Condom effectiveness in reducing heterosexual HIV transmission: a systematic review and meta-analysis of studies on HIV serodiscordant couples.
OBJECTIVE
This systematic review and meta-analysis aimed to reassess the effectiveness of condoms in reducing heterosexual transmission of HIV.


METHODS
Medline, Scopus, and the ISI Web of Science databases were searched up to June 2014. Eligible studies were synthesized using random-effects models.


RESULTS
Twenty-five studies with 10,676 HIV serodiscordant heterosexual couples were analyzed. The risk of HIV transmission was considerably lower among couples that were always using condoms compared to never-users (RR: 0.29, 95% CI: 0.20-0.43) or inconsistent users (RR:  0.23, 0.13-0.40). The protective effect was slightly higher when the male rather than the female partner was infected (RR: 0.31, 0.20-0.48; vs. RR: 0.44, 0.24-0.80), and very high in Asian settings (RR: 0.06, 0.01-0.46).


CONCLUSIONS
Though imperfect, condoms reduce HIV transmission by more than 70% when used consistently by HIV serodiscordant heterosexual couples. Social, cultural and biological differences need to be studied further to inform projection modelers and policy makers.
a Department of Hygiene, Epidemiology and Medical Statistics, Medical School , University of Athens , Athens , Greece.|b HIV & STIs Office, Hellenic Centre for Disease Control and Prevention , Athens , Greece.
Foteini K
FK
Giannou
b HIV & STIs Office, Hellenic Centre for Disease Control and Prevention , Athens , Greece.
Chrissa G
CG
Tsiara
a Department of Hygiene, Epidemiology and Medical Statistics, Medical School , University of Athens , Athens , Greece.|b HIV & STIs Office, Hellenic Centre for Disease Control and Prevention , Athens , Greece.
Georgios K
GK
Nikolopoulos
c Postgraduate Program in Healthcare Management , Open University of Cyprus , Nicosia , Cyprus.
Michael
M
Talias
a Department of Hygiene, Epidemiology and Medical Statistics, Medical School , University of Athens , Athens , Greece.
Vasiliki
V
Benetou
a Department of Hygiene, Epidemiology and Medical Statistics, Medical School , University of Athens , Athens , Greece.
Maria
M
Kantzanou
Stefanos
S
Bonovas
a Department of Hygiene, Epidemiology and Medical Statistics, Medical School , University of Athens , Athens , Greece.
Angelos
A
Hatzakis
D017280:Condoms / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D020010:Heterosexuality; D006801:Humans; D008297:Male; D012747:Sexual Partners
HIV; condom effectiveness; heterosexual transmission; meta-analysis; prevention; serodiscordant couples; systematic review