[Originally published in 2004 updated in 2009]

Condom use is a critical element in a comprehensive, effective and sustainable approach to HIV prevention and treatment. Prevention is the mainstay of the response to AIDS. Condoms are an integral and essential part of comprehensive prevention and care programmes, and their promotion must be accelerated. In 2007, an estimated 2.7 million people became newly infected with HIV. About 45% of them were young people from 15 to 24 years old, with young girls at greater risk of infection than boys.

The male latex condom is the single, most efficient, available technology to reduce the sexual transmission of HIV and other sexually transmitted infections.

The search for new preventive technologies such as HIV vaccines and microbicides continues to make progress, but condoms will remain the key preventive tool for many, many years to come. Condoms are a key component of combination prevention strategies individuals can choose at different times in their lives to reduce their risks of sexual exposure to HIV. These include delay of sexual initiation, abstinence, being safer by being faithful to one’s partner when both partners are uninfected and consistently faithful, reducing the number of sexual partners, correct and consistent use of condoms(1), and male circumcision.

Conclusive evidence from extensive research among heterosexual couples in which one partner is infected with HIV shows that correct and consistent condom use significantly reduces the risk of HIV transmission from both men to women, and also from women to men(2). Laboratory studies show that male latex condoms are impermeable to infectious agents contained in genital secretions(3). To ensure safety and efficacy, condoms must be manufactured to the highest international standards. They must be procured according to the quality assurance procedures established by the WHO, UNFPA and UNAIDS and they should be stored away from direct heat sources. Prevention programmes need to ensure that high-quality condoms are accessible to those who need them, when they need them, and that people have the knowledge and skills to use them correctly.

Condoms must be readily available universally, either free or at low cost, and promoted in ways that help overcome social and personal obstacles to their use.

Condom use is more likely when people can access them at no cost or at greatly subsidized prices. Effective condom promotion targets not only the general population, but also people at higher risk of HIV exposure, especially women, young people, sex workers and their clients, injecting drug users and men who have sex with men. UNFPA estimates that the current supply of condoms in low- and middle-income countries falls well short of the number required (the condom ‘gap’)(4). Despite the gap, international funding for condom procurement has not increased in recent years. Collective actions at all levels are needed to support efforts of countries, especially those that depend on external assistance for condom procurement, promotion and distribution.

HIV prevention education and condom promotion must overcome the challenges of complex gender and cultural factors.

Young girls and women are regularly and repeatedly denied information about, and access to, condoms. Often they do not have the power to negotiate the use of condoms. In many social contexts, men are resistant to the use of condoms. This needs to be recognized in designing condom promotion programmes. Female condoms can provide women with more control in protecting themselves. However, women will remain highly vulnerable to HIV exposure, until men and women share equal decision-making powers in their interpersonal relationships.

Condoms have played a decisive role in HIV prevention efforts in many countries.

Condoms have helped to reduce HIV infection rates where AIDS has already taken hold, curtailing the broader spread of HIV in settings where the epidemic is still concentrated in specific populations.

Condoms have also encouraged safer sexual behaviour more generally. Recent analysis of the AIDS epidemic in Uganda has confirmed that increased condom use, in conjunction with delay in age of first sexual intercourse and reduction of sexual partners was an important factor in the decline of HIV prevalence in the 1990s(5). Thailand’s efforts to de-stigmatize condoms and its targeted condom promotion for sex workers and their clients dramatically reduced HIV infections in these populations and helped reduce the spread of the epidemic to the general population. A similar policy in Cambodia has helped stabilize national prevalence, while substantially decreasing prevalence among sex workers. In addition, Brazil’s early and vigorous condom promotion among the general population and vulnerable groups has successfully contributed to sustained control of the epidemic.

Increased access to antiretroviral treatment creates the need and the opportunity for accelerated condom promotion.

The success of antiretroviral therapy in industrialized countries in reducing illness and prolonging life can alter the perception of risk associated with HIV(6). A perception of low-risk and a sense of complacency can lead to unprotected sex through reduced or non-consistent condom use. Promotion of correct and consistent condom use within antiretroviral treatment programmes, and within reproductive health and family planning services, is essential to reduce further opportunities for HIV transmission. Rapid scale-up of HIV testing and counselling is needed to meet the prevention needs of all people, whether they are HIV-positive or negative.

