infections. Limitations of the meta-analysis include extreme heterogeneity in the studies, exclusion of some important studies for methodological reasons, and a cut-off point of September 2007, after which other relevant studies were published.

Condom use is among a range of HIV-related indicators in this report on 23 countries in sub-Saharan Africa. The report illustrates great variation in use, but in all countries more men than women reported ever using a condom and using one in the previous 12 months. Similarly, condom use during high-risk sex varied widely across sub-Saharan Africa, while condom use at first intercourse among those aged 15 to 24 varied but was low overall. Detailed tables present country-level data with figures for two time points where available.

Over 100 studies were reviewed to compile this summary of data on male-to-male sex, including condom use, in low- and middle-income countries. Asia accounted for the highest proportion of recent research, and there were also new studies from sub-Saharan Africa revealing epidemics of HIV among men who have sex with men. However, the authors found there is still a paucity of information from other regions, and Latin American studies were less extensive than anticipated. This newly available data should be used in the development of future interventions, but more systematic data collection would improve the evidence base for HIV prevention planning, the authors conclude.

This is a systematic review of 28 interventions targeting female sex workers. The interventions are presented in four categories: structural interventions, behavioral interventions incorporating condom promotion, provision of vaginal microbicide, and treatment for sexually transmitted infection. The evidence supports condom promotion as a HIV risk reduction strategy when combined with other sexual risk reduction and better access to treatment for sexually transmitted infections.

This systematic review of 137 articles on the female condom, including five randomized controlled trials, looked at the impact of female condoms on risk reduction and incidence of sexually transmitted infections. Among the five randomized controlled trials, two indicated notable decreases in STI incidence and all five indicated increases in the number of protected sex acts. Data from multiple studies showed that female condoms are used by women who are not as likely to use other dual protection methods. Of the studies reviewed, almost half looked at acceptability, while other studies focused on cost-effectiveness, facilitators and barriers to use, negotiation, and promotion. The authors suggest that future research should move away from the focus on acceptability to examining the effectiveness and impact on diverse settings and to more closely examine the view that female condoms empower women to negotiate safer sex.

Condom use errors are widespread globally and continue to lessen the efficacy of condoms. These results are from a systematic literature review of 50 articles on condom use representing 14 countries and a diverse set of populations (e.g., sex workers, clients at clinics for sexually transmitted infections [STIs], monogamous married couples, etc.) from 1995 to 2011. According to the authors, common errors involve incomplete use (e.g., putting on a condom after intercourse has begun or early removal of a condom followed by unprotected intercourse), not leaving space at the tip, not squeezing air from the tip prior to use, putting the condom on inside out and having to remove and replace it, not using water-based lubricants, and incorrect withdrawal. Some common problems include breakage, slippage, leakage, erection problems during condom application, erection problems during condom use, and problems with the fit or feel of a condom. The authors found that the majority of articles discussed breakage and slippage, yet argue that other problems, such as early removal of condoms and incomplete use, may be just as serious, particularly when they expose a partner to STIs. Some under-researched areas include duration of condom use during intercourse and condom-associated erection difficulties. The authors offer some guidelines on correct condom use before, at the time of, and after intercourse, and offer a Condom Use Experience model to guide future research.

This systematic review and meta-analysis assessed 28 interventions for reported condom use and condom use intentions. It revealed that sexual behavior, whether risky or not, did not increase after sex education and condom promotion. However, only condom use by males at last sex increased, and the interventions did not result in positive changes to sexual behavior. The design of many studies was suboptimal, and the heterogeneity of studies suggests a lack of consensus on interventions and research into their efficacy.

An intervention in Taiwanese gay bathhouses to ensure availability and accessibility of condoms was successful in increasing use of condoms, according to this study. Bathhouse attendees were recruited before the intervention and were then surveyed six months later to assess whether or not greater access to condoms inside the bathhouses reduced unprotected sex and cut prevalence rates of HIV and sexually transmitted infections. Among attendees at bathhouses in the intervention group, self-reported consistent condom use during anal sex increased, but prevalence of HIV and sexually transmitted infections remained unchanged. It is important to ensure distribution of condoms in areas of the bathhouses where sexual encounters take place, the authors comment.

