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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Saturday, January 11, 2003

    Condom Capers:

    If I could be the “condom queen” and get every young person who engaged in sex to use a condom in the United States, I would wear a crown on my head with a condom on it! I would!
    -Joycelyn Elders former Surgeon General of the United States. As quoted in the New York Times Magazine, January 30, 1994.

    The difficulties of compliance with condom use, even in a cohort of research subjects, should make us pause and think about crusades for the supremacy of the condom in preventing the transmission of HIV.
    - editorial in the New England Journal of Medicine commenting on the paper that has been used to buttress condoms as the linchpin of safe sex practices, August 1994.

    Writing in the New York Times yesterday, Nicholas Kristof said that there is a secret war on condoms:

    Over the last few years conservative groups in President Bush's support base have declared war on condoms, in a campaign that is downright weird — but that, if successful, could lead to millions of deaths from AIDS around the world.

    I first noticed this campaign last year, when I began to get e-mails from evangelical Christians insisting that condoms have pores about 10 microns in diameter, while the AIDS virus measures only about 0.1 micron. This is junk science (electron microscopes haven't found these pores), but the disinformation campaign turns out to be a far-reaching effort to discredit condoms, squelch any mention of them in schools and discourage their use abroad.

    So far so good. There are groups out there who make this claim. They are misinformed. A latex condom that has been kept sealed in its wrapper does not have pores this size discernable by electron microscopy. A latex condom left exposed to air for 72 hours does. (Sorry, I would provide a link but my source comes from the pre-internet days of JAMA.)

    Kristof then goes on to quote some over-the-top statements by groups that favor abstinence:

    "The only absolutely guaranteed, permanent contraception is castration," one Catholic site suggests helpfully. Hmmmm. You first.

    Then there are the radio spots in Texas: "Condoms will not protect people from many sexually transmitted diseases."

    A report by Human Rights Watch quotes a Texas school official as saying: "We don't discuss condom use, except to say that condoms don't work."

    Which leads into his assault on the Bush Administration:

    So far President Bush has not fully signed on to the campaign against condoms, but there are alarming signs that he is clambering on board. Last month at an international conference in Bangkok, U.S. officials demanded the deletion of a recommendation for "consistent condom use" to fight AIDS and sexual diseases. So what does this administration stand for? Inconsistent condom use?

    Maybe what they stand for is presenting the role of condoms in preventing HIV and other sexually transmitted diseases realistically. (See this rundown of some of the drawbacks of complete reliance on condoms. And this.) Maybe what they stand for is using the same sort of language that responsible medical organizations use when discussing the role of condoms. Here is the American Academy of Family Physicians statement on condoms and sexually transmitted diseases:

    The AAFP endorses and encourages the following HIV, STDs and blood borne infections prevention strategies:

    1. The most effective strategies to prevent sexual transmission are abstinence and the maintenance of life-long mutually monogamous relationship with one uninfected partner. For individuals choosing to be sexually active in other situations, the following are generally effective for infections transmitted through bodily fluids:

    ·Engaging in sexual activities that do not involve or lead to vaginal, anal, or oral intercourse;
    ·Having intercourse with one uninfected partner;
    ·Using latex and other effective condoms in a correct manner from the start to finish of every episode of intercourse

    And here is the American Academy of Pediatrics on condoms:

    For the individual, however, condom use, even if consistent and correct, does not ensure prevention of unintended pregnancy or acquisition of an STD or HIV. It is for this reason that abstinence remains the major focus of primary prevention in efforts to decrease adolescent pregnancy, STDs, and HIV infection, whereas condom use is the main focus of secondary prevention for those who are already sexually active and plan to remain so.

    Maybe, they stand for telling the truth instead of promoting false assurances of the effectiveness of condoms. But, of course, the whole column’s purpose so far was to give the tempest over the changes in wording on condoms at the CDC website more importance than it deserves:

    Then there was the Condom Caper on the Web site of the Centers for Disease Control. A fact sheet on condoms was removed in July 2001 and, eventually, replaced by one that emphasized that they may not work.

    "The Bush administration position basically condemns people to death by H.I.V./AIDS," said Adrienne Germain, president of the International Women's Health Coalition. "And we're talking about tens of millions of people."

    Does it? Here’s what the fact sheet says about condoms:

    The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and you know is uninfected.

    For persons whose sexual behaviors place them at risk for STDs, correct and consistent use of the male latex condom can reduce the risk of STD transmission. However, no protective method is 100 percent effective, and condom use cannot guarantee absolute protection against any STD. Furthermore, condoms lubricated with spermicides are no more effective than other lubricated condoms in protecting against the transmission of HIV and other STDs. In order to achieve the protective effect of condoms, they must be used correctly and consistently. Incorrect use can lead to condom slippage or breakage, thus diminishing their protective effect. Inconsistent use, e.g., failure to use condoms with every act of intercourse, can lead to STD transmission because transmission can occur with a single act of intercourse.

    While condom use has been associated with a lower risk of cervical cancer, the use of condoms should not be a substitute for routine screening with Pap smears to detect and prevent cervical cancer.

    That’s no different than the statements of the American Academy of Family Physicians and the American Academy of Pediatrics. It’s medically sound advice. Condoms aren’t 100% effective in protecting against either pregnancy or sexually transmitted diseases. People deserve to know that rather than being fed false reassurances that all they have to do to prevent infection is wear a condom. I haven’t been able to find a copy of the CDC’s old fact sheet. I’m sure that reading it would provide an informative contrast. Especially if it had been penned under the influence of people like Joycelyn Elders, condom enthusiast par excellence. Which makes me wonder why it hasn't been reproduced by all of these people crying so loudly about its demise. Could it be that the old fact sheet wouldn't hold up to scrutiny?

    UPDATE: A reader emailed this comment about condom efficacy:

    a quick review of data on-line regarding birth-control efficacy reveals that:

    1. "perfect use" of condoms is 98% effective (2/100 pregnancies per year), and
    2. "practical use" of condoms is somewhere between 86% and 98% effective, probably closer to 86%-88% effective.

    relative to what most teens are told and what they expect, I think that 13 pregnancies per 100 annual rate is astonishing . . . . . . hope you'd mention that, next time.

    Consider it mentioned.

    UPDATE II: Justin Katz has found the old condom fact sheet. (warning: pdf file), and as expected, it overstates the case for condom effectiveness. Justin also has a terrific take down of the Kristof column.

    posted by Sydney on 1/11/2003 11:18:00 AM 0 comments


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