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Feature Articles
Condom effectiveness |
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by Joel Mclhaney, M.D.,
Medical Institute for Sexual Health Condoms always have and always will pose a great use-effectiveness problem. In fact, the FDArequires the manufacturer to list the ideal use-effectiveness rates of approved contraceptives in the package inserts for oral contraceptives, which are even more easily controlled in use. Combining the ideal and the use-effectiveness rates, condoms are listed at 90-70 percent, which translates to a failure rate of 10-30 percent. These rates are based on birth prevention, not disease prevention. This distinction is critical when safety and protection are honestly considered and evaluated. For example, a woman’s window of fertility is 7 days out of an average 28-day cycle. Infections such as AIDS, however, can occur every day at any given minute, depending on the immune system. |
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This means that there are at least four times as many days during which disease can be transmitted as opposed to the occurrence of fertilization - the simple transmission of a sperm into an egg. Some claim that condoms will cut down on the spread of many sexually transmitted diseases, including AIDS. However, a study published in Sexually Transmitted Diseases fails to show any reduction in newly acquired STDs among those who are described as “always users” of condoms. S. duBose Ravenel, M.D., comments that “the obvious possibility that condoms do not provide significant protection was not even discussed by the authors.” According to Joe S. McIlhaney, Jr., M.D., there is clinical evidence to show that “the same rate of chlamydial infection occurs in those who use condoms and those who do not.” We can conclude that the condom also fails to protect women from chlamydia trachomatis, “the most common bacterial sexually transmitted disease in the United States.” Doctors Zelig Friedman and Liliana Trivelli of the HIV/AIDS Advisory Council of New York City’s Board of Education express grave concerns about condom effectiveness and write: Although no one would argue that condoms may help reduce the risk of pregancy and of some diseases if used perfectly, a closer look at the circumstances of failure renders this option unacceptable. Condoms have a poor track record as contraceptives (15% failure for youngsters in the first year of use), offer no protection for chlamydia or HPV [human papiloma virus] and have a 2Ü4% rate of tearing, breakage and slippage. With regard to HIV they are not impermeable. THE SPERM VS. THE AIDS VIRUS.
A paper in the February 1992 issue of Applied and Environmental Microbiology reports that filtration techniques show the HIV-1 virus to be 0.1 micron (4 millionths of an inch) in diameter. It is three times smaller than the herpes virus, 60 times smaller than the syphilis spirochete, and 50 to 450 times smaller than sperm. THE FLAWED CONDOM Naval Research Laboratory (NRL) researchers, using powerful electron microscopes, have found that new latex, from which condoms are fabricated, contains “maximum inherent flaw[s]” (that is, holes) 70 microns in diameter. These holes are 700 times larger than the HIV-1 virus. There are pores in latex, and some of the pores are large enough to pass sperm-sized particles. Carey, et al., observed leakage of HIV-sized particles through 33%+ of the latex condoms tested. In addition, as Gordon points out in his review, the testing procedures for condoms are less than desirable. United Statescondom manufacturers are allowed 0.4% leaky condoms (AQL). Gordon states, “The fluctuations in sampling permits many batches not meeting AQL to be sold.” In the United States, 12% of domestic and 21% of imported batches of condoms have failed to meet the 0.4% AQL. CONDOMS FAIL TESTING In a 1988 study sponsored by the National Institutes of Health, Bruce Voeller of the Mariposa Foundation in Topanga, California, a non-profit organization dedicated to preventing the spread of sexually transmitted diseases, ranked 31 brands of latex condoms according to how well they met the U.S. and international quality assurance standards designed to ensure that condoms provide an effective barrier against human sperm. “Many of the condoms now on the market would not get FDA approval if they were required to meet today’s standards,” says Voeller. Although all condoms sold in the U.S.are supposed to pass quality assurance tests, those marketed before 1976 need not meet the more stringent requirements necessary to win FDA marketing approval. Dr. Collart reports that “Gotszche and Hording in their study of in vivo [real life] condom failure rates concluded ‘Condoms to prevent HIV transmission do not imply truly safe sex.’ In addition Steiner, et al., observed newer lots of condoms had actual breakage rates of 3.5-8.8%, while actual breakage rates for older lots ranged from 9.8-18.6%. In a study conducted by Ahmed, et al., 29%-42% of those who had used condoms experienced at least one breakage. In a survey conducted by the University of Manchester, 52% of those who had obtained condoms from their family planning clinic had one or more either burst or slip off in the 3 months before the survey. In studies by Albert, et al., and by Wright, et al., 36% and 38% of their respondents reported condom failures respectively.” CONDOM + SPERMICIDE Some have advocated the use of spermicide containing nonoxynol-9 in the prevention of HIV infection. However, the protective effects of nonoxynol-9 have not been established in vivo for any of the viral STDs. Some reports suggest that spermicides (including nonoxynol-9) may be associated with irritation and ulceration of genital and rectal epithelia, side-effects that may actually facilitate HIV infection. In a study with Nairobi prostitutes, a higher rate of new HIV infections was found among women using nonoxynol-9 than among those not using it. Additionally, in a study of rhesus monkeys who were exposed to a high dose of simian immunodeficiency virus following vaginally inserted nonoxynol-9 foam, half the monkeys developed an infection. CLIMATE CONTROL Condoms are sensitive to heat and cold, yet they are not normally transported in climate-controlled vehicles. Vesey, in his study of condoms,checked 72,000 trucks and has actual photographs of eggs frying in the backs of trucks used for condom distribution. Partly due to Vesy’s study, Burlington County, NJ, banned the distribution of condoms at the county’s AIDS counselling center, because they concluded that the risk of liability for condom failures was too great. DEADLY DELUSIONS In a 1990 review article by April and Schreiner, the authors summarize recent studies on HIV infection and conclude, “Recent studies on HIV prevention show the assumption that condoms provide reliable protection against HIV to be a dangerous illusion.” The studies reviewed by the authors showed that the rate of seroconversion (HIV infection) associated with condom use ranged from 13% to 27% and more. Frosner concludes that “Available data now indicate that efficacy of condoms has been largely overestimated.” In a study in Florida, where heterosexual couples used condoms, 17% of partners of AIDS patients became infected within 18 months, despite the frequency of sexual relations being lower if one partner is HIV-positive. Detels, et al., observed a risk reduction of only 3.3:1 for those who used condoms with all of their partners, and a 1.8:1 increase in risk for those who used condoms for some of their partners as opposed to using condoms for none of their partners. This would indicate that condoms are ineffective for prolonged or lifelong protection from AIDS. In addition, since 100% condom use is difficult if not impossible to obtain, the realistic number to look at would be the risk while using condoms some of the time. It is more realistic to expect teens to be abstinent (which is 100% effective in preventing sexual transmission of HIV) than it is to expect them to use condoms 100% of the time (which has an HIV failure rate approaching 100% with life-long use.) Joffe, et al., state: “The association between categories of condom use and history of an STD were not statistically significant at conventional levels after adjustment for number of partners.” Cohen, et al., conducted a study in which patients who had contracted an STD were given a condom education course. Within nine months “19.9% of the men and 12.6% of the women returned with new STD,” some multiple times. The STD reinfection rate actually increased for women. Frosner states the U.S. government has withdrawn a $2.6 million grant to study condoms because “An unacceptably high number of condom users probably would have been infected in such a study.” PANACEA OR PLACEBO? In conclusion, Herbert Ratner, M.D., offers the best summary of all when he says, Actually, the major accomplishment of the condom campaign to prevent AIDS is to impress the promoters, politicians and the public at large that something is being done; and although well-intentioned, it offers more of a placebo than a panacea. Publicizing the condom to the four winds is, for the most part, the bravura of a puritan who is trying to prove to the world that he is not a puritan. To concentrate on the mechanical aspects of the sex act to the exclusion of the emotional and psychological aspects (which the condom campaign ignores) is the essence of Puritanism. The only difference between the new and the old is that whereas the traditional puritans were alleged to believe that sex was something to be isolated and repressed, neo-puritans accept sex as something to be isolated and exercised. Reviewed by Joel McIlhaney, M.D., of the Medical Institute for Sexual Health |
