Preventing HIV/AIDS

Comprehensive Condom Programming: A Strategic Response to HIV and AIDS

Condoms, both male and female, are currently the only effective technology that prevents HIV and other sexually transmitted infections (STIs), as well as unintended pregnancies. They are inexpensive, cost-effective, their use does not require the assistance of medical or healthcare personnel, and they can be utilized by anyone who is sexually active.

The correct and consistent use of condoms is an integral component of combined HIV prevention strategies that individuals can choose to reduce the risks of sexual exposure to HIV and other STIs, as well as unintended pregnancies. Other options include delaying sexual initiation, abstinence, being faithful to one's partner when both partners are uninfected, reducing the number of sexual partners, undergoing voluntary medical male circumcision, and complying with treatment or test-and-treat approaches to HIV prevention by people living with HIV, to lower their viral load and by extension the potential to transmit HIV.

Comprehensive Condom Programming (CCP) is a means to ensure that persons at risk of STIs, including HIV, and/or unintended pregnancies are motivated to use male and/or female condoms, have access to quality condoms, have accurate condom information and knowledge, and use condoms correctly and consistently.

Both supply and demand are critical

Creating demand for condoms by convincing people at risk of sexually transmitted infections to use them routinely is an important part of the equation for preventing the spread of HIV and other sexually transmitted infections. But in many places, people who want to use condoms are unable to obtain them.

An estimated 13 billion condoms per year are needed to help halt the spread of HIV and other sexually transmitted infections, according to UNAIDS. The reality falls short.  In 2012, some three billion condoms were provided by donors, UNFPA and social marketing organizations. In that year, sub-Saharan Africa, the region with greatest HIV prevalence and the largest share of donor support, received about eight male condoms per man of reproductive age, and one female condom for every eight women of reproductive age.

The UNFPA guide to comprehensive condom programming outlines a 10-Step Strategic Approach that encourages the participation of donors and international agencies while placing ultimate responsibility for decision-making and implementation in the hands of national partners.

Highlights from the UNAIDS Position Statement on Condoms and HIV Prevention

  • Condom use is a critical element in a comprehensive, effective and sustainable approach to HIV prevention and treatment.
  • The male latex condom is the single, most efficient, available technology to reduce the sexual transmission of HIV and other sexually transmitted infections.
  • Condoms must be readily available universally, either free or at low cost, and promoted in ways that help overcome social and personal obstacles to their use.
  • HIV prevention education and condom promotion must overcome the challenges of complex gender and cultural factors.
  • Condoms have played a decisive role in HIV prevention efforts in many countries.
  • Increased access to antiretroviral treatment creates the need and the opportunity for accelerated condom promotion.

An effective element in reducing infection

Condoms have helped to reduce HIV infection where AIDS has already taken hold and curtailed the broader spread of sexually transmitted infections. They have also encouraged safer sexual behaviour more generally.

In studies of sero-discordant couples in East Africa, condom use was found to reduce infectivity by 78 per cent in both sexes. Similarly, a Cochrane review of data on the effectiveness of condoms found that consistent condom use was associated with an 80 per cent lower rate of HIV acquisition.

Thailand's efforts to de-stigmatize condoms and its targeted condom promotion for sex workers and their clients dramatically reduced HIV infections in these populations and helped reduce the spread of the epidemic to the general population. A similar policy in Cambodia has helped stabilize national prevalence, while substantially decreasing prevalence was observed among sex workers. In addition, Brazil's early and vigorous condom promotion among the general population and vulnerable groups successfully contributed to sustained control of the HIV epidemic. Increased condom use is believed to be a contributing factor in the decline in HIV prevalence reported in Zimbabwe between 2003 and 2005.

Gender dimensions of condom use

Physiologically, men are more likely to transmit HIV to women than vice-versa. Although condoms can provide effective protection against HIV infection, and female condoms are agreed to increase women's empowerment, several issues impact upon the use of both male and female condoms. Cost, availability and perceptions of risk are important factors. Power relations between men and women, including the relative social and economic status of partners, influence the extent to which condom use can be successfully negotiated.

Accepted notions of masculinity and femininity also come into play. For instance, in many cultural settings, young women are supposed to be sexually innocent and may therefore be reluctant to carry or suggest using condoms. Since condoms are also associated in many contexts with illicit or extra-marital sex, married women are often powerless to request their partner to wear a condom despite suspecting that he may be infected with HIV, for fear of reprisal at the implied accusation of being unfaithful.

Myths, misperceptions and fears on male and female condoms

UNFPA and WHO have produced a publication that addresses commonly held condom myths, misperceptions, fears and negative attitudes that act as barriers to correct and consistent condom use around the world. Myths and misperceptions were collected from regional and country programme managers and health care providers and the most commonly occurring myths and misperceptions are addressed in this publication.

Assuring high quality and low cost

Condoms must be procured according to the quality assurance procedures established by WHO, UNFPA and UNAIDS. Condoms are manufactured utilizing the highest international standards and then stored in a dry environment away from direct heat sources to ensure safety and efficacy.

Manufacturing standards have also been established by the International Organization for Standardization, the Comité Européen de Normalisation, and the American Society for Testing and Materials. These standards are mainly concerned with the safety and integrity of the condoms and establish minimum acceptable quality levels.

WHO, UNFPA, and UNAIDS work with manufacturers, testing laboratories, researchers, donors, international agencies and program managers to establish an internationally accepted specification, quality assurance and procurement procedure for male latex condoms. In accordance with these quality assurance procedures, all donor procured condoms are quality controlled and tested for safety and efficacy during the manufacturing process and before they enter a country's distribution network. Their ultimate effectiveness depends on user behaviour in opening the package, applying the condom, sexual activity, lubrication, and number of times an individual condom is used.

Low cost is also essential for government distribution and social marketing of condoms. As the largest public-sector procurer of condoms in the world, UNFPA is able to negotiate the lowest prices possible. Developing countries are the suppliers for virtually all of the male condoms procured by UNFPA.

Key Publications