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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.
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%.
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.
The efficacy of an intervention is how well it works in a scientific trial or when people use it as indicated, i.e.
The spermatozoon can easily pass through the 'net' that is formed by the condom.
The evidence we have is based on three types of trials, and each has potential weaknesses.
For efficacy against HIV and other chronic STIs, studies of the incidence of HIV (or HSV or HPV) in monogamous serodiscordant couples provides the best evidence.
Women were much less likely to report inconsistent use of condoms than never using them: over the course of the study, 46% of women said they used condoms ‘always’, 48% ’never’ and only 6% ’sometimes’.
For the reasons described above, there is a convention to use two different words when describing the effect of prevention interventions.