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Condom Safety
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Condoms: Still "best practice" in preventing HIV/AIDS Infection 

Dear AFRO-NETS readers, 

Please find below a contribution and a list of information sources to 
this important topic. Prevention is the first line of defence against 
HIV/AIDS and condoms are the best way to prevent HIV transmission in 
sexual intercourse. Nevertheless, questions about the effectiveness 
of condoms as a means to prevent sexually transmitted infections 
(STIs), including HIV continue to be raised. For instance misinter-
pretation and misunderstanding of a report on condom effectiveness 
published in July 2001 by the US National Health Institute caused 
lively discussions on condom effectiveness with condom opponents pro-
moting "abstinence only" programs. The point raising arguments 
against condom effectiveness was the result of the report that there 
is "insufficient" evidence to say that condoms guard against STDs 
other than HIV and gonorrhoea in men. These interpretations of insuf-
ficient condom effectiveness lack validity as:

1. A "lack of evidence of effectiveness" does not imply a "lack of 
effectiveness." According to W. Cates, president of FHI, several 
relevant studies were not considered in the report and "when used 
correctly and consistently, we should expect male latex condoms to be 
highly effective in preventing the risk of the other discharge dis-
eases" (gonorrhoea, chlamydia and trichomoniasis). If condoms do not 
protect sufficiently against some STDs this has nothing to do with 
the quality of condom. In these cases STIs are transmitted by skin-
to-skin contact with infected areas that are not covered by the con-
dom (e.g. genital herpes, syphilis, chancroid and HPV). Thus, as the 
diseases sometimes are and sometimes are not covered by the condom it 
is expected to protect in some, but not all, instances.

Reasons given by UNAIDS for the current lack of evidence are that 
"studies to establish reliably the effectiveness of condoms against 
specific STIs can be very difficult to conduct in a scientifically 
valid and ethical manner. Nonetheless, additional studies are already 
under way and more are planned".

2. The report clearly confirms the effectiveness of condoms in pre-
venting HIV infection in women and men and gonorrhoea in men. The re-
view examines the relative risk of exposure to semen for condom use 
compared to non-use and gives a relative risk of 0.0 for correct use 
without breakage or leakage, and a relative risk of 0.006 if a condom 
is used but breaks.

These results are underlined by WHO/UNAIDS: "Laboratory studies have 
established the impermeability of male latex condoms to infectious 
agents contained in genital secretions, including the smallest vi-
ruses." 

Giving an impressive analysis of condom safety based on a broad range 
of studies and hundreds of references, the Population Report Vol. 
XXVII states that one "most convincing evidence of condom effective-
ness comes from studies of HIV-discordant couples -- couples in which 
one partner is infected with HIV and the other is not. A multicountry 
European study of 256 HIV-discordant couples followed for an average 
of 20 months found that not one infection occurred among such couples 
using condoms during every sex act."

So giving this clear evidence that data support the use of condoms 
for HIV prevention, the question of whether condoms prevent other 
STDs is moot, because we should go full out to advocate them for HIV 
prevention.

Ressources: 

US National Institutes of Health (NIH) and the Centers for Disease 
Control and Prevention (CDC): "Scientific Evidence on Condom Effec-
tiveness for Sexually Transmitted Disease (STD) Prevention", June 
2000
<http://www.niaid.nih.gov/dmid/stds/condomreport.pdf>

WHO and UNAIDS Information Note: Effectiveness of Condoms in Prevent-
ing Sexually Transmitted Infections Including HIV, 15 August 2001, 
<http://www.who.int/reproductive-health/rtis/Condom%20Effectiveness%20-%20WHO%20UNAIDS%20Statement.doc>

USAID: The Effectiveness of Condoms in Preventing Sexually Transmit-
ted Infections
<http://www.usaid.gov/pop_health/aids/TechAreas/condoms/condom_effect.html> 

Population Report Volume XXVII, Number 1, April, 1999, How effective 
are condoms? 
<http://www.jhuccp.org/pr/h9/h9chap4_2.stm>

Family Health International: "U.S. study panel confirms condoms are 
effective against HIV/ AIDS" 
<http://www.reproline.jhu.edu/english/6read/6issues/6network/v21-2/nt2126.htm>

Family Health International: The latex condom: recent advances, fu-
ture directions
<http://www.fhi.org/en/fp/fpother/conom/index.html>

Alan Guttmacher Institute, "Condom Effectiveness Examined in New Gov-
ernment Report"
<http://www.agi-usa.org/pubs/journals/gr040413.html>

Center for AIDS Prevention Studies, University of California, San 
Francisco, "Do Condoms Work?" 
<http://www.ama-assn.org/special/hiv/preventn/prevent2.htm>

Program for Appropriate Technology in Health (PATH): A Response to 
Recent Questions about Latex Condom Effectiveness in Preventing Sex-
ual Transmission of the AIDS Virus
<http://www.jsi.com/intl/fplm/pdf/CondomResponce.pdf>


Dr. Barbara Ritter
MD, DTM&H, MSc (IHT)
Project Officer
Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH
Sector project "AIDS Control in Developing Countries"
Dag-Hammerskjoeld-Weg 1-5
65760 Eschborn, Germany
mailto:barbara.ritter@gtz.de
http://www.gtz.de/aids/

Cordula Schuemer
GTZ Reproductive Health
P.O Box 65350
Dar es Salaam, Tanzania
mailto:repro-gtz@africaonline.co.tz

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