Clear evidence that people

Clear evidence that people can be convinced to use condoms, and that condoms can be
a successful public health strategy for HIV prevention, has been documented among
MSM and sex workers. In San Francisco, condoms were heavily promoted from the
beginning of the epidemic by public health officials and by leaders of the local gay
community 28. Incidence rates for all STIs fell substantially, and annual HIV incidence
rates fell from double digits in the early 1980s to less than 1% after 1985 29.
There have been similar increases in condom use among MSM in many places in
industrialized countries. However, this has not necessarily been true in developing
countries. Where condom use among MSM remains low, this has more often been
due to lack of effort than to failure of condom promotion campaigns. HIV prevention
programmes in many countries have not given MSM the prevention and care services
that they warrant. This may be because of outright discrimination and stigmatization or
because of a belief that MSM are hard to reach. Yet, concerted efforts targeted at MSM
have usually been successful in increasing condom use. In Salvador, Brazil, for example,
consistent condom use during anal sex increased from 81% to 97% in MSM following
Making condoms work for HIV prevention:
Cutting-edge perspectives
19
participation in safer-sex workshops30. Recent epidemiological and behavioural data
show a rise in unprotected sex among a small but significant proportion of MSM in
developed countries coinciding with widespread access to accessible antiretroviral
(ARV) treatment regimens 31. Findings in many industrialized countries that show lower
condom use among young MSM, combined with growing complacency among those
on ARV treatment, demonstrate the need to revitalize and sustain primary prevention
messages aimed at promoting protected sex for MSM in high-income countries.