Bay Area Reporter - July 26, 201
David Fraser

Condoms work. They help reduce HIV transmission. And gonorrhea.

That's the latest from the National Institutes of Health of the U.S. Department of Health and Human Services.

This stunning insight comes in a report that has burst into controversy because of the politics around its creation and publication. A number of health care professionals and HIV/AIDS activists said they feared uncertainty in some parts of the report would spur abstinence-only efforts.

Doc Coburn

Commissioned at the request of conservative physician and former U.S. Representative Tom Coburn (R-Oklahoma), the study was done by several key agencies including NIH, the Centers for Disease Control and Prevention, the Food and Drug Administration, and the U.S. Agency for International Development and released July 20.

The study is titled "Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention." It's online at www.niaid.nih.gov/dmid/stds/condomreport.pdf.

Researchers analyzed more than 138 peer-reviewed, published studies on properties and user patterns of the male latex condom in penile-vaginal intercourse.

The report did not address gay approaches to sex. It concluded that condoms work well for HIV in male-to-female intercourse and in male gonorrhea, but found evidence inconclusive on several other common STDs.

Coburn, who has long pushed for abstinence, has tried to use the report to portray condoms as not safe enough.

The Washington Post quoted him as writing 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.'"

Though the CDC participated in the NIH study, it has since reiterated condoms' effectiveness against STDs.

Response among many 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. The NIH report supports this view of condoms even though the research is not fully completed.

"We encourage people to use condoms. Of course abstinence is the only real way to ensure no transmission, but, given reality, it's not the smart way. We want to make sure people have protection."

Manipulation

"This politically motivated report has been manipulated to support the notion that only abstinence-based education and prevention programs are effective and worthy of support," said Gustavo Suárez, communications director of the San Francisco AIDS Foundation.

In a counter-report draft dated July 19 and provided by SFAF to the Bay Area Reporter, 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."

Calling the NIH research politically motivated and unscientific, the AIDS community response from SFAF tackled the NIH study point by point.

Among their charges: the report omits important studies and more recent findings since the panel review.

The NIH report itself notes that most epidemiological studies examining STD transmission were not really designed to see how well condoms worked.

Some, for example, studied clinical manifestations of disease, not diagnostic tests that measure infection.

"Many [studies] were done in special populations at high risk for infection, such as commercial sex workers or STD clinic patients - making it difficult to generalize results to other groups not at such high risk," the report noted.

Gender ignored

Gender-based susceptibility to infection was ignored in many reviewed studies.

Much of the news in the report was widely seen as positive.

One important finding reported by the FDA, which regulates condom production, was done by studying a laboratory virus much smaller than the smallest STD organism, the hepatitis B virus.

"... FDA scientists found that condoms are highly effective barriers, with a very small chance of leaking. What they found is that intact condoms are essentially impermeable to particles the size of STD pathogens."

Condom use may be old hat as far as safer sex discussions go in some gay populations. But Dr. Jeff Klausner, director of STD Prevention and Control Services at the San Francisco Department of Public Health, told the B.A.R. that some of the study's findings were useful outside the mostly straight population studied.

"The report validated that there are very large and well-done scientific studies showing that condoms work to decrease the transmission of HIV and gonorrhea," Klausner said. "HIV and gonorrhea are two STDs very relevant to men who have sex with men, particularly in San Francisco, where rates of new HIV infections and rectal gonorrhea have increased.

"The government group 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."

Klausner agreed with an anonymous person "close to the process" quoted in the Washington Post that "It is extremely important that the public understand the difference between data being inadequate and condoms being inadequate."

"This comment is right on," Klausner told the B.A.R. "The media has an opportunity to do the right thing and educate the public that the report focused on the quality of the data available and not the effectiveness of condoms.

Got protection?

"Condoms are adequate. Condoms do work. This report is similar to one evaluating whether speed limits reduce car accidents and death. There may be 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 our loved ones," Klausner added.

In fact, Klausner said, there are numerous studies of the MSM population showing that condoms, properly and consistently used, help block HIV transmission.

The issue, he said, is how to get persons to use condoms consistently, to use condoms correctly, and to make condom use the norm. "In populations where condom use is the norm, STD transmission is rare. For example in Thailand, 100 percent condom use has led to dramatic reductions in new STDs and HIV.

"If we could reduce the number of acts of unprotected anal intercourse between HIV-positive tops and HIV-negative bottoms among MSM, we could reduce the number of new HIV infections by 95 percent.

"To achieve this MSM must know their HIV status, MSM must use condoms for every act of anal intercourse with partners of unknown HIV status, MSM who are HIV-positive must take personal responsibility for not transmitting the virus and owners, managers and staff of venues like sex clubs, bars, parties and bookstores must take responsibility as well."

Klausner said regular testing is critical because many people with STDs including HIV are asymptomatic.

Wellness and condoms

Local wellness organizations also said condoms were key elements in their outreach.

John Manzon-Santos, Asian & Pacific Islander Wellness Center's executive director, told the B.A.R.: "Even if condoms only prevented the transmission of HIV and not all STDs, then using a condom has tremendous value and saves lives. If someone is sexually active, especially with multiple partners, they should get tested for both HIV and STDs regularly.

"A core strategy for Asian & Pacific Islander Wellness Center's prevention efforts is promoting condom use combined with regular voluntary HIV testing. That's why we offer HIV pre- and post-test counseling - especially for immigrants and refugees - in various Asian and Pacific Islander languages and disseminate community-wide messages that help promote isolation-breaking, sex-positive cultural norms."

At the Black Coalition on AIDS, outreach efforts include condoms along with other mechanisms to promote community well-being, said Daniel Hlad, communications associate.

Among the many test sites in the Bay Area is the DPH-run City Clinic, 356 7th Street, San Francisco, between Folsom and Harrison. For more information, call (415) 487-5500.
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