How can condom promotion programmes be more effective?

These studies demonstrate that lower age seems to be one of the strongest predictors
of condom use. At the same time, there remain a number of obstacles to ensuring that
young people use condoms. Myths, fears and misperceptions about condoms among
young people, combined with inaccessibility to supplies, severely weaken prevention
practices among 15–24-year-olds, yet this is the age group hit hardest by the epidemic
in many settings. Structural barriers such as gender norms and roles, social stigma,
and lack of access to youth friendly health services constitute additional major factors
undermining the capacity of young people to protect themselves from HIV infection.
Top-level commitment is needed to put in place policy and programmatic interventions
aimed at young people, which back up prevention education with access to prevention
tools।
How can condom promotion programmes be more
effective?
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.
The examples of Senegal and Thailand indicate that the introduction
of condom-promotion programmes early in the epidemic strengthens
HIV prevention. High rates of condom use among populations
at higher risk of HIV acquisition, before an epidemic spreads to
the general population, may account for successful control of the
epidemic. In countries where the HIV epidemic has spread to the
general population, high rates of consistent condom use among the
general population will be needed over an extended period of many
years before an effect on prevalence rates can be detected.
The available evidence clearly shows that a dramatic increase in
condom use can make, and over the past two decades has made, a
difference. This has occurred in a variety of geographic regions
and cultures and has far exceeded what many sceptics would have
believed possible even a few years ago. People can be and have been
convinced of the need to use condoms, supporting the argument that
for many people condoms represent an acceptable, viable strategy for
HIV control