Comprehensive Condom Use


  1. Definition of the Prevention Area

    Unprotected sex is the leading cause of HIV transmission, accounting for more than 80 percent of the total number of infections. Male and female condoms, when worn correctly, serve as an impermeable barrier to the sexual exchange of secretions that carry HIV and a number of other sexually transmitted infections (STIs), providing protection against transmission.

    In recent guidance on HIV prevention, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) recommends programming that combines multiple, evidence-based approaches to increase availability, accessibility, acceptability, and use of condoms in targeted groups and in the general population. Comprehensive condom programming remains an essential component of combination prevention programs.

  2. Epidemiological Justification for the Prevention Area

    Condoms, both male and female versions, are the most effective barrier method currently available to sexually active individuals who require protection from HIV and other STIs and from unwanted pregnancies. Male condoms reduce the risk of HIV by 80 percent or more when used correctly and consistently. Modeling studies indicate female condoms can provide the same level of protection against HIV infection, although evidence is limited.

    Consistent and correct use of male latex condoms is associated with lower rates of transmission among higher-risk groups, notably sex workers, men who have sex with men, and serodiscordant couples. In countries with concentrated epidemics (e.g., Thailand), programs promoting 100 percent condom use in the commercial sex industry have lowered overall prevalence levels. While the impact of condom use is unknown at the population level in mixed and generalized epidemics, condom programming remains an important aspect of the overall prevention portfolio.

  3. Core Programmatic Components

    Components of comprehensive condom programs are identified by the United Nations Population Fund as well as by PEPFAR in its recent guidance on prevention:

    • Create demand: Understanding the local environment and characteristics of specific client groups is necessary to target individuals at higher risk and the venues they frequent. Demand can be accelerated by promoting condoms along with treatment and prevention, particularly for serodiscordant couples and for dual protection.
    • Increase supply and availability: This is important for both male and female condoms in low and middle income countries. Managing the pipeline is critical to maintaining a constant supply of condoms. Advocacy for female condoms at both the international and national levels will increase demand, reduce production costs, and increase supply.
    • Ensure high quality and low cost: Making high quality male and female condoms available for free or at very low cost at key distribution points frequented by men and women (e.g., marketplaces, hair salons, and workplaces) can increase use.
    • Address acceptability: Confront prevailing cultural myths and inaccuracies using media campaigns and behavior change strategies—education and individual training—to target specific groups and communities, as well as larger audiences. Female condoms have unique advantages for women (greater control and dual protection) and men (increased sexual pleasure). Programs can capitalize on these features.
    • Conduct monitoring and evaluation.
  4. Current Status of Implementation Experience

    Meta-analyses and well-designed evaluations have shown that when coupled with education and counseling, condom promotion programs can be effective in increasing male condom use among youth and among such marginalized groups as sex workers, men who have sex with men, and serodiscordant couples. Successful condom programs employ multiple strategies, such as ensuring high coverage in accessible venues, training people on how to use condoms, building negotiation skills and self-efficacy, and working within social networks.

    Condom programs have been implemented using mass media campaigns, community-level initiatives, and interpersonal outreach. They have also targeted people in the general population who engage in higher-risk sex (e.g., multiple partners, concurrent partners, commercial sex) in high-prevalence settings. Although these initiatives have shown success, male condom use between longstanding sexual partners, such as married couples, does not persist over time.

    Demand for condoms exceeds availability; only a quarter of the total number of male condoms needed is available. Female condoms are even less available, due primarily to high cost and policymaker bias. Greater international funding and support for both male and female condoms must be increased to reduce the current gap and meet future needs.

UPDATED 05/2015

What We Know

Condom Effectiveness in Reducing Heterosexual HIV Transmission

Weller, S. C., & Davis-Beaty, K. The Cochrane Library (2009). doi: 10.1002/14651858.CD003255.

This study reviewed data from 14 longitudinal studies of sexually active serodiscordant heterosexual couples. In 13 of the studies, all the participants used condoms at 100 percent of sexual encounters, while the cohort in one study comprised those who never used condoms. Overall, the studies showed that consistent condom use for all acts of penetrative vaginal intercourse was associated with an 80 percent reduction in HIV seroconversion. The authors noted a lack of detail in the studies (e.g., on correct use), and there were inconsistencies in terminology about condom use across the different studies. The review also found limited information on disease-free exposure time. The results suggested that condom use is less effective for HIV prevention than it is for pregnancy prevention. Recommendations for future studies included improving the way that condom use is coded to give more detailed information.

