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Doubts About Condoms

6/28/2004 - 8:00 AM PST

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Science Questioning Their Efficacy in Halting HIV/AIDS

NAIROBI, Kenya, JUNE 28, 2004 (Zenit) - The Catholic Church has long been criticized for opposing condom promotion as part of AIDS prevention programs and "safe sex" campaigns. Yet opposition to condoms does not mean the Church does not care about AIDS. Last year Kenya's health minister, Charity Ngilu, praised the Church for its role in fighting HIV and AIDS, the Catholic Information Service for Africa reported Aug. 17.

Ngilu commended the Catholic Church for its focus in three key areas: prevention through awareness-raising and promotion of behavior change; care and treatment of the people living with HIV/AIDS; and social and economic support for those infected and affected by the scourge.

And recently published information is showing the wisdom of the Church's refusal to back condoms. The journal Studies in Family Planning in its March issue published a wide-ranging review of scientific literature on the subject of condoms.

Authored by Norman Hearst, a professor at the University of California, and Sanny Chen, an epidemiologist with the San Francisco Department of Health, the article "Condom Promotion for AIDS Prevention in the Developing World: Is It Working?" notes that "Measuring condom efficacy is nearly impossible." A commonly accepted figure for their efficacy is 90%, the article affirms.

But this is not enough for condoms to be effective in AIDS prevention. For example, the articles notes: "In many sub-Saharan African countries, high HIV transmission rates have continued despite high rates of condom use." The authors admit that "no clear examples have emerged yet of a country that has turned back a generalized epidemic primarily by means of condom promotion."

Uganda's noted success in reducing the prevalence of AIDS was due a program that focused on delaying sexual activity among adolescents, promoting abstinence, encouraging faithfulness to a single partner, and condom use. Condom promotion was last in order of importance, notes the article.

Hearst and Chen explain that increased use of condoms was not responsible for the decline in AIDS among Ugandans. "The main cause of falling incidence in Uganda was a substantial drop in numbers of casual sex partners," they wrote. Their article also attributes falling HIV prevalence among pregnant women in parts of Zambia and Tanzania to reductions in numbers of sexual partners.

In another article, a group of experts on HIV stressed the need for greater emphasis in changing sexual behavior. "It seems obvious," said an article in the April 10 issue of the British Medical Journal, "but there would be no global AIDS pandemic were it not for multiple sexual partnerships." The article was entitled "Partner reduction is crucial for balanced 'ABC' approach to HIV prevention."

The authors explained that a high number of sexual partners is "a crucial determinant in the spread of sexually transmitted infections." As well, HIV transmission is facilitated by the presence of other sexual infections, which in turn are propagated by having multiple partners.

The article also notes that while condoms were credited for Thailand's reduction in the high levels of HIV infection, their use was also accompanied "by a striking reduction" in the numbers of sexual partners.

Regarding the campaign in Uganda, the authors state that it is difficult to prove a direct causal link between the promotion of monogamy and the fall in HIV rates, though "it seems likely that it was critical to the success."

The article observed that, despite the evidence of how partner reduction and monogamy can reduce the spread of HIV, many programs give these means little attention. "We believe it is imperative to begin including (and rigorously evaluating) messages about mutual fidelity and partner reduction in ongoing activities to change sexual behavior," the authors commented.

Not so safe

Doubts have also been cast on the reliance of condoms for "safe sex" programs. In the United States more than 15 million cases of sexually transmitted diseases (STDs) occur every year, according to Dr. Joe McIlhaney Jr., president of the Medical Institute for Sexual Health, a nonprofit organization based in Austin, Texas.

Writing in the Atlanta Journal-Constitution last Aug. 25, McIlhaney noted that the consequences of relying on condoms can be grave. One widely prevalent STD, the human papillomavirus (HPV), causes more than 90% of cervical cancer which, in 2001, killed an estimated 4,100 women in the United States.

"Based on the science and the science alone, there is only one conclusion: Condoms do not make sex safe enough," McIlhaney commented. "While condoms can reduce some risk, they still often leave individuals vulnerable to STD infection." ...

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