STDs / STIs

February 2008: STDs and Condoms

Condom Debate "Hijacked" and Drifting from "Evidence Based" Science
The British Medical Journal is running a pair of articles offering two opposed views on the question, "Are condoms the answer to rising rates of non-HIV sexually transmitted infections?"

The idea that condoms are the first, last and usually only recommended protection against sexually transmitted diseases (STDs) is one of the most widely accepted in the field of public health. But the message of the life and family movement that abstinence before marriage and chaste fidelity within are the only sure means of avoiding STDs is starting to be heard…

Drs Markus J Steiner and Willard Cates, of Family Health International, of North Carolina and Dr. Stephen Genuis [associate clinical professor at the University of Alberta] have written on either side of the issue.

The former, Drs. Steiner and Cates argue that condoms "can and should play a central role in halting the rising rates of sexually transmitted infection other than HIV".

Dr. Stephen Genuis, however, warns that the debate has been "highjacked" by an argument between two "mutually exclusive perspectives on sexual morality" and has moved away from "evidence based" science.

On the one hand, Genuis writes, those promoting "safe sex (or safer sex) are accused of corrupting youth with amoral values", while their "opponents are perceived as zealots who disregard scientific fact in imposing their fanaticism on society".

The idea that condoms are the first, last and usually only recommended protection against sexually transmitted diseases (STDs) is one of the most widely accepted in the field of public health.

But the message of the life and family movement that abstinence before marriage and chaste fidelity within are the only sure means of avoiding STDs is starting to be heard.

Cates and Steiner argue that "strong evidence from laboratory studies and mounting clinical studies" show that condoms reduce the risk of infections including HIV, gonorrhoea, chlamydia, trichomoniasis, and hepatitis B.

Condoms also reduce the risk of infections that are transmitted primarily through skin such as genital herpes, syphilis, chancroid, and human papillomavirus infection.

They admit, however, that clinical studies have shown "inconsistent protective effects for most sexually transmitted infections other than HIV."

But they attribute this to "limitations in study design". They also admit that their studies did not measure "critical factors such as exposure to infected partners, consistent and correct condom use, or incident infection". They dismissed the promotion of abstinence as "difficult to achieve".

Dr. Genuis answered that it is consistent use of condoms that has proved "difficult to achieve" and calls for a more "comprehensive" approach than simply encouraging those "who choose to be sexually active" to use a condom.

He says that condoms cannot be "the definitive answer" to STDs because they "provide insufficient protection" against many common diseases transmitted through "'skin to skin' and 'skin to sore'" contact. These include human papillomavirus, herpes simplex virus, and syphilis, which, he says, are often transmitted despite condom use.

But the greatest problem with condoms, he writes, is that people, particularly "aroused youth," do not use them consistently, "regardless of knowledge or education".

"In theory, condoms offer some protection against sexually transmitted infection; practically, however, epidemiological research repeatedly shows that condom familiarity and risk awareness do not result in sustained safer sex choices in real life."

The use of condoms has been adopted as the central pillar of the fight against STDs in general, and HIV in particular, by most international health organisations.

In recent years the slogan, "Abstinence, be faithful, use a condom," also known as the "ABC strategy", has been adopted as a means of appeasing "faith-based" organisations such as the UK's overseas aid agency CAFOD that has adopted condoms as a key part of its programmes.

Dr. Genuis writes, "The relentless rise of sexually transmitted infection in the face of unprecedented education about and promotion of condoms is testament to the lack of success of this approach".

He cites numerous large studies that have shown this failure even in countries such as Canada, Sweden and Switzerland that have "advanced sex education programmes."

"The ongoing assertion that condoms are 'the' answer to this escalating pandemic reminds me of Einstein's words, 'The definition of insanity is doing the same thing over and over again and expecting different results'."

Read Dr. Genuis' article:
http://www.bmj.com/cgi/content/full/336/7637/185

Related coverage: Uganda AIDS Prevention Success Being Undermined by Infuriated UN Condom-Pushers http://www.lifesite.net/ldn/2005/feb/05020408.html

UN Anger Over Uganda's Successful Abstinence Program Fuelled by Loss of Funds Says Researcher
http://www.lifesite.net/ldn/2005/oct/05101404.html

AIDS a Glamorous Multi-Billion Dollar Industry – Sufferers Forgotten
http://www.lifesite.net/ldn/2006/aug/06081704.html
[25Jan08, Hilary White, Edmonton, LifeSiteNews.com]