Efficacy of Structural-Level Condom Distribution Interventions: A Meta-Analysis of U.S. and International Studies, 1998−2007

Charania, M. R., Crepaz, N., Guenther-Gray, C., et al. AIDS and Behavior (2011), 15: 1283-1297. doi: 10.1007/s10461-010-9812-y.

This meta-analysis concludes that structural-level condom distribution interventions are effective in preventing both HIV and sexually transmitted infections. Structural interventions improve the availability, acceptability, and accessibility of male condoms. The analysis shows that structural-level interventions are particularly effective in achieving increased condom acquisition, carrying, and use; abstinence or delayed sexual debut in young people; and reduced incidence of sexually transmitted infections. Limitations of the meta-analysis include extreme heterogeneity in the studies, exclusion of some important studies for methodological reasons, and a cut-off point of September 2007, after which other relevant studies were published.

Quick Reference Guide to Family Planning Research

Family Health International (2010).

This synthesis with links to abstracts places research on condoms, both male and female, in the wider context of integrating family planning and HIV prevention services. Links to research papers and other documents demonstrate that the correct and consistent use of latex male condoms reduces the risk of HIV transmission by an estimated 80 to 90 percent. Other studies show that interventions targeted at both long-standing and serodiscordant couples significantly improve self-reported condom use rates; concentrated counseling can increase acceptability of condoms; and condom use has increased in high-risk groups, especially if condoms are widely available where risky sex takes place.

Changes in HIV-Related Knowledge and Behaviors in Sub-Saharan Africa

Mishra, V., Agrawal, P., Alva, S., et al. DHS Comparative Reports. No. 24 (2009).

Condom use is included among a range of HIV-related indicators in this report on 23 countries in sub-Saharan Africa. The report illustrates great variation in use, but in all countries, more men than women reported ever using a condom and using one in the previous 12 months. Similarly, condom use during high-risk sex varied widely across sub-Saharan Africa, while condom use at first intercourse among those aged 15 to 24 varied but was low overall. Detailed tables present country-level data with figures for two time points where available.

Performance and Safety of the Second-Generation Female Condom (FC2®) Versus the Woman’s, the VA Worn-of- Women®, and the Cupid® Female Condoms: A Randomized Controlled Non-Inferiority Crossover Trial

Beksinska, M., Piaggio, G., Smit, J., et al. The Lancet Global Health (September 2013), 1 (3). doi: 10.1016/S2214-109X(13)70054-8.

This randomized, controlled, study assessed the functional performance and safety of three new condom types— the Woman’s Condom®, the VA worn-of women condom Feminine® (w.o.w.), and the Cupid® female condom—against existing second-generation female condom (FC2)®. A total of 600 sexually active, monogamous women, aged 18–45 years and not engaged in sex work participated in the study, which took place at three sites in Shanghai, China and one site in Durban, South Africa. The researchers assessed the four condom types through women's reports of clinical failure and total female condom failure. There was no difference between the new condoms and FC2 modes. Findings were similar between Chinese and South African study participants, which reinforced the study's validity. The authors concluded that the availability of new, effective, and safe female condoms will provide donors and users with more options at different costs.

Condom Effectiveness for HIV Prevention by Consistency of Use among Men Who Have Sex with Men in the United States

Smith, D. K., Herbst, J. H., Zhang, H., and Bose, C. E. Journal of Acquired Immune Deficiency Syndromes (March 2015), 68 (3): 337–344.

