We found that the overall provision of condoms was 4.6 per man per year, which seems low. Another 1.9 billion condoms need to be provided a year for all countries to equal the level of provision of the six highest providing countries.
We may have overestimated the condom gap since we omitted the commercial sector and probably missed some national government and donor support. However, given the resource poor environments in Africa, we believe our rough estimate missed only a small proportion of condoms. The true gap could be considerably larger than our estimate because the need may be larger than 17 condoms per man and the population in Africa is still growing.
How much would it cost to close the 1.9 billion condom gap for sub-Saharan Africa? At the international price of $0.025 per condom, the annual cost would be only $47.5m (£34m). However, as with drugs to treat HIV, the commodity costs are only the beginning. Service delivery costs (including promotion) are a greater challenge. Nevertheless, effective models for delivery are known and much infrastructure is in place or can be scaled up through existing successful mechanisms such as condom social marketing and clinics.2
But health programming of any sort requires concerted effort and resources. Finding ways to promote condom use and other prevention among high transmitting people is particularly important. Experience in Thailand shows such an approach can greatly reduce sexually transmitted infection and HIV.3
Relative to the enormity of the HIV/AIDS pandemic in Africa, providing condoms is cheap and cost effective. All aspects of HIV control are important, but a first priority must be prevention.