HIV Prevention Knowledge Base
Behavioral Interventions: Comprehensive Condom Use Programs
Condom Effectiveness in Reducing Heterosexual HIV Transmission
This study reviewed data from 14 longitudinal studies of sexually active serodiscordant heterosexual couples. In 13 of the studies, all the participants were 100 percent condom users, while the cohort in one study comprised those who never used condoms. Overall, the studies showed that consistent condom use for all acts of penetrative vaginal intercourse was associated with an 80 percent reduction in HIV seroconversion. The authors note a lack of detail in the studies (e.g., on correct use), and there were inconsistencies in terminology about condom use across the different studies. There was also a lack of information on disease-free exposure time, the review found. The results imply that condom use is less effective for HIV prevention than it is for pregnancy prevention. Recommendations for future studies include improving the way that condom use is coded to give more detailed information.
Efficacy of Structural-Level Condom Distribution Interventions: A Meta-Analysis of U.S. and International Studies, 1998-2007
This meta-analysis concludes that structural-level condom distribution interventions are effective in preventing both HIV and sexually transmitted infections. Structural interventions improve the availability, acceptability, and accessibility of male condoms. The analysis shows that structural-level interventions are particularly effective for increased condom acquisition, carrying, and use; abstinence or delayed sexual debut in young people; and reduced incidence of sexually transmitted infections. Limitations of the meta-analysis include extreme heterogeneity in the studies, exclusion of some important studies for methodological reasons, and a cut-off point of September 2007, after which other relevant studies were published.
Quick Reference Guide to Family Planning Research
This synthesis with links to abstracts places research on condoms, both male and female, in the wider context of integrating family planning and HIV prevention services. Links to research papers and other documents demonstrate that the correct and consistent use of latex male condoms reduces the risk of HIV transmission by an estimated 80 to 90 percent. Other studies show that interventions targeted at both long-standing and serodiscordant couples significantly improve self-reported condom use rates; concentrated counseling can increase acceptability of condoms; and condom use has increased in high-risk groups, especially if condoms are widely available where risky sex takes place.
Changes in HIV-Related Knowledge and Behaviors in Sub-Saharan Africa: DHS Comparative Reports 24
Condom use is among a range of HIV-related indicators in this report on 23 countries in sub-Saharan Africa. The report illustrates great variation in use, but in all countries more men than women reported ever using a condom and using one in the previous 12 months. Similarly, condom use during high-risk sex varied widely across sub-Saharan Africa, while condom use at first intercourse among those aged 15 to 24 varied but was low overall. Detailed tables present country-level data with figures for two time points where available.
Saving Lives Now: Female Condoms and the Role of U.S. Foreign Aid.
This report is based on expert interviews and an extensive literature search. It highlights the unique nature of female condoms as a means of protection from HIV that women can initiate. Female condoms are not readily available and awareness of this method of HIV prevention is low, the authors write. The way to stimulate demand for female condoms is to ensure high-quality female condom programming, including creative solutions to distribution; training for both providers and consumers; and promotion through civil society organizations that work with vulnerable population. The report makes recommendations to U.S. agencies involved in female condom programming to promote their integration into HIV prevention and family planning efforts, expand technical assistance, and scale up programming efforts. The scope of female condom promotion should be widened to the general public to avoid stigmatization of female condoms and supports the removal of hallmarked funding for abstinence-based HIV prevention programs.
Epidemiology of Male Same-Sex Behavior and Associated Sexual Health Indicators in Low- and Middle-Income Countries: 2003–2007 Estimates
Over 100 studies were reviewed to compile this summary of data on male-to-male sex, including condom use, in low- and middle-income countries. Asia accounted for the highest proportion of recent research, and there were also new studies from sub-Saharan Africa revealing epidemics of HIV among men who have sex with men. However, the authors found there is still a paucity of information from other regions, and Latin American studies were less extensive than anticipated. This newly available data should be used in the development of future interventions, but more systematic data collection would improve the evidence base for HIV prevention planning, the authors conclude.
Comprehensive HIV Prevention: Condoms and Contraceptives Count
This report stresses the importance of male and female condoms and other forms of contraception in HIV prevention and advocates scaled up access as well as integration into wider prevention strategies. Expanding access to condoms continues to face cultural and policy barriers and wide regional variations in condom use persist, the report finds. One section is dedicated to how programs address barriers to use and to improve rates of condom use among young people, those in long-term partnerships, serodiscordant couples, sex workers, and other socially marginalized groups. The section highlights specific issues such as gender-based violence as an obstacle to condom use and the experience of 100 percent condom use programs.
