Condoms

GENEVA, 13 February 2017—On International Condom Day, UNAIDS is calling for countries to remove barriers that hinder access to, and the use of, condoms. Condoms are an effective means of preventing HIV and sexually transmitted infections. With the annual number of new HIV infections among adults remaining static at 1.9 million for the past five years, and increasing in some parts of the world, there is an urgent need for improved access to HIV prevention options, including condoms and lubricants. For example, the gap between availability and need in sub-Saharan Africa—the region most affected by HIV—is estimated to be more than 3 billion condoms. 

UNAIDS supports creative and strategic thinking around innovative approaches to improving condom availability. Countries should make condoms available for free or at a low cost through their public health facilities and engage in imaginative marketing strategies and distribution systems, including social enterprises and community-based programmes.

In 2015, there were 2.1 million new HIV infections. Increasing access to condoms is a critical element to meeting the target of fewer than 500 000 new HIV infections by 2020—an important milestone in efforts to end the AIDS epidemic by 2030.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

“I want to make it in the corporate world,” says 19-year-old Millicent, known as Milly. A marketing major at the University of Botswana, she exudes sophistication and self-confidence.

But Milly has not always felt so confident about making the right decisions. She has not always felt able to protect herself from sexually transmitted infections, including HIV, or from unintended pregnancy. She was embarrassed to be seen to be sexually active and didn’t feel comfortable taking free condoms at the government clinic. And her boyfriend, Peter, felt self-conscious buying condoms at the pharmacy so they didn’t always have protected sex.

Milly says people tend to link condom use with promiscuity. “There’s a stereotype about teenagers using condoms,” she explains. “Condoms are said to be for adults. People don’t want to talk about them.” At the clinic, “You couldn’t just go in and take one,” she explains. “You were criticized because you were young and wanted condoms.”

Milly’s parents gave her only the most general information about preventing HIV, even though her father is a physician. Cultural norms in Botswana inhibit parents and children from talking openly about sex; it is assumed that if teenagers know about condoms, “they will want to experiment,” says Milly. She and Peter read a little about condoms, but they were still unsure how to use them. “We knew we were taking risks,” she says.

Milly and Peter belong to the age group, 15–24-year-olds, most at risk of HIV infection and UNAIDS reports that females 15–24 years old are twice as likely as males to be living with HIV.  Kabo Ngombe of Botswana’s Ministry of Health says that a reluctance to talk about condoms is one reason why more young people do not use them. “A lot of people know about HIV and prevention methods, but they’re not changing their behaviour,” she says. “Young people lack role models. Their parents can’t talk to them about HIV. They prefer to learn from other young people.”

This is what happened to Milly. One day she saw a brightly painted truck moving slowly down the road with the word CONDOMIZE! painted on its side, surrounded by a lively young crowd. Standing in the bed of the truck were other young people, all wearing sleek black T-shirts with the words “Love Smart! Play Safe! CONDOMIZE!” blazoned across the front in electric pink. They wore bright pink hard hats on their heads. Rock music played as they warmly invited passers-by to step up and learn about condoms.

“This truck was really pulling a crowd!” says Milly. “I wanted to know who these people were and what they were doing in our community. It turned out they were educating young people about how to use condoms! And these were young people just like me! As a teenager, I want another teenager to give me information, not someone who criticizes me. This was really great!”

To date, this truck and a smaller one like it have covered some 2000 kilometres throughout Botswana. They are a major feature of the country’s CONDOMIZE! campaign, launched in June 2014 by the United Nations Population Fund and the Condom Project to draw attention to condoms in a user-friendly, welcoming, fun way that attracts young people like Milly. The young people on the truck were among 35 local volunteers trained to educate their peers about condoms. Botswana is one of six African countries where CONDOMIZE! campaigns have been going on since 2011.

The truck pulled up in a park where a table covered with bright displays of condoms had been set up, and the crowd continued to grow. The CONDOMIZE! team passed out baskets full of colourful condoms and packets of water-based lubricant, encouraging everyone to help themselves. “It was amazing!” says Milly “I didn’t know colourful condoms existed!” The condoms she saw that day came in many varieties as well as colours, different sizes and textures (ribbed, studded with little bumps, etc.), different thicknesses and appealing scents (banana, strawberry, chocolate), and had attractive packaging. By contrast, the free government condoms come in one size, shape and colour: orange. They are considered inferior because they are not branded and people say they smell bad and break easily.

But the new condoms went like hot cakes. “I took a lot,” Milly says with a giggle. “It was so much fun! Everybody was very surprised, very impressed and very happy to have such a campaign coming to educate them, to give them free condoms!”

