Stronger promotion of condom use could help put the brakes on the global HIV-AIDS epidemic according to a new study published in the British medical journal, The Lancet.The study suggests condom use could be especially helpful in sub-Saharan Africa, a region that accounted for 65 percent of the 4.3 million new HIV infections reported this year by the World Health Organization.
The Lancet study surveyed the sexual behavior of 130,000 young single women from 18 African countries between 1993 and 2001. Abstinence and fidelity rates among this population aged 15-24 remained relatively unchanged, while the percentage of respondents who said their male partners used condoms more than tripled from 5.3 to 18.8 percent. In 13 of the 18 countries in the survey, 60 percent of the women said they were using condoms for pregnancy prevention.Lead author John Cleland, professor of medical demography with the London School of Hygiene and Tropical Medicine says the numbers are encouraging, especially for this group of sexually active women who are also at risk for contracting HIV. "What it tells you is that condom promotion campaigns in all their various forms are working," he says.
Family Planning Strategy Could Work to Lower AIDS Risk
The Bush administration's response to the worldwide AIDS epidemic, known as the President's Emergency Plan for AIDS Relief, or PEPFAR, funds global HIV prevention programs. PEPFAR promotes a three-pronged approach to prevention of the sexually- transmitted disease that it calls "ABC," where A stands for abstinence, B for be faithful and C for condoms. PEPFAR administrator Mark Dybul says, "The data are clear that you need all three components" to effectively fight the AIDS epidemic.
But some critics fault the ABC approach for emphasizing abstinence over condom use. Lancet study author John Cleland says the U.S. policy amounts to an embargo on the social marketing and promotion of condoms. "Other donors have to step in and fill that gap, because the unsung hero of the game are the people who make condoms familiar, available and affordable."
But U.S. Global AIDS coordinator Mark Dybul says that the United States supports condom distribution. "This year," he says, "the U.S. planned to ship more than 486 million condoms worldwide." That is triple the number shipped in 2001.
Study author John Cleland says the finding that condoms are becoming a more popular method of contraception in Sub-Saharan Africa is welcome news because of their value in protecting against both unwanted pregnancy and HIV. He says this is of immediate importance to women in the region, who make up 60 percent of HIV-infected people.
"The big message is that pregnancy prevention and HIV control should get together more closely. It might well be more effective to provide condoms for pregnancy prevention than for disease control."
That's because, Cleland says, "It is easier for a young woman to persuade her sexual partner to use a condom to prevent pregnancy than to prevent disease."
Cleland hopes the survey will be a wake-up call for public health policy makers.