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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.

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.

Consistently used condoms provide significant protection against HIV, pregnancy and sexually transmitted infections (STIs).

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 margins of uncertainty...should represent an obligation on the part of the health ministries and all these campaigns to act in the same way as they do with regard to cigarettes, which they state to be a danger." Finding out the degree to which condoms protect against HIV is important both for HIV-negative people who want to protect themselves against HIV, and HIV-positive people who want to avoid transmitting it.

Therefore questions of condom efficacy have to be addressed and misapprehensions corrected.

The main findings of studies we look at in more detail below are as follows: These degrees of protection may be lower than some readers expect, and rates of 98% reliability are still sometimes quoted for condoms.

These are based upon observations of their use in contraception: studies have shown that 98% of women relying on condoms as their sole form of contraception remain pregnancy free if condoms are used perfectly, meaning that they are used consistently and correctly at every act of sexual intercourse.

In these circumstances, it is easy to see why condoms sometimes fail, even in consistent users.

In addition, however, people are not consistent in their use of condoms, and may not even be consistent when they claim to be, or think they are.

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