More people using family planning need to know about the added benefit of condoms — as an effective barrier against infection — in order to make an informed, free choice on their personal contraceptive method, say the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Population Fund (UNFPA). For those millions of women who already use effective family planning other than condoms, this may mean adding condom use to their chosen family planning method.

These United Nations agencies urge that more reproductive health counsellors clearly communicate to their clients that many excellent contraceptive methods do not offer any protection whatsoever against sexually transmitted infections. The promotion of condoms as both family planning and protection against infection for those who need it should be ensured in all family planning programmes.

"The successes of family planning programmes in reducing unwanted pregnancies have unfortunately not been matched by a reduction in sexually transmitted infections (STIs), which are on the rise throughout the world," said Dr Gro Harlem Brundtland, Director-General of WHO.

Currently, more than 340 million curable STIs occur each year. To that number can be added many million more currently incurable viral STIs, including more than 5 million HIV infections each year.

Male and female condoms are the only family planning methods currently available which provide dual protection, when used consistently and correctly.

Dual protection may be particularly important for certain individuals:

• sexually active young people;
• men and women (and their partners) who have high-risk sexual behaviour;
• sexually active people in settings with a high prevalence of HIV and other STIs;
• sex workers and their clients; and
• those who already have HIV or an STI, and their partners.

WHO and its partners recommend a number of remedial measures to promote the condom. Among them, family planning and STI/HIV prevention services need to be better integrated. Service providers and counsellors need to be trained about dual protection, so they can inform clients and promote dual protection when needed.

Many family planning counsellors, concerned about incorrect and inconsistent use of condoms, favour and promote other contraceptive methods. One study found that only 12% of new family planning clients in Kenya and only 7% in Zimbabwe heard about the condom and its unique advantage in protecting against STI/HIV.

Even informed women may not persist with condom use. After the initial stages of a relationship, some women who use, for instance, both a hormonal contraceptive and a condom, no longer insist on a partner’s condom use. In so doing they became vulnerable to infections.

In promoting dual protection, a special effort needs to be made to reach out to and educate:

• men, the traditional condom users, and
• young people, especially those aged 15-24 who account for half of all newly acquired HIV infections

As men are not the usual users of family planning services, creative ways of reaching them to convey the dual importance of condoms will need to be used, such as sporting events and through the media.

The female condom may also be helpful in protecting against both infection and unplanned pregnancy but its price, nearly 10 times that of male condoms, and lack of availability have limited its use. In order to ultimately empower women, research is needed on ways to make the female condom more accessible and affordable, as well as to develop female-controlled microbicides.

A greater array of products offering dual protection is clearly needed, but for now significantly more attention and promotion of the one effective dual protection method currently available, the male condom, is strongly urged in family planning clinics.