Condoms and prevention of HIV

Promotion of condoms has been a mainstay of HIV prevention policy. Over the past few years, however, the value and effectiveness of condoms have increasingly been called into question. The growing “abstinence only” movement in the United States questions the provision of condoms as part of the policy and messaging of the US Agency for International Development (USAID) and claims that condoms have had little to do with the successes achieved in reducing HIV in countries such as Uganda.1–2 Senior officials in the Roman Catholic Church also continue to argue about the morality of condom use and dispute its efficacy.3

But what does the evidence tell us? A recent review from the National Institutes for Health says that condoms are protective against HIV infection,4 reducing the probability of HIV transmission per sex act by as much as 95% and reducing the annual HIV incidence in serodiscordant couples by 90-95% when used consistently.5 However, the impact of inconsistent use of condoms is less substantial: a meta-analysis found that condom use of variable consistency among serodiscordant couples reduced the annual HIV incidence by 69%.6 This illustrates how the protection provided by a …