Consistent Condom Use Significantly Reduces Risk of New HIV Infection

New research finds that consistent condom use can reduce the rate of HIV transmission by 91% (95% CI 69-101) per HIV-positive partner among men who have sex with men (MSM).

The study affirms the importance of condoms in HIV prevention strategies and suggests that condom use might be even more effective than previously thought.

Wayne D. Johnson, PhD, MSPH, of the US Centers for Disease Control and Prevention’s Division of HIV/AIDS Prevention, said part of the condom study’s significance is simply that it was done in the first place. He said studies on condom use have been rare and told MD Magazine® there are several probable reasons for the dearth of research, including the fact that latex has long been known to be an effective barrier against sexually transmitted disease pathogens and HIV.

“Also, it is hard to study condoms in an era of multiple prevention options—few people use just one option,” said Johnson, the study’s lead author. “And even when there were fewer prevention options, tracking consistent and correct condom use, a private behavior, has always been challenging.”

In this case, Johnson and colleagues looked at 4 studies of MSM conducted between 1993 and 2003. They analyzed the data to track the impact of no condom use, consistent condom use, and intermittent condom use on infection rates among men who had anal sex with HIV-positive partners.

The results indicated condoms are 91% effective, and thus have a 9% failure rate. Those numbers are better than the 70% effectiveness rate among MSM reported in a 2015 study. The new study had a larger data set.

While his study affirms—and strengthens—the case that condoms are an important HIV-prevention tool, Johnson said general practitioners should not forget that condoms need to be used correctly and consistently in order to be effective.

“The number of different partners for condomless sex is also important, particularly partners who may have HIV,” he said. “More partners means a greater chance of having a more infectious partner (presumably due to higher viral load).”

Johnson added that physicians need to speak with patients about testing and offer antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) when appropriate.

Though the range of tools available to prevent or lessen the odds of HIV infection has grown, Johnson said one of the strengths of condoms is that they are low-tech and relatively ubiquitous. “They are easy to obtain (no prescription required) and many people have made them a standard part of their sexual practices,” he said.

He said combining PrEP with condom use creates an even lower risk of HIV transmission and noted that condoms prevent more than just HIV.

“CDC’s PrEP guidelines recommend condom use with PrEP,” he said. “Although PrEP is effective at reducing the risk of getting HIV, it does not reduce the risk of getting STDs.”

The study, “Per-partner condom effectiveness against HIV for men who have sex with men,” was published this month in AIDS.