By Kai Wright
How does a device as simple as a rubber dredge up such complicated debates? Condoms are, after all, among healthcare’s most basic tools: a simple latex sheath to unfurl over an erect penis before inserting it into someone else’s orifice. With that uncomplicated act, countless sexually transmitted diseases are slowed, if not stopped. Or, so say most folks — and that’s the rub, so to speak.
Critics on both the left and right wing of the sexual culture wars say HIV prevention’s condom-mania dangerously oversimplifies sex. Those on the left complain that public health’s use-a-condom-every-time mantra does little to address the difficult emotions that drive decisions about risk-taking in bed (disclosure: I have made this argument in other publications). Those on the right, meanwhile, charge that public health vastly overstates how much protection condoms provide from both the physical and emotional dangers of sex.
But given the current political landscape, it’s the right-flank attack that’s causing the most headaches for HIV prevention’s condom promotion efforts today.
Throughout the early summer, Lester Crawford’s nomination as Food and Drug Administration commissioner sat captive in the Senate, pinned in by the small-scale turf battles that preoccupy both sides of the sexual and reproductive health wars. Any Senator can place a “hold” on a nominee once it hits the chamber floor, effectively blocking a vote until 60 Senators call for one. Conservative Republican Sen. Tom Coburn (Okla.) placed a hold on Crawford’s nomination in June, demanding that he promise to enforce a law Coburn shepherded through Congress in 2000 that would change warning labels on condoms.
(Democratic Sens. Hillary Clinton of New York and Pat Murray of Washington State also put a hold on the nomination, asking for a prompt decision on nonprescription sales of emergency contraception, known as “morning after” pills.)
Currently, condom packages must carry a label stating, “If used properly, latex condoms will help to reduce the risk of transmission of HIV infection (AIDS) and many other sexually transmitted diseases.” Coburn’s 2000 law orders the FDA to expand this requirement to include more information about their “effectiveness or lack of the effectiveness in preventing STDs,” according to the Associated Press.
Coburn, who is a medical doctor, lifted his hold on Crawford in mid-July. A spokesperson told the Washington Post that Coburn cleared the way only after receiving a guarantee from Crawford that the FDA will act on the law, though it remains to be seen what specifically the FDA will do. The Senate overwhelmingly approved Crawford the next day, on July 19.
Coburn’s goal is to highlight abstinence promoters’ argument that condoms do not provide absolute protection against STDs. Rightwing researchers most commonly cite herpes and HPV (or human papillomavirus) as examples, because they are transmitted via skin-to-skin contact in areas a condom doesn’t cover.
“Condoms may provide moderate protection from some sexually transmitted diseases (e.g. HIV/AIDS, and Gonorrhea) but are likely to be much less effective for others (e.g. Chlamydia, Herpes, and HPV),” reads an explanation on 4parents.gov, a controversial abstinence-promotion website set up by the Bush administration’s Department of Health and Human Service. “Condom effectiveness in protecting from diseases such as Hepatitis B and Syphilis has not been well studied.”
Mainstream researchers angrily object to such statements. They argue that Coburn and his ilk have manipulated the facts to drastically overstate their case. “A federally funded Web site should present the facts as they are, not as you might with them to be,” wrote Rep. Henry Waxman (D-Calif.) in a letter to the administration after a study he commissioned found several inaccurate or misleading statements about condoms and STD prevention on 4parents.gov.
The site was not developed by a federal public health agency, but rather by the National Physicians Center for Family Resources, a group that has been closely associated with efforts to ban abortion and promote homosexuality as a disease. The Senate Appropriations Committee has added a stipulation to its funding bill for Health and Human Services that orders an internal review of the site, and the department is now accepting applications from various groups seeking to take over the site, according to a Washington Blade report.
Mainstream researchers concede that condoms do not in fact provide 100 percent protection against STDs. But recent research has aimed to nail down just how far shy of that mark condoms fall.
A 2001 National Institutes of Health panel, convened at Coburn’s request, found that, when used properly and consistently, condoms do reduce the risk of HIV transmission to nearly nil and drastically cut gonorrhea transmission. But the panel found wide disparity among then-published studies on condoms’ effectiveness in stopping a range of other STDs.
In June of last year, however, a group of Washington State-based researchers published a follow-up study in the Bulletin of the World Health Organization, looking at research done since the NIH panel’s review. The researchers looked at studies published in English since June 2000. They found “condom use is associated with statistically significant protection of men and women against several other types” of infections, including Chlamydia, type 2 herpes and syphilis.
The Washington researchers, however, found there’s still no evidence in the literature of condoms protecting against HPV infection.
What neither study discussed in depth was why condoms may fail to stop STDs.
In some cases, they simply don’t block the route of transmission — like in cases where infections are passed through skin contact with parts of the genitals condoms don’t cover. But most defenders of public health’s focus on condoms note that the problems with their effectiveness lie not in the device itself but in how they are used.
People cause tears when opening the packages or putting them on; they use oil-based lubricants that break down the latex, rather than the recommended water-based ones; they penetrate vaginal and anal openings at some point prior to putting condoms on; and more. The solution, defenders thus argue, is to spend less time questioning the device and more time tutoring the user.
Kai Wright is editor of BlackAIDS.org.