This study assessed the effectiveness of condom in reducing HIV incidence among 3,490 men who have sex with men (MSM) enrolled in two large prospective HIV prevention trials in the U.S. between 1998 and 2001. The authors estimated the effectiveness of condom use for men during anal sex with an HIV-positive man by comparing self-reported “always use” to "never use” of condoms. The analysis found no significant differences in condom effectiveness between receptive and insertive anal sex; effectiveness was 72.3 percent for receptive anal sex, 62.9 percent for insertive anal sex, and 70.5 percent for any receptive or insertive anal sex. However, the effectiveness for consistent condom use during anal sex with HIV-positive male partners was 70 percent, which is less than the estimated 80 percent effectiveness for consistent condom use among heterosexual serodiscordant couples. Therefore it is more appropriate to use the MSM-specific estimate of 70 percent effectiveness for condoms in discussions and models of HIV acquisition among MSM who report anal sex with HIV-positive male partners. The study also found minimal effectiveness with inconsistent condom use among MSM. These study findings, the authors said, could contribute to a better understanding of the persistent rates of HIV infections among MSM in the U.S.

Comprehensive HIV Prevention: Condoms and Contraceptives Count

Haddock, S., Hardee, K., Gay, J., et al. (2008).

This report stresses the importance of male and female condoms and other forms of contraception in HIV prevention; and advocates scaled-up access and integration of condom promotion into wider prevention strategies. However, the report finds that cultural and policy barriers continue to impede expanded access to condoms, and that wide regional variations in condom use persist. One section is dedicated to how programs address barriers to use, and approaches for improving rates of condom use among young people, those in long-term partnerships, serodiscordant couples, sex workers, and other socially marginalized groups. The section highlights specific challenges, such as gender-based violence as an obstacle to condom use; and describes the experience of 100 percent condom use programs.

Effectiveness of Interventions for the Prevention of HIV and Other Sexually Transmitted Infections in Female Sex Workers in Resource Poor Setting: A Systematic Review

Shahmanesh, M., Patel, V., Mabey, D., et al. Tropical Medicine & International Health (2008), 13 (5): 659−679. doi: 10.1111/j.1365-3156.2008.02040.x.

This systematic review of 28 interventions targeting female sex workers presents findings in four categories: structural interventions, behavioral interventions incorporating condom promotion, provision of vaginal microbicide, and treatment for sexually transmitted infection. The evidence supports condom promotion as an HIV risk reduction strategy when combined with other sexual risk reduction approaches and better access to treatment for sexually transmitted infections.

A Systematic Review of Published Evidence on Intervention Impact on Condom Use in Sub-Saharan Africa and Asia

Foss, A. M., Hossain, M., Vickerman, P. T., et al. Sexually Transmitted Infections (2007), 83 (7): 510-516. doi:10.1136/sti.2007.027144.

Condom promotion interventions targeted at sex workers and their clients can result in significant increases in condom use, according to this systematic review of 62 studies in sub-Saharan Africa and Asia. The evidence supporting such interventions with long-term partners who are not serodiscordant, and also with young people, is far weaker, the review found. The findings were consistent across different countries. Relying on self-reported condom use leaves studies open to reporting bias; biological outcomes would be optimal, the authors noted. They suggested that standardized measures of condom use would facilitate future synthesis of condom promotion intervention evaluations.

A Review of Female-Condom Effectiveness: Patterns of Use and Impact on Protected Sex Acts and STI Incidence

Vijayakumar, G., Mabude, Z., Smit, J., et al. International Journal of STD and AIDS (2006), 17 (10): 652−659. doi: 10.1258/095646206780071036.

This systematic review of 137 articles on the female condom, including accounts of five randomized controlled trials, looked at the impact of female condoms on risk reduction and incidence of sexually transmitted infections (STIs). Two of the five randomized controlled trials indicated notable decreases in STI incidence, and all five showed increases in the number of protected sex acts. Data from multiple studies showed that female condoms are used by women who are not as likely to use other dual protection methods. Of the studies reviewed, almost half looked at acceptability, while other studies focused on cost-effectiveness, facilitators and barriers to use, negotiation, and promotion. The authors suggested that future research should move away from the focus on acceptability and toward examination of the female condom's effectiveness and impact on diverse settings, and of the view that female condoms empower women to negotiate safer sex.

Condom Promotion For AIDS Prevention in the Developing World: Is It Working?

Hearst, N., and Chen, S. Studies in Family Planning (2004), 35 (1): 39−47. doi: 10.1111/j.1728-4465.2004.00004.x.

