Key Recommendations

There is no one magic bullet for HIV prevention: All prevention technologies and strategies are additive in the fight against HIV and AIDS. Condoms and contraceptives must be promoted as scientifically proven components of comprehensive HIV prevention, in tandem with other evidence-based interventions such as partner reduction and male circumcision-along with continued investigation of microbiocides and a vaccine. There is more than 20 years of epidemiological, psychological, programming and marking data on which to design programs and interventions. It is time to put this research to work on the ground and develop a comprehensive prevention strategy that supports national and local ownership and generates local solutions to affecting the social and gender norms that influence sexual behavior and use of condoms and contraceptives, among other prevention strategies.

2. Close the gap in funding between prevention and treatment

There is an immense disparity between what is being spent on HIV prevention versus treatment, and yet, tragically, new infections still out-number persons receiving treatment by nearly 3 to 1. Despite 2.5 million new HIV infections las year, donor financing of condoms for HIV prevention has remained relatively stagnant. Donors and country governments must support the indispensable role of condom promotion and family planning services in HIV prevention, and commit to providing the necessary resources. Improved donor coordination--including full accounting of condom procurement by all donors--is necessary to make an accurate assessment of global need and inform investments. Supply of condoms and contraceptives, inexpensive and cost-effective technologies, should no longer be a barrier to HIV prevention.

3. Eliminate harmful government policies

Government policies must not restrict access to and education about the role contraceptives and condoms play in preventing HIV infection and unintended pregnancies. The U.S. government's "ABC" approach to prevention under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has emphasized abstinence until marriage and faithfulness in marriage. This approach ignores the reality that many people face in preventing HIV infection. Instead, policies should be based on scientific evidence of the very high efficacy rates of condoms and contraceptives in preventing the spread of HIV and unintended pregnancies.

4. Scale-up and integrate condoms and contraceptives into other HIV prevention strategies

Based on the social marketing concept of supply, demands and support, and built on a foundation of leadership and coordination, the Comprehensive Condom Programming (CCP) Framework (see Box 10)--which includes ten steps designed to guide programming to identify and address gaps in provision and use of condoms for HIV prevention and promoting sexual health--can serve as a guide for ensuring the accessibility, acceptability and use of condoms--both male and female. The CCP Framework can also guide the expansion of contraceptive provision as a part of HIV prevention. Stimulating demand for condoms and contraceptives through programming remains critical. These technologies will not prevent against HIV and AIDS and unintended pregnancies unless they are made available and used--consistently and correctly.

5. Logistics are critical to making sure condoms and contraceptives get where they are needed most

Strong systems are needs for the timely delivery and constant flow of condoms and contraceptives--thereby preventing stock-outs and ensuring that a wide range of contraceptive methods--and condoms--are available in all settings. Condom forecasts must be made well in advance of when the condoms will actually be used. Mechanisms such as the RH supplies Coalition, global logistics support projects and tools such as the RHInterchange (see Box 11) can help with commodity management and should be expanded.

6. Put the Contraceptives in Comprehensive Prevention

As with all women and couples, women living with HIV or AIDS have the right to make informed decisions about their sexual and reproductive health and need access to contraception. Many 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, there are high rates of unintended pregnancies among all women, including women living with HIV or AIDS in some settings. Given often low rates of HIV testing, many women who have unintended pregnancies do not know their HIV status. Voluntary family planning services are needed for women who want to prevent or delay pregnancy. For all women and couples, integrating family planning with other HIV services can increase contraceptive use and reduce unintended pregnancies. As HIV and AIDS prevention, treatment and care programs scale-up, they should be part of a continuum of care that includes strong family planning and other integral health services from the onset.