Condoms Count for HIV Prevention

Able to block the bodily fluids that carry the HIV virus, condoms are a highly effective method of preventing HIV. According to the WHO and the US National Institutes of Health, “intact condoms…are essentially impermeable to particles the size of sexually transmitted disease pathogens, including the smallest sexually transmitted virus.”⁵⁶ Studies show that condoms are a highly effective method of preventing HIV, with effectiveness rates ranging between 80 to 95 percent, largely depending on how correctly they are used.^{57 58 59 60} While no studies have evaluated the specific HIV prevention effectiveness of the female condom, estimates derived from laboratory tests and data on effectiveness for pregnancy prevention indicate that the female condom provides at least the same level of protection as the male condom.⁶¹ [See Box 4: The Female Condom].

Box 4: The Female Condom

In 2008, the Center for Health and Gender Equity (CHANGE) published a report on the female condom, titled Saving Lives Now, as part of the Prevention Now! Campaign. Citations in this box are taken from the CHANGE Report.⁸²

The female condom is currently the sole available HIV prevention technology that is designed to be initiated by the woman. Female condom promotion and use has been shown to increase the total number of protected sex acts.^{83 84 85} 

Studies show that some women view use of the female condom as a means of enhancing safe sex bargaining power.^{86 87 88 89} For some male and female users, the female condom has been reported to be more pleasurable than the male condom.⁹⁰ However, acceptability has been varied and more operations research is needed to address barriers to uptake and consistent use in a variety of sexual relationships.⁹¹ Although the female condom is available in 108 countries, in many instances it is not readily accessible at shops and clinics.⁹² To generate demand and increase availability, greater support needs to be devoted to the strategic introduction, marketing and programming of female condoms in countries.

The only female condom currently approved for use by the U.S. Food and Drug Administration (FDA) is the polyurethane FC1, manufactured by the Female Health Company (FHC). The FHC has also developed a second generation nitrile female condom, FC2, which performs statistically the same as FC1, and has been designed to mitigate the "rustling" noise that some consumers have attributed to FC1. The nitrile material also allows for significant reductions in female condom pricing because it can be produced with a new manufacturing process that lowers cost as volume increases. The United Nations Population Fund (UNFPA) is now procuring FC2, while the U.S. Agency for International Development (USAID) is awaiting FDA approval.

In countries such as Brazil, South Africa and Zimbabwe, where sustained uptake of female condoms has been achieved, both country governments and donors have been committed to their long-term supply and funding.⁹³ Costing US$0.60 , female condoms are expensive compared to the US$0.03 cost of male condoms. However if FC2 were purchased in large volumes—equal to only about 3 percent of the estimated male condom market—the cost per unit could be as little as US$0.22.⁹⁴ Compared to the price of life-long anti-retroviral treatment (ART), use of female condoms for HIV prevention is highly cost effective.⁹⁵

Condoms are an effective prevention method of many STIs other than HIV. Because some STI infections may increase a person’s risk of acquiring HIV, preventing STIs may be effective in reducing HIV incidence.⁶² This is particularly true where HIV prevalence is low, but that of other STIs is high.⁶³ However, trails have shown mixed results in assessing the impact of STI treatment on preventing HIV.⁶⁴ Male condoms are most effective in protecting against STIs spread by discharge, such as HIV, gonorrhea, and chlamydia, but also protect against STIs spread by skin-to-skin contact, such as herpes and human papillomavirus (HPV). Male condoms may also protect against conditions caused by STIs, including recurring pelvic inflammatory disease and chronic pelvic pain, cervical cancer and infertility.⁶⁵ The female condom is at least as effective as the male condom in reducing the risk of contracting sexually transmitted infections.⁶⁶

Condoms are also an important means of pregnancy prevention and are the mainstay of dual protection (taking measures to prevent both pregnancy and STIs). However, because condoms are less effective for pregnancy prevention than other contraceptive methods [see Section IV], dual method use should be promoted among contraceptive users. As commonly used, male condoms are about 85 percent effective for pregnancy prevention. If used consistently and correctly with every sex act, effectiveness for pregnancy prevention is higher--about 98 percent.⁶⁷ As commonly used, the female condom is 79 percent effective for pregnancy prevention, whereas it is 95 percent effective with perfect use.⁶⁸

High rates of incorrect use and condom slippage and breakage need to be addressed. The quality of well manufactured condoms is high and, if used properly, they are unlikely to break, however slippage rates can increase the risk of HIV transmission.⁶⁹ Only consistent and correct use of the condom offers effective prevention against HIV, and only a small percentage of individuals and couples use condoms in this manner. However, consistent use by a small number of vulnerable people may have a greater impact on reducing HIV transmission than a large number of people who use condoms inconsistently.⁷⁰ Some studies show that because their behavior may be riskier in other ways, inconsistent condom users can actually be at higher risk of HIV transmission than those who never use condoms.^{71 72 73 74 75}Condom education and promotion should therefore be integrated with other HIV prevention strategies to address a range of behaviors.

Programs should not only encourage condom use, but also help people to become effective users of the method.^{76 77}Evidence from Botswana, for example, found that a sample of college students needed information on condom use, including timing and method of removal: male partners were not comfortable touching female fluids on the condom; female partners were not comfortable touching male genitalia and one male said he removed the condom before ejaculation.^{78 79} Figure 2 provides an illustration of the pregnancy rates and transmission rates of STIs—including HIV—in one hypothetical year of unprotected sex, versus fifty years of sex using condoms consistently and correctly.

Figure 2: HIV and Other STI Transmission and Pregnancy with Unprotected Sex and Protected by Condom Use Twice Weekly Sex

Please refer to the Appendix for end notes.