In a direct attack on the Bush administration's stance on HIV prevention, authors from a leading US sexual health and family planning organisation asserts that consistent use of condoms can reduce the risk of HIV transmission in discordant couples to “near zero" in an editorial in the August edition of the journal Sexually Transmitted Infections. The authors also note that although condoms are extremely cost effective, their importance to HIV prevention seems to have been forgotten in the push for global treatment access, and that other substantial obstacles still exist to effective condom distribution schemes.
The authors from Family Health International (FHI) point out that only 3% of presentations ar recent international AIDS conferences have focused on condoms as an effective means of HIV prevention, with seven times as many abstracts focusing on treatment access. Although “the life saving benefit of antiretroviral therapy is undeniable” the authors note, “progress on treatment access must not come at the expense of prevention…including condom use.”
”Condoms are effective for HIV prevention” says the editorial, a forthright statement which challenges the abstinence approach favoured by the Bush administration in both its domestic and international HIV prevention programmes. Consistent condom use can reduce the risk of HIV transmission to “near zero” stress the FHI authors, adding that “condom promotion has been a critical component of all population level HIV success stories to date.”
Even though condom distribution programmes, particularly if targeted at high-risk groups, are highly cost effective, substantial barriers still stand in the way of the wide-spread availability of condoms. Not the least of which is a reduction in the number of condoms provided by donors in recent years, with no more condoms provided to fight the spread of HIV in resource-limited setting in 2000 than in 1990. Even where condoms are available there can be important gaps in their provision. For example, “in western Kenya clients of sex workers indicated that they do not have access to condoms in places where sexual encounters occurred”. This problem also exists in other parts of Africa and, “unfortunately, not nearly enough condoms reach the region, hardest hit by HIV.”
What’s more “stigma, myth and rumour” surround condoms, resulting in “low uptake and inconsistent use.” Such myths and rumours condoms being ineffective, having holes, or cause promiscuity. This is another clear attack on the Bush administration’s support for abstinence-only programmes, which only mention of condoms relation to their failure rate. This is despite the fact that when used correctly, condoms have an extremely unlikely to fail. Indeed, the authors stress, “condom manufacturing and packaging processes have improved to the point that the initial quality of most devices is no longer questioned.”
The editorial concludes that “condoms are efficacious” and urges donors to learn how to best promote condom use as part of HIV primary prevention packages.
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Feldlum PJ et al. Don’t overlook condoms for HIV prevention. Sexually Transmitted Infections 79: 268 – 69, 2003.