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Seminar on Taking Stock of the Condom in the Era of HIV/AIDS

Gaborone, Botswana, 13-17 July, 2003

Organized by the IUSSP Committee on Reproductive Health
in collaboration with The Department of Population Studies, university of Botswana

Scientific Organiser for this seminar:
Gigi Santow GSantow@bigpond.net.au

Call for papers

Note: This is a revised Call for Papers, the original meeting planned for October 2002 having been postponed for administrative and logistical reasons until July 2003. People who submitted abstracts or papers in response to the earlier call are invited to re-submit them, bearing in mind the new deadline given at the foot of this announcement.

Although it was originally designed to prevent infection rather than pregnancy, in the middle of the nineteenth century the condom began to assume a major role as a means of contraception: indeed, it was instrumental in the fertility declines of the late nineteenth century. The condom retained its contraceptive role for many decades, Himes dubbing it in the mid-1930s "the most important contraceptive of our day". But with the advent in the 1960s of the great coitus-independent "female" methods, the pill and the IuD, the condom lost popularity throughout the industrialized world as a routine, long-term method of contraception, except in Japan.

The choice of the condom for routine contraception is even rarer outside the industrialized countries. The uN estimates that 14 per cent of married couples in the more developed regions rely on the condom (a prevalence heavily weighted by Japan) but only two per cent of couples in the less developed regions in general, and one per cent of couples in Africa.

The emergence of HIV/AIDS in the 1980s, and the virus’s rapid spread to create the epidemic of today, have once again brought the condom into centre stage as the primary means of preventing disease transmission through sexual contact. Nevertheless, despite concerted efforts to the contrary, the condom is grossly under-used, and especially in those regions where the need for it is greatest. In sub-Saharan Africa, condom use with perceivably "risky" sexual partners such as casual partners and prostitutes is undoubtedly more common than with a spouse or other stable or regular partner, but this does not allay concern because the HIV epidemic in that region has now engulfed the general population.

The first seminar of the new reproductive health committee aims to take stock of the condom in the era of HIV/AIDS. We are interested not just in looking at the present situation but in learning from the past, and therefore welcome historical case studies as well as contemporary accounts of condom use for either contraception or disease prevention, or both. Given that the poorest region in the world - sub-Saharan Africa - exhibits both the least condom use and the worst AIDS epidemic, we are mindful of the role that poverty may play in restricting people’s choices. We focus primarily on the male condom but are also interested in the female condom, and our approach is broadly empirical.

The seminar will be based around the following four themes. Depending on the submissions we receive, there may also be a session devoted to case studies from Southern and Eastern Africa, with a special focus on Botswana.

1. Condom use for pregnancy prevention

Who used the contraceptive condom in the past, and who uses it today?

How effective should condoms be as contraceptives, how efficient are they in practice, and what causes the difference?

Can one reconcile contraceptive failure rates during one year (or one month) of typical use, which is how the contraceptive condom is generally assessed, with estimated per-coitus probabilities of slippage and breakage?

What can we learn from past or present condom "success" stories, measuring success in terms of efficiency of use, prevalence of use, or continuation of use? What can we learn from past or present condom "failure" stories?

2. Condom use for disease prevention

How much did condom use contribute to the past curtailment of epidemics of sexually transmitted diseases?

What are current population prevalences of condom use, and who are the users? What proportions of sexual acts are protected by condom use, and who are the users?

What do we know about the effectiveness of condoms for preventing disease transmission? Can one use data such as the per-coitus probabilities of conception and of disease transmission (various STDs and HIV), with and without condom use, to model the disease-specific effectiveness of the prophylactic condom?

Does poverty play a role in restricting access to condoms? Where condoms are readily available does poverty still play a role because it prevents women from insisting that a condom be used?

Where are the contemporary "success" stories of condom use for the prevention of the transmission of disease, particularly of HIV, and what explains such success? Where are the contemporary "failure" stories, and what explains such failure?

Are we making good use of existing data?

3. Removing barriers to condom use

What are the most significant barriers to condom use, distinguishing between the contraceptive condom and the prophylactic condom? How do these barriers vary from society to society? How important is poverty as a barrier to use, and in which circumstances?

Are there different barriers to continuing use than adopting the condom in the first place? Are there different barriers to consistent use?

How does one promote condom use among people who are at high risk of contracting HIV but who do not wish to restrict their fertility?

How important for condom promotion are technical improvements designed to reduce the condom’s interference with sexual pleasure?

How important are beliefs about the condom’s side effects and its effectiveness? How important are beliefs about disease transmission? How important are religious or cultural beliefs and proscriptions? How important is the input of government and health officials? What is the role of advertising, the press, and PUBLIC debate? What is the role of poverty?

4. Intervention strategies

What are the characteristics of successful intervention strategies for promoting condom use for disease prevention, measuring success in terms of efficiency of use, prevalence of use, or continuation of use? What are the characteristics of unsuccessful strategies?

In designing programmes to promote condom use for disease prevention can we draw any lessons from the decades-long experience - both positive and negative - of family-planning programmes? Can we draw any lessons from PUBLIC-health efforts to control and prevent infectious diseases in general and sexually-transmitted diseases in particular?

To what extent have intervention strategies been hampered by a waning of interest from rich countries where AIDS has come to be seen as a disease of the poor, or of poor countries such as those of sub-Saharan Africa? What can be done?

Complete papers or abstracts and a brief (less than one page) curriculum vitae should be submitted to the organizer no later than December 31st 2002. Final decisions regarding acceptance will be made by January 31st 2003. Completed papers for accepted abstracts should be sent to the organizer no later than May 15th, 2003.

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