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Research early on in the epidemic showed that 40 to 70% of men who claimed they use condoms 100% of the time in fact did not use them for every act of intercourse.

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%.

The next problem is deciding what kind of study provides truly reliable evidence.

It would be unethical to mount a randomised trial of condom use because the control group would have to stop using them altogether.

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.

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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.

Therefore questions of condom efficacy have to be addressed and misapprehensions corrected.

One widely quoted remark of this nature came from Ugandan President Yoweri Museveni who, at the Fifteenth International AIDS Conference in Bangkok in 2004, advocated for HIV prevention based on “optimal relationships based on love and trust instead of institutionalised mistrust, which is what the condom is all about…I think of condoms as an improvisation, not a solution”.

(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.

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