NIH Condom Report Draws Fire
August 1, 2001
A National Institutes of Health (NIH) report released amid controversy recently has a number of health care professionals and HIV/AIDS organizations worried. The uncertainty the report reflects about research on the use of condoms, many fear, will end up making individuals uncertain about condom use -- a devastating thought for public health workers.Adapted from:
Conservative physician and former US Rep. Tom Coburn (R-Okla.) commissioned the report, "Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention." Conducted by several key agencies, including NIH, CDC and the Food and Drug Administration, the study was released July 20. It analyzed more than 138 peer-reviewed published studies on the properties and user patterns of male latex condoms in penile-vaginal intercourse. No gay approaches to sex were included in the analyses.
The report concluded that condoms work well in HIV in male-to-female intercourse and in male gonorrhea, but found evidence inconclusive on several other STDs. Although the CDC participated in the NIH study, the CDC has since reiterated that condoms are effective against STDs.
Coburn's response to the release of the study was a letter to Health and Human Services Secretary Tommy Thompson saying, "This report means that when condom use is discussed, it is no longer medically accurate -- or legal for the CDC -- to refer to sex as 'safe' or 'protected.'"
Response among AIDS activists and service organizations was scathing. Maureen O'Leary, executive director of the national Gay and Lesbian Medical Association, said, "The danger is taking what Coburn is suggesting so that people might stop using condoms, thinking they're not going to have any effect whatsoever. Our stand is that used properly, they reduce AIDS [risk] and other STDs . . . ."
In a counter-report drafted on July 19 by the San Francisco AIDS Foundation (SFAF), activist researchers argued: "The bottom line is that abstinence fails more often than condoms. And abstinence, like a condom, is only effective when it is consistently used as a means of STD and HIV prevention." Point for point, the SFAF refuted the NIH study. Included in its analysis: the NIH omits important studies, and its study, by the report's admission, was not designed to see how well condoms worked. "The government groups looked at the quality of published research studies. The group did not look at the effectiveness of condoms. We know that when condoms are used consistently and correctly they reduce the transmission of HIV and other STDs, including gonorrhea, chlamydia, syphilis and herpes," said Dr. Jeff Klausner, director of the STD Prevention and Control Services at the San Francisco Department of Public Health. "Condoms are adequate. Condoms do work. This report is similar to one evaluating whether speed limits reduce car accidents and death. There may be a few large published research studies but we all know that driving slower is safer and an effective way to protect ourselves, protect others, and protect loved ones," Klausner added.
The issue for most public health workers is how to make condom use the norm. In populations where condom use is the norm, STD transmission is infrequent. In Thailand, according to health experts, 100 percent condom use has led to great reductions in new STDs and HIV transmission. "A core strategy for Asian and Pacific Islander Wellness Center's (APIWC) prevention efforts is promoting condom use combined with regular voluntary HIV testing," said John Manzon-Santos, APIWC's executive director. "Even if condoms only prevented the transmission of HIV and not all STDs, then using a condom has tremendous value and saves lives."
Bay Area Reporter (San Francisco)
07.26.01; Vol 31; No 30: P 1; David Fraser
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.