Thailand’s "100% Condom Program," which mandates enforced condom use in brothels, stands out as a significant success story in two decades of HIV prevention via condom promotion. The authors of this review found that condom promotion among men who have sex with men and among sex workers and their clients can be successful, but there is less evidence in support of promotion to the general public. Their conclusion was that condom promotion strategies should be examined in conjunction with other interventions, such as partner reduction, because of the potential for interaction, and interventions should truthfully represent the less than total efficacy of condoms in prevention of HIV transmission.

Putting it Into Practice

Social Network-Based Interventions to Promote Condom Use: A Systematic Review

Wang, K., Brown, K., Shen, S. Y., et al. AIDS and Behavior (2011), 15 (7): 1298−1308. doi: 10.1007/s10461-011-0020-1.

This review compiled evidence from 11 studies on social network-based condom promotion interventions. All of the studies used social networks as defined by the study participants themselves, and 10 studies measured significant improvements in condom use. Only three of the studies (among drug users in Thailand, Roma men in Bulgaria, and high-risk women in Baltimore, Maryland, in the United States) had biological outcomes, and the primary outcome of condom use varied greatly by timeframe. Eight of the nine studies with controls showed a substantial improvement in at least one condom measure among intervention groups versus controls. The authors concluded that social network-based HIV prevention interventions can increase condom use and reduce other HIV risk behaviors.

Effectiveness of HIV Prevention for Youth in Sub-Saharan Africa: Systematic Review and Meta-Analysis of Randomized and Nonrandomized Trials

Michielsen, K., Chersich, M. F., Luchters, S., et al. AIDS (2010), 24 (8): 1193−1202.

This systematic review and meta-analysis assessed 28 interventions for reported condom use and condom use intentions. It revealed that sexual encounters, whether risky or not, did not increase after sex education and condom promotion. However, only condom use by males at last sex increased, and the interventions did not result in positive changes to sexual behavior. The design of many studies was suboptimal, and the heterogeneity of studies suggests a lack of consensus on the most appropriate interventions and research into their efficacy.

School Based Sex Education and HIV Prevention in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis

Fonner, V., Armstrong, K., Kennedy, C., et al. PLOS ONE (March 2014), doi: 10.1371/journal.pone.0089692, eCollection 2014.

This meta-analysis examined the efficacy of school-based sex education interventions on changing HIV-related knowledge and risk behaviors in low- and middle-income countries. The analysis included 64 studies on interventions that focused exclusively on abstinence or emphasized abstinence (n = 9), or provided comprehensive sex education (n = 55). Students who had been exposed to a sex education intervention were more knowledgeable than non-exposed youth about HIV and related topics; and interventions led by health professionals appeared to produce more knowledgeable students than those led by teachers, peers, or a mix of instructors. Students who received the school-based sex education exhibited significantly more condom use and self-efficacy in refusing sex or using a condom during sex. Studies (n = 3) that included training for health care workers on providing youth-friendly sexual and reproductive health information showed a significant difference in condom use between intervention and control groups. Students receiving interventions were significantly less likely to report more partners and early sexual debut compared to control or comparison groups. The outcome data of interest (on sexual debut and consistent condom use) were very limited in abstention programs (n = 2). The review showed that school-based sex education is an effective intervention for increasing knowledge about HIV and decreasing sexual risk behaviors among participants.

Structural and Community-Level Intervention for Increasing Condom Use to Prevent the Transmission of HIV and Other Sexually Transmitted Infections

Moreno, R., Nabahan, H. Y., Ota, E., et al. Cochrane Database of Systematic Reviews (July 2014), doi: 10.1002/14651858.CD003363.pub3.

This comprehensive review selected randomized clinical trials (RCTs) to assess whether structural interventions to promote condom use at the community level reduced the incidence or prevalence of HIV and other sexually transmitted infections (STIs), based on laboratory assessments and secondary outcomes such as knowledge, self-efficacy, and sexual behaviors. The authors examined nine RCTs involving 75,891 participants among general, rather than high-risk, populations. The interventions included such activities as increasing condom acceptability through sexual education and social marketing; increasing accessibility by providing free condoms; and implementation of micro-finance. The meta-analysis demonstrated that the interventions had no significant effect in reducing the incidence or prevalence of HIV or that of herpes simplex virus 2, syphilis, gonorrhea, chlamydia, or trichomonas. However, the analysis did show significant changes in knowledge about HIV and STIs in favor of the interventions, though not for consistent condom use and self-efficacy. The authors thus failed to find clear evidence that condom promotion implemented at community and structural levels led to reduced transmission of HIV or other STIs among the general population.