Nowadays, Milly and Peter use condoms consistently and correctly, including the female condom, which was new to them. They enjoy the variety of textures, colours and scents, as well as the lubricants, which they didn’t know about before. Milly has come across other CONDOMIZE! events since then, and she is well-supplied with condoms. 

Condoms are at the centre of a combination HIV prevention approach; they are also cost-effective tools for preventing other sexually transmitted infections and unintended pregnancies. An estimated 45 million HIV infections have been averted through condom use globally since 1990. Achieving the global condom target for 2020 would avert 3.4 million new infections. The cost per infection averted would be approximately $450, well below the lifetime cost of providing antiretroviral treatment.

PREVENTION GAPS

• Stagnation of international and domestic funds for condom procurement and programming.
• An annual gap of more than 3 billion male condoms in sub-Saharan Africa.
• Inconsistent condom use within many populations and locations in greatest need, including challenges for women to negotiate condom use.
• Insufficient availability of lubricants and female condoms.

WAY FORWARD

• Increase resources for condom procurement, distribution and promotion.
• Provide male and female condoms in combination prevention packages.
• Diversify condom products, including provision of female condoms alongside male condoms and lubricants.
• Develop new approaches to increase condom use and to enhance the positive perception of condoms among the various populations in need.
• Engage communities in condom provision and use innovative service provision mechanisms. 

In 2015, an estimated 1.9 million [1.7 million–2.2 million] adults (15+) were newly infected with HIV—the vast majority through sexual transmission—and an estimated 357 million people acquired chlamydia, gonorrhoea, syphilis or trichomoniasis. Every year, more than 200 million women have unmet needs for contraception, leading to approximately 80 million unintended pregnancies. Condoms effectively prevent all of these conditions. Optimal condom programming is a key part of the ambitious global targets to provide access to comprehensive prevention services to 90% of people at risk of HIV infection and to reduce new HIV infections to fewer than 500 000 globally. In recognition of this, countries agreed in the 2016 Political Declaration on HIV and AIDS to increase the annual availability of condoms to 20 billion by 2020. This includes approximately seven billion condoms for sub-Saharan Africa annually and 30–50 condoms per male, per year in high-prevalence countries.

New York City was the first city in the world to have its own municipally branded condom, and it currently maintains the largest free condom programme in the United States of America. Even in this high income, cosmopolitan city, free condom distribution is instrumental in preventing HIV, other sexually transmitted infections and unintended pregnancies among key populations.  Free condom distribution is included as a cost-saving and cost-effective prevention strategy within the 2015 Blueprint for ending the AIDS epidemic in New York State by 2020.

New HIV diagnoses in New York City, 2001-2014

Source: New York City Health Department

New York City’s free condom programme started in 1971, with free condoms distributed through the city’s clinics for sexually transmitted infections. In 2007, the Health Department launched the NYC Condom. Since then, every National Condom Awareness Day (held on St Valentine’s Day) has included a change in the look of the NYC condom packaging or the addition of a new layer of social marketing to the programme.

The Health Department supplies male condoms, female condoms and lubricant freely to any New York City organization or business that wishes to distribute them. In 2011, the Health Department created the NYC Condom Finder, a mobile phone application that uses GPS to assist users to find condom outlets across the city; this app has been downloaded by tens of thousands of people.

New York City’s Condom Availability Program (NYCAP) has over 3500 condom distribution partners and in 2014 distributed over 37.1 million male condoms and almost 1.2 million female condoms across the five boroughs. These partners focus distribution on neighbourhoods with the highest rates of HIV in the city, and to locations that serve people living with HIV and key populations, such as gay men and other men who have sex with men.

The programme works to increase the awareness, availability and accessibility of condoms to the residents of New York City by maintaining a strong community presence. In 2014, NYCAP participated in over 105 community events, provided 825 presentations in the Health Department’s clinics for sexually transmitted infections, and participated in all official and unofficial Gay Pride events in the city, reaching over 53 500 individuals.

Awareness and access to NYC Condoms is high among key populations. Over 75% of individuals polled at Gay Pride events and an African American Day Parade had seen or heard of NYC Condoms and had obtained them.

At the Health Department’s clinics for sexually transmitted infections, 86% of people surveyed were aware of NYC Condoms and 76% had obtained them. Condom use was also high, ranging from 69% to 81% among people who obtained NYC condoms.

Since the launch of the NYC Condom, more than 300 million NYC Condoms have been distributed. The trend in new diagnoses of heterosexually transmitted HIV infections has been reversed with a reduction of 52% between 2007 and 2014.