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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”.(See the text of Museveni’s speech.) Museveni later complained of being misunderstood and signed an article in The Lancet saying that condoms formed a valuable part of HIV prevention.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.

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.

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

However, the same studies show that condoms come off the penis altogether 3 to 5% of the time but may slip down (but not off) up to 13% of the time.

Studies of condom efficacy have therefore largely contrasted HIV and STI incidence or prevalence in people who claim 100% consistent use against people who use them inconsistently or not at all.

Because these studies involve private behaviours that investigators cannot observe directly, it is difficult to determine accurately whether an individual is a condom user and whether condoms are used consistently and correctly.

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