Reduction in STIs in an Empowerment Intervention Programme For Female Sex Workers in Bangalore, India: The Pragati Programme

Souverein, D., Euser, S. M., Ramaiah, R., et al. Global Health Action (December 2013), doi: 10.3402/gha.v6i0.22943.

The Pragati program in Bangalore, India uses empowerment and capacity building to reduce transmission of HIV and other sexually transmitted infections (STIs) among female sex workers (FSWs), and to improve their well-being. Program components include a crisis response team, a microfinance system, a de-addiction program, condom use promotion, STI prevention and detection, and provision of safe spaces. From April 2005 to July 2008, 17,092 FSWs joined the Pragati program. The contact rate (total number of contacts by FSWs within the program, divided by the sum of per person-year follow-ups) in the first year of follow-up was 9.49 percent, and greatly increased over time. Also, the proportion of FSWs without STIs increased from 63 percent in follow-up year 1 to 96 percent in year 4. The STI incidence rate decreased significantly during the study period: 0.69 percent in year 1, 0.43 percent in year 2, 0.47 percent in year 3 and 0.63 percent in year 4. The proportion of FSWs reporting condom use at last paid sex increased from 77.6 percent in year 1, to 85.5 percent in year 3, and to 100 percent in the last year of follow-up. The authors concluded that exposure to the Pragati program led to significant increase in condom use and decreases in STIs incidence among participating FSWs.

The Female Condom Learning Curve: Patterns of Female Condom Failure Over 20 Uses

Beksinska, M., Smit, J., Greener, R., et al. Contraception (January 2015), doi: 10.1016/j.contraception.2014.09.011.

This paper assessed the proportion of total and individual failure modes across four female condoms (the FC2® female condom, the Woman’s Condom, the VA worn-of-women (w.o.w.®) Condom Feminine female condom, and the Cupid® female condom) used successively by 272 women attending a reproductive health clinic in Durban, South Africa. All participants had previously used male condoms, and 14 percent had experience with female condoms. The total female condom (FC) failure (defined as occurence of non-clinical breakage, clinical breakage, or slippage of FCs, or misdirection, invagination, or any additional failure modes) for all condoms was similar (between 3.86 percent and 4.72 percent) except for Cupid®, which was greater (5.4 percent). Individual failures modes (defined as clinical breakage, non-clinical breakage, slippage, misdirection, or invagination) were comparable. The total incidence of clinical failure (defined as breakage during sexual intercourse or during withdrawal of the FC from the vagina) decreased over successive uses. The authors suggested that learning to use one type of FC reduces failures in subsequent use of FCs of a different design. Overall, the study found that the decrease in female condom failure rates was greater in the early stages of use regardless of condom type, suggesting a short learning curve and the need to thoroughly train women on correct use of female condoms.

Risk Reduction among HIV-Seroconcordant and -Discordant Couples: The Zambia NOW2 Intervention

Jones, D., Kashy, D., Chitalu, N., et al. AIDS Patient Care and STDS (August 2014), doi: 10.1089/apc.2014.0039.

This study investigated whether an HIV risk reduction intervention would increase the acceptability of sexual barrier methods and decrease risk behavior when delivered to 216 couples, either individually or in same-sex groups. It also explored the relationship between product availability, intimate partner violence, partner communication, and sexual barrier use. The individual-based strategy, delivered to both partners together during health education sessions, entailed HIV risk reduction information and counseling and information on using sexual barrier methods. Group strategies included establishing a safe environment for sharing personal experiences, roleplaying, problem solving and communication skills, and hands-on training with condoms. All participants received hands-on training in condom use and a week’s supply of male and female condoms at the end of each session. They were also encouraged to practice HIV-risk reduction strategies and share their HIV status and information with their partners. Participants' acceptance of barrier methods and use of these methods increased in both groups over a 12-month follow-up period. Gender influenced changes in the acceptability of specific methods: the acceptability of male condoms increased most among men, while the acceptability of gels increased most among women. Reports of intimate partner violence predicted less male condom use. This study illustrated the way in which couple communication and mutual influence between partners affect the use of sexual barrier methods among couples in sub-Saharan Africa.

