Support for Primary HIV Prevention -- August 5, 2003

Research Triangle Park, NC — Slowly, progress is being made in the fight against HIV and AIDS. But in an editorial in the July 2003 issue of the journal Sexually Transmitted Infections, researchers share concern that an international focus on treatment may be diverting attention from primary prevention through a broad array of behavior change interventions, including condom promotion.

"Promoting condoms is undeniably difficult, yet hopes for better access to HIV treatment in the future cannot divert us from the prevention needs of the present," say authors Dr. Paul Feldblum, Dr. Michael Welsh, and Dr. Markus Steiner of Family Health International.

While treatment is an essential component of any comprehensive HIV/AIDS program, recent progress in treatment and access to care, especially for antiretroviral therapy, does not change the fact that the epidemic continues to grow. In 2001, 3.5 million new HIV infections occurred worldwide; and since 1996, the number of HIV-positive individuals in Africa alone has doubled.

The main reasons given in the editorial for supporting condom promotion are that condoms are cost-effective and, simply, that they work. A recent consensus report from the U.S. government showed that condoms are effective against HIV infection and gonorrhea in men. (Evidence is scant for other sexually transmitted infections.) Despite persisting obstacles to promotion — including provider bias, lack of physical access to condoms, and stigma and myth surrounding condom use — the authors urge public health donors to keep promoting condoms as part of a comprehensive approach to primary HIV prevention through behavior change.

"Although it takes more than distributing condoms to reduce HIV incidence, and the relative contributions of different kinds of behavior change cannot be assigned precisely, condom promotion has been a critical component of all population-level HIV success stories to date," they say.

Accurate messages about condoms must build on, and not substitute for, a wide range of HIV risk-avoidance and risk-reduction approaches. These include delayed initiation of sexual intercourse, mutual faithfulness, and selection of low-risk partners. Together with condoms, these approaches have been labeled the "ABC strategy": abstinence, be faithful to one partner, or — if "A" or "B" cannot be achieved — use condoms.

To read Family Health International's online materials on condoms, click here.

For additional facts on condoms and sexually transmitted infections, including HIV, click here (PDF).

For additional information about FHI's work in HIV/AIDS prevention, care, and treatment, click here.

Source

Feldblum PJ, Welsh MJ, Steiner MJ. Don't overlook condoms for HIV prevention. Sex Transm Infect 2003;79(4):268-69.