By Kevo Chiwa
Since 1980s efforts to curb HIV/AIDs has been employed throughout the world with notable positive responses being noted especially in the developed world. Measures such as absteinance, reduction of multi-partner relationship and use of condoms have been over time advocated for in the fight against HIV/AIDs.
There has been debate over the years on the effectiveness of condoms in prevention of HIV/AIDS with proposers highly recommending the use of the rubber while opposers arguing that the protective rubbers may not be a 100 per cent effective. These opposers believe the most reliable ways to avoid transmission of STDs are to abstain from sexual activity, or to be in a long-term mutually monogamous relationship with an uninfected partner.
On the other hand the proposers have been versatile in campaigning the use of Condom as a preventive measure against STDs. Spearheaded by the World Health Organisation, the proposers have endorsed condoms as an integral and essential part of comprehensive prevention and care programmes.
Condoms have played a decisive role in HIV prevention efforts in many countries. Condoms have helped to reduce HIV infection rates where AIDS has already taken hold and curtailed the broader spread of HIV in settings where the epidemic is still concentrated in specific populations. Condoms have also encouraged safer sexual behaviour more generally. Recent analysis of the AIDS epidemic in Uganda has confirmed that increased condom use, in conjunction with delay in age of first sexual intercourse and reduction of sexual partners, was an important factor in the decline of HIV prevalence in the 1990s. Thailand’s efforts to de-stigmatize condoms and its targeted condom promotion for sex workers and their clients dramatically reduced HIV infections in these populations and helped reduce the spread of the epidemic to the general population. A similar policy in Cambodia has helped stabilize national prevalence, while substantially decreasing prevalence among sex workers. In addition, Brazil’s early and vigorous condom promotion among the general population and vulnerable groups has successfully contributed to sustained control of the epidemic.
Condom effectiveness for STD and HIV prevention has been demonstrated by both laboratory and epidemiologic studies. Evidence of condom effectiveness is also based on theoretical and empirical data regarding the transmission of different STDs, the physical properties of condoms, and the anatomic coverage or protection provided by condoms.
Laboratory studies have shown that latex condoms provide an effective barrier against even the smallest STD pathogens.
Epidemiologic studies that compare rates of HIV infection between condom users and nonusers who have HIV-infected sex partners demonstrate that consistent condom use is highly effective in preventing transmission of HIV. Similarly, epidemiologic studies have shown that condom use reduces the risk of many other STDs. However, the exact magnitude of protection has been difficult to quantify because of numerous methodological challenges inherent in studying private behaviors that cannot be directly observed or measured.
Theoretical and empirical basis for protection: Condoms can be expected to provide different levels of protection for various STDs, depending on differences in how the diseases or infections are transmitted. Male condoms may not cover all infected areas or areas that could become infected. Thus, they are likely to provide greater protection against STDs that are transmitted only by genital fluids (STDs such as gonorrhea, chlamydia, trichomoniasis, and HIV infection) than against infections that are transmitted primarily by skin-to-skin contact, which may or may not infect areas covered by a condom (STDs such as genital herpes, human papillomavirus [HPV] infection, syphilis, and chancroid).
Conclusive evidence from extensive research among heterosexual couples in which one partner is infected with HIV shows that correct and consistent condom use significantly reduces the risk of HIV transmission from both men to women, and also from women to men. Laboratory studies show that male latex condoms are impermeable to infectious agents contained in genital secretions. To ensure safety and efficacy, condoms must be manufactured to the highest international standards.
However despite the above observations, it is logistically and ethically impossible to conduct randomized controlled trials to find out whether condom use reduces the risk of HIV transmission. Hence, we have to rely on observational studies, which inherently carry a risk of bias. In such studies, consistent use of condoms has been found to result in an 80% reduction in HIV incidence.
As a result of impressive effectiveness of the sex rubber, it has been highly recommended that condoms must be readily available universally, either free or at low cost, and promoted in ways that help overcome social and personal obstacles to their use. Condom use is more likely when people can access them at no cost or at greatly subsidized prices. Effective condom promotion targets not only the general population, but also people at higher risk of HIV exposure, especially women, young people, sex workers and their clients, injecting drug users and men who have sex with men.
REFERENCES
aids.about.com/od/safersexquestions/f/latex.htm
UNAIDS. 2004 Report on the global AIDS epidemic, page.72.
Holmes K, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bulletin of theWorld Health Organization. Geneva. June 2004.
WHO/UNAIDS. Information note on Effectiveness of Condoms in Preventing Sexually Transmitted Infections including HIV. Geneva. August 2001.
UNAIDS. 2004 Report on the global AIDS epidemic. Geneva. July 2004.
Singh S, Darroch J.E, Bankole A. A,B, and C in Uganda: The Roles of Abstinence, Mongamy and Condom Use in HIV
Gremy I, Beltzer N. HIV risk and condom use in the adult heterosexual population in France between 1992 and 2001
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