Facts About Condoms and Their Use in Preventing HIV Infection and Other STDs

With nearly one million Americans infected with HIV most of them through sexual transmission, and an estimated twelve million cases of other sexually transmitted diseases (STDs) occurring each year in the United States, effective strategies for preventing these diseases are critical.

Refraining from having sexual intercourse with an infected partner is the best way to prevent transmission of HIV and other STDs. But for those who have sexual intercourse, latex condoms are highly effective when used consistently and correctly.

The correct and consistent use of latex condoms during sexual intercourse--vaginal, anal, or oral--can greatly reduce a person's risk of acquiring or transmitting STDs, including HIV infection. In fact, recent studies provide compelling evidence that latex condoms are highly effective in protecting against HIV infection when used for every act of intercourse.

This protection is most evident from studies of couples in which one member is infected with HIV and the other is not, i.e., "discordant couples". In a two year study of discordant couples in Europe, among 124 couples who reported consistent use of latex condoms, none of the uninfected partners became infected. In contrast among the 121 couples who used condoms inconsistently, 12 (10%) of the uninfected partners became infected.

In another study, among a group of 134 discordant couples who did not use condoms at all or did not use them consistently, 16 partners (12%) became infected. This contrasts markedly with infections occurring in one 3 partners (2%) of the 171 couples in this study who reported consistently using condoms over the two year period.

Condoms must be used consistently and correctly to provide maximum protection. Consistent use means using a condom with each act of intercourse. Correct condom use includes all of the following steps:

• Put on the condom as soon as erection occurs and before any vaginal, anal, or oral contact with the penis.
• Hold the tip of the condom and unroll it onto the erect penis, leaving space at the tip of the condom, yet ensuring that no air is trapped in the condom's tip.
• Adequate lubrication is important to prevent condom breakage, but use only water-based lubricants such as glycerine or lubricating jellies (which can be purchased at any pharmacy). Oil based lubricants, such as petroleum jelly, cold cream, hand lotion, or baby oil, can weaken the condom.
• Withdraw from the partner immediately after ejaculation, holding the condom firmly to the base of the penis to keep it from slipping off.

Recommended Prevention Strategies

Abstaining from sexual intercourse is the most effective HIV prevention strategy.

For individuals who are sexually active, the following are highly effective:

• Engaging in sexual activities that do not involve vaginal, anal, or oral intercourse.
• Having intercourse only with one uninfected partner.
• Using latex condoms correctly from start to finish with each act of intercourse.

Other HIV Prevention Strategies

Condoms for Women

The female condom or vaginal pouch has recently become available in the United States. A small study of this condom as a contraceptive indicates a failure rate of 21-26% in one year among typical users; for those who use the female condom correctly and consistently, the rate was approximately 5%. Although laboratory studies indicate that the device serves as a mechanical barrier to viruses, further clinical research is necessary to determine its effectiveness in preventing transmission of HIV. If a male condom cannot be used, consider using a female condom.

Plastic Condoms

A polyurethane male condom was approved by FDA in 1991 and is now available in the United States. It is made of the same type of plastic as the female condom. The lab studies show that the new polyurethane condoms have the same barrier qualities as latex. Lab testing has shown that particles as small as sperm and HIV cannot pass through this polyurethane material. A study of the effectiveness of this polyurethane condom for prevention of pregnancy and STDs is underway. The new polyurethane condoms offer an alternative for condom users who are allergic to latex. Also, polyurethane condoms can be made thinner than latex, have no odor, and are safe for use with oil-based lubricants.

Spermicides

Although studies indicate that nonoxynol-9, a spermicide, inactivates HIV in laboratory testing, it is not clear whether spermicides used alone or with condoms during intercourse provide protection against HIV. Therefore, latex condoms with or without spermicides would be used to prevent sexual transmission of HIV.

Making Responsible Choices

In summary, sexually transmitted diseases, including HIV infection, are preventable. The effectiveness of responsible prevention strategies depends largely on the individual. Whatever strategy one chooses, its effectiveness will depend primarily on consistent adherence to that choice.