Hearst Norman, Chen Sanny
University of California, Box 0900, 500 Parnassus Avenue MU3E, San Francisco, CA 94143, USA.
Stud Fam Plann. 2004 Mar;35(1):39-47. doi: 10.1111/j.1728-4465.2004.00004.x.
Two decades of experience and research provide new insights into the role of condoms for AIDS prevention in the developing world. This literature review and synthesis is based on computerized searches of the scientific literature and review of conference presentations, publications of national and international organizations, and popular media. Condoms are about 90 percent effective for preventing HIV transmission, and their use has grown rapidly in many countries. Condoms have produced substantial benefit in countries like Thailand, where both transmission and condom promotion are concentrated in the area of commercial sex. The public health benefit of condom promotion in settings with widespread heterosexual transmission, however, remains unestablished. In countries like Uganda that have curbed generalized epidemics, reducing the number of individuals' sex partners appears to have been more important than promoting the use of condoms. Other countries continue to have high rates of HIV transmission despite high reported rates of condom use among the sexually active. The impact of condoms may be limited by inconsistent use, low use among those at highest risk, and negative interactions with other strategies. Recommendations include increased condom promotion for groups at high risk, more rigorous measurement of the impact of condom promotion, and more research on how best to integrate condom promotion with other prevention strategies.
二十年的经验与研究为避孕套在发展中国家预防艾滋病方面的作用提供了新的见解。这篇文献综述与综合分析基于对科学文献的计算机检索以及对会议报告、国家和国际组织出版物及大众媒体的审查。避孕套预防艾滋病毒传播的有效率约为90%，其使用在许多国家迅速增加。在泰国等国家，避孕套已产生了巨大益处，在泰国，传播和避孕套推广都集中在商业性交易领域。然而，在异性传播广泛的环境中推广避孕套对公共卫生的益处仍未得到证实。在乌干达等控制了广泛流行的国家，减少个体性伴侣数量似乎比推广避孕套使用更为重要。尽管据报告性活跃人群中避孕套使用率很高，但其他国家的艾滋病毒传播率仍然很高。避孕套的影响可能因使用不一致、高危人群中使用率低以及与其他策略的负面相互作用而受到限制。建议包括加大对高危群体的避孕套推广力度、更严格地衡量避孕套推广的影响，以及更多地研究如何最好地将避孕套推广与其他预防策略相结合。