Smarter Programming of the Female Condom: Increasing Its Impact on HIV Prevention in the Developing World

Marseille, E., & Kahn, J. FSG Social Impact Advisors (2008).

This study looked at the relative effectiveness of female condoms as a HIV prevention strategy within the range of HIV prevention options. The study included a comparative review of 14 female condom programs across 10 countries in the developing world, well a wider literature review, interviews with stakeholders, and a cost-effectiveness analysis. This report found that female condoms are significantly less cost-effective than male condoms. For sex workers, female condoms are not cost-effective because substitution rates (of female condoms for male condoms) are very high in this group, so that only a small portion of female condoms provides additional protection; for women with regular sexual partners, they are not cost- effective because of the high cost relative to male condoms, the study found. However, the authors noted that cost-effectiveness is not the sole criterion for programmatic decisions to fund female condoms; for example, they are useful for protecting women whose male sexual partners cannot or will not use a male condom. Also, the benefits to women’s empowerment are implied by female condom programming, but difficult to quantify.

Condoms and Condiments: Compatibility and Safety of Personal Lubricants and Their Use in Africa

Geibel, S. Journal of the International AIDS Society (July 2013), doi: 10.7448/IAS.16.1.18531.

This article reviewed the evidence of the compatibility, safety, and use of lubricant with latex condoms in sub-Saharan Africa. Research on lubricant-condom compatibility and human safety is limited. Because of the high cost and low accessibility of water-based lubricants in many African settings, oil-based lubricants or household products (including Vaseline or petroleum jelly, baby oil, lotions, and cooking oil) are being used during sexual intercourse. These are known to be damaging to latex condom. Current World Health Organization recommendations advise avoiding oil-based lubricants as well as products that can cause epithelial and mucosal damage and or irritation associated with their use. Given the paucity of evidence on the compatibility of condoms and lubricants, there is a need for more research on safety and procurement criteria for some water- and silicon- based lubricants, as well as epidemiologic surveys to assess lubricant use and accessibility in Africa.

Evaluation of the 100% Condom Program in Thailand

Joint United Nations Programme on HIV/AIDS (2000).

This report describes in detail Thailand’s 100% Condom Program and evaluates its success in significantly increasing consistent condom use in commercial sex settings, which in turn dramatically reduced the rates of sexually transmitted infections in Thailand. Factors affecting the success of the program include the wide implementation of all components of the program; the degree of collaboration among stakeholders; and the program's flexibility, which accommodated various types of commercial sex establishments and their diverse needs. Improving condom access in indirect sites for commercial sex would increase the accomplishments of this program; surveillance had found the number of such sites increasing in 2000 when Thailand’s program was evaluated.

Tools and Curricula

Comprehensive Condom Programming: A Guide for Resource Mobilization and Country Programming

United Nations Population Fund. (2010).

This 16-page report states the rationale for condom promotion, arguing that condoms are central to HIV prevention because they are both cost-effective and effective in reducing HIV transmission. The study outlines a step-by-step strategic approach to developing a condom program, starting with establishing a national condom team, conducting a situation analysis, and developing a comprehensive national condom strategy. This is followed by guidance on developing budget and operational plans linked to national commodity security plans, resources mobilization, capacity strengthening, and demand creation. The final steps are strengthening advocacy and media engagement, along with monitoring and evaluation.

Lot Quality Assurance Sampling for Monitoring Coverage and Quality of a Targeted Condom Social Marketing Programme in Traditional and Non-Traditional Outlets in India

Piot, B., Mukherjee, A., Navin, D., et al. Sexually Transmitted Infections (2010), 86 (S1): i56−i61. doi:10.1136/sti.2009.038356.

A large-scale social marketing campaign under the Bill & Melinda Gates Foundation, the Avahan initiative resulted in wider availability of condoms in areas with a concentration of female sex workers. The improved coverage largely due to the increase in the network of non-traditional sales outlets, such as bars, fuel stations, grocery stores, and restaurants. These areas were monitored to ascertain the availability and quality of condoms using lot quality sampling. The authors recommended lot quality sampling for routine monitoring of geographic coverage because it is easy to collect data, sample sizes are small, and the data can be analyzed using simple methods.

