Reinvigorating Condoms as an HIV prevention Tool

Published: September 21, 2012

The world is enticingly close to realizing the vision of an AIDS-free generation. More HIV- infected individuals are accessing treatment earlier in the course of their disease, and elimination of vertical (mother-to-child) transmission—while still a challenge—is closer to becoming a reality (Ciaranello et al. 2012). However, this vision cannot be achieved through treatment alone. HIV will only slow down when new infections, currently at two for every one person put on treatment, diminish dramatically (Joint United Nations Programme on HIV/AIDS 2010). This means improved access to, and utilization of, combination prevention—a mix of evidence- based HIV prevention interventions including condoms.

In this editorial, we summarize the evidence on condoms for HIV prevention, discuss barriers and
oppor tunities regarding supply, and propose ways to reinvigorate the use of condoms as an HIV
prevention tool. This reinvigoration is needed now more than ever, given the vital role of condoms in both primary HIV prevention and in interventions to promote positive health, prevention, and dignity for
people living with HIV.

Condoms Work, and Many People Use Them

Condoms are an effective barrier method for preventing HIV, other sexually transmitted infections
(STIs), and unintended pregnancy, and are used in hundreds of millions of sex acts each year (Davis and Weller 1999; Pinker ton and Abramson 1997; Weller and Davis-Beaty 2002). They play a key role in sustaining the benefits of other high-impact HIV prevention interventions such as male circumcision
and prevention of mother-to-child transmission. Thus, condoms are a vital component of a comprehensive HIV prevention strategy.

Condom promotion is generally considered a cost- effective HIV prevention intervention as measured
by the cost per disability-adjusted life year (DALY) aver ted. The DALY is a composite metric that
combines years lived with disability and years lost to premature death, and one DALY aver ted represents one year of healthy life. While cost effectiveness ratios are context-specific and there isn’t universal agreement on thresholds of cost effectiveness, a cost per DALY aver ted ratio of under U.S.$50 is generally considered cost-effective. The cost per DALY aver ted for male condoms ranges from U.S.$19 to $205, and this range indicates condom programs vary in design and implementation (Jamison et al. 2006).

Condom promotion can be controversial. Earlier in the course of the epidemic, there were concerns
that condoms were being promoted in ways that ignored structural barriers and religious
sensitivities, failed to include communities, and potentially increased promiscuity (Pfeiffer 2004). Were these concerns overstated? Perhaps. We now know that condoms.

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