Behavioural Interventions to Promote Condom Use among Women Living with HIV

"In this review, behavioral interventions to promote condom use and/or modify risky sexual behaviours among women living with HIV failed to demonstrate any positive effects on behaviour change in favour of consistent condom use during intercourse."

This document is a commentary on the Cochrane review, which assesses the effectiveness of interventions focused on HIV-positive women to increase their motivation, skills, and ability to use condoms during sexual intercourse. It is written for the World Health Organisation (WHO) Reproductive Health Library. [Footnotes have been removed throughout by the editor.]

As stated here, antiretroviral therapy (ART) has shown a reduction in HIV transmission in serodiscordant couples. "However, to date reducing heterosexual transmission of HIV infection through universal testing and ART treatment remains an unattainable expectation because of stigma, insufficient human and financial resources and lack of health-care infrastructure in the most affected parts of the world." Because studies show that women report unprotected sex more frequently than men, the female condom is the one tool under the control of women - thus, spurring the review of intervention effectiveness.

Using a combination of terms applicable search terms and specific research standards, Cochrane review authors found five studies, which together involved a total of 725 women, that met the review criteria. Not one found a significant positive effect or trend towards a positive effect on consistent condom use from these 5 interventions. In the analysis, both by the Cochrane study authors and this author, the sample size was recognised as too small for meta-analysis, suggesting that more research is needed.

The author analyses underlying reasons for lack of intervention success, citing disclosure between sexual partners as affected by stigma and fear of rejection. Thus, the commentary suggests that "individual women living with HIV might have specific needs according to their age, partnership status (not yet in partnership, married or separated, transactional sex), economic independence, reproductive intentions, etc." In addition, prevention methods such as medical male circumcision and tenofovir vaginal gel (not yet marketed as of the writing of the commentary) only prevent HIV acquisition. Once one partner is HIV-positive, condoms are the only method available for protection. Therefore, the review concludes that "[t]he challenge for behavioral researchers is to conduct studies with focused interventions and well-defined precise objectives in specific subgroups of women. Further studies on the benefits to HIV-positive women of female condom use are also needed."