The Antidote Is Still Whispered

"At the 14th International AIDS conference... it may be inevitable that public interest and press attention will focus on the most high-tech approaches, including new analytical techniques to probe for a weak spot in the structure of HIV and genetically engineered tricks to fool either the virus or the body's own immune system....

"All of this is exciting and may eventually help stop the spread of AIDS. Yet, despite the hubbub over vaccines, once-a-day treatment cocktails and all the rest, it is entirely possible that a great, simple and widely acknowledged approach to control the spread of HIV will get scarce attention: the humble condom....

"Right now, the condom works better at controlling the spread of HIV than any AIDS vaccine, medication, injection, vitamin or prayer that has been tried. In fact, condoms do a better job at preventing new HIV infection than the BCG vaccine does at controlling tuberculosis in the countries where it is in use. Famous studies from Thailand, where the sex tourism industry is a key source of income, show that an aggressive campaign to promote condom use led to a 50 percent decline in infection rates among young men. Were a vaccine to be comparably effective at preventing HIV, the FDA would scramble to approve it.

"How is it that condoms can be so important in the fight to keep AIDS from spreading faster, and yet figure so little in the fanfare about a conference like this one? The plain truth is that 20 years into the epidemic, many people are still sheepish about condoms....

"What might be called America's condom-phobia reaches back more than a century. In 1873, Congress passed the Comstock Act, which equated all forms of birth control with pornography. The law resulted in the confiscation of any birth control device, driving the condom market underground. Although now legal, condoms in many ways remain in the shadows....

"The answer to controlling the AIDS epidemic in the immediate future is not stronger medications or better vaccines. Everyone, of course, hopes they will be available some day soon. But for today, the best remedy already sits on store shelves, as it has for the entire 21 years of the epidemic."

Kent A. Sepkowitz, M.D., is head of the Clinical Infectious Disease Section at the Memorial Sloan-Kettering Cancer Center.

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