An important area that has received

An important area that has received surprisingly little scientific attention is the
interaction between condom promotion and other strategies in reducing the
transmission of HIV. Examining condom promotion in isolation from other strategies
gives, at best, a narrow view of HIV prevention. The optimum role of condom promotion
in a comprehensive AIDS prevention programme depends on several factors including
local epidemiology, the populations being targeted and the sociocultural context.
Condom promotion and other prevention interventions have to be balanced so that they
work in synergy to achieve the greatest overall impact.
Synergies between multiple interventions
The use of combination approaches in HIV prevention is recognized as sound strategy.
Multiple interventions complement each other and compound the impact for curbing
the epidemic. For instance, reducing the average number of sexual partners that persons
have in a given population could cut the rate of transmission of HIV just as much as an
increase in the numbers of people consistently using condoms. If both these changes
were achieved simultaneously, the reduction in the rate of transmission would likely
be more than the additive effects of the two interventions on their own. The greater
the number of effective strategies employed, the greater the potential for achieving
maximum overall impact.
In settings where resources are constrained, decisions on the best possible mix of
interventions are usually made on the basis of cost-effectiveness. Interventions that
score highly are more likely to pull in financial support. Systematic monitoring and
evaluation of the effectiveness of interventions can provide useful information on
whether combined interventions are working in harmony toward desired prevention
objectives.
Programmes that promote use of the female condom have demonstrated that different
risk-reduction strategies can reinforce one another. The female condom provides women
with an additional option to protect themselves from both pregnancy and infection.
Female condom acceptability studies in Tanzania, Zimbabwe, Senegal, Costa Rica,
Indonesia, and Mexico show that women find the female condom empowering, as it
provides an opportunity for improving dialogue within couples on the issues that put
them at risk, such as sexual partners external to the relationship 3.