Condoms and HIV Prevention -- April 2003

What is the role of the condom in HIV prevention?

Research Triangle Park, NC — Male condoms reduce the risk of acquiring and transmitting the deadly human immunodeficiency virus (HIV), but only if they are used consistently and correctly.

To maximize consistent condom use among sexually active people at risk for HIV infection, public health messages must continue to emphasize that condoms are effective against not only HIV, but also gonorrhea (in men) and unplanned pregnancy. Yet, controlling the spread of HIV and other sexually transmitted infections (STIs) will also require the use of other strategies, according to the current issue of Network, the quarterly reproductive health journal published by Family Health International (FHI).

"Accurate messages about condoms must build on and not substitute for a wide range of STI/HIV risk avoidance and risk reduction approaches," says Willard Cates, Jr., MD, MPH, and president of FHI's Institute for Family Health at Research Triangle Park. "These approaches include delayed initiation of sexual intercourse, mutual faithfulness, and selection of low-risk partners."

Weapons against HIV, he says, also include potentially effective interventions such as screening and treatment for other STIs, male circumcision, use of antiretroviral agents for prevention, various approaches to prevention of mother-to-child transmission, screening of blood products, and needle-exchange programs.

Meanwhile, examples of the ways in which condom promotion campaigns are helping to prevent HIV infection in Thailand, Cambodia, and the Dominican Republic are highlighted in the current issue of Network. Efforts to make condoms increasingly attractive to men are also described. For example, FHI researchers are studying whether giving men a choice of male condoms increases use and decreases STI rates. "We need to know why participants like particular condoms," says Carol Joanis, an FHI associate director and principal investigator for condom choice studies in Ghana, South Africa, and Kenya. "Do they prefer condom attributes, like the bumps and ridges? Are they attracted to a condom based on the way it was promoted? Or, do they simply like the color of the packaging?"

Finally, the current issue of Network discusses recommendations for reuse of the female condom; strategies for protecting against both unplanned pregnancy and STIs; and continuing investigations into what role diaphragms and microbicidal agents might play in providing a protective barrier against HIV and other STIs. While such a microbicide is unlikely to reach the market until after 2010, six microbicide products are expected to enter efficacy trials — the most advanced stages of testing in humans — in 2003 and 2004.

Network is provided free to family planning providers and other health professionals worldwide.