Comprehensive HIV Prevention: Condoms and Contraceptives Count

July 22, 2008

Sarah Haddock, Karen Hardee, Jill Gay, Piotr Maciej Pawlak and Christina Stellini

The AIDS epidemic has now spanned nearly three decades. In 2007, 2.5 million people became newly infected with HIV, bringing the total number of people living with HIV or AIDS to 33 million. Recent evidence shows that national HIV prevalence is stabilizing or showing signs of decline in most of sub-Saharan Africa and in some Southeast Asian countries,²  yet AIDS remains the leading cause of death in sub-Saharan Africa, and generalized epidemics¹  persist. Around the world, most HIV epidemics are fueled by unprotected sex between men and women. Outside of sub-Saharan Africa, a number of HIV epidemics are mostly concentrated among high-risk populations such as men who have sex with men (MSM), sex workers and their clients and injecting drug users (IDUs). Despite advances in treatment, nearly three individuals become infected with HIV for every one person who begins antiretroviral treatment.³  The global number of persons living with HIV and AIDS is increasing because new infections continue and, thanks to treatment, people living with HIV and AIDS are living longer and healthier lives. In addition to HIV and AIDS, many of the world’s poorest women, particularly in sub-Saharan Africa, continue to contend with another urgent health and rights crisis—high risk of unintended pregnancy. Data from 53 countries show that one in seven married and one in 13 never-married women have an unmet need for contraception and are therefore at risk of unintended pregnancy. Unmet need is even higher in sub-Saharan Africa, the region most affected by HIV and AIDS, where one in four married women have an unmet need for contraception. This unmet need is lower, but still significant in the regions of Latin American and the Caribbean, North Africa, West and Central Asia, and South and Southeast Asia.⁴ 

It is absolutely critical that, in addition to expanding life-saving treatment, programming and scale-up of HIV prevention programs become a top priority. The lessons of the past decades have taught us that there is no silver bullet to HIV prevention, although there is increasing evidence of what works, and replicable models exist. Worldwide, almost half of the people living with HIV or AIDS are women, and in sub-Saharan Africa—where heterosexual transmission is highest—61 percent of those living with HIV or AIDS are women.⁵  Preventing unintended pregnancies among infected women and those at risk of infection is essential for preventing mother-to-child transmission of HIV. In fact, all women and couples, irrespective of their HIV status, need access to voluntary family planning services.

Male and female condoms remain the primary technologies currently available to protect individuals from sexual transmission of HIV. While male condoms are generally accepted as a cornerstone of comprehensive HIV prevention, expanded access and use of this proven technology is still facing enormous cultural and policy barriers, and much more needs to be done to increase the supply and use of female condoms. Despite 2.5 million new HIV infections occurring every year, overall donor support for condoms in developing countries has remained largely unchanged over the past few years. Similarly, despite a growing demand for modern contraception, including condoms, donor support for contraceptives has increased only minimally, and remains far below the projected need.

Effective comprehensive prevention strategies must include a range and mix of evidence-based interventions tailored to the needs of various people and their social contexts.⁶  With this report, Comprehensive HIV Prevention: Condoms and Contraceptives Count, Population Action International (PAI) presents evidence that scaling-up HIV prevention – which is critical to stem new HIV infections—will require much broader access to and use of these proven technologies—namely male and female condoms to prevent primary infection, and contraceptives to prevent mother-to-child transmission by preventing unintended pregnancies.