Clinical Scenario A 25-year-old m...

Clinical Scenario

A 25-year-old man reports having multiple female sexual partners. He asks by what means effective condoms are in preventing human immunodeficiency virus (HIV) infection.

Clinical Question

in what manner effective are male condoms in reducing heterosexual HIV transmission?

Evidence-Based Answer

Evidence indicates that male condoms abridge the risk of heterosexual HIV transmission on 80 percent.

Practice Pointers

Programs for the prevention of HIV infection prefer and measure condom use as an important ingredient of HIV risk-reduction behavior. (2-4) any experts suggest that condoms may form HIV infection risk by as often as 90 percent, (2) and the Center for Disease curb and Prevention states that "latex condoms, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV...." (5) Because effectiveness of condoms for HIV infection the amplitude to which male condoms interrupt transmission of HIV.

The review reports HIV transmission rates by 100 person-years; these results intimate that of 100 heterosexually active, HIV-serodiscordant ties who do not use condoms, there would be five to seven of recent origin cases of HIV each year, and that if those same twos always used condoms, there would be merely one new case each year. Therefore, condom use appears to provide 78 to 83 percent relative reduction in the risk of heterosexual HIV transmission.

Because these data ensue from multiple studies and different populations, they must be interpreted with caution. The "never users" appear to have more baseline HIV infection risk factors than the "always users" and may be at higher risk for having multiple partners. Comparing them with a lower risk assign places to of "always users" may have given an artificially high estimate of risk reduction. Although the actual magnitude of HIV infection risk reduction from condom use for heterosexual intercourse likely will vary based upon other risk factors and behaviors, the best evidence to date indicates that condom use decreases the risk of heterosexual HIV transmission by way of approximately 80 percent. Educating patients about this 80 percent risk reduction may help them understand more clearly to what extent effective, even though imperfect, condoms are in protection against HIV transmission.

REFERENCES

(1) Weller s Davis K. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev 2004;2:CD003255

(2) Hearst N Chen s Condom promotion for AIDS prevention in the developing world: is it working? button Fam Plann 2004;35:39-47.

(3) Morisky DE Ang A, Coly A, Tiglao TV A example HIV/AIDS risk reduction programme in the Philippines: a comprehensive community-based approach by the and of participatory action research. Health Promot Int 2004;19:69-76

(4) Allen s Meinzen-Derr J, Kautzman M, Zulu I, Trask s Fideli U, et al. Sexual behavior of HIV discordant man and wifes after HIV counseling and testing. AIDS 2003;17:733-40

(5) Center for Disease direction and Prevention. Male latex condoms and sexually transmitted diseases. Accessed online June 4 2004 at: http://www.cdc.gov/nchstp/od/latex.htm.

WILLIAM E CAYLEY, JR MD M.DIV., is assistant professor at the University of Wisconsin Eau Claire Family Practice Residency Program.

Address correspondence to William E Cayley, Jr MD M.Div., University of Wisconsin Eau Claire Family Practice Residency, 807 s Farwell, Eau Claire, WI 54701 (e-mail: bcayley@yahoo.com). Reprints are not available from the author.

This clinical satisfied conforms to AAFP criteria for evidence-based continuing medical education (EB CME) EB CME is clinical satisfied presented with practice recommendations supported by way of evidence that has been systematically reviewed on an AAFP-approved source. The practice recommendations in this activity are available online at http://www.cochrane.org/cochrane/revabstr/AB003255.htm.

The Cochrane Abstract below is a summary of a review from the Cochrane Library. It is accompanied by the agency of an interpretation that will help clinicians deposit evidence into practice. William E Cayley, Jr MD M.Div., existings a clinical scenario and question based onward the Cochrane Abstract, along with the evidence-based answer and a glutted critique of the abstract.

RELATED ARTICLE: Cochrane Abstract.

Background. The amount of protection that condoms provide against transmission of HIV and other sexually transmitted infections is unknown. Cohort studies of sexually active, HIV-serodiscordant man and wifes with follow-up of the seronegative partner provide a situation in which a seronegative partner has known prospect to the disease, and disease incidence can be estimated. When an persons use condoms 100 percent of the time and an never use condoms, condom effectiveness can be estimated from comparing the infection incidence rates. Condom effectiveness is the proportionate reduction in disease as a come of condom use.

Objectives. The objective of this review is to estimate condom effectiveness in reducing heterosexual transmission of HIV.