 

1 UNAIDS. 2004 Report on the global AIDS epidemic, page.72.

 

2 Holmes K, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bulletin of the World Health Organization. Geneva. June 2004.

3 WHO/UNAIDS. Information note on Effectiveness of Condoms in Preventing Sexually Transmitted Infections including HIV. Geneva. August 2001.

4 UNFPA. 2007 report on donor support for contraceptives and condoms for STI/HIV prevention 2007.

5 Singh S, Darroch J.E, Bankole A. A,B, and C in Uganda: The Roles of Abstinence, Mongamy and Condom Use in HIV Decline. The Alan Guttmacher Institute. Washington DC. 2003.

6 Gremy I, Beltzer N. HIV risk and condom use in the adult heterosexual population in France between 1992 and 2001: return to the starting point? AIDS 2004;18:805-9.

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As part of a joint HIV prevention campaign, some 100,000 high-quality condoms are being made available to athletes free of charge in health clinics in the Olympic Villages of Beijing, Qingdao and Hong Kong. Athletes are also able to find useful information on HIV from thousands of posters and leaflets in English, French and Chinese.

In the waiting room of the polyclinics, HIV prevention videos with UNAIDS Special Representative and German footballer Michael Ballack and Chinese basketball star Yao Ming are being shown in three languages. In addition, all athletes competing in the 2008 Olympic Games have received flash sticks that include fact sheets on HIV.

These HIV prevention and anti-discrimination efforts are part of the 2008 Olympics HIV campaign “Play safe – Help stop HIV” launched by UNAIDS, International Olympic Committee (IOC), and the Beijing Organizing committee of the Olympic Games (BOCOG). The objective of the campaign is to educate athletes participating in the Beijing Games about HIV and encourage them to be ambassadors of AIDS response.

“Athletes should know about how HIV can be transmitted, how it does not transmit and how HIV can be prevented. This will help them educate their peers and fight discrimination against people with HIV. It really is a topic relevant to sport,” said Campaign Ambassador and Egyptian swimmer Rania Elwani.

The campaign not only aims to benefit the many athletes taking part but also members of the national delegations and the more than 100,000 volunteers.

Today about 33 million people are living with HIV worldwide. Young people, 15–24 years of age, account for around 45% of all new HIV infections in 2007. However, many young people still lack accurate, complete information on how to avoid exposure to the virus.

Many young people are involved in sport, either as spectators or participants. Through this global sport gala of the Beijing Olympics, messages about AIDS can reach out to communities, especially to youth, to promote safer sexual behavior and to stop stigma and discrimination.

“Famous athletes can play an important role to bring across messages about HIV prevention, care and support as they are regarded as role models by young people," said IOC President Jacques Rogge. UNAIDS Country Coordinator Dr Bernhard Schwartländer said, “We know that sport and the Olympic Games are universal languages that can play a very important and positive role in raising AIDS awareness and reducing stigma and discrimination of people living with HIV.”

In 2004, UNAIDS signed a Memorandum of Understanding with the IOC, combining efforts to enhance the role of sports organization in the AIDS response at community and national levels, and to organize AIDS awareness activities with coaches, athletes and sport personalities.

The use of condoms in Brazil is preventing the spread of HIV and it might also be helping to save the rainforest thanks to a condom factory opened in April in the Amazon region. This unique factory uses natural latex collected by local rubber tappers and it will be able to supply the Brazilian government with 100 million condoms a year.

The company which runs the factory – Natex - is a joint venture between the local state of Acre, the Ministry of the Environment and the Ministry of Health. It represents Acre’s new vision for the Amazon - “Florestania” - which seeks to increase the living standards of its inhabitants whilst also preserving the rain forest, through increasing the value of the products extracted from it.

