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AIDS. 2003 May 23;17(8):1227-37.

Shifts in condom use following microbicide introduction: should we be concerned?

Author information

1
Health Policy Unit, Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK. anna.foss@lshtm.ac.uk

Abstract

OBJECTIVES:

Abandoning condoms for microbicides is termed 'condom migration'. This study estimated the reduction in condom use that can be tolerated following the introduction of an HIV- and sexually transmitted disease (STD)-efficacious microbicide without increasing an individual's risk of HIV infection, and explored how microbicide use affects HIV-risk.

DESIGN:

Development of a static mathematical model to compare how different combinations of condom and microbicide use affect individual risk of HIV and STD infection at a particular point in time.

METHODS:

The model is used to identify the 'break-even point' at which any increased risk associated with condom migration is counter-balanced by the protection afforded with microbicides. Data from Benin is used as a case-example.

RESULTS:

Considering a 50% HIV- and STD-efficacious microbicide, groups that use condoms with 25% consistency or less could cease using condoms without increasing their risk if they use microbicides in 50% or more of sex acts. However, migration may increase risk if the initial condom-consistency is high (> 70%) and microbicide-consistency is low (< 50% of non-condom-protected acts). For the Benin case-example, if condoms are initially used in 70% or less of sex acts, and if consistency of condom use is sustained following microbicide introduction, there will be a 20% or greater reduction in HIV-risk if the microbicide is used in 50% of non-condom-protected sex acts.

CONCLUSIONS:

There are likely to be many situations in which the benefits of microbicide use outweigh the negative impact of condom migration, and where microbicides could substantially reduce HIV-risk.

[Indexed for MEDLINE]

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