Amid all the dire warnings about the AIDS pandemic, researchers announce some good news: Young African women report they are increasingly using condoms with their partners.
The study, published in the British journal The Lancet, analyzed data in 18 African countries from 1993 to 2001, looking at changes in the sexual behaviour of 132,800 women, 15 to 24 years old.
'You might get more impact for your dollar in aligning condom use with contraception than disease prevention.' -Study author John Cleland, London's School of Hygiene and Tropical Medicine
While abstinence rates changed little, the study found that condom use more than tripled, from 5.3 per cent in 1993 to 18.8 per cent in 2001, with a median yearly increase of 1.4 per cent.
"It's not rapid enough, but if that increase continues or even accelerates, it's bound to make a dent on HIV transmission," said John Cleland, a professor at London's School of Hygiene and Tropical Medicine who conducted the study along with Dr. Mohamed Ali of the World Health Organization.
Women make up 60 per cent of adults infected with HIV in sub-Saharan Africa, according to UNAIDS.
AIDS workers have long been concerned that Africans were slow to change their sexual habits, making it difficult to control the epidemic on the continent. But Cleland and Ali showed condom use has increased at about the same rate at which contraceptive practices were adopted by married couples in developing countries from 1965 to 1998.
Dr. Kevin O'Reilley, an HIV prevention expert at the WHO, said progress may be slow, but is being made at an appreciable rate. "It's not as desperate as people are painting it to be," he said.
O'Reilly was not connected to the study.
Three-pronged prevention strategy
The study found the use of condoms might be further accelerated by linking them to family planning, since 60 per cent of single women in Africa use a condom to avoid pregnancy.
"You might get more impact for your dollar in aligning condom use with contraception than disease prevention," said Cleland.
For Vivian Anichebe, 23, of Lagos, Nigeria, using a condom is less about HIV than about preventing pregnancy. "We do use condoms," Anichebe said of her relationship with her boyfriend. "But it's so I don't have a baby."
Another student in Lagos, Princess Chukwuma, said using a condom is like an insurance policy. "You don't know about men," the 24-year-old said. "Maybe they go with other girls behind your back and you can't tell."
The researchers did not comment on the politically charged issue of condom distribution in AIDS control strategies. But Dr. Paul Zeitz, executive director of the Washington-based Global AIDS alliance, said the study provides evidence that the U.S. AIDS program has been misdirected.
Critics say the U.S. program has shifted emphasis from condoms toward abstinence and fidelity, especially among the young. U.S. officials say their three-pronged HIV-prevention strategy, emphasizing abstinence, fidelity and condom use, offers people the best options to protect themselves.
"The data are clear that you need all three components," said Dr. Mark Dybul, the U.S. deputy global AIDS coordinator in Washington. He said the U.S. will ship 486 million condoms worldwide this year, nearly triple the number in 2001.
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