Executive Summary

Prevention must remain a top priority in the continued fight against HIV and AIDS and, as this report shows, both condoms and contraceptives count as key components of comprehensive HIV prevention. In 2007, new HIV infections out-numbered persons receiving treatment by nearly 3 to 1. More than 6,800 people become infected with HIV every day. Because most HIV epidemics are fueled by sexual transmission of the virus, behavior change, including condom use, is critical to steming the number of new infections. At the same time, more than 120 million women say they would prefer to avoid a pregnancy, but are not using any form of contraception. High rates of unintended pregnancies, including among women living with HIV or AIDS, is an urgent health and rights crisis. Preventing unintended pregnancies among women living with HIV and AIDS and those at risk of infection is essential for preventing mother-to-child transmission of HIV.

Expanding Access to and Use of Male and Female Condoms

Male condoms are generally accepted as a cornerstone of comprehensive HIV prevention; yet expanded access to and use of this proven technology is still facing enormous cultural and policy barriers. For female condoms, the barriers are even greater and much more needs to be done to increase their supply and use. Persistent variations in condom use across regions, countries and populations indicate that condom promotion should be targeted to address socio-cultural, political, economic and structural barriers faced by different groups (e.g. youth, married women and men, discordant couples, sex workers, men who have sex with men, and injecting drug users, among other groups). Successful interventions highlighted in Comprehensive HIV Prevention: Condoms and Contraceptives Count demonstrate that programs can increase correct and consistent condom use when they address the barriers and concerns experienced by different people. Understanding the factors that affect individuals' perceptions of their risk and of acceptable risk-reduction strategies is an essential step towards curbing the spread of HIV. Addressing cultural, social and economic barriers faced by various groups in accessing and using male and female condoms is also critical.

Recognizing the Role of Contraceptives in HIV Prevention

Unlike condoms, the role of contraceptives and voluntary family planning services in HIV prevention is not sufficiently recognized, even though preventing uninteded pregnancies is one of the four pillars of preventing mother to child transmission (PMTCT). Preventing unintended pregnancies is more cost-effective than providing treatment to prevent perinatal transmission. Family planning services provide clients with critical information about the varying degrees of effectiveness of contraceptive methods for pregnancy prevention, the safety of pregnancy with HIV and contraceptive choices for women living with HIV or AIDS. Family planning services also educate clients on STI prevention and correct and consistent condom use. Manyc women living with HIV or AIDS want to have more children and are in need of family planning services to provide counseling on reversible contraceptive methods and on how to prevent mother-to-child transmission of HIV, as well as possible transmission to their husband or sexual partner. At the same time, voluntary family planning services are needed for those women who want to prevent or delay pregnancy. It is estimated that current levels of contraceptive use in sub-Saharan Afica are already preventing 22 percent of unintended HIV-positive births. Highling successful interventions, this report shows that integrating family planning with other HIV services can increase contraceptive use and further reduce unintended pregnancies.

Increased Funding for Condoms and Contraceptives is Key

Condoms and contraceptives are inexpensive and cost-effective technologies, yet cost continues to be a barrier to their availability. This report highlights that the growing need for condoms and contraceptives worldwide has been met with long-term stagnant funding on the part of donors and only small increases in numbers of commodities. For female condoms in particular, greater support needs to be devoted to their strategic introduction, marketing and programming in countries. International donors and developing country governments need to give due regard to the indispensable role of condoms and contraceptives in HIV prevention, and commit to providing the necessary resources to implement programs and services. Some promising mechanisms to coordinate and track commodity procurement and distribution are underway and should continue to be supported and expanded.

Creating a Conducive Environment for Scaling up HIV Prevention

There is no doubt that a comprehensive HIV prevention agenda must include condoms and contraceptives, along with other proven prevention strategies. However, as discussed in this report, successful scale-up of condoms and contraceptives for HIV prevention depends upon strong leadership and coordination-for advocacy and policy dialogue, capacity building and rescue mobilization. Scale-up also requires a supportive policy environment-one where policies are based on sound evidence that supports the efficacy of condoms and contraceptives in prevention the transmission of HIV. Likewise, the integration of contraceptives into HIV prevention programs must be supported at all policy levels.

Successful interventions that address barriers to the demand for condoms and promote marketing strategies that are tailored to particular audiences can work. Programs must also be supported by strong management, links with other programs, monitoring and evaluation and high quality services. On the supply side, strong commodity management and logistics systems are a prerequisite for reliable availability of condoms and contraceptives. Distributing condoms and contraceptives across a range of networks can help to reduce costs of service delibery and promotion by maximizing the contribution of existing outlets and programs. By limiting subsidized or free condoms to low-income consumers, market segmentation maximizes government and donor investments, freeing up funds for other strategies. This report details successful public health strategies and a programming framework that incorporates all of these elements and can be applied to address gaps in the provision and use of condoms and contraceptives.