Condom Effectiveness: Fact Vs. Fiction

Earlier this week, I invited everyone to start an open dialogue about human sexuality, how we communicate about sex, and sex education.

Yesterday, I received an email from a reader that asked, "I have an aunt...who says that latex condoms don't work against AIDS, because the latex has microscopic holes and actually those don't work against the virus. Is this correct?"

It sounds like your aunt is getting her information from the Vatican. This pseudoscientific claim is used to discourage condom use in third-world countries, an extremely frightening thought. The United Nations Population Fund, the World Health Organization, and the Joint United Nations Programme on HIV/AIDS released an updated statement in 2009:

"Laboratory studies show that male latex condoms are impermeable to infectious agents contained in genital secretions."

The Center for Disease Control (CDC) states that "laboratory studies have demonstrated that latex condoms provide an essentially impermeable barrier to particles the size of STD pathogens."

This does NOT mean that condoms are 100% effective, however. The CDC warns that "to achieve maximum protection by using condoms, they must be used consistently and correctly.
The failure of condoms to protect against STD/HIV transmission usually results from inconsistent or incorrect use, rather than product failure."

A 1992 meta-analysis of condom effectiveness showed a 69% reduction in HIV transmission in individuals who use condoms. The authors are candid in reporting that the original studies had design limitations. It is also unclear what role condom malfunction or "user error" played in the reduction in efficacy. A 2001 study of condom usage shows that women think that condoms slip or break more often than they actually do, and there seems to be an inconsistency in self-report of condom efficacy and actual protection.

There is a remote chance that very small viruses, like HIV, may be able to pass through a condom if the condom is defective, although the semen containing the virus cannot. A study performed with artificial virus in a laboratory setting revealed that the latex membrane of condoms is usually HIV-sized virus impervious, and 98.8% of HIV-sized virus penetration in the study came from 2 of 470 tested condoms.

One thing is clear, however. Using a condom is significantly safer than not using one. Condoms do prevent pregnancy and they do reduce the risk of transmitting HIV. A recent study shows that HIV/AIDS misinformation is rampant in South Africa, a country where 20% of the young male population is HIV-positive. Especially among young black adults, those who hold misconceptions about HIV/AIDS are less likely to use condoms. A meta-analysis of 67 studies published earlier this year confirms that having access to condoms, being instructed on their proper application, and actually using them significantly reduces the transmission of HIV and other sexually transmitted infections.

And for any HIV/AIDS deniers out there, please read these fact sheets provided by The Skeptic's Dictionary, AidsTruth.org, and SMU.

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Comments

[hivgirl]

01:18 PM on 11/21/2011

I think it is important to note that the type of lubrication makes a huge difference. Put a condom on your hand and rub vaseline on it to see what happens - #fail And just to be clear, I was abstinent before marriage, totally loyal during marriage and finally left due to his infidelity. My meeting with the next guy was my undoing. Don't think it can't happen to you. It only takes one meeting or your spouse meeting someone.

[Ivabradine]

04:39 AM on 11/18/2011

So where are we, as this interesting correspondence comes to an end? The evidence tells us that (used properly) condoms work but condom promotions (at least in epidemic AIDs) do not This appears to be because condom publicity “normalises” promiscuous sexuality. However when abstinence before marriage and fidelity within marriage has been promoted, the rate of Aids in the population decreases. Read the experts at

http://www.washingtonpost.com/wp-dyn/content/article/2009/03/27/AR2009032702825.html

While much of the cause of the epidemic seems to be rooted in poverty, extensive work needs to be done in helping those already infected, and protecting the newborn. (And I should mention here the value of male circumcision as a prophylactic.)

The Catholic Church has been putting into practice this well established evidence for years. It is led by someone who is rather bizarrely described by Rober Frano as “A sadistic, serial-sociopathic”

[pavementends42]

12:17 PM on 11/18/2011

Not very convincing from a NewsCorp owned pub. Reducing? Maybe. Reducing enough? Most definitely not! Also, rabidly fundamentalist Christian and Catholic proselytizing has been responsible for the rejection of contraception and sexual barriers in Africa, which also happens to have the greatest concentration of HIV infection, as well as the fastest rate of infection, in the world. That kinda puts a damper on the idea that promoting abstinence is helping much. People will have sex. Married people also can spread HIV. So, based on reality, maybe they should revise their strategy a little?

