High rates of condom use have

High rates of condom use have been achieved, at least for casual sexual partnerships,
in some of the countries hardest hit by AIDS. This has not invariably led to a
demonstrable fall in the rate of HIV infection because of the timing of their introduction,
the target population and the level of coverage. For example, it is estimated that overall
provision of condoms in Africa in 1999 amounted to only 4.6 per man per year 42.
It is quite possible that HIV prevalence would have risen even faster in some countries
if condom use had not increased. But the current situation raises many questions, such
as the following:
• What level of condom use is necessary to control and roll back a generalized
heterosexual epidemic?
• In settings reporting high rates of condom use, are condoms being used
consistently and correctly enough to have the desired impact?
• At what point is condom use only with casual sexual partners no longer good
enough?
• How can high rates of condom use in steady sexual partnerships be achieved
when HIV prevalence in the general population is high?
These questions remind us that the number of condoms distributed is not the sole
indicator of success of an HIV prevention programme. In addition to measuring condom
uptake and condom use, we need to ask ourselves what exactly should be measured.
From an epidemiological point of view, rates of condom use are essential indicators in
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situations where exposure to HIV is more likely, such as sex between
new, nonsteady or casual partners. Most condom use studies tend to
focus on this indicator. However, condom use with regular partners is
also an important indicator of successful condom promotion and must
be included in monitoring and evaluation efforts.