This randomized controlled trial of 400 Californian women examined the impact of a four-session female condom skills training intervention. Women received instructions in female condom use including self-efficacy training at baseline and supplies of male and female condoms during the study period. Information on condom use was gathered using computer-assisted self-interviews at baseline and at three and six months. At follow-up, female condom use among the intervention group participants increased and the absolute difference in at least one incidence of condom usage was over 20 percent higher in the intervention group versus the control group at both time points. However, there was no difference in male condom use. The study showed that women in the intervention group exhibited safer sexual practices without reducing baseline male condom use, suggesting the intervention can be an effective supplement to other prevention strategies.

This study looks at the relative effectiveness of female condoms as a HIV prevention strategy within the range of HIV prevention options. The study includes a comparative review of 14 female condom programs across 10 countries in the developing world as well as a wider literature review and interviews with stakeholders. There was also a cost-effectiveness analysis. This report found that female condoms are significantly less cost-effective than male condoms. Female condoms are not cost-effective for female sex workers due to the very high rate of substitution for male condoms; for women with regular sexual partners, they are not cost-effective because of the high cost relative to male condoms, the study found. However, the authors note that cost-effectiveness is not the sole criterion for funding decisions, that female condoms have utility in protecting women whose male sexual partners cannot or will not use a male condom, and that the benefits to women’s empowerment are implied by female condom programming, but difficult to quantify.

This report describes in detail Thailand’s 100% Condom Program and evaluates its success in significantly increasing consistent condom use in commercial sex settings, in turn dramatically reducing rates of sexually transmitted infections. Factors affecting the success of the program include the wide extent of implementation of all components of the program, the degree of collaboration between stakeholders, and taking account of different types of commercial sex establishments and their varying needs. This success story can be built upon by improving condom access in indirect sites of commercial sex, given that surveillance had found the number of such sites increasing in 2000 when Thailand’s program was evaluated.

This 16-page report states the rationale for condom promotion, arguing that condoms are central to HIV prevention because they are both effective in reducing HIV transmission and cost-effective. The study outlines a step-by-step strategic approach to developing a condom program, starting with establishing a national condom team, conducting situation analysis, and developing a comprehensive national condom strategy. This is followed by budget and operational plans linked to national commodity security plans, resources mobilization, capacity strengthening, and demand creation. The final steps are strengthening advocacy and media engagement as well as monitoring and evaluation.

This report presents findings from three case studies of condom promotion activities in Cambodia, Jamaica, and India. All three case studies are described in detail, and there is a summary of the sociocultural, legal, economic, and financial barriers to condom access and use. Despite the diverse nature of the three settings, they had four elements in common. They all used a peer-based model; addressed stigma and discrimination as a precursor to condom promotion; had a practical, evidence-based approach; and integrated condom advocacy with other health services related to HIV as well as wider sexual and reproductive health services.

This report is aimed at a broad readership including donors, public health officials, national HIV program managers, health care workers, and other stakeholders. It describes priority interventions for HIV prevention, treatment, and care. There are also policy and technical recommendations and guidance on setting HIV program priorities. Recommendations on prevention of sexual transmission of HIV include condom promotion for the general population as well as at-risk groups such as serodiscordant couples and sex workers. There is also a list of over 230 useful resources.

Launching a new condom program or improving an existing one can be done with the seven-step process laid out in this manual. There are detailed chapters on understanding condom users and the program environment; creating an action plan; ensuring a pipeline of high-quality condoms; expanding distribution, condom promotion at distribution points, promoting condoms in the community and at district and national levels; and program monitoring and evaluation. The manual provides a checklist of key actions, examples from the field, and useful worksheets and contacts. There are also fact sheets on male and female condoms, their dual role as protection against HIV and pregnancy, and gender and condom programming.