[DJMarian]

01:31 AM on 11/20/2011

I don't think condoms are given out with a tag that says go have sex, they are given out with a tag that says protect yourself if you do have sex and prevent pregnancy too! You know what is normal, people rolling their eyes when the church tells them to wait till marriage or they will burn in Hell! Is that a normal thing to do? Threaten eternal damnation for premarital sex? Is it normal for people to be ashamed of their feelings? Is it normal for people to wait for marriage?

[Robert Frano]

08:49 PM on 11/17/2011

Poster 'Thymos' informs me I’m “uncivil”, (re: “Condom effectiveness: Fact vs. Fiction”, see post).

I DON’T intend to soothe ruffled piety-plumage!
33-35+million Hiv-deaths is pretty G.D.’d uncivil, as is the effort to allow STD’S free reign under the Vatican’s rip-off of StarTrek's ‘prime_directive’…
Ever treated a person with an (easily_prevented), terminal disease??! It’s MORE fun than a 55G drum o’ lubricant w/ a ladel amongst 1,000 meth-addled bishops in a ‘no-tell’ motel!!
Bodily fluids, devastated families, hostile neighbors, former friends, co-workers, scared by some pie-hole-runnin’ cleric, who as easily as not is, himself, a ‘typhoid mary’, despite (alleged) chastity!
22 years of ‘911’-employment gave me scandalous insight & '4+' alcoholism.
I have a huge anger reservoir re child rapists / those who prefer disease-spread to prevention: aka, Catholicism’s hierarchy.
2.1 billion faithful seek spiritual direction, while Benny.16 seeks to rid humanity of condoms! What's happened to common decency?!

…An abortion is auto-excommunicative; Thermonuclear species-death by Trident, (an 'abortificient'), allows ‘savior-cannibalism’ 24 x 7!
Preventable human death stats, starvation, war profiteering, rape, diseases, sexually / otherwise acquired rival my P/c’s binary code process-rate!
That’s uncivil!
Spread-of-contagion is a crime.
Does 'Thymos'‘ have a problem with that? Who knows...
A sadistic, serial-sociopathic, (Joseph Ratzinger, alias: “Benny-16’), & his protectors, defenders, and excuse makers, (‘under-assistant blame shifters’), has a problem w/ that!
That's uncivil!

[pavementends42]

12:22 PM on 11/18/2011

Perpetuating a snow-balling epidemic under orders of his Holiness, doesn't sound very holy.

[Ivabradine]

06:30 PM on 11/17/2011

Sorry, Thymos, while your 80% figure is quoted nearly correctly (it’s 85%), your interpretation is wrong. It shows the comparative safety achieved measured against no preventive steps. But, surprisingly perhaps, HIV is not that easy to catch. In optimum conditions (stable couples using standard condoms regularly etc) the overall rate of infection is 0.9 per 100 woman years.
P.14 of http://www.niaid.nih.gov/dmid/stds/condomreport.pdf.

I appreciate your approach but this is an area in which we all have to be as accurate as possible. The article which heads this discussion is written by someone with an apparent anti Catholic bias, and little knowledge in depth of this field.– not worthy of the Huffington Post, sadly.

[Syllogizer]

02:18 PM on 11/18/2011

But typical both of this columnist and of HuffPost, especially since the AOL acquisition.

[Thymos]

05:18 PM on 11/17/2011

Cara Santa Maria cites the CDC numerous of times in her article. Why didn't she cite this:

Individuals who use condoms consistently and correctly "were 80% less likely to become HIV-infected" (CDC).

That leaves the individual with a 20% risk of transmitting/receiving the HIV virus.

Knowledge of human behavior reflects that not each person will practice safe sex (i.e. use a condom) consistently and correctly.

Problems of HIV/AIDS in Africa is due to condom failure: individuals do not use it correctly, consistently, and many are not in monogamous relationships, having as many as 3 partners at a time.

Cara provides a disservice to the HIV/AIDS community and humanity by turning a blind eye to the internal problems of African governments (corruption and mishandling money from Western countries to use for HIV/AIDS), using the Vatican as a scapegoat.

[Joseph J Schuler]

08:24 PM on 11/17/2011

You need to check your math. 80% less likely does not equal a 20% chance of infection. It means 80% less than the base odds of infection. Odds are multiplicative.

[pavementends42]

12:20 PM on 11/18/2011

Thank you... please, no more instruction from those who CANT READ THE STATS.

[Robert Frano]

03:14 PM on 11/17/2011

Quote: "A 1992 meta-analysis of condom effectiveness showed a 69% reduction in HIV transmission..."

