December 2004

Condoms only 85 percent effective - not true!

    

  

 
My friend, Christopher Low, is fighting a one-man crusade against what he feels are "deceptive practices" by religious fundamentalists in their abstinence programs.

In particular, he has focussed his ire on the claim by Hui Keem Peng that condoms are only 85 percent effective. Hui, whom Christopher believes is affiliated with the Catholic Medical Guild, wrote in his letter published in Today newspaper, 4 Dec 2004

"In a 2001 report by the United States' National Institute for Health, the condom was not found to be effective in preventing the transmission of a number of STIs. In the area of HIV prevention, it was found to be only 85 per cent effective and only if used consistently and correctly."

Other letter writers have likewise asserted that condoms are not completely effective. For instance, Tan Thuan Seng, President of the Christian fundamentalist group Focus on Family, said in his letter that was published in Today newspaper, 16 Nov 2004, " At best, condoms only provide 85-90 per cent protection against HIV/Aids." [1] 

Their assertions are plain wrong.

By spreading such untruths, they scare people away from using condoms. Of course they hope that people won't have sex at all, but human nature is such that this is impossible. So the net result of their misguided zeal is that people will still have sex, but feel there's no point using condoms.

These religious extremists are being irresponsible. In short, they kill.

Hui Keem Peng cited a 2001 Report from the US' National Institute for Health, so it would seem that the figure of (only) 85% effectiveness had scientific backing.

Well, they are either scientific illiterates, unable to understand scientific writing, or they have deliberately distorted the facts to suit their agenda.

An example of an attempt to mislead comes from the sentence in Hui's letter above, "the condom was not found to be effective in preventing the transmission of a number of STIs." If you read that sentence very carefully, it is true. The condom doesn't help much with sexually transmitted diseases like genital warts, or pubic lice, which don't depend on an exchange of body fluids. But note the following: the condom is designed to hold back the exchange of body fluids, so of course it isn't meant to counter other infections. It's like expecting the condom to protect you from catching the flu from someone sneezing in the vicinity.

Another thing you should note is that Hui used "STI" without expanding it, so that the reader continues to think "HIV/AIDS" even as Hui talks about other sexually transmitted diseases. By that sleight of hand, the phrase, "not found to be effective" is then associated, in the readers' minds, with HIV/AIDS.

Yet. the very report by the National Institute of Health said, "These data provide strong evidence for the effectiveness of condoms for reducing sexually transmitted HIV."

 
* * * * *

So, what exactly did the NIH say? [2]

 

 

 

 

 

Abstinence pledges

The religious rightwing is very keen on their abstinence pledging campaign. Teenagers and young adults are asked to sign a pledge that they will refrain from sex until married.

Besides promoting "morality" as Christians understand the term, the campaign is advertised as a public health virtue as well.

Well, bullocks.

Follow-up data has shown that the drop-out rate from these abstinence pledges are very high. In other words, the youngsters pledge to abstain, but they aren't actually abstaining.

Worse, the teenagers who sign up with these programs often get taught that condoms are useless (that's how abstinence is sold as the only safe measure), and when they fall off the abstinence pledge, they are far less likely to use condoms, compared to the teenagers who didn't sign up in the first place. 

In other words, these campaigns, do not much reduce sex, but do reduce condom use. So much for public health virtue.

 
The box on the right gives you their exact words leading up to their conclusion. A careful reading of the report, including the section preceding the quoted passage gives a fuller picture of what they found.

Davis and Weller had done a meta-analysis of various studies. Their meta-analysis was based only on longitudinal and cohort studies, These studies followed sero-discordant, sexually active heterosexual couples over a period of time. 'Sero-discordant' meant that at the start of the studies, one partner was HIV-positive and the other HIV-negative.

These couples were in faithful relationships through the study period. Some of them always used condoms when they had sex. Others never did.

The researchers then measured how many of the initially HIV-negative partners became HIV-positive after a while. The results were expressed as the number of sero-conversions per 100 person-years.

This ratio was 0.9 for those who always used condoms and 6.7 for those who never used condoms.

In layman's language:

For every 100 couples having sex repeatedly through the course of a year, using condoms every time, only 0.9 persons sero-converted to HIV-positive.

(This suggests that if you are HIV-negative, and with the consistent benefit of condoms, you had sex with an HIV-positive person over a 100-year period, your chance of being HIV-positive after 100 years would be 0.9%.)

For every 100 couples having sex repeatedly through the course of a year, but never used condoms, 6.7 of the initially HIV-negative partners, sero-converted to HIV-positive.