The factory is located in Xapuri, made famous by the environmentalist and rubber tapper Chico Mendes who was assassinated there twenty years ago, and it is a direct legacy of his life’s work. Threatened with the destruction of their livelihood by the cattle ranchers who were clearing the forest, Mendes’s great achievement was to forge an alliance between the interests of the rubber tappers and the environmentalists. Mendes saw the rubber tappers as the natural custodians of the forest.

The factory provides employment for around 100 people and the latex is supplied by around 700 rubber tappers. As well as payment for the latex, the rubber tappers receive a fee for “environmental services”, recognising their importance in safeguarding the forest. This has greatly improved the living conditions of rubber tappers such as Chico Mendes’s cousin Sebastiao Teixeira Mendes who gets a guaranteed income for his latex which is higher than he could get elsewhere. He sees the rubber tappers as the “soldiers of the forest – patrolling and managing the forest”.

At the opening of Natex, the then Minister of Environment Marina Silva - the daughter of rubber tappers herself – was in no doubt of the significance of the factory: “This is a project where high technology will help to preserve the soul of the forest”. Adding, “The forest will remain the forest and the rubber tappers will remain rubber tappers through a new way of working and producing”.

As well as the environmental and social aspects of the factory, the other main driver of the project has been the Government’s need for an increasing supply of good quality condoms. The distribution of free condoms coupled with a national campaign for their usage has been at the core of the Brazilian Governments AIDS prevention strategy.

Since 1994, 1.5 billion free condoms have been distributed and it is projected that 557 million will be distributed this year reaching out to 52% of the population. The change in people’s attitudes can be seen from a national study, which showed that the percentage of those who used condoms during their first sexual encounter rose from 10% in 1986 to 47.8% in 1998 and 65.8% in 2005. In another study in 2004 showed that 96% of the adult population cited the use of condoms as the best method of preventing HIV transmission.

In 2007, the Government of Brazil imported one billion condoms and plans to purchase an additional 1.2 billion by the end of the year. It is expected that the factory will eventually increase its annual production from 100 to 200 million condoms and diversify into female condoms, therefore greatly reducing the Government’s reliance on importing condoms.

Whilst the condoms will be slightly more expensive to produce than importing from Asia, it is a cost that the director of the National AIDS Programme Dr Mariangela Simao believes is well worth paying as it “reflects the social benefits of increasing the income of the autochthonous population and a sustainable way of managing the native rubber trees”.

UNAIDS Country Director Mr Pedro Chequer, who was previously the National AIDS Director and as such was involved in the planning stages for the factory believes that it “represents the Government’s high level political commitment to maintain HIV as a priority agenda for the Country”. The world, he notes, faces a huge shortage of condoms. “As far as male condoms are concerned the annual deficit would be around 30 billion if we consider half of the world male population using a condom once a week. Of course the initial production of 100 million condoms will not have much affect on the world scenario, but it will help the country have guaranteed access to the production of condoms”.

It is a model that he believes Brazil could export through joint ventures with other Latin American Countries.

Sebastiao Mendes and the local community have a name for Natex that sums up how they feel about the factory - “The love factory”. It is easy to see why there is such enthusiasm for the factory - a factory that is helping in the response to AIDS, but also helping to improve the living conditions of the local population whilst at the same time preserving the endangered rain forest.

On 1 December 2006, UNAIDS joined with a broad range of UN and Thai partners to organize a World AIDS Day event with a difference.

As well as hosting a packed celebration event, Thailand captured international attention with an attempt to create the world’s longest chain of condoms.

And at the end of March, confirmation arrived—at 2,715 metres long, the condom chain sets a new Guinness World Record™.

The tying of the world’s longest chain of condoms was one of the events of the “Condom Chain of Life Festival”, a unique celebration of World AIDS Day, held at Lumpini Park in Bangkok. The festival was organized by the United Nations Educational, Scientific and Cultural Organization (UNESCO) Bangkok in collaboration with the Thai Red Cross, PLAN Thailand, UNAIDS and local NGOs as part of efforts to promote the acceptance of condoms, emphasize the need for safe sex, and encourage strengthening of national policies for comprehensive treatment, care and support for people living with and affected by HIV.