As a child I was exposed to potential STD’s from multiple offenders, via indifferent parents who (literally) saw 'dirty' laundry.
To castigate condoms as STD transmission-gateways, is, to this former Christian & retired EMS-professional, a 'passive genocide', particularly in 3rd. world settings, where ‘health care’, (as spoiled westerners use that loaded term), is virtually as good as Rome’s...circa 440 A.D.!

…Pretty Ironic for a religion attempting to ‘manage’ non-believer’s sexuality & reproduction issues via legislation, praises 'celibacy', is ‘pro-life’, etc.!

To dismiss a worldwide felony crime tsunami, which, (among other socially destructive results) promotes STD transmission by offender-clerics blindly following their lusts & their fearless leader’s condom-war, (…while ignoring children's 'consent’ issues), then dismisses multi-offense indictments as catholic bashing, as the hierarchy & Bill Donahue, of the Catholic League, still (occasionally) attempt, is grounds for a sweeping I.C.C. criminal indictment.
Throw enough bovine waste & some surely sticks, right, Cardinal Law?

I read Bishop Flynn sweet-talked his (latest) prosecutor; He's free, if he keeps his…’nose’ clean for ‘a while’! Same conditions he failed to observe during previous crimes!
Just imagine: clerics, dripping with degrees, (and, one wonders, 'what else'?), still claiming, post hyper-privileged education, they, "...didn't know what to do"!

Such nonsense is as cynical amusing as Bush’s fellow gangster, ‘Kenny boy’ Lay, ‘un-convicted’ in the Enron mess…due to his less-than-graceful-exit!

[Ivabradine]

01:54 PM on 11/17/2011

Anyone who seriously wants to review the strategies which are effective in controlling AIDs in sub Saharan Africa, should go to http://www.cafod.org.uk/resources/policy/aid/hiv

Click on HIV prevention 318.82kb. This paper, by the leading Catholic charity in the UK is a comprehensive investigation into the different approaches and the part they can play. It is thoroughly realistic.

[Mark Van Kekerix]

02:55 PM on 11/17/2011

The paper you link to advocates an "ABC" approach (Abstinence, Be faithful, Condoms). But in discussing the approach, most of the time and weight of discussion focuses on the first two. In fact the paper says directly that this "interpretation of the C component cannot support a 'condoms only' or even a 'condoms mainly' campaign", and goes on to refer to approaches promoting condoms as "flawed".

Another big problem with this paper is that there is absolutely no mention of the effectiveness of the ABC approach.

Frankly, given that the paper was written by a Catholic group, it would appear that this is just a way for Catholic charities to say "see, we sort of included condoms, but only when abstinence and faithfulness don't work".

Honestly, I agree that an approach focused only on condoms isn't as effective as an approach that uses condoms, medications, and behavioral changes together. But the science says that condoms are by far the most effective tool. Sadly, the Catholic church wants condoms removed from the tool box, making their efforts at HIV & STD prevention far less effective than they could be.

[Weiqiu Liu]

04:45 AM on 11/18/2011

"Honestly, I agree that an approach focused only on condoms isn't as effective as an approach that uses condoms, medication­s, and behavioral changes together. But the science says that condoms are by far the most effective tool. "

Science simply says that condoms are the most effective for lowering risks in the process of unsafe sexual behavior, not that usage will lower someones overall lifetime risk. Because people seem to compensate for usage of condoms by having more sex. As the Daily Mail reported, "Free condoms are failing to stop the spread of HIV because users end up having more sex, according to a report.

The sheaths are not 100 per cent effective, even when used properly, US researchers found.

Instead, the spread of the virus is a behavioural problem, said Harvard researcher Dr Edward Green. He added: "Having multiple sexual partners drives Aids epidemics."

After studying the number of condoms available in many African countries, he added: "We are not seeing what we expected - that higher levels of condom availability result in lower HIV prevalence."'

[Weiqiu Liu]

12:29 PM on 11/17/2011

"A meta-analysis of 67 studies published earlier this year confirms that having access to condoms, being instructed on their proper application, and actually using them significantly reduces the transmission of HIV and other sexually transmitted infections."

No it didn't! HIV and STI transmission was not measured. In the design of the analysis, condom negotiation skills, usage skills, and frequency of condom usage were OUTCOMES, not variables. So this study has nothing to do with the criticisms you are supposedly answering.

Furthermore, as noted in the study, the participants in the reviewed studies were heavily biased towards North Americans, so other studies are needed to find out what works in Africa and Asia.

If you want to see how condom intervention ACTUALLY fared in Africa, not some a look at Potts et al., "Reassessing HIV Prevention." Science. 5/9/2008, or the work of Edward C. Green, former Senior Research Scientist at the Harvard School of Public Health and former director of the AIDS Prevention Research Project at the Harvard Center for Population and Development Studies. I.E., people who studied HIV/AIDS transmission in AFRICANS, not condom use in Americans and Canadians.

