Revitalising the condom for the next generation – the missing piece of the prevention puzzle
HIV prevention is in need of a re-boot, cried many at AIDS 2018. Where better to start than with the condom, the most simple and effective intervention in our toolkit.
The International AIDS Conference (AIDS 2018) in Amsterdam last month kicked-off amidst calls for renewed commitments and warnings about complacency relating to HIV prevention.
Clearly, much progress has been made in getting people onto treatment and along the cascade, but a back-to-basics approach is much needed for HIV prevention. And nowhere more so than in our efforts to promote condoms.
“There is a condom crisis at the centre of the prevention crisis,” said Henk Van Renterghem, UNAIDS Senior Advisor, Fast-Track Country Support, at an AIDS 2018 session titled Condoms 2.0: Reinvigorating effective condom programming in the era of epidemic control. “We are missing a cost-effective opportunity to maximise the contribution of condoms to reducing HIV infections, sexually transmitted infections (STIs) and unintended pregnancies.”
There is a condom crisis at the centre of the prevention crisis. We are missing a cost-effective opportunity to maximise the contribution of condoms to reducing HIV infections.
It is thought that since the beginning of the epidemic, condoms have averted 50 million new HIV infections, and data tells us that where condom use is above 60%, new infections fall by more than 30%. Yet despite the evidence in their favour, condoms have been left behind.
Although global condom use has increased over the past three decades, gaps remain, and especially in sub-Saharan Africa where an astonishing 3 billion condoms are thought to be needed to properly respond to the epidemic.
The reality is that international funding for condom procurement has fallen in recent years and the insufficient scale-up of domestic funding has been unable to plug the gap. As a result, condom promotion and programming has stalled and in many countries is on the verge of collapse.
It is clear that our approach to condoms needs modernising and reinvigorating in order to reach our prevention goals.
“We need to recapture lost ground, that means, do business not as usual,” said Bernard Haufiku, Minister of Health and Social Services of Namibia at the conference.
But what does innovation look like when the condom itself has remained relatively unchanged in the past 163 years?
At another session, Bending the curve: Modernising HIV prevention through balanced curation of interventions, Miah Kiat Goh, CEO of the world’s largest condom manufacturer, Karex Malaysia, remarked that the biggest challenge relating to the condom is pleasure. He gave insight into the challenges faced when modernising and innovating around the design of the condom, recalling Bill and Melinda Gates’ call in 2013 for ideas for the ‘next generation condom’.
Despite 812 responses, not a single proposal has been commercially viable. Even the slightest modernisation of the condom faces heavy regulatory standards and procedures, which can slow creativity and innovation in this field.
“We are at a point now where condoms are seen as effective but not enticing,” said Miah Kiat Goh. Whereas before challenges lay in increasing the reliability and safety of condoms, innovation in the condom now needs to focus on increasing pleasure. To modernise the condom for the next generation we must adopt a sex-positive, pleasure-based approach.
There is also a need for further innovation around condom programming. “Half measures only get you half way,” said Casper Erichsen, Head of influence at the International HIV/AIDS Alliance at the same session. He looked back to primary prevention in the early 2000s, when “rudimentary tools were pursued with zeal and passion,” and frontline communities were mobilised to disseminate information along with essential commodities, such as condoms, in order to highlight what he described as the “weak, scattered and insufficiently-scaled” condom programming we see today.
When compared to the impact these early interventions had, curbing new infections before the advent of effective treatment, it’s clear to see that in recent years we have not capitalised on their full potential.
To modernise our approach to condom programming, we need to go back and find the zeal of the 2000s, but this time targeting our efforts at key populations, where 44% of new infections take place.
For every new generation of young people we need to renew our efforts in promoting condoms.
We also need to look at where we could be doing more to create demand, marketing condoms so that they are appealing, especially for young people.
"For every new generation of young people we need to renew our efforts in promoting condoms to ensure young people can enjoy sex and be free from HIV, STIs and unintended pregnancy," said Daniel Nagel, Youth Against AIDS.
Innovative thinking around condom promotion has been lacking and efforts to reach young people with the condoms they need has not been prioritised. UNAIDS reported that of the 100 countries that had national plans around condoms, only 26 included plans to promote the use of condoms in secondary schools.
The Condomize booth, in the AIDS 2018 Global Village showed us what could be achieved with young, energetic marketing of condoms. Through silent discos, dance-offs, and giving out free headphones and condoms, they were able to inject some much-needed fun into condom promotion, and their constantly crowded booth was proof that finding the right messaging around condoms can make all the difference in the reach and impact they can have.
It’s abundantly clear that innovation and modernisation are needed all along the condom trail. To make serious ground in prevention we need to go back to this all too familiar tool and find ways to bring it to life – and into the modern day. Reimagining our approach to condoms, to make them work for us in the miles that we have to go.