# Presentation: 668800

## Condom Promotion for AIDS Prevention in the Developing World: Is it Working? 

- Norman Hearst, MD MPH1 and Sanny Chen, MHS1,2
- 1 University of California, San Francisco, USA
- 2 San Francisco Department of Public Health, USA

## Table 1. Seroconversion rates in cohort studies of HIV transmission within discordant couples 

- Table 1. Seroconversion rates in cohort studies of HIV transmission within discordant couples

| Study | Study Site | Direction of Transmission | Condom Use |  |  |
| --- | --- | --- | --- | --- | --- |
|  |  |  | Always | Some | Never |
| Fischl 1987 | U.S.A. | Not specified | 1/10 | - | 12/14 |
| Goedert 1987 | U.S.A. | M+ F- | 0/6 |  | 4/18* |
| Peterman 1988 | U.S.A. | M+ F-
M- F+ | -
- | 0/4
0/2 | 10/51
2/23 |
| Roumelioutou 1988 | Greece | M+ F- | 0/37 |  | 12/16* |
| Johnson 1989 | London | M+ F- | 0/4 |  | 15/74* |
| Laurian 1989 | France | M+ F- | 0/14 | - | - |
| van der Ende 1988 | Netherlands | M+ F- | 0/2 | 0/3 | 0/8 |
| Henry 1991 | U.S.A. | M+ F- | - | - | 1/1 |
| Kamenga 1991 | Zaire | M+ F-
M- F+ | 1/50
3/56 | 1/10
1/1 | -
- |
| Allen 1992 | Rwanda | M+ F-
M- F+ | 0/4
0/5 | 2/16
0/15 | 4/10
2/3 |
| European Study Group 1992 | 6 countries in European Community | M+ F-
M- F+ | 0/83
0/41 | 8/74
4/47 | 74/314
15/104 |

## *seroconversion rates for never and sometimes condom users.

| Study | Study Site | Direction of Transmission | Condom Use |  |  |
| --- | --- | --- | --- | --- | --- |
|  |  |  | Always | Some | Never |
| Siddiqui 1992 | U.S.A. | Not specified | 0/7 | 0/6 | 0/9 |
| Saracco 1993 | Italy | M+ F- | 3/171 | 8/55 | 8/79 |
| Musicco 1994 | Italy | M+ F- | 5/243 | - | - |
| O’Brien 1994 | U.S.A. | Not specified | - | 0/4 | 0/2 |
| Deschamps 1996 | Haiti | Not specified | 1/42 | 6/45 | 13/90 |
| Hira 1997 | Zambia | M+ F- | 0/30 | 5/49 | - |

- M+ F- indicates transmission from an infected man to a female partner; M- F+ indicates transmission from an infected woman to a male partner.
- Source: Weller S et al., Pinkerton SD et al., Davis KR et al.

## Figure 1.  HIV incidence among men who have sex with men in San Francisco, 1978-88

- *The denominator is men beginning each year seronegative.
- Source: Hessol N et al.

## Table 1a. Condom use at last high-risk sex in past year among 15-24 year old females in Africa, 2001

## Table 1b. Condom use at last high-risk sex in past year among 15-24 year-old males in Africa, 2001

## Prevalence

- Condom Sales

- HIV Prevalence

- Kenya

**Prevalence**

**Sales**

- Source: PSI/ AIDSMARK

## Botswana

- Condom Sales

- HIV Prevalence

## Cameroon

- Condom Sales

- HIV Prevalence

## Figure 4.  Male STIs and condom non-use in commercial sex in Thailand

- Source: Brown T

## Figure 5

- Source: Ugandan Ministry of Health, 2001

## Slide 12

##    How consistent must condom use be to protect the individual?

   How high must rates of condom use be to protect the community?

	Can a generalized HIV epidemic be overcome primarily through condoms?

	How can condom promotion best be integrated into multifaceted prevention? 

-    How high must rates of condom use be to protect the community?
- 	Can a generalized HIV epidemic be overcome primarily through condoms?
- 	How can condom promotion best be integrated into multifaceted prevention?

## Condom use in Uganda

a) Coupon redemption
				No. participants	No. coupons
Control		 	  90/165 (54.5%)	  403/1875 (21.5%)
Intervention		128/218 (58.7%)	1472/1875 (78.5%)

b) Average coupons redeemed
				Mean 		Median	Min 	Max
Control			  6.76		  6		1	30
Intervention		17.9		13		1	73

Ranksum No. coupons by group
p=<.0001

- a) Coupon redemption
- 				No. participants	No. coupons
- Control		 	  90/165 (54.5%)	  403/1875 (21.5%)
- Intervention		128/218 (58.7%)	1472/1875 (78.5%)
- b) Average coupons redeemed
- 				Mean 		Median	Min 	Max
- Control			  6.76		  6		1	30
- Intervention		17.9		13		1	73
- Ranksum No. coupons by group
- p=<.0001

## p=0.004*

- p<0.001*

**Mean change in number of sex partners in the last 6 months, young men in peri-urban Kampala, Uganda, 2001-2002.**

**All partners**

**Casual partners**

## Uganda: Casual partners

- 49.7%

- 57.3%

- 55.9%

- 58.8%

- 35.7%

- 40.6%

- 43.0%

- 40.4%

## What We Know

1)  Condoms when used consistently are effective, but not 100% effective.
2)  Condom promotion is proven effective in certain settings (commercial sex, MSM, etc)
3)  Condom promotion for the general population has not yet produced the expected benefits.
4)  Sexual behavior change is possible and can make a big difference in the epidemic.

- 1)  Condoms when used consistently are effective, but not 100% effective.
- 2)  Condom promotion is proven effective in certain settings (commercial sex, MSM, etc)
- 3)  Condom promotion for the general population has not yet produced the expected benefits.
- 4)  Sexual behavior change is possible and can make a big difference in the epidemic.

## 			What We Don’t Know

1)  Can outside donors “do” A and B or must it be endogenous?
2)  If so, what strategies work best?
3)  How can A and B be done so as not to discourage C?
4)  How can C be done so as not to discourage A and B?

- 1)  Can outside donors “do” A and B or must it be endogenous?
- 2)  If so, what strategies work best?
- 3)  How can A and B be done so as not to discourage C?
- 4)  How can C be done so as not to discourage A and B?