Background: What interventions will be most effective in improving condom use and thus preventing STDs including HIV? This is an important health policy question for governments throughout the world, and one that is currently being asked in South Africa. Although the efficacy of consistent and correct condom use in preventing the spread of HIV and other STDs has been well-demonstrated rates of condom use are still low in most parts of the world. Researchers, programmers and policy-makers alike are searching for cost-effective ways of promoting condom use. The objective of this review is to assess the effects of alternative condom promotion strategies, with particular attention to comparing: interventions that focus on improving condom use as their main goal, versus those that seek to address STD/HIV prevention by focussing on a range of preventive behaviours or as part of a broader intervention package; interventions that are based on psycho-social theory; interventions that address gender power relations and skills training; and interventions which are peer-led .

Methods: Included will be randomised controlled trials that compare two alternative condom promotion strategies and randomised controlled trials that compare one condom promotion strategy with a control (i.e., no condom promotion strategy). Studies that include the following study participants will be included in the review: 'general' populations, including adolescents; sexually-transmitted disease patients; drug users, including IV drug users as well as other drug-using populations; commercial sex workers (male and female); sexually-active homosexual populations. The interventions will include those focussing on directly on changing individual behaviours, such as health education or voluntary testing and counselling. In addition, interventions may focus on changing individual behaviour by changing social norms, or by some other social intervention. Examples of the latter include the use of opinion leaders, social learning strategies, peer educators, social marketing strategies, improving condom accessibility and legislative interventions (such as mandating condom use among sex workers). Only trials that include a measure of condom-related knowledge, attitudes or practices will be reviewed. The following outcomes will be included in the systematic review, if they are included in the trial: reported condom use; knowledge about condoms (both self-reported and tested); attitudes towards condoms (both self-reported and tested); condom acquisition/procurement; intention to use condoms; negotiation skills around condom use (both self-reported and tested); use of condom for dual protection against STDs and pregnancy; changes on other STD risk-related practices; incidence of STD/HIV; and comparative costs of interventions.

Results: The review has been submitted as a protocol (May 1998) to the Cochrane Collaborative Review Group on HIV Infection and AIDS. Preliminary results will be presented in the poster as available.

Conclusions: Although only in the protocol stage at present, when completed this review may provide important insights into the characteristics of effective interventions to promote condom