HIV Prevention, Treatment, Care and Support for Adolescents and Youth

Guidance Note, Joint United Nations Programme on HIV/AIDS (2014).

This guidance document provides an up-to-date overview of effective approaches for addressing HIV in adolescents and youth as a priority population globally. The document describes the HIV epidemic among young people and lays out the key elements (Improved linkage to proven and effective HIV prevention services; Improved access to and demand for HIV testing and counseling, treatment and care; Improved management of care and the transition of adolescents from pediatric to adult care particularly addressing adherence, disclosure and retention; Development and empowerment of adolescents and youth through improved access to quality health care, protection, education and skills development including gender sensitive comprehensive sexuality education) for achieving better HIV programming results in this population. It also covers young subpopulations of particular importance; describes the data needed to design programs; suggests programmatic response and financial needs; and outlines legal and regulatory considerations that might hinder effective HIV responses. The guidance also describes programmatic challenges and identifies areas of HIV prevention, treatment, care, and support that need to be analyzed and adapted to derive optimal impacts from HIV investments in adolescents and youth.

Public Health Procurement Guide and Product Catalog 2010

U.S. Agency for International Development | DELIVER PROJECT (2009).

This document is published annually by the USAID | DELIVER PROJECT and spells out the ordering procedures for use by missions to procure male and female condoms as well as other contraceptive supplies. It includes logistics forecasts to individual countries to aid calculation of delivery lead times, guidelines on the disposal of expired contraceptive products, and a product catalog and price list.

Priority Interventions: HIV/AIDS Prevention, Treatment and Care in the Health Sector

World Health Organization. (2009).

This report is aimed at a broad readership including donors, public health officials, national HIV program managers, health care workers, and other stakeholders. It describes priority interventions for HIV prevention, treatment, and care. There are also policy and technical recommendations and guidance on setting HIV program priorities. Recommendations on prevention of sexual transmission of HIV include condom promotion for the general population as well as at-risk groups such as serodiscordant couples and sex workers. There is also a list of over 230 useful resources.

The Logistics Handbook: A Practical Guide for the Supply Chain Management of Health Commodities

U.S. Agency for International Development/ DELIVER PROJECT (2011).

This handbook was developed to guide anyone who manages health commodities or is responsible for assessing or strengthening the functionality of elements, or the entirety, of a logistics system. It covers a wide range of logistics principles and practices for managing a variety of health commodities, including essential drugs, antiretroviral drugs, vaccines, contraceptives, antimalarial drugs, and diagnostic tests. The handbook describes each function of the logistics cycle, and also discusses assessment of stock status, inventory control, and system design and monitoring.

Condom Programming for HIV Prevention: An Operations Manual for Programme Managers

United Nations Population Fund, World Health Organization, and PATH. (2005).

This manual lays out a seven-step process for launching a new condom program or improving an existing. It includes detailed chapters on understanding condom users and the program environment; creating an action plan; ensuring a pipeline of high-quality condoms; expanding distribution, condom promotion at distribution points, promoting condoms in the community and at district and national levels; and program monitoring and evaluation. The manual provides a checklist of key actions, examples from the field, and useful worksheets and contacts. There are also fact sheets on male and female condoms, their dual role as protection against HIV and pregnancy, and gender and condom programming.

Making Condoms Work for HIV Prevention: Cutting Edge Perspectives

Joint United Nations Programme on HIV/AIDS. (2004).

This report provides guidance on how to ensure optimal use of condoms as part of a comprehensive HIV prevention strategy. Steps include ensuring sufficient condom supplies, promoting their use within at-risk groups and the general population, clearly communicating their effectiveness, and addressing misconceptions. The report spells out the common features of condom promotion success stories, and explains how to make condom campaigns more effective. It gives useful but succinct information on the evidence base supporting condom promotion. Attention is given to recognizing and capitalizing on the interactions between different elements of condom promotion, such as social marketing and condom education.

Additional Resources

Condoms for HIV Prevention

World Health Organization. (2011).