[Leadsled]

04:28 PM on 11/17/2011

Ummm...you think that Africans and Americans are a different species or something? Because otherwise a person is a person, a condom is a condom and an HIV virus is an HIV virus. It doesnt matter where you live.

[jf12]

04:33 PM on 11/17/2011

Because attidues vary, location can matter. Some people may think condoms are magic, enabling riskier behavior. Plus, when they run out there is always the matter of getting more.

[Weiqiu Liu]

05:32 AM on 11/18/2011

Wrong, it matters very much, the environments are completely different. See the BBC article, "The pope was right about condoms, says Harvard HIV expert." They found those populations with more condom usage had higher HIV prevalence, and in investigating the causes of that, the did a prospective study in Uganda which found that among two random groups the one given "intensive condom promotion" had more sexual partners. There seems to be "risk compensation", where those with condoms cancel out the benefits by having more sex.

The biggest difference between the countries is that in the US, Thailand, Cambodia, etc. heterosexual transmission of HIV is rare between citizens (and studies have suggested it is even rarer than official statistics suggest because so many of those reported heterosexual transmissions were later found upon further investigation to have used injected drugs or had sex with between two men and lied initially), whereas it is common in Africa (the mainstream view is that this is probably because of the epidemic in Africa of untreated infections that end up causing open sores on women's genitals.) So, to cancel out the benefits of condoms for Americans, you need to have sex many, many extra times. But for Africans, you only need to have sex a few extra times because a single tear or slip is so dangerous.

Furthermore, targeted interventions were used in countries like the US, Thailand, etc. at sex workers, MSM (somewhat unsuccessfully), and injected drug users (of course needles for them).

[Thymos]

05:28 PM on 11/17/2011

Excellent analysis.

[Darwincrat]

12:28 PM on 11/17/2011

Condoms save lives and are highly effective. However, the most effective approach to stopping HIV includes a holistic approach that includes behavioral intervention, education, treatment (effective ART therapy reduces transmission by 96%), and tools that empower women to prevent transmission when their partners shun condom use(microbicides, pre-exposure prophylaxis).

Condoms alone won't solve the global AIDS crisis but we shouldn't throw the baby out with the bathwater.

[Thymos]

05:23 PM on 11/17/2011

One strategy that worked in Uganda, Africa:

"Sexual debut" of woman, meaning sexual intercourse, at a later age, decreased HIV/AIDS transmission.

[pavementends42]

12:28 PM on 11/18/2011

I don't think it matters much at what age one first has unprotected sex. They can still transmit disease. Period.

[SanityWillPrevail]

11:52 AM on 11/17/2011

Some friends of mine in college wanted to have a baby. They were afraid not to use a condom because they didn't want to take a chance on spreading a venereal disease to each other or to their baby. So while making love, at the right moment, he would withdraw, remove condom, enter, squirt, withdraw, put condom back on, then continue. Their logic was that the short time they were unprotected made no difference since the viruses probably couldn't swim that fast. It worked because she got pregnant. College kids can be so resourceful.

[Darwincrat]

12:20 PM on 11/17/2011

I hope that people do not take this advice to heart. It depends on the type of venereal disease (these days called STIs) you're talking about. Some STI's are present in higher amounts in seminal secretions than others. For Herpes, which is usually spread through skin contact, that strategy might have some benefit (albeit not nearly 100%). However that strategy would be completely ineffective against HIV. Keep in mind that transmission rates are fairly low for most STI's on a per sexual act basis. The couple simply got lucky that they did not transmit the virus.

[stuoverit]

02:21 PM on 11/17/2011

Idiocy

[Ivabradine]

11:31 AM on 11/17/2011

It is true that the late Cardinal Trujillo, speaking in 2003 – after taking professional advice, said that the AIDs virus could fit through the pores of the condom. But every Catholic interested in such matters, knows that this is not true. Condoms (in good condition and used properly) give a high level of protection, on an incident by incident basis.

What the Pope did say is that condom promotions in societies of epidemic Aids are counterproductive, while programmes which promote marital fidelity and avoidance of sexual relationships outside marriage have proved significantly effective. The evidence for this is quite clear, and supported by the secular experts.

Meanwhile Catholic organisations, working often with non Catholic partners, are doing massive work in ensuring that people are able to have anti-retroviral therapy, and their newborn protected from perinatal infection. You will perhaps find that they are being funded by people just like your Catholic friends next door. You might go round and thank them.

