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These are based upon observations of their use in contraception: studies have shown that 98% of women relying on condoms as their sole form of contraception remain pregnancy free if condoms are used perfectly, meaning that they are used consistently and correctly at every act of sexual intercourse.
However, because they are not always used correctly even if they are used consistently, studies have found efficacy rates of 85 to 87% when young women use condoms as their sole form of contraception.
(See the text of Museveni’s speech.) Museveni later complained of being misunderstood and signed an article in The Lancet saying that condoms formed a valuable part of HIV prevention.
Moral questions about condom use are not within the remit of this resource, but questions of fact are, and condoms’ ability to stop HIV is periodically questioned by people opposed to their use on religious or moral grounds.
The degree of protection they offer against HIV and STIs is significantly better than any other single prevention method, taken in isolation, other than sexual abstinence or complete mutual monogamy between two people who have tested negative for HIV.
Despite this, the use and promotion of condoms continue to be targets for controversy and criticism, and sexual abstinence and monogamy are often promoted as superior alternatives.
Studies of condom efficacy have therefore largely contrasted HIV and STI incidence or prevalence in people who claim 100% consistent use against people who use them inconsistently or not at all.One disadvantage is that condom use in long-term relationships, even in serodiscordant couples, is relatively rare.Another is that the HIV-positive partner will be chronically infected and so will not have the very high viral load characteristic of acute HIV infection.Twenty years later, 51 to 66% of women taking part in a microbicide study reported 100% condom usage at different time points during the trial, but the researchers calculated from inconsistency in their answers that the actual proportion who maintained 100% condom use was 25%.Women were much less likely to report inconsistent use of condoms than never using them: over the course of the study, 46% of women said they used condoms ‘always’, 48% ’never’ and only 6% ’sometimes’.
For the reasons described above, there is a convention to use two different words when describing the effect of prevention interventions.