Effectiveness of Interventions for the Prevention of HIV and Other Sexually Transmitted Infections in Female Sex Workers in Resource Poor Setting: A Systematic Review
This is a systematic review of 28 interventions targeting female sex workers. The interventions are presented in four categories: structural interventions, behavioral interventions incorporating condom promotion, provision of vaginal microbicide, and treatment for sexually transmitted infection. The evidence supports condom promotion as a HIV risk reduction strategy when combined with other sexual risk reduction and better access to treatment for sexually transmitted infections.
A Systematic Review of Published Evidence on Intervention Impact on Condom Use in Sub-Saharan Africa and Asia
Condom promotion interventions targeted at sex workers and their clients can result in significant increases in condom use, according to this systematic review of 62 studies in sub-Saharan Africa and Asia. The evidence in support of such interventions with long-term partners who are not serodiscordant, and also with young people, is far weaker, the review finds. The findings were consistent across different countries. Relying on self-reported condom use leaves the studies open to reporting bias, and biological outcomes would be optimal. Standardized measures of condom use would also help future synthesis of condom promotion intervention evaluations, the authors note.
A Review of Female-Condom Effectiveness: Patterns of Use and Impact on Protected Sex Acts and STI Incidence
This systematic review of 137 articles on the female condom, including five randomized controlled trials, looked at the impact of female condoms on risk reduction and incidence of sexually transmitted infections. Among the five randomized controlled trials, two indicated notable decreases in STI incidence and all five indicated increases in the number of protected sex acts. Data from multiple studies showed that female condoms are used by women who are not as likely to use other dual protection methods. Of the studies reviewed, almost half looked at acceptability, while other studies focused on cost-effectiveness, facilitators and barriers to use, negotiation, and promotion. The authors suggest that future research should move away from the focus on acceptability to examining the effectiveness and impact on diverse settings and to more closely examine the view that female condoms empower women to negotiate safer sex.
Condom Promotion For AIDS Prevention in the Developing World: Is it Working?
Thailand’s 100% Condom Program, which mandates enforced condom use in brothels, stands out as a significant success story in two decades of HIV prevention via condom promotion. Condom promotion among men who have sex with men and among sex workers and their clients can be successful, but there is less evidence in support of promotion to the general public, the review finds. Condom promotion strategies should be examined in conjunction with other interventions, such as partner reduction because of the potential for interaction, and interventions should truthfully represent the less than total efficacy of condoms in prevention of HIV transmission, the authors conclude.
Condom Use Errors and Problems: A Global View
Condom use errors are widespread globally and continue to lessen the efficacy of condoms. These results are from a systematic literature review of 50 articles on condom use representing 14 countries and a diverse set of populations (e.g., sex workers, clients at clinics for sexually transmitted infections [STIs], monogamous married couples, etc.) from 1995 to 2011. According to the authors, common errors involve incomplete use (e.g., putting on a condom after intercourse has begun or early removal of a condom followed by unprotected intercourse), not leaving space at the tip, not squeezing air from the tip prior to use, putting the condom on inside out and having to remove and replace it, not using water-based lubricants, and incorrect withdrawal. Some common problems include breakage, slippage, leakage, erection problems during condom application, erection problems during condom use, and problems with the fit or feel of a condom. The authors found that the majority of articles discussed breakage and slippage, yet argue that other problems, such as early removal of condoms and incomplete use, may be just as serious, particularly when they expose a partner to STIs. Some under-researched areas include duration of condom use during intercourse and condom-associated erection difficulties. The authors offer some guidelines on correct condom use before, at the time of, and after intercourse, and offer a Condom Use Experience model to guide future research.
Behavioral Interventions to Reduce the Transmission of HIV Infection among Sex Workers and their Clients in Low- and Middle-income Countries
This review describes the results of a meta-analysis on HIV prevention projects implemented among sex workers in low- and middle-income countries. The objectives of the review were to 1) evaluate and 2) assess the effectiveness of behavioral interventions in reducing the transmission of HIV and sexually transmitted infections (STIs) among sex workers and their clients. Only randomized and quasi-randomized controlled trials were included, a total of 13 studies. The outcomes of interest were STI and HIV incidence and prevalence. Secondary outcomes included changes in behavior such as condom use, sexual and drug use risk behavior, and STI treatment-seeking behavior. Two reviewers searched the gray and peer-reviewed literature from various sources, and included published data from 1980 to 2010. Primary outcomes were identified in seven studies (e.g., HIV incidence, STI incidence, and STI prevalence). It was found that a Social cognitive intervention did reduce HIV incidence among sex workers compared to standard counseling, and an intervention promoting both male and female condoms was more effective than promoting male condoms alone. Six interventions were effective in reducing STI incidence. Positive findings were also found among the secondary outcomes of successful interventions, such as an increase in condom use, reduction of drug use, and reduction of sexual partners. The authors concluded that a combination of behavioral interventions is the most effective, but not all interventions are successful in ameliorating health outcomes.