[Anaxamenes]

01:11 PM on 11/17/2011

But ignoring the people that abstinence education doesn't work for doesn't make them go away. They still need to be educated about proper use of condoms and where to get them.

[pavementends42]

12:30 PM on 11/18/2011

Yes, don't give them the tools to protect themselves, change their culture to save them from themselves. Arrogance approaching that of the "White Man's Burden."

[Syllogizer]

02:30 PM on 11/18/2011

But you 'libs' shoulder that "white man's burden" even more gladly when you spread the education of women and fight against female 'circumcision'. Why is it right when you do it but wrong then the Roman Church does it?

[Mindy Czech]

11:09 AM on 11/17/2011

During the sad point of my life when I was having sex with men to try to turn myself straight, I was never able to use condoms. I am severely allergic to latex, and condoms from other materials don't protect from disease. My mom put me on the pill at the age of twelve because I was having two full, seven day, painful periods a month and this was a way to stop that, and also because she didn't know when I would start having sex and wanted me to be protected. I made everyone I slept with get tested every few months for STDs while with them, and before I would even be willing to sleep with them.

My way to prevent pregnancies now is by just making love to my wife. We are both on Depo Provera to stop our periods, and now we are also protected from rape pregnancies and immaculate conception. It's a fine thing. We avoid the STD risks we were both clean when we got together and are monogamous. Plus, lesbians have the lowest STD transfer rate of all types of couples, so that's a plus.

[JustThisGuy]

02:21 PM on 11/17/2011

A friend of mine with latex allergies is quite happy with the (more expensive) polyurethane condoms, which provide the same level of protection.

[Mindy Czech]

02:25 PM on 11/17/2011

I don't need them anymore because I got myself out of denial and started dating women, and now I am married to one with no STDs or chances of me getting pregnant. When I was sleeping with guys 8-10 years ago, I don't think those were around. I never saw them, at least. But that was a time before most hospitals and doctor's offices didn't have non-latex examination gloves onhand and they were crazy expensive, so I wouldn't be surprised if they didn't have them or if they were hard to attain. Latex allergies were much less prevalent then, too.

[LeftRight]

10:39 AM on 11/17/2011

And when you include a viricidal lubrication, condom effectivness at reducing HIV goes above 99%....

[niko73]

10:29 AM on 11/17/2011

Have no doubt, the people who are perpetuating these myths about condoms are killing people. Whether it’s the Pope or brainwashed right wingers, their lies result in deaths. I’ve lived in Kenya for 4 years and I’ve heard them all and seen what they can do. Condoms are part of a conspiracy, they’re ineffective, they’re evil, etc. This plants enough doubt in people’s heads, especially if it’s being spread by someone of influence such as a priest, and people (read: men) don’t use them. HIV prevalence grows and deaths from AIDS become more common.

The enablers are certainly to blame, but I don’t mean to excuse the men who believe these lies and often infect their innocent partners. Many people know condoms are effective but lack the resolve to change their behavior and use one. (I can’t count how many times I heard the line “but using a condom is like eating a sweet with the wrapper on”). I will not excuse personal responsibility, which needs to improve too.

Condoms WORK to slow the spread of HIV. Uganda greatly cut its prevalent rates with an aggressive condom campaign. It should be used as a model around the world.

[pavementends42]

12:33 PM on 11/18/2011

These kinds of misinformation campaigns disgust me to no end. They call repealing DADT and marriage equality in the US a social experiment... what do the Evangelicals who preach over seas and spread these kinds of lies call this travesty?!

[GeorgeBurnsWasRight]

10:15 AM on 11/17/2011

I'm SO proud to live in a country where a significant portion of the population can't use a condom properly.

Two possibilities, equally depressing:
1) People in the US are too dumb to use them properly
2) Sex education in our schools is so limited that it doesn't give kids enough info to know how to use them. Thank you, abstinence-based "education".

[Drama Llama]

12:07 PM on 11/17/2011

Very much #2... abstinence education leads to ignorant sex.

[I try to be reasonable]

12:12 PM on 11/17/2011

Number 2. Imagine if there was no such thing as drivers' ed, and you were expected to just get behind the wheel of a car and start driving, in traffic, and get on the highway. Crazy!

This is not much different, and could be just as lethal. People need to be taught.

[jf12]

04:36 PM on 11/17/2011

Almost everyone actually learns to drive from their parents. Of all driving teachers, dads do the brunt of the guidance, the vast majority of the encouragement, and provide almost all the gas money.