Condoms Count for HIV Prevention

Box 6: Condom Use Increases Among Sero-discordant Couples in India, Thailand and Uganda.

An intervention among sero-discordant couples showed promising results in increasing condom use after an HIV diagnosis. The intervention was carried out in India, Thailand and Uganda, and through four group sessions, focused on communication, problem solving and safer sex negotiation skills among 43 couples. Responses indicated an increase in the number of acts in which a condom was used to 100 percent at the different sites by first follow-up at one month, demonstrating the potential of the intervention to affect condom use across cultures and stages of epidemic. Information about correct condom use was considered vital, or as one participant stated, “It helps to know how to use a condom.” ²¹¹ Another participant stated: “Now I don’t feel frightened within sexual relationship.” ²¹² The intervention also significantly increased the proportion of those who felt they could refuse sex if their partner did not use a condom.

Condom Use Can be High Among People Living With HIV or AIDS (PLWHA) On Treatment

Treatment with HAART is not associated with higher sexual risk behavior. A comparative study of people living with HIV or AIDS on HAART and those receiving preventative therapy (PT) in Kenya found participants receiving HAART were more likely to report condom use at last sex and consistent condom use with regular partners than those receiving PT. The study also found fewer multiple and casual partners among PLWHA receiving HAART compared with those receiving PT, consistent with findings from Côte d’Ivoire.¹⁹⁷ However, more than 40 percent of all participants in the study did not know the HIV status of their regular partners. HIV care services need to emphasize partner testing and consistent condom use with all partners.¹⁹⁸

A 2007 review of evidence for the impact of ART on sexual behavior in developing countries yielded only three studies that met the inclusion criteria.¹⁹⁹ All three studies were conducted in Africa—one in Côte d’Ivoire and two in Uganda. In each study, condom use at last sexual intercourse was significantly higher among ART patients compared to non-ART patients. In the Côte d’Ivoire study, condom use at last sex was 80 percent for ART patients versus 59 percent for non-patients, regardless of partnership type.²⁰⁰ Bateganya et al (2005) reported 71 percent condom use at last sex with a spouse for ART patients, versus 47 percent for non-patients.²⁰¹ Among study participants receiving weekly home-based ART delivery and individual counseling in Uganda, Bunnell et al (2006) found that condom use at last sex increased from 59 to 82 percent among participants with uninfected partners or with partners they did not previously know, and from 58 to 74 percent among participants with HIV-positive partners.²⁰² While the available evidence indicates that ART is associated with significant behavior changes, there are few rigorous studies and more evidence is needed to guide programs.²⁰³

Programs Should Pay Special Attention to Promoting Condom Use Among Sex Workers and their Clients

By the nature of their work, sex workers have multiple concurrent sexual partners. Furthermore, male clients who do not use condoms put sex workers and any other partners they might have at high risk of HIV. Therefore, condom use during commercial sex is critical. Condom promotion among sex workers has proven successful in many contexts [See Box 7: Experience with 100% Condom Use Policies]. In a systematic review of evidence on the impact of condom interventions between 1998 and 2006, 15 of the 19 studies on condom use in commercial sex reported statistically significant increases.²⁰⁴ In eight of these, condom use more than doubled and in seven studies—conducted in Côte d’Ivoire, Zimbabwe, India, China, Thailand (2 studies) and Singapore— levels of post-intervention condom use exceeded 70 percent by the measure utilized. Although results were significant, post-intervention levels of condom use remained low in five of the studies (19 to 56 percent use in last sex or last five acts, 41 to 58 percent consistent use). All of these interventions involved some combination of health education (often peer-led), condom provision, and STI testing and treatment.

Please refer to the Appendix for end notes.