Recent epidemiological modeling from Avenir Health and Mann Global Health underscores a definitive conclusion for the global HIV response: Condoms remain the most cost-effective, high-impact primary prevention tool available. Even with ARV based prevention, condoms are still necessary to protect one from other STI's and unplanned pregnancies, highlighting the relevance of condoms even with the advent of PrEP innovations. While biomedical interventions like PrEP and ART are vital, empirical data suggests that any erosion in condom programming threatens to materially reverse decades of progress across sub-Saharan Africa.

Historical evidence and comparative impact

Between 1990 and 2024, the historical scale-up of condom use averted an estimated 100 million HIV infections globally. Within the 13 modeled African countries, condoms currently account for an average of 62% of infections averted relative to primary (non-treatment) prevention interventions including PrEP (15.2%) and VMMC (23.1%).

The foundational role of condom use in diverse epidemic structures across all 13 modeled nations:

Even in mature treatment settings where ART is the primary driver of averted infections, condoms continue to provide the largest share of incremental, non-treatment protection.

Economic evaluation and fiscal sustainability

Funding reductions currently threaten condom supply, yet economic evaluations show that scaling back would be a costly mistake. From a health economics perspective, condom use has been ranked the most cost-effective HIV prevention intervention across multiple countries. As a result of their broad population reach and low unit cost, condoms are heavily cost-saving. This means the lifetime ART costs saved by preventing a single infection through condom use significantly exceed the programmatic investment required.

‍

13-Country Financial Spotlight: When analysing the "cost per DALY (Disability-Adjusted Life Year) averted" over the 2025–2050 period, the financial contrast between condoms and other tools becomes staggering. In every single modeled nation, condom supply and promotion produces net financial savings, whereas alternative primary prevention interventions can cost thousands of dollars per DALY averted:

‍

Projections of usage erosion: The risk of resurgence

The "so what" of this analysis is most visible in the projected impact of declining usage. Modest reductions in condom use are forecast to lead to a disproportionate surge in new infections by 2035, totaling an additional 490,000 infections under a 15% decline scenario, and 900,000 under a 30% decline scenario across the 13 countries. 

Projected, country-specific fallout of a 30% decline in condom usage by 2030:

‍

The risk is profoundly concentrated within high-transmission networks: a 30% decline is projected to increase infections among clients of female sex workers by 59.1% and among key populations by 49.4%

The impending crisis: A call to action on condom shortages

Despite their unmatched cost-effectiveness, current funding reductions severely threaten the global condom supply. In many high-burden countries, these financial cuts are translating directly into commodity shortages on the ground. When supply chains break down and access decreases, usage inevitably drops. The modeling data serves as a stark warning to policymakers: failing to fund a roughly $20-per-year condom program today will inevitably result in overwhelmed health systems tomorrow as countries are forced to absorb the massive, lifelong treatment costs of preventable new HIV infections.

Translating this evidence into action requires immediate advocacy to address these looming shortages. To prevent a massive resurgence of the epidemic, governments, donors, and stakeholders must prioritise:

• Restoring critical funding for HIV prevention
• Protecting long-term treatment budgets
• Investing in condom supply and demand generation
• Advocating for "triple protection" against HIV, other STIs, and unintended pregnancies

Conclusion

The data clarifies that condom programming is not a legacy strategy but a fiscal and public health necessity. Treatment scale-up, while essential in reducing new HIV infections, cannot fully offset the impact of decreased condom use. This limitation highlights the need for low-cost and financially sustainable HIV prevention tools that include condom supply alongside ART and PrEP. Strategic investment in condom supply, demand generation, and promotion is essential to protect long-term treatment budgets and maintain impact. Sustaining condom demand and supply isn't just a historical victory; it is a future imperative to maintain epidemic control.