The World Health Organization’s webpage on HIV and condoms provides links to general information as well as technical documents, scientific evidence, and data. The page recommends readings on a range of topics, such as condom effectiveness and common myths and misperceptions associated with condom use, as well as a report on a 100 percent condom use program in China. A podcast on condoms for HIV prevention and links to condom-related information on the websites of related UN organizations are also accessible via the site.

HIV Prevention Gains Momentum: Successes in Female Condom Programming

United Nations Population Fund. (2011).

This report profiles specific country examples of successful female condom promotion programs. It includes seven country profiles covering awareness-raising and behavior change to increase demand for female condoms, such as social marketing in hair salons and barbershops in Zimbabwe, and assertiveness training for women in Malawi. The document cites programs in the Caribbean and Nigeria as examples of successfully integrating female condom promotion into existing programs; examples for the Caribbean, Malawi, and Nigeria explore supply logistics and quality assurance. Four case studies from sub-Saharan countries also cover approaches for strengthening government capacity.

Condoms and STDs: Fact Sheet for Public Health Personnel

U.S. Centers for Disease Control and Prevention (2011).

This three-page fact sheet explains how male condoms must be used correctly and consistently to reduce transmission of sexually transmitted infections, making a distinction between the degree of protection against diseases transmitted by genital secretions and genital ulcer diseases. It explains that male condoms offer a very high degree of protection from HIV, gonorrhea, chlamydia, and trichomoniasis; and reduced risk for transmission of genital ulcer diseases such as genital herpes, syphilis, chancroid, and human papillomavirus-related infections, i.e., genital warts and cervical cancer. For both categories of sexually transmitted infections, there are plain-language summaries of the theoretical basis for protection and the findings of laboratory and epidemiologic studies.

Compendium of Evidence-Based HIV Prevention Interventions

U.S. Centers for Disease Control and Prevention. (2011).

The risk-reduction chapter of this compendium includes evidence-based interventions for HIV risk reduction. Among the best individual- and group-level interventions are those promoting condom use. The database can be searched according to different characteristics such as risk category, race, and gender of participants. Condom use interventions with the most successful outcomes are those that provide education/training in condom use and are delivered to individuals or small groups using a social-cognitive theoretical approach.

Male Latex Condom: Specification, Prequalification and Guidelines for Procurement

World Health Organization, United Nations Population Fund, and Family Health International, 2010 (revised April 2013).

The document describes procedures for the procurement and distribution of high-quality natural latex male condoms. It is intended for a wide range of users, including policymakers, program and logistics officers, and other professionals responsible for procuring, supplying, and promoting condoms. Its comprehensive guidance, which covers quality assessment, international standards for condoms, and pre-qualification and procurement of male condoms, will also be helpful for programs focused on family planning and prevention of HIV and sexually transmitted infections, bulk procurement agencies, testing laboratories, and national social marketing programs.

UNAIDS Report on the Global AIDS Epidemic 2013

Joint United Nations Programme on HIV/AIDS (2013).

The 2013 UNAIDS report summarizes progress towards the targets and commitments established in the 2011 United Nations Political Declaration to support achievement of Millennium Development Goal 6—halting and beginning to reverse the global HIV epidemic. Using epidemiological estimates, reports from the country-level Global AIDS Response Progress Reporting tool, and national midterm reviews, the report assesses progress towards the 10 targets for 2015; identifies persistent challenges; and postulates new directions. The document is organized according to the 10 targets and includes appendices reporting on HIV and AIDS indicators by region and country.

The Development Experience Clearinghouse

U.S. Agency for International Development (2006).

The Development Experience Clearinghouse of the U.S. Agency for International Development (USAID) is a searchable repository of documents from USAID-funded projects worldwide.

FC2 Female Condom

FC2 Female Condom. (2009).

This website provides detailed information on the FC2 second-generation female condom, which combines the same safety and efficacy of the first-generation female condom with lower cost. There is information on where to obtain female condoms from both the public sector and on the retail market in the United States. There are step-by-step instructions on how to use the female condom, also available in Spanish. Health professionals can find resources and training materials, and there are pages for quick facts, frequently asked questions, and FC2 in the news. There is also a link to a 55-page bibliography of research on the female condom.