Comprehensive Condom Use Programs

Introduction

I. Definition of the Prevention Area

Unprotected sex is the leading cause of HIV transmission, accounting for more than 80 percent of the total number of infections. Male and female condoms, when worn correctly, serve as an impermeable barrier to the sexual exchange of secretions that carry HIV and a number of other sexually transmitted infections (STIs), providing protection against transmission.

In recent guidance on HIV prevention, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) recommends programming that combines multiple, evidence-based approaches to increase availability, accessibility, acceptability, and use of condoms in targeted groups and in the general population. Comprehensive condom programming remains an essential component of combination prevention programs.

II. Epidemiological Justification for the Prevention Area

Condoms, both male and female versions, are the most effective barrier method currently available to sexually active individuals who require protection from HIV and other STIs and from unwanted pregnancies. Male condoms reduce the risk of HIV by 80 percent or more when used correctly and consistently. Modeling studies indicate female condoms can provide the same level of protection against HIV infection, although evidence is limited.

Consistent and correct use of male latex condoms is associated with lower rates of transmission among higher-risk groups, notably sex workers, men who have sex with men, and serodiscordant couples. In countries with concentrated epidemics (e.g., Thailand), programs promoting 100 percent condom use in the commercial sex industry have lowered overall prevalence levels. While the impact of condom use is unknown at the population level in mixed and generalized epidemics, condom programming remains an important aspect of the overall prevention portfolio.

III. Core Programmatic Components

Components of comprehensive condom programs are identified by the United Nations Population Fund as well as by PEPFAR in its recent guidance on prevention:

IV. Current Status of Implementation Experience

Meta-analyses and well-designed evaluations have shown that when coupled with education and counseling, condom promotion programs can be effective in increasing male condom use among youth and among such marginalized groups as sex workers, men who have sex with men, and serodiscordant couples. Successful condom programs employ multiple strategies, such as ensuring high coverage in accessible venues, training people on how to use condoms, building negotiation skills and self-efficacy, and working within social networks.

Condom programs have been implemented using mass media campaigns, community-level initiatives, and interpersonal outreach. They have also targeted people in the general population who engage in higher-risk sex (e.g., multiple partners, concurrent partners, commercial sex) in high-prevalence settings. Although these initiatives have shown success, male condom use between longstanding sexual partners, such as married couples, does not persist over time.

Demand for condoms exceeds availability; only a quarter of the total number of male condoms needed is available. Female condoms are even less available, due primarily to high cost and policymaker bias. Greater international funding and support for both male and female condoms must be increased to reduce the current gap and meet future needs.

What we know

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Putting it into practice

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Tools and Curricula

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Learn more

Condoms for HIV Prevention

World Health Organization. (2011).

The World Health Organization's webpage on HIV and condoms provides links to general information as well as technical documents, scientific evidence, and data. There are recommended readings on a range of topics such as condom effectiveness and common myths and misperceptions associated with condom use, as well as a report on a 100 percent condom use program in China. A podcast on condoms for HIV prevention and links to condom-related information on the websites of related UN organizations are also accessible via the site.

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HIV Prevention Gains Momentum: Successes in Female Condom Programming

United Nations Population Fund. (2011).

This report profiles specific country examples of successful female condom promotion programs. There are seven country profiles covering awareness-raising and behavior change to increase demand for female condoms, such as social marketing in hair salons and barbershops in Zimbabwe, and assertiveness training for women on Malawi. Programs in the Caribbean and Nigeria are cited as examples of successfully integrating female condom promotion into existing programs, while supply logistics and quality assurance are explored with examples from the Caribbean, Malawi, and Nigeria. Strengthening government capacity is also covered with four case studies from sub-Saharan countries.

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Prevention Now

Center for Health and Gender Equity. (2011).

The publications page of the Center for Health and Gender Equity's Prevention Now website has links to a wide range of materials on female condoms and female condom programming. There are fact sheets on female condoms and the Prevention Now campaign to increase donor funding for female condoms. A report on U.S. support for female condom programming is complemented by a poster detailing five-year trends in U.S. funding. There are country profiles from Malawi, Uganda, and Zimbabwe, and many of the publications are also available in French, Portuguese, and Spanish.

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Condoms and STDs: Fact Sheet for Public Health Personnel

U.S. Centers for Disease Control and Prevention. (2011).

This three-page fact sheet explains how male condoms must be used correctly and consistently to reduce transmission of sexually transmitted infections, making a distinction between the degree of protection against diseases transmitted by genital secretions and genital ulcer diseases. It explains that male condoms offer a very high degree of protection from HIV, gonorrhea, chlamydia, and trichomoniasis, and reduced risk for transmission of genital ulcer diseases such as genital herpes, syphilis, chancroid, and human papillomavirus-related infections, i.e., genital warts and cervical cancer. For both categories of sexually transmitted infections, there are plain-language summaries of the theoretical basis for protection and the findings of laboratory and epidemiologic studies.

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Compendium of Evidence-Based HIV Prevention Interventions

U.S. Centers for Disease Control and Prevention. (2011).

The risk-reduction chapter of this compendium includes 74 HIV risk-reduction evidence-based interventions, identified by a thorough literature review through December 2009. Among the 43 individual- and group-level best interventions are those promoting condom use. The database can be searched according to different characteristics such as risk category, race, and gender of participants. Condom use interventions that have the most successful outcomes are those that provide education/training in condom use and are delivered to individuals or small groups using a social-cognitive theoretical approach.

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Reducing Sexual Transmission

Joint United Nations Programme on HIV/AIDS. (2011).

The Joint United Nations Programme on HIV/AIDS (UNAIDS) website has a range of documents on male condoms, including a joint UNAIDS/United Nations Population Fund/World Health Organization position statement on condoms and HIV prevention and review document on condom programming.

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UNAIDS Report on the Global AIDS Epidemic 2010

Joint United Nations Programme on HIV/AIDS. (2010).

The 2010 Joint United Nations Programme on HIV/AIDS (UNAIDS) report on the global HIV epidemic draws on the latest available data from 182 countries, including incidence trend data from 60 countries, the first time such data has been included in a UNAIDS global report. Data is disaggregated by country and by demographic categories. There are chapters giving an update of the epidemic, HIV prevention, HIV treatment, human rights and gender, and HIV investments. The report can be downloaded in its entirety or chapter by chapter.

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U.S. Agency for International Development Documents

U.S. Agency for International Development (2006).

The Development Experience Clearinghouse of the U.S. Agency for International Development (USAID) is a searchable repository of documents from USAID-funded projects worldwide. There are currently more than 3,000 documents related to HIV, and the site is due to relaunch with more downloadable documents and more user-friendly search tools.

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FC2 Female Condom

FC2 Female Condom. (2009).

This website provides detailed information on the FC2 second-generation female condom, which combines the same safety and efficacy of the first-generation female condom with lower cost. There is information on where to obtain female condoms from both the public sector and on the retail market in the United States. There are step-by-step instructions on how to use the female condom, also available in Spanish. Health professionals can find resources and training materials, and there are pages for quick facts, frequently asked questions, and FC2 in the news. There is also a link to a 55-page bibliography of research on the female condom.

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