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01-Aug-2020 16:29

Consistently used condoms provide significant protection against HIV, pregnancy and sexually transmitted infections (STIs).The degree of protection they offer against HIV and STIs is significantly better than any other single prevention method, taken in isolation, other than sexual abstinence or complete mutual monogamy between two people who have tested negative for HIV.These can be done in individuals whose characteristics are known and can be controlled for, and if the relationship truly is monogamous then infections by acute STIs and from outsiders can be ruled out.One disadvantage is that condom use in long-term relationships, even in serodiscordant couples, is relatively rare.In one of the most highly publicised statements, in October 2003, the President of the Vatican's Pontifical Council for the Family, Cardinal Alfonso Lopez Trujillo, said: "The AIDS virus is roughly 450 times smaller than the spermatozoon.The spermatozoon can easily pass through the 'net' that is formed by the condom.

For efficacy against HIV and other chronic STIs, studies of the incidence of HIV (or HSV or HPV) in monogamous serodiscordant couples provides the best evidence.One widely quoted remark of this nature came from Ugandan President Yoweri Museveni who, at the Fifteenth International AIDS Conference in Bangkok in 2004, advocated for HIV prevention based on “optimal relationships based on love and trust instead of institutionalised mistrust, which is what the condom is all about…I think of condoms as an improvisation, not a solution”.(See the text of Museveni’s speech.) Museveni later complained of being misunderstood and signed an article in The Lancet saying that condoms formed a valuable part of HIV prevention.Research early on in the epidemic showed that 40 to 70% of men who claimed they use condoms 100% of the time in fact did not use them for every act of intercourse.

Twenty years later, 51 to 66% of women taking part in a microbicide study reported 100% condom usage at different time points during the trial, but the researchers calculated from inconsistency in their answers that the actual proportion who maintained 100% condom use was 25%.Despite this, the use and promotion of condoms continue to be targets for controversy and criticism, and sexual abstinence and monogamy are often promoted as superior alternatives.