Advancing Sexual and Reproductive Health and Rights
 
The Guttmacher Report on Public Policy
August 2001, Volume 4, Number 4
 
For the Record

Condom Effectiveness Examined in New Government Report

In June 2000, a panel of experts convened for a two-day workshop to assess the effectiveness of condoms in preventing the transmission of eight sexually transmitted diseases (STDs): HIV, gonorrhea, chlamydia, syphilis, chancroid, trichomoniasis, genital herpes and human papillomavirus (HPV). More than a year later, on July 20, the Department of Health and Human Services finally issued the eagerly anticipated summary report from that workshop. The report concludes that there are sufficient, condition-specific data to demonstrate that when used correctly and consistently, condoms prevent HIV infection and gonorrhea transition from women to men (in addition, of course, to pregnancy), but that the published epidemiologic literature is insufficient to warrant definitive statements about condom effectiveness specific to the other six STDs considered by the panel.

The report explicitly notes that the panel—which the National Institutes of Health had convened at the behest of congressional condom opponents—"stressed that... inadequacies of the evidence available...should not be interpreted as proof of the adequacy or inadequacy of the condom." Yet condom opponents, who advocate abstinence for all unmarried people as the only acceptable means of preventing STDs and pregnancy, were quick to do just that. Tom Coburn, the former Republican representative from Oklahoma who initially requested the report while still in office, issued a press release that was headlined, "Condoms Do Not Prevent Most STDs." In the release, Coburn said, "This report finally exposes the 'safe' sex myth for the lie that it is....[W]hen condom use is discussed, it is no longer medically accurate—or legal for the CDC—to refer to sex as 'safe' or 'protected.'" Coburn has called for the resignation of Centers for Disease Control and Prevention (CDC) Director Jeffrey Koplan for not providing "medically accurate" information about condom effectiveness, as required by federal law. The CDC's overarching "prevention message" for HIV and other STDs, set forth in a fact sheet also issued in July, reads, "Latex condoms, when used consistently and correctly, are highly effective in preventing transmission of HIV.... In addition, correct and consistent use of latex condoms can reduce the risk of other sexually transmitted diseases."

Indeed, supporters of public health messages that promote condom use for sexually active individuals point to a critical conclusion in the workshop summary report that largely has been ignored by the popular press: "Studies...have demonstrated that condoms provide a highly effective barrier to transmission of particles of similar size to those of the smallest STD viruses. These data also provide a strong probability of condom effectiveness when used correctly, where the etiology of STD transmission is linked to containment of pre-ejaculate and seminal fluids or barrier coverage of lesions on the penis and there is no slippage or breakage." In other words, supporters say, despite the lack of definitive, disease-specific studies, condoms should be regarded as protective against "discharge diseases" beyond HIV (gonorrhea, chlamydia and trichomoniasis) and would also be expected to protect against infections that are transmitted through "skin-to-skin" contact (genital herpes, syphilis, chancroid and HPV) provided that the source of the infection is in an area that is covered or protected by the condom. Although the three "genital ulcer diseases" and HPV can occur in genital areas that are covered or protected, they also can occur in areas that are not. Accordingly, again in the words of the CDC prevention-messages fact sheet, condom use "would be expected to protect against transmission of genital ulcer diseases and HPV in some, but not all, instances."

Supporters of HIV and STD prevention efforts say the fact that condoms are not 100% effective does not mean that they have no value in prevention, noting, for example, that most vaccines are not 100% effective. To the contrary, condoms must be the mainstay of prevention efforts both in the United States and globally, they argue, for the simple reason that as the workshop summary report itself says, "Beyond mutual lifelong monogamy among uninfected couples, condom-use is the only method for reducing the risk of HIV infection and STDs available to sexually active individuals."