spotlight on prevention
reinvigorating Condoms as an hiv prevention tool
Understanding the underlying reasons or risk-takingbetter, and designing interventions based on thatunderstanding, becomes even more important with the U.S. Food and Drug Administration’s recentapproval o pre-exposure prophylaxis (U.S. Food andDrug Administration 2012). Messages may need toaddress several types o barriers—such as a risk-basedcalculation that condom use is not as necessary, or arousal-based barriers to condom use.
It is essential to consider, and address where possible,structural actors that may contribute to increased risk- taking. These barriers—including stigma, criminalization,and other legislative and social barriers—can impedecondom use in important ways. For example, even though we know that unprotected receptive anal sex is the most ecient route or transmitting HIV, condompromotion among MSM and transgendered peopleis patchy or absent in a number o countries (Ayalan.d.; Baggaley, White, and Boily 2010). A recent reportshows that limited or absent condom promotionresults rom criminalization o same-sex behaviors,homophobia, and discrimination against this vulnerablepopulation (Beyrer 2010; Global Commission onHIV and The Law 2012). When condoms, lubricants,and educational materials promoting condom useare used as evidence o crime, it becomes dicult toreach MSM—and other at-risk populations such assex workers—with these much-needed interventions.Sadly, such criminalization continues despite growingevidence that robust coverage o HIV interventions or MSM has positive epidemiologic eects and is cost-eective (Beyrer et al. 2011).
Dual Protection and Dual Use
Another prevention option that needs to be better understood is the use o condoms or dual protection(against STIs and pregnancy), as well as dual useo condoms plus one other modern contraceptivemethod to prevent unintended pregnancy and HIV transmission or re-inection (Pazol, Kramer, andHogue 2010; Prata, Sreenivas, and Bellows 2008).There is no globally accepted indicator or measuringuse o dual protection, and Demographic and HealthSurveys only report on the primary amily planningmethod used. These are missed opportunities tounderstand the impact o amily planning and HIVintegration programs—with potential negative impactson reduction o both heterosexual and vertical transmission (Wilcher and Cates n.d.).These and other challenges demand resh thinkingabout how to address impediments to equitable access,as well as rigorous evaluation o which elements o condom programming work—and, equally importantly,don’t work—in both concentrated and generalizedepidemics (Hearst and Chen 2004).
The Suppy Side: Wh Prcures andDistributes Cndms?
Next, we discuss who buys and distributes condomsor HIV prevention, quality considerations, and key challenges in condom commodity procurementplanning and orecasting.
Condoms are listed on the WHO’s Model List o Essential Medicines (2011). Male condoms are very aordable (U.S.$0.02–0.04per unit) and are widely distributed. In 2010, procurement o male condomsby bilateral and multilateral donors or public sector distribution and social marketing exceeded 2 billionor the rst time and refected a 22 percent increaseover 2009 (Reproductive Health Supplies Coalitionn.d.). The ve leading agencies that purchased maleand emale condoms in 2010 were the U.S. Agency or International Development (USAID; 37 percent), the UN Population Fund (UNFPA; 22 percent), theGlobal Fund to Fight AIDS, Tuberculosis and Malaria(9 percent), Kreditanstalt Für Wiederaubau (KW; 2percent), and the UK Department or International