HIV and other sexually transmitted infections and unintended pregnancies continue to pose a high health burden for millions of people, specially for young women and key populations, according to participants at an AIDS2018 session titled Condoms 2.0: Reinvigorating effective condom programming in the era of epidemic control.
Data presented during the session shows that condom promotion has averted an estimated 50 million new HIV infections since the onset of the HIV epidemic. Condom use at last higher risk sex has increased over the past three decades in most countries across the world and, is as high as 80-90%, in some countries. Furthermore, in all countries for which data are available, a steady decrease (>30%) in adult HIV infections between 2000 and 2016 is associated with steady increases and high levels (>60%) of condom use by both men and women at last sex with a non -regular partner and condom use by men at last paid sex.
However, 30 years into the response to HIV and despite increased use of condoms over the past three decades, condom availability and use gaps remain, in particular in sub-Saharan Africa where the gap between availably and need is estimated to be more than 3 billion condoms. The estimated condom need in 47 countries in sub-Saharan Africa in 2015 was 6 billion male condoms; however, only an estimated 2.7 billion condoms were distributed.
Participants highlighted the many barriers and inequities hindering access to, and the use of, condoms that continue to exist, including poor access, age restrictions, gender norms, religious norms, stigma, insufficient supply and, in some places, laws that make it an offence to carry condoms. Many countries also prohibit condom promotion and distribution in schools and other venues where adolescents socialize. According to participants, of the 100 countries that reported having a national plan or strategy related to condoms in 2017, only 26 reported that the plan included condom promotion in secondary schools.
International funding for condom procurement in sub-Saharan Africa has decreased in recent years, and domestic funding has not sufficiently increased, participants noted. In several countries condom programming, in particular condom promotion and demand creation, has stalled due to lack of funding and decreased investment.
During the session, participants stressed the need for a new generation of comprehensive, data-driven and people-centred condom programmes as part of the delivery of combination HIV prevention and sexual and reproductive health services for people at higher risk of HIV, STIs and unintended pregnancies.
These new programmes should aim at strengthening demand for and supply of condoms and water-based lubricant and address the barriers and inequities that hinder demand, provision, access and use of condoms by young people, key populations and other people at higher risk. Furthermore, condom promotion and distribution strategies and approaches need to be informed by data, tailored to the context and needs of different communities.
Lastly, participants agreed on the need to set-up effective multi-stakeholder condom programming coordination and oversight platforms and ensure full involvement of beneficiaries and communities in planning, service delivery and monitoring.
“We need to recapture lost ground, that means do business not as usual”
“There is a condom crisis at the centre of the prevention crisis. We are missing a cost-effective opportunity to maximise the contribution of condoms to reducing HIV infections, STIs and unintended pregnancies”
“For every new generation of young people we need to renew our efforts in promoting condoms to ensure young people can enjoy sex and b free from HIV, STIs and unintended pregnancy”
“Not even for a million euros I would accept to do it with a client without a condom”