Condoms play a key role in preventing HIV infection around the world. In sub-Saharan Africa, most countries have seen an increase in condom use in recent years. In studies carried out between 2001 and 2005, eight out of eleven countries in sub-Saharan Africa reported an increase in condom use.
The distribution of condoms to countries in sub-Saharan Africa has also increased: in 2004 the number of condoms provided to this region by donors was the equivalent of 10 for every man,8 compared to 4.6 for every man in 2001. In most countries, though, many more condoms are still needed. For instance, in Uganda between 120 and 150 million condoms are required annually, but less than 40 million were provided in 2005.
Relative to the enormity of the HIV/AIDS epidemic in Africa, providing condoms is cheap and cost effective. Even when condoms are available, though, there are still a number of social, cultural and practical factors that may prevent people from using them. In the context of stable partnerships where pregnancy is desired, or where it may be difficult for one partner to suddenly suggest condom use, this option may not be practical.
In many parts of Africa, as elsewhere in the world, the AIDS epidemic is aggravated by social and economic inequalities between men and women. Women and girls commonly face discrimination in terms of access to education, employment, credit, health care, land and inheritance. These factors can all put women in a position where they are particularly vulnerable to HIV infection. In sub-Saharan Africa, around 59% of those living with HIV are female.
In many African countries, sexual relationships are dominated by men, meaning that women cannot always practice safer sex even when they know the risks involved. Attempts are currently being made to develop a microbicide – a cream or gel that can be applied to the vagina, preventing HIV infection – which could be a significant breakthrough in protecting women against HIV. It is likely to be some time before a microbicide is ready for use, though, and even when it is, women will only use it if they have an awareness and understanding of HIV and AIDS. To promote this, a greater emphasis needs to be placed on educating women and girls about AIDS, and adapting education systems to their needs. In some Southern African countries the rate of HIV among 23-24 year old females is far higher than that of 15-17 year old girls. This suggests prevention activities should target women at a young age and ensure they have the knowledge and skills to avoid HIV infection from when they become sexually active.
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