Are people using condoms: current evidence from sub-Saharan Africa and Asia
Condom use has greatly increased in the last ten years. This study aimed to summarise evidence on current levels of condom use in different relationships in different settings in sub-Saharan Africa and Asia. It documents levels of condom use achieved after HIV prevention interventions, and identifies key lessons for microbicide promotion. Findings are based on a review of literature from 1984 to 2002 on levels of condom use in main, casual and commercial partnerships, compilation of data on sexual behaviour and condom use from Demographic and Health Surveys and Family Health International studies, and an in-depth review of project documents and behavioural data from intervention literature.
Among women, trends were generally of higher levels of condom use in commercial than main/casual partner sex. In 15 sub-Saharan countries, surveys suggest that less than 7% of women used a condom at last sex with their main partner and less than 50% with a casual partner. Among women sex workers in sub-Saharan Africa, levels of condom use ranged from 30–90% at last sex with a client, with higher rates where active HIV prevention interventions were based. Among women sex workers in Asia, there was greater than 80% condom use at last commercial sex in several settings, particularly high in Vietnam. In 75% of sites, more than 70% of women sex workers in Asia reported condom use at last sex with a client. Levels of condom use with a main/casual partner in Asia ranged from 14–76% at last sex.
Among men, trends generally were high levels of condom use in commercial sex in some African settings (>80% in Zimbabwe) and many Asian settings. Levels of condom use with casual partners ranged from 29–70% in different sub-Saharan countries, 3–44% in South Asia and 13–78% in East Asia and the Pacific. In sub-Saharan Africa, low levels of condom use with main partners were reported by men.
Among sexually active youth in sub-Saharan Africa, more young men than young women reported condom use at last sex. Where prevention activities are less widespread, levels of use were lower. In Uganda, where prevention activities are strong, 50% of sexually active young single women reported condom use at last sex.
Pre-and post-intervention data from all countries studied showed the levels of condom use went up, e.g. from 30% to 81% among sex workers in Guangzhou, China; 55% to 83% in truckers with commercial sex in Tamil Nadu, India; 32% to 44% among youth aged 12–25 in Cameroon; and 6% to 42% among women plantation workers in Kenya.
In general, interventions led to increased condom use, mostly in relation to casual and commercial sex; levels of condom use decreased with degree of intimacy and regularity of partnership; and few condom users achieved 100% use. As regards the female condom, although distribution is not adequate, there has been substantial uptake where it is available, and it fills an important niche. The current supply of both male and female condoms internationally is highly inadequate and urgently requires increased funding, greatly increased intervention activity and strengthened logistics.1
| 1. | Foss A, Watts C, Vickerman P, et al. Are people using condoms?: current evidence from sub-Saharan Africa and Asia and the implications for microbicides. London: International Family Health, HIV Tools Research Group, London School of Hygiene and Tropical Medicine, 2003. (Unpublished) | ||||
Reliability of self-reported condom use in HIV discordant couples in Zambia
This study of 963 HIV-discordant couples who attended a voluntary testing and counselling (VCT) centre in Lusaka, Zambia, investigated the reliability of self-reported condom use. Biological markers such as sperm on vaginal smears, pregnancy and evidence of sexually transmitted infection were used to assess the validity of self-reports of condom use at three-monthly intervals. Reported condom use by these couples rose from 3% before VCT to over 80% afterwards. Most intervals with reported unprotected sex were negative for all biological markers, showing that not every such act results in transmission of HIV. However, half the incidences of sperm and one third of those of pregnancy and HIV transmission were found in couples who had reported continuous use of condoms, indicating that there is a tendency to overstate condom use. DNA sequencing suggested that most (87%) new HIV transmission was between the partners in stable couples, with only 13% of new infections coming from outside the relationship. Thus, it appears that joint VCT prompts sustained but imperfect condom use in HIV discordant couples, reducing but not completely eliminating the opportunities for HIV transmission between them.1
Naples, Italy, 1997
| 1. | Allen S, Meinzen-Derr J, Kautzman M, et al. Sexual behaviour of HIV discordant couples after HIV counselling and testing. AIDS 2003;17(5): 733–40. | ||||