viaCSIRO Publishing, by Richard Crosby and Willard Cates Jr.

The global pandemics of HIV, sexually transmitted infections (STIs) and unintentional pregnancy clearly necessitate innovative prevention strategies. Although recent biomedical approaches such as antiretroviral (ARV) treatment for persons living with HIV,3 ARV pre-exposure prophylaxis (PrEP) for HIV-negative people at risk of acquisition4–6 and adult male circumcision7,8 programs are valuable assets against the spread of HIV, these biomedical strategies are not a panacea. Moreover, their associated costs are sizeable.9
Condoms are the oldest and most affordable method of HIV prevention. Recent advances in knowledge about the nuances of this method have been spawned by the AIDS pandemic. These condom innovations are not always product-oriented; indeed, most involve harnessing the behavioural and social sciences to promote improved frequency and quality of condom use, especially among those at greatest risk.

This special issue of Sexual Health provides state-of-the-art reviews of recent research on both male and female condoms. More importantly, it builds upon the foundation of ‘what we know’ to offer concrete future directions for optimal public health impact. Even today, condom use remains a fundamental prevention practice for both the HIV and STI pandemics, as well as the ongoing global problem of unintentional pregnancy.

The issue opens with Warner and colleagues11 making an eloquent case that condom use is a complex behaviour, embedded in the fabric of gender inequalities. They highlight the need for creative programs to rectify issues that users experience with condoms. They offer a scenario – however utopian – where condom use could be perceived as pleasurable. Indeed, a population-level, sex-positive approach to promoting condom use is an aspirational aspect of this opening commentary. It also touches upon the empirical question of condom effectiveness, an issue dealt with at length in the subsequent article.

Rather than being an exhaustive review of the extant literature, the condom effectiveness review captures the immensely complicated challenges inherent in studies of human sexual behaviour. Prospective observational studies offer a relatively strong body of evidence supporting condom effectiveness even in the presence of the multiple forms of bias towards the null. This suggests that our current condom effectiveness estimates are usually understated. The review concludes that consistent and correct use of condoms is highly effective in protecting against STIs, HIV and unintended pregnancy.

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[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article’s content, whether in support or in opposition.]