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Posted by / 08-Oct-2017 17:45

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Another is that the HIV-positive partner will be chronically infected and so will not have the very high viral load characteristic of acute HIV infection.

Thirdly, in long-term serodiscordant relationships, studies have shown that the HIV-negative partner can acquire a degree of immunity to their partner’s HIV.

For these reasons, HIV transmission within long-term serodiscordant relationships, especially heterosexual ones, may be rarer than it is between casual sex partners.

For all these reasons, large studies may be needed to establish differences in HIV (and HSV and HPV) incidence between condom users and non-users.

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”.

The degree of protection they offer against HIV and STIs is significantly better than any other single prevention method, taken in isolation, other than sexual abstinence or complete mutual monogamy between two people who have tested negative for HIV.

These can be done in individuals whose characteristics are known and can be controlled for, and if the relationship truly is monogamous then infections by acute STIs and from outsiders can be ruled out.

One disadvantage is that condom use in long-term relationships, even in serodiscordant couples, is relatively rare.

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.

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Laboratory studies and product testing have shown that reputable condoms tested in the laboratory are completely impermeable to micro-organisms as small as viruses.