"NIH Condom Report Draws Fire"
Bay Area Reporter (San Francisco) (07.26.01) Vol 31; No 30: P
A National Institutes of Health (NIH) report released amid
controversy recently has a number of health care professionals
and HIV/AIDS organizations worried. The uncertainty the report
reflects about research on the use of condoms, many fear, will
end up making individuals uncertain about condom use -a
devastating thought for public health workers.
Conservative physician and former US Rep. Tom Coburn (R-
Okla.) commissioned the report -"Scientific Evidence on Condom
Effectiveness for Sexually Transmitted Disease (STD)
Prevention." Conducted by several key agencies, including NIH,
CDC and the Food and Drug Administration, the study was released
July 20. It analyzed more than 138 peer-reviewed published
studies on the properties and user patterns of male latex condoms
in penile-vaginal intercourse. No gay approaches to sex were
included in the analyses.
The report concluded that condoms work well in HIV in male-
to-female intercourse and in male gonorrhea, but found evidence
inconclusive on several other STDs. Although the CDC participated
in the NIH study, the CDC has since reiterated that condoms are
effective against STDs.
Coburn's response to the release of the study was a letter
to Health and Human Services Secretary Tommy Thompson saying,
"This report means that when condom use is discussed, it is no
longer medically accurate -or legal for the CDC -to refer to
sex as 'safe' or 'protected.'"
Response among AIDS activists and service organizations was
scathing. Maureen O'Leary, executive director of the national Gay
and Lesbian Medical Association, said, "The danger is taking
what Coburn is suggesting so that people might stop using
condoms, thinking they're not going to have any effect
whatsoever. Our stand is that used properly, they reduce AIDS
[risk] and other STDs...."
In a counter-report drafted on July 19 by the San Francisco
AIDS Foundation (SFAF), activist researchers argued: "The bottom
line is that abstinence fails more often than condoms. And
abstinence, like a condom, is only effective when it is
consistently used as a means of STD and HIV prevention." Point
for point, the SFAF refuted the NIH study. Included in its
analysis: the NIH omits important studies, and its study, by the
report's admission, was not designed to see how well condoms
worked. "The government groups looked at the quality of
published research studies. The group did not look at the
effectiveness of condoms. We know that when condoms are used
consistently and correctly they reduce the transmission of HIV
and other STDs, including gonorrhea, chlamydia, syphilis and
herpes," said Dr. Jeff Klausner, director of the STD Prevention
and Control Services at the San Francisco Department of Public
Health. "Condoms are adequate. Condoms do work. This report is
similar to one evaluating whether speed limits reduce car
accidents and death. There may be a few large published research
studies but we all know that driving slower is safer and an
effective way to protect ourselves, protect others, and protect
loved ones, " Klausner added.
The issue for most public health workers is how to make
condom use the norm. In populations where condom use is the norm,
STD transmission is infrequent. In Thailand, according to health
experts, 100 percent condom use has led to great reductions in
new STDs and HIV transmission. "A core strategy for Asian and
Pacific Islander Wellness Center's (APIWC) prevention efforts is
promoting condom use combined with regular voluntary HIV
testing," said John Manzon-Santos, APIWC's executive director.
"Even if condoms only prevented the transmission of HIV and not
all STDs, then using a condom has tremendous value and saves