AFRO-NETS> Condom Use Must Triple to Curb Spread of HIV/AIDS and other STI's

["Stephen M. Goldstein" <sgoldste@welch.jhu.edu>]

Condom Use Must Triple to Curb Spread of HIV/AIDS and other STI's
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Condom use around the world should triple to help stop the spread of 
HIV/AIDS and other sexually transmitted Infections (STIs), according to 
a new Johns Hopkins estimate. Condom use should rise from the current 6 
to 9 billion condoms a year to 24 billion. "Narrowing the gap between 
condom need and use is a major public health challenge," according to 
Hopkins researchers in a report from the Johns Hopkins School of Public 
Health.

As HIV/AIDS and other STIs spread, the need for condoms grows. World-
wide, at least 33 million people are living with HIV/AIDS and another 
14 million have died. An estimated 16,000 new HIV infections occur 
every day. Each year some 333 million new cases of other STIs occur in 
adults, according to the report 'Closing the Condom Gap', in the latest 
issue of Population Reports, published by the Johns Hopkins Population 
Information Program:
http://www.jhuccp.org/pr/h9edsum.stm

Many of these HIV/AIDS cases and other STIs could be prevented if peo-
ple used condoms correctly and consistently. As the report notes, 
"Laboratory tests show that no STI, including HIV, can penetrate an in-
tact latex condom."

So why don't more people use condoms? Some dislike them. Some, espe-
cially in developing countries, cannot afford them, or obtain them eas-
ily. Others believe, wrongly, that they face little or no risk of preg-
nancy or STIs. In addition, write authors Robert Gardner, Richard 
Blackburn, and Ushma Upadhyay, "Family planning programs usually focus 
on the contraceptive needs of married women, while much of the need for 
condoms is to prevent HIV/AIDS and other STIs among unmarried people, 
particularly youth." Hopkins researchers estimate that 71% of condom 
need is among sexually active unmarried men. The remaining need is for 
use by married men who have extramarital affairs and for use by married 
couples. 

Hopkins researchers call on programs to launch a co-ordinated effort to 
promote condoms and close the gap between need and use. Communication 
campaigns can help make condom use the social norm rather than risk-
taking. Counsellors and mass media entertainment can help people ad-
dress issues of trust, negotiation, and communication--essential for 
safe sexual relationships. Affordable condoms can be made accessible in 
hotels, bars, barber shops, and through vending machines. Programs can 
reach out to youth, unmarried men, and commercial sex workers. 

Many men and women report that they have changed their sexual behaviour 
in response to AIDS. The Population Reports issue cites data from Demo-
graphic and Health Surveys showing that both married and unmarried men 
and women are beginning to change their sexual practices. "Among mar-
ried people the most common reported change in sexual behaviour ...is 
to restrict sex to the person's spouse....Among married men, using con-
doms is the third or fourth most common response." In Zambia, for exam-
ple, 72% of married men surveyed said they had restricted sex to one 
partner and 13 percent said they began using condoms. "Among never -
married men and women...the most commonly reported change ...is to stop 
having sex or, if not yet sexually experienced, to delay sexual initia-
tion....Many...report that they started to use condoms." In Malawi 52% 
of respondents delayed first sex or stopped sex and 24% began using 
condoms.

But many men and women who are at risk still do not protect themselves 
and their partners. This is partly due to lack of knowledge. "In most 
countries everybody has heard of AIDS. Knowledge of condoms is also 
widespread. Yet many people who know about AIDS and about condoms do 
not know that using condoms can prevent AIDS," according to the report. 
For example, in Uganda in 1995, all never-married men surveyed had 
heard about AIDS, but only 40% knew that condoms could prevent AIDS. In 
Bangladesh 33% of married men had heard of AIDS, but only 18% knew that 
condoms could prevent AIDS. 

One group facing the most risk of AIDS and STIs is youth. Half of all 
people who become infected are between ages 10 and 25. "In the era of 
AIDS young people need guidance, encouragement, and access to condoms," 
according to the report. One US study cited in the report found that 
young people whose mothers had talked to them about condoms in the year 
before first intercourse were three times more likely to have used a 
condom at first intercourse. And those who used a condom at first in-
tercourse were 20 times more likely to use condoms regularly. The re-
port also cites studies which show that sex education and condom dis-
tribution do not lead to earlier sex, do not increase sexual activity, 
and may actually decrease the number of sexual partners. 

Condoms can be a very cost-effective STI prevention method, according 
to the Hopkins report. In the US each case of AIDS costs an estimated 
US$100,000 to $200,000 in lifetime expenditures for medical care. One 
estimate puts health care savings for using condoms at US $27 per con-
dom, increasing to US $530 per condom when condoms are used by men hav-
ing sex with male multiple partners. Total US health care costs for 
treating STIs including HIV/AIDS were nearly $17 billion in 1994. 

"Making condoms more accessible, lowering their cost, promoting them 
more, and helping to overcome social and personal obstacles to their 
use would save many lives and reduce the enormous consequences and 
costs of STIs and unintended pregnancies," according to the authors.

--
Population Reports is an international review journal of important is-
sues in population, family planning, and related health matters. It is 
published four times a year in four languages by the Population Infor-
mation Program at the Johns Hopkins Center for Communication Programs 
for more than 170,000 family planning and other health professionals 
world-wide, with support from the US Agency for International Develop-
ment (USAID). USAID administers the US foreign assistance program, pro-
viding economic and humanitarian assistance in more than 80 countries 
world-wide. 

For more information contact: 
Stephen Goldstein
Johns Hopkins Center for Communication Programs
111 Market Place, Suite 310, 
Baltimore, Maryland 21202, USA
Tel: +1-410-659-6300
Fax: +1-410-659-6266
mailto:PopRepts@jhuccp.org

A full-text version of 'Closing the Condom Gap' can be found at JHU / 
CCP's web site:
http://www.jhuccp.org

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