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Another kind of study is to conduct a prospective cohort study, looking at differences in HIV incidence between two groups of people according to their usage of condoms.
This cannot be a randomised controlled study, but participants’ HIV and STI incidence can be related to their condom use either at baseline or preferably (because behaviours change over time) by means of regular questionnaires and monitoring.
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.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.Knowing how well they protect against other STIs is important for sexual health in general and may be particularly important for people with HIV, who may be more vulnerable to the effects of certain STIs.In one of the most highly publicised statements, in October 2003, the President of the Vatican's Pontifical Council for the Family, Cardinal Alfonso Lopez Trujillo, said: "The AIDS virus is roughly 450 times smaller than the spermatozoon.The spermatozoon can easily pass through the 'net' that is formed by the condom.
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”.