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For Immediate Release May 18, 1999
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Hopkins Report: Condom Use Must Triple To Curb
Spread of HIV/AIDS and Other Sexually Transmitted Infections
Condom use around the world should triple to help stop the spread of HIV/AIDS and other sexually transmitted infections (STIs), according to a new Johns Hopkins estimate. Condom use should rise from the current 6 to 9 billion condoms a year to 24 billion. "Narrowing the gap between condom need and use is a major public health challenge," according to Hopkins researchers in a report from the Johns Hopkins School of Public Health.
As HIV/AIDS and other STIs spread, the need for condoms grows. Worldwide, at least 33 million people are living with HIV/AIDS and another 14 million have died. An estimated 16,000 new HIV infections occur every day. Each year some 333 million new cases of other STIs occur in adults, according to the report, Closing the Condom Gap, in the latest issue of Population Reports, published by the Johns Hopkins Population Information Program.
Many of these HIV/AIDS cases and other STIs could be prevented if people used condoms correctly and consistently. As the report notes, "Laboratory tests show that no STI, including HIV, can penetrate an intact latex condom."
So why don't more people use condoms? Some dislike them. Some, especially in developing countries, cannot afford them, or obtain them easily. Others believe, wrongly, that they face little or no risk of pregnancy or STIs. In addition, write authors Robert Gardner, Richard Blackburn, and Ushma Upadhyay, "Family planning programs usually focus on the contraceptive needs of married women, while much of the need for condoms is to prevent HIV/AIDS and other STIs among unmarried people, particularly youth." Hopkins researchers estimate that 71% of condom need is among sexually active unmarried men. The remaining need is for use by married men who have extramarital affairs and for use by married couples.
Hopkins researchers call on programs to launch a coordinated effort to promote condoms and close the gap between need and use. Communication campaigns can help make condom use the social norm rather than risk-taking. Counselors and mass media entertainment can help people address issues of trust, negotiation, and communication—essential for safe sexual relationships. Affordable condoms can be made accessible in hotels, bars, barber shops, and through vending machines. Programs can reach out to youth, unmarried men, and commercial sex workers.
Many men and women report that they have changed their sexual behavior in response to AIDS. The Population Reports issue cites data from Demographic and Health Surveys showing that both married and unmarried men and women are beginning to change their sexual practices. "Among married people the most common reported change in sexual behavior...is to restrict sex to the person's spouse....Among married men, using condoms is the third or fourth most common response." In Zambia, for example, 72% of married men surveyed said they had restricted sex to one partner and 13 percent said they began using condoms. "Among never-married men and women...the most commonly reported change...is to stop having sex or, if not yet sexually experienced, to delay sexual initiation....Many...report that they started to use condoms." In Malawi 52% of respondents delayed first sex or stopped sex and 24% began using condoms.
But many men and women who are at risk still do not protect themselves and their partners. This is partly due to lack of knowledge. "In most countries everybody has heard of AIDS. Knowledge of condoms is also widespread. Yet many people who know about AIDS and about condoms do not know that using condoms can prevent AIDS," according to the report. For example, in Uganda in 1995, all never-married men surveyed had heard about AIDS, but only 40% knew that condoms could prevent AIDS. In Bangladesh 33% of married men had heard of AIDS, but only 18% knew that condoms could prevent AIDS.
One group facing the most risk of AIDS and STIs is youth. Fully half of all people who become infected are between ages 10 and 25. "In the era of AIDS young people need guidance, encouragement, and access to condoms," according to the report. One US study cited in the report found that young people whose mothers had talked to them about condoms in the year before first intercourse were three times more likely to have used a condom at first intercourse. And those who used a condom at first intercourse were 20 times more likely to use condoms regularly. The report also cites studies which show that sex education and condom distribution do not lead to earlier sex, do not increase sexual activity, and may actually decrease the number of sexual partners.
Condoms can be a very cost-effective STI prevention method, according to the Hopkins report. In the US each case of AIDS costs an estimated US$100,000 to $200,000 in lifetime expenditures for medical care. One estimate puts health care savings for using condoms at US$27 per condom, increasing to US$530 per condom when condoms are used by men having sex with male multiple partners. Total US health care costs for treating STIs including HIV/AIDS were nearly $17 billion in 1994.
"Making condoms more accessible, lowering their cost, promoting them more, and helping to overcome social and personal obstacles to their use would save many lives and reduce the enormous consequences and costs of STIs and unintended pregnancies," according to authors.
Population Reports is an international review journal of important issues in population, family planning, and related health matters. It is published four times a year in four languages by the Population Information Program at the Johns Hopkins Center for Communication Programs for more than 170,000 family planning and other health professionals worldwide, with support from the US Agency for International Development (USAID). USAID administers the US foreign assistance program, providing economic and humanitarian assistance in more than 80 countries worldwide.
For more information contact: Stephen Goldstein at Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA. Tel: 410 659-6300; Fax: 410 659-6266; E-mail PopRepts@jhuccp.org. Full-text version of Closing the Condom Gap.
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