DREAMS Ambassador sensitizes her male peers about the female condom during the PEPFAR HIV-Music Festival Lira District, Uganda Sept 10, 2016. DREAMS is supported by USAID/SDS Program and implemented by Cardno Emerging Markets USA Ltd.
Photo Credit: USAID/SDS Program
Per World Health Organization recommendations, condoms should be provided as part of a package of comprehensive life-saving prevention services that include pre-exposure prophylaxis (PrEP), voluntary medical male circumcision (VMCC), and structural interventions that aim to reduce vulnerability to HIV infection. Condoms are key to a successful combination HIV prevention approach and remain a cost-effective tool and to date, the only multi-purpose tool for preventing HIV, other sexually transmitted infections and unintended pregnancies. While no barrier method is 100 percent effective, correct and consistent use of male and female condoms can greatly reduce the risk of acquisition and transmission of HIV, sexually transmitted infections and unintended pregnancies. Consistent condom use is dependent on a reliable, widely available, and accessible supply of condoms. Social and behavior change programs are also necessary to create demand for correct and consistent condom usage. In many countries, condom supplies have been inconsistent and condom promotional efforts have been insufficient.
Declining support for condom procurement and programming, compounded by a decreased focus on condom demand generation and weak stewardship of condom programs over the past decade has led to lower use of condoms, especially in sub-Saharan Africa. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2020 global report, condom use at last higher risk sex by young women (aged 15-24) declined in five countries in West and Central Africa (Benin, Ghana, Guinea, Mali, and Nigeria) and three countries in East and Southern Africa (Ethiopia, Uganda, and Zambia), and condom use at higher risk sex among men (aged 15-49) also declined in five out of nine countries (compared to the previous survey). Additionally, 59 (out of 83) reporting countries did not achieve 90 percent coverage of condom use at last sex among sex workers in 2021.
Condoms and personal lubricants play an important role within USAID’s HIV prevention, care, and treatment efforts, and their promotion and distribution are most effective when integrated with other services as part of an informed choice and client-centered approach to prevention.
USAID’s condom programming under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is strategically integrated into:
- HIV testing services
- Care and treatment
- Programs to engage men
- Key population service delivery interventions, and
- Other community interventions
USAID assists countries in creating and implementing national condom strategies that address key supply and demand issues related to increasing condom use. It employs a total market approach to condom programming that engages the public sector for free condoms, social marketing sector for subsidized condoms, and commercial sector for regular priced condoms. This approach supports increased sustainability by reducing reliance on donor subsidies and increases host-country ownership of and oversight for condom programming.
Globally, USAID condom programming emphasizes key interventions related to strengthening condom supply, increasing demand, and improving use. These include:
- Procuring low-cost male and female condoms and lubricants for government and nongovernmental condom distribution programs in lower- and middle-income countries to ensure equitable access to products among key and priority populations and low-income groups;
- Providing individualized technical assistance to improve forecasting, supply planning, and distribution systems for condoms and lubricants through the USAID Global Health Supply Chain Procurement and Supply Management (GHSC-PSM) project;
- Providing support to governments for increased sustainability and greater stewardship, leadership, coordination, and management of condom programs, including through the development of national strategies and policies that create a supportive context for condom and lubricant distribution and promotion within the public and private sectors;
- Improving access to affordable and accessible male and female condoms and lubricants through condom social marketing projects;
- Creating demand for male and female condoms through evidence-based social and behavior change programs targeting specific populations; and,
- Coordinating with other global donors on condom supply and programming to ensure adequate and uninterrupted condom supplies in relevant countries, including the UNAIDS’ Global HIV Prevention Coalition, the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund), and the United Nations Population Fund.
In FY 2022, USAID provided the following commodities to 30 countries in Africa, Asia, and/or Latin America and the Caribbean using PEPFAR funds:
- 486 million male condoms
- 4.2 million female condoms
- 22.7 million sachets of lubricants
Central Condom Fund
USAID procures male and female condoms and/or lubricants for Africa, Asia, and/or Latin America and the Caribbean using PEPFAR and family planning funds. Since FY 2020, PEPFAR has focused Central Condom Fund support to select countries with the intention of transitioning greater responsibility of procurement of condoms and lubricants to host-country governments and/or the Global Fund. Condoms are provided at no cost, enabling countries to make condoms available to individuals for free or at highly subsidized prices. There is also limited funding available on a first-come, first-served basis to cover unexpected or emergency condom and/or lubricant requests from PEPFAR-supported countries.
USAID Technical Briefs:
- USAID Condom Fact Sheet and Supplemental Technical Information on Condoms
- USAID Technical Issue Brief: The Female Condom is Safe and Effective
- USAID Technical Issue Brief: Condom Use - How it Relates to HIV and STI Prevention
Condom Supply Chain and Programming Tools:
- Male Latex Condom: Specification, Prequalification, and Guidelines for Procurement
- Use and Procurement of Additional Lubricants for Male and Female Condoms: Advisory Note
- WHO/UNFPA Prequalification Programme for Male Latex Condoms
- WHO/UNFPA Prequalification Programme for Female Condoms
- Condom Needs and Resource Requirement Estimation Tool Comprehensive Condom Programming: A Guide for Resource Mobilization and Country Programming