What Works for Women and Girls

3A. Prevention for Women: Male and Female Condom UseThe role of condom use in prevention of sexual transmission of HIV is clear. According to theWHO and the U.S. National Institutes of Health, male condoms that are intact are essentiallyimpermeable to even the smallest sexually transmitted virus (UNAIDS, 2004). The effectivenessof male condoms has been shown to be between 80–95 percent, depending on howcorrectly they are used (Weller and Davis-Beaty, 2007; Holmes, Levine and Weaver, 2004;Hearst and Chen, 2004).While the efficacy of the female condom in preventing HIV transmission has yet to bestudied (IOM, 2001), mathematical modeling indicates that consistent use of female condoms,even at lower rates of efficacy, can play an important role in HIV prevention, especially forwomen whose partners will not use male condoms (Musaba et al., 1998). The efficacy of thefemale condom in preventing HIV transmission may never be fully determined. “While allevidence points to the effectiveness of female condoms to prevent HIV transmission and acquisition,it would be ethically impossible to test female condoms for HIV prevention: one cannotconduct a trial and give participants only female condoms and female and male condomscannot be combined during the same sexual act. There is no possibility of doing a true goldstandard randomized controlled clinical trials for female condoms” (Gabelnick, 2007, citedin CHANGE, 2008). Still, with laboratory and modeling studies indicating that the femalecondom is likely as effective as the male condom, the female-controlled female condom is acritical component to HIV prevention for women.Consistent Condom Use Is Effective in Reducing HIV TransmissionConsistency is key. Women’s lifetime risk of infection decreases with the consistent use ofcondoms. A microsimulation in Malawi found that if men always use male condoms withwomen who are not their wives, women’s lifetime risk falls to 9 percent and that if both menand women always use condoms with partners other than their spouses, women’s lifetime riskof infection falls to 8 percent (Bracher et al., 2004). Findings from Rakai, Uganda, showed thatamong 350 women who reported consistent male condom use, none became HIV-positive,but annual HIV incidence was 4.6 percent among women who reported inconsistent condomuse (Kiddugavu et al., 2003). Conversely, many studies have shown that inconsistent condomusers are at higher risk of HIV transmission than those who never use condoms. This maybe because their behavior is riskier in other ways. Mathematical models suggest that a smallnumber of people who use male condoms consistently can have a greater impact on reducingHIV transmission than a larger number who use them inconsistently (Hearst and Chen,2004). Interventions promoting consistent condom use are therefore paramount in reducingthe incidence of HIV.Variations in condom use across regions, countries and populations indicate that condompromotion should address barriers (socio-cultural, legal and policy, economic and financialand structural barriers) faced by different groups of women such as youth, married women,discordant couples, sex workers, and IDUs, among others (Drezin, Torres and Daly, 2007).50 CHAPTER 3 PREVENTION FOR WOMEN