And where's the "85 percent" in all this? By this mathematical formula:

(6.7-0.9)/6.7 = 0.85

What the researchers said was that the condom-protected couples, with their 0.9 sero-conversion rate, had an 85% lower likelihood of getting HIV compared to the no-condom couples. They didn't mean to say that if you used a condom you still had a 15% chance of getting AIDS.

Your chances of actually getting HIV, with consistent, correct condom use is estimated to be less than 1% even after a hundred years of sex.

* * * * *

But the fundamentalists don't want you to know that. They want you to think that condoms "only offer you 85% protection". They want to you to think that if you have sex -- just once -- with an HIV-positive person, you have a 1 in 7 chance of getting AIDS despite the rubber.

That's just not true.

That's why Christopher is furious about their deceptive tactics.

© Yawning Bread 

 

 

Excerpt from the 2001 NIH report on the effectiveness of condoms in preventing transmission of STDs:

Condom usage was classified into the following three categories always (100% use), sometimes, and never. Among participants who reported always using condoms, the summary estimate of HIV/AIDS incidence from the twelve studies was 0.9 seroconversion per 100 person years. Among those who reported never using condoms, the summary estimate of HIV/AIDS incidence from the seven studies was 6.7 seroconversions per 100 person years. Overall, Davis and Weller estimated that condoms provided an 85% reduction in HIV/AIDS transmission risk when infection rates were compared in always versus never users.

Conclusions

The methodological strength of the studies on condoms to reduce the risk of HIV/AIDS transmission far exceeds that for other STDs. There is demonstrated exposure to HIV/AIDS through sexual intercourse with a regular partner (with an absence of other HIV/AIDS risk factors). Longitudinal studies of HIV- sexual partners of HIV+ infected cases allow for the estimation of HIV/AIDS incidence among condom users and condom non-users. From the two incidence estimates, consistent condom use decreased the risk of HIV/AIDS transmission by approximately 85%. These data provide strong evidence for the effectiveness of condoms for reducing sexually transmitted HIV.

 

Footnotes

  1. This letter can be seen in
    Balaji on AIDS – Christian fundamentalists rush in   
    Return to where you left off

  2. The report can be read at: www.niaid.nih.gov/dmid/stds/condomreport.pdf
    Return to where you left off

  3. Another example of the fundamentalists misquoting science can be seen in the article Playing fast and loose with science  

  4. See also:
    Condom letters in 'Today'  
    Condom letters in the Straits Times   
    Abstinence programs contain false and misleading information  
    Don't spread falsehoods, I said to the editor

Addenda

Sunday Times, 5 December 2004: Reporters following the Health Minister Khaw Boon Wan (Balaji's boss) got some comments from him. The newspaper reported:

"You know my style. The problem is identified, let's be open about it, discuss it, and let's get views while we study what we should do," he said. "I think we are more likely to succeed if we treat this as a purely public health problem. So let's take away the morality and religion from all this."

Encouraging words!

 
Reader's comment

Just to add my two cents worth. Being a pharmacist, I know about trials and studies, effects and response rates of drugs. To my knowledge, no drug is 100% effective. Typically, a 50-60% response is already considered very good while trials involving antibiotics report successes in the 80 to 90% range. For the record, no regulatory authority will discourage a drug simply because it is not 100% effective. Instead, statements on drug safety, appropriate usage and which groups of patients will most likely benefit, are released. A drug will only be discouraged or withdrawn if new data shows the risks associated with its use outweighs the potential benefits.

So coming to the issue on condoms, even if that 85% protection is true, there is absolutely no reason to suggest, no matter how subtly, that its use does not amount to much. We do not stop approval of use of a drug simply because it did not show 100% effectiveness.

Incidentally, Dr Lee Hew Mun wrote to the ST forum pages on 4th December, promoting abstinence and faithfulness. In the same breath, I detected from his writing obvious overtones of disapproval of condoms since "their effectiveness is only 80 per cent. A draft report for UNAids puts the failure rate of condoms at about 10 per cent." This is not particularly responsible and is only going to get a lot of people killed ultimately. I have my suspicions that he belongs to some pro Christian group that basically subscribes to the believe that sex is solely for procreation. Unfortunately, I doubt that many people are going to stop having sex.

So emphasis that condoms are only 80 per cent effective is like saying Prozac was found to be effective in 50 per cent of severe depression. Do we highlight and hint that Prozac is not the way to go simply because it is not 100 per cent foolproof? If psychiatrists indeed believe and start publishing such statements, I shudder to think of the suicide statistics.

Leuk.