Accuracy of religious document against condoms
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I am involved in producing a training pack for youth groups attached to
churches and mosques in Zambia, on sexual and reproductive health.
The pack takes the form of participatory learning activities, with
"fact-sheets" for facilitators attached.
Condoms will of course be mentioned as one way of preventing unplanned
pregnancy, STIs and HIV/AIDS.
We want to give a balanced view, mentioning religious objections to
condoms, and the disadvantages of condoms. We also want to mention the
health benefits of using condoms. An important part of the fact-sheet
will be to highlight and explode any myths. So we are looking for accu-
rate information.
In this context, we would be grateful for comments on the following ma-
terial, taken from "Education For Life: A Behaviour Change Process For
Groups", published by the Catholic Church in Zambia and based on a
similar publication from Uganda. This is a booklet for use by facilita-
tors of intensive 4-day workshops for young people.
This section on condoms occupies 4.5 pages out of 39; there is no
equivalent reference material in the book promoting the alternatives,
e.g. sexual abstinence, faithfulness between two uninfected partners,
i.e. discouragement of use of condoms seems to be a major thrust of
this training curriculum and publication.
The "behaviour change process" is widely used in Zambia and Uganda - I
do not know if it is used elsewhere. Regardless, the material quoted
below is commonly believed by many people, and is often given as justi-
fication for not using condoms.
I am particularly interested in identifying and rebutting any myths,
and in the weight and veracity of the references.
Sorry it's so long.
Comments, please!
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Start quotation:
STD/HIV/AIDS Lecture Notes AIDS