UNAIDS Special Representative Senator Mechai Viravaidya, well known for his groundbreaking HIV prevention efforts in Thailand, led the tying of the chain.

Here, UNAIDS Country Coordinator for Thailand, Patrick Brenny, tells (click on link below to listen to the interview) www.unaids.org about how the World Record attempt came about and its importance to the Thai AIDS response.

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Links:

Listen to the interview with UNAIDS Country Coordinator for Thailand (mp3, 3 MB)
Read UNESCO press release: Record set for world’s longest condom chain

Thousands of condoms pile in the corner. Buckets of paint lie on the shelf. She cuts, twists, shapes, melts, pastes, colors, crochets and sculpts, with her fingers and nails stained black. 365 hours later, a colourful elegant gown made of 6,500 condoms debuts.

Adriana Bertini, a Brazilian artist living in São Paulo, uses expired or defective condoms as raw material to make pieces of art. Her creations include ornate evening dresses, vivid bikinis, elegant shawls, flowery carnival costumes, and other plastic arts.

"I want my art to be visible everywhere, reminding people of the necessity of HIV prevention" Bertini says. “I prefer working more with the figurines, because I noticed that they make people think about the meaning of ‘Wear against AIDS’.”

Bertini started her career at Brazil's fashion houses, and made her first dress from condoms in 1997. Since then, the designer has made around 200 sculptures, 80 tapestries and 160 figurines from condoms. The most condoms she has ever used on a gown - around 80 thousand - was on one wedding dress.

"My idea is to promote condom use not as a commercial fashion but as a conceptual fashion, be it conscious or subconscious. The idea is to wear them at the right time, not just as a trend, on clothes" says Bertini.

Bertini started working in HIV prevention in 1994, after she spent time with HIV positive children as a volunteer for GAPA, an HIV prevention group. "In the beginning, I worked with condoms but not necessarily in the context of AIDS," the designer says "The AIDS issue came along with my work with children living with HIV. I realized that I could use fashion for AIDS awareness."

“I volunteered to do the HIV prevention work,” says Bertini, who at the time did not know anyone living with HIV. “Then I made friends who were HIV positive and this stimulated me even more to promote prevention.  Today, I have already lost some dear people to AIDS. I think this is the minimum I can do, being a conscientious person faced with a problem of this magnitude. ‘If you have conscience, act'.”

Bertini’s designs can be seen at fashion shows and in magazines, or are exhibited in museums. “The focus is not on wearing my gowns, but on introducing condoms into everybody’s lives, breaking taboos and giving the public a chance to ponder.”

While Bertini’s designs are often shown in Brazil, she has also had important international exposure. Her work was exhibited at the International AIDS Conference in Barcelona, Spain, in 2002, and at the 15th International AIDS Conference in Bangkok, Thailand, in 2004, among others. She has also proposed an exhibit in the cultural programme of the 16th AIDS Conference in Toronto this coming August: “I am waiting for the selection to be finalized.”

Reactions of the public to her designs vary. Some people whisper about it, others laugh or dismiss it as inappropriate, and then there are those who want to meet her and tell her their problems.

“There a lot of parents who want to thank me because it was through my art that they’ve reached out to their children to talk about sexuality,” she says.

All her material comes from condom manufacturers, and the proceeds from the sales of dresses - prices range from $700 to $5,000 - go directly to organizations involved in the fight against AIDS. Bertini and her HIV-positive apprentices do not make their living directly from their work, but instead rely on sponsors.

"I'm not doing this to make money but rather as a social act, as art aimed at others. I hope that by using condoms to create something new, I can inspire reflection, foster discussion, and challenge taboos." says Bertini who is quickly becoming well-known in international activism circles.

The 34 year-old was awarded with the Nkosi Johnson Community Spirit Award in 2004 by the International Association of Physicians in AIDS Care, Washington DC, (IAPAC) in recognition of her 10 years of artistic activism. "You understand, condoms must become as basic as a pair of jeans and as necessary as a great love," Bertini emphasizes.

