Doubts About Condoms: Science Questioning Their Efficacy in Halting HIV/AIDSZENIT
The Catholic Church has long been criticized for opposing condom promotion as part of AIDS prevention programs and "safe sex" campaigns.
Ngilu commended the Catholic Church for its focus in three key areas: prevention through awareness-raising and promotion of behavior change; care and treatment of the people living with HIV/AIDS; and social and economic support for those infected and affected by the scourge.
And recently published information is showing the wisdom of the Church's refusal to back condoms. The journal Studies in Family Planning in its March issue published a wide-ranging review of scientific literature on the subject of condoms.
Authored by Norman Hearst, a professor at the University of California, and Sanny Chen, an epidemiologist with the San Francisco Department of Health, the article "Condom Promotion for AIDS Prevention in the Developing World: Is It Working?" notes that "Measuring condom efficacy is nearly impossible." A commonly accepted figure for their efficacy is 90%, the article affirms.
But this is not enough for condoms to be effective in AIDS prevention. For example, the articles notes: "In many sub-Saharan African countries, high HIV transmission rates have continued despite high rates of condom use." The authors admit that "no clear examples have emerged yet of a country that has turned back a generalized epidemic primarily by means of condom promotion."
Uganda's noted success in reducing the prevalence of AIDS was due to a program that focused on delaying sexual activity among adolescents, promoting abstinence, encouraging faithfulness to a single partner, and condom use. Condom promotion was last in order of importance, notes the article.
Hearst and Chen explain that increased use of condoms was not responsible for the decline in AIDS among Ugandans. "The main cause of falling incidence in Uganda was a substantial drop in numbers of casual sex partners," they wrote. Their article also attributes falling HIV prevalence among pregnant women in parts of Zambia and Tanzania to reductions in numbers of sexual partners.
In another article, a group of experts on HIV stressed the need for greater emphasis in changing sexual behavior. "It seems obvious," said an article in the April 10 issue of the British Medical Journal, "but there would be no global AIDS pandemic were it not for multiple sexual partnerships." The article was entitled "Partner reduction is crucial for balanced 'ABC' approach to HIV prevention."
The authors explained that a high number of sexual partners is "a crucial determinant in the spread of sexually transmitted infections." As well, HIV transmission is facilitated by the presence of other sexual infections, which in turn are propagated by having multiple partners.
The article also notes that while condoms were credited for Thailand's reduction in the high levels of HIV infection, their use was also accompanied "by a striking reduction" in the numbers of sexual partners.
Regarding the campaign in Uganda, the authors state that it is difficult to prove a direct causal link between the promotion of monogamy and the fall in HIV rates, though "it seems likely that it was critical to the success."
The article observed that, despite the evidence of how partner reduction and monogamy can reduce the spread of HIV, many programs give these means little attention. "We believe it is imperative to begin including (and rigorously evaluating) messages about mutual fidelity and partner reduction in ongoing activities to change sexual behavior," the authors commented.
Not so safe
Doubts have also been cast on the reliance of condoms for "safe sex" programs. In the United States more than 15 million cases of sexually transmitted diseases (STDs) occur every year, according to Dr. Joe McIlhaney Jr., president of the Medical Institute for Sexual Health, a nonprofit organization based in Austin, Texas.
Writing in the Atlanta Journal-Constitution last Aug. 25, McIlhaney noted that the consequences of relying on condoms can be grave. One widely prevalent STD, the human papillomavirus (HPV), causes more than 90% of cervical cancer which, in 2001, killed an estimated 4,100 women in the United States.
"Based on the science and the science alone, there is only one conclusion: Condoms do not make sex safe enough," McIlhaney commented. "While condoms can reduce some risk, they still often leave individuals vulnerable to STD infection."
His arguments received support in a report to the U.S. Congress by the federal Centers for Disease Control and Prevention earlier this year. The centers' director, Dr. Julie Gerberding, said that the best way to avoid HPV "is by having only one uninfected partner," the Washington Times reported Feb. 3.
The report recommended that men and women not in monogamous relationships should reduce the number of sexual partners. The report also noted that most studies show that condoms do not prevent the spread of HPV.
Abstinence promotion even received support in a long article published June 13 in the New York Times Magazine. Written by Helen Epstein, a visiting research scholar at the Center for Health and Wellbeing at Princeton University, it observed that many efforts aimed at stopping the spread of HIV have had disappointing results.
A case in point is the situation in Botswana. The Washington Times on June 17 described how Tsetsele Fantan, leader of the African Comprehensive HIV/AIDS Partnerships, sponsored by pharmaceutical giant Merck & Company and the Bill & Melinda Gates Foundation, felt embarrassed on taking a visitor to a primary school, whose walls had posters about using condoms and whose children sang songs about prophylactics.
"At that age, they should have been singing about 'saying no to sex,'" said Fantan. "The message should have been about abstinence. We need to focus our message better."
Kgomotso Ntsatsi, who directs the Christian AIDS Intervention Program that promotes abstinence, explained that she needs more financial support to get that message out, the article reported. "Condoms were the first thing people thought of. People never stopped to see if it was working," she said. "It eroded our culture terribly. Condoms brought so much unfaithfulness and so much early pregnancy. Now it looks like everyone is promiscuous."
In fact, there are signs that more governments are waking up to the need to promote abstinence. Recently, Zambia banned the distribution of condoms in schools, BBC reported March 15. Education Minister Andrew Mulenga explained that condoms were encouraging young people to have premarital sex. Some 120,000 Zambians die from AIDS each year, according to U.N. figures.
BBC quoted Mulenga as saying that students "should be advised to abstain from sex as a measure to fight the disease instead of being urged to use condoms which promote immorality."
The Catholic Church's opposition to condoms is not based on medical studies. Rather, it stems from a profound analysis of the need to integrate sexuality in an exclusive and permanent relationship open to life in the context of marriage. The wisdom of this view is becoming increasingly clearer.
"Doubts About Condoms: Science Questioning Their Efficacy in Halting HIV/AIDS." ZE04062602, Nairobi, Kenya, June 26, 2004.
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