More prevention activities eventually could reduce the number of cases needing treatment (587). For example, in Nairobi, Kenya, where free condoms were provided to 500 CSWs, most of whom were infected with HIV, condom use among them rose from 10% to 80%, averting an estimated 10,000 new cases of HIV infection or more per year (368).

Exactly how much money STI prevention saves compared with treatment is unknown (497). Estimates are possible, however, by calculating the risk of contracting HIV from having unprotected sex and then comparing the subsequent health costs of treating HIV/AIDS with the much lower costs of using condoms. In the US, for example, each case of AIDS costs an estimated $100,000 to $200,000 in lifetime expenditures for medical care (251, 277, 409).

For high-risk heterosexual men, one calculation estimated the savings per condom at over US$27; for men having sex with men, the savings per condom was over US$530 when condoms were used regularly with multiple partners (407, 408). The magnitude of the difference suggests that in the US condom promotion is clearly a good investment. Total US health care costs of treating STIs including HIV/AIDS in 1994 were nearly $17 billion (67, 155).

As the AIDS epidemic continues to spread, prevention programs become an ever more urgent priority and wise use of public funds: many lives are at stake (192). Assuring widespread use of condoms deserves a coordinated, strategic approach that involves all concerned—national governments, international donors, NGOs, social marketing programs, technical assistance providers, individual health care providers, educators and communicators, and the commercial sector. Closing the condom gap is the responsibility of everyone in reproductive health care.