Related links

Adriana Bertini official website

Following the recent publication of an article on antiretroviral treatment and sexual transmission of HIV in the Swiss medical journal ‘Bulletin des médecins suisses’, UNAIDS and WHO reiterate the importance of a comprehensive approach to HIV prevention including correct and consistent use of condoms.

The Joint United Nations Programme on HIV/AIDS and its Cosponsors, WHO, UNFPA, UNICEF and the World Bank, note with considerable interest today’s announcement by the US National Institutes of Health that two trials assessing the impact of male circumcision on HIV risk are being stopped on the recommendation of the NIH Data Safety and Monitoring Board (DSMB).

The UN system in Uganda supports the Uganda government policy on prevention of HIV/AIDS including the use of the triple strategy of Abstinence; Faithfulness; and correct and consistent Condom usage (the so-called ABC strategy). The UN system position is that condoms are one of the effective prevention tools in reducing HIV infection rates in Uganda. The UN Theme Group on HIV/AIDS in Uganda has worked closely with other development partners in the last few months to ensure that Uganda’s long standing policy of condom promotion is supported.

Geneva, 3 February 2012—The World Health Organization (WHO) will later this month issue further guidance on the reported link between hormonal contraceptives such as the pill, injectables, implants and HIV.

On 31 January and 1 February, WHO convened a technical consultation WHO and Partners Stakeholders' Meeting on Hormonal Contraception and HIV Infection: A review of the evidence and implications for service delivery and priority research, made up of 53 experts from 20 countries to review the body of published evidence on the use of hormonal contraceptives and HIV acquisition, progression, and transmission. The review was prompted by new findings in 2011 that implied a possible increase in HIV infection among women at risk of HIV who use hormonal contraception, or increased transmission to an un-infected partner when a woman is living with HIV and using hormonal contraceptives.

The outcomes of this meeting will now be assessed by the WHO Guidelines Review Committee (GRC) –  the body that oversees the production of WHO public health guidelines for countries. The Committee will meet on 15 February and announce its recommendations the following day.  

However, WHO guidelines clearly state, and call on health service providers to remind their patients, that neither hormonal contraceptives nor intrauterine devices (IUDs) offer protection against HIV or other sexually transmitted infections (STIs). Condoms are the mainstay of dual protection against both unwanted pregnancy and STIs including HIV.

As outlined in WHO's recent guidance in 2009, based on the best evidence available at that time, The Medical Eligibility Criteria for Contraceptive Use, 4th Edition 2009 (MEC) says that women at high risk of HIV infection and those who are living with HIV can safely use hormonal methods.

All WHO information can be found at: www.who.int

More information on the WHO Department of Reproductive Health and Research can be found at: http://www.who.int/reproductivehealth/about_us/en/

GENEVA, 20 November 2010—UNAIDS welcomes the reported statement of Pope Benedict XVI calling for “a humane way of living sexuality” and that the use of condoms are justified "in the intention of reducing the risk of HIV infection".

“This is a significant and positive step forward taken by the Vatican today,” said UNAIDS Executive Director Michel Sidibé. “This move recognizes that responsible sexual behaviour and the use of condoms have important roles in HIV prevention.” 

UNAIDS has worked closely with the Vatican, in 2009 Mr Sidibé held far-reaching discussions with Archbishop Zygmunt Zimowski on HIV prevention issues including the prevention of mother-to-child transmission, protecting young people and reducing sexual violence against women and girls. “This will help accelerate the HIV prevention revolution, in promoting evidence-informed and human rights based approaches to achieve universal access goals towards HIV prevention, treatment, care and support,” said Mr Sidibé. “Together we can build a world with zero new HIV infections, zero discrimination and zero AIDS-related deaths.”

With more than 7000 new HIV infections each day, UNAIDS advocates the use of a combination HIV prevention approach that utilizes all proven methods for HIV prevention including use of male and female condoms, choosing to have sex later, having fewer multiple partners, male circumcision, reducing stigma and discrimination, and the removal of punitive laws. The male latex condom is the single, most efficient, available technology to reduce the sexual transmission of HIV and other sexually transmitted infections.