Plug the supply and resource gaps.

Plug the supply and resource gaps. It is critical that a regular supply of condoms be
guaranteed by national programmes and supported by the donor and non-governmental
organization communities. Male and female condoms should be available to everyone who
needs them, whenever and wherever they want them. Condom education and promotion
must be accompanied by a stable and affordable supply of condoms. Coordinated and
collective actions at global and national levels (between donors, national governments
and the private sector) are required to improve commodity purchasing and distribution.
Improve impact measurement. Condom-promotion programmes need to have
programme effectiveness measured, regardless of the group being targeted. Other than
Senegal, Thailand, Uganda and, possibly, Cambodia, there are still too few examples
of low- and middle-income countries that have successfully halted and begun reversing
their epidemics. Trends in the parameters of condom use in countries (e.g., distribution
numbers, consistent condom use with casual and regular partners) should be vigilantly
monitored and the effects on HIV transmission assessed. For example, there are
encouraging findings from a study among 18–24-year-old young men in a South African
township that showed significant impact at the general population level of consistent
condom use on HIV, herpes simplex-2, and genital ulceration. Young men who used
condoms consistently were two to three times less likely to be infected with HIV and to
have genital ulceration 46.
Behavioural information on the proportion of people in different populations in a country
who consistently use condoms with various types of partners is a key to tracking the
effects of condom programming on HIV incidence, although methodological challenges
remain. Condom promotion aimed at the general population should ideally include
measurement of trends in the numbers of sexual partners (especially casual partners and
among the young). Research should focus on establishing the level of condom use that
is required to make a difference in incidence and prevalence rates in different epidemic
situations.
Whatever the challenges to ensuring condom access, availability and correct and
consistent use, the promotion of condoms is a strategy that must be used to the best
advantage. There are so few effective tools to prevent HIV transmission that there is
no leeway to forego any of them—least of all the one that, arguably, provides the best
chance of success.