Jun 30 2005
Although condoms are an effective method of contraception and stop the spread of AIDS, evidence that they protect against other sexually transmitted diseases is scant.
Now a conservative senator Tom Coburn, a physician from Oklahoma, and groups advocating abstinence are urging that condom labels be made "medically accurate", and are blocking the appointment of a new federal drug agency chief until the labels are changed.
In the meantime "Safe sex" advocates are concerned that this will lead to an increase in unwanted pregnancies and encourage the spread of AIDS and other diseases by undermining public confidence in condoms.
Heather Boonstra, a public policy official with the Alan Guttmacher Institute, a nonprofit group that researches reproductive health issues, says although condoms do not provide 100 percent protection, for sexually active people they are the best and the only method for preventing these diseases.
Boonstra says that Coburn and the abstinence-promoting Medical Institute for Sexual Health are just manipulating the data to endorse their own anti-condom, anti-contraceptive message.
She says there are already indications that the use of condoms and other contraceptives is on the decline.
James Trussell, who serves on the Guttmacher board and is director of Princeton University's Office of Population Research, says the evidence that condoms reduces the transmission of the most serious sexually transmitted disease, AIDS is "absolutely incontrovertible".
Trussell says all Coburn and the others are really concerned about is people who are not married having sex.
John Hart, a spokesman for Coburn, denies this, and says the senator's June 15 hold on Lester Crawford's nomination as commissioner of the Food and Drug Administration (FDA) is an effort to make Crawford obey a 2000 law Coburn sponsored.
He said it requires the FDA to change condom labels to give more information on their effectiveness or lack of the effectiveness in preventing STDs.
FDA spokeswoman Julie Zawisza refused to discuss policy issues.
Dr. Marie Savard, a women's health specialist in Philadelphia, said though she has qualms about using the word "ineffective" she does agree that people need reliable information.
At present the FDA requires condom boxes and packets to state: "If used properly, latex condoms will help to reduce the risk of transmission of HIV infection (AIDS) and many other sexually transmitted diseases." Many brands also state condoms are highly effective in preventing pregnancy.
If latex condoms are used each time, and put on early enough, they can reduce the risk of pregnancy over a one-year period to 3 percent, compared with 85 percent without birth control.
Condoms also cut the risk of HIV infection by about 80 percent, to less than a 1 percent chance of infection per year.
The National Institutes of Health, says condoms are impermeable to the smallest viruses and only break or slip off 1 percent to 2 percent of the time, but surveys have shown that most people don't use them properly or consistently, and roughly 12 million Americans each year contract an STD.
A 2001 NIH expert panel, which was convened at Coburn's request, examined dozens of published studies.
The panel reported that for STDs other than AIDS and gonorrhea, for which condoms cut transmission by 50 percent to 100 percent, the evidence on protection was unclear.
The report mentioned studies which showed prevention rates range from 18 percent to 92 percent, depending on the disease.
According to Boonstra the NIH has said inadequate evidence should not be taken to mean condoms are inadequate.
Dr. Tom Fitch, chairman of the Medical Institute for Sexual Health, says some STDs are much more easily spread than others.
Herpes and human papilloma virus, or HPV, can be transmitted by contact with skin not covered by a condom.
Fitch said he does not discourage condom use, but his group advocates abstinence or monogamy and it trains teachers how to teach students about abstinence.
But Dr. Shari Brasner, an obstetrician/gynecologist at Mount Sinai Medical Center in New York, who has patients as young as 13 who are sexually active, says that is an "unrealistic explanation" for young people.
Brasner says Coburns group are the same people that are trying to limit access to the morning-after pill, and if allowed would leave young people with no contraceptive options.
Lori Heise of the Global Campaign for Microbicides, says her group is trying to correct the false belief that nonoxynol-9, the spermicide used in contraceptive creams, some lubricated condoms and some personal lubricants, protects against spread of STDs, as recent evidence shows it does not.
Heise says the detergent-like spermicide can irritate the vagina or rectum, and make it easier to become infected with an STD. The campaign is working to have nonoxynol-9 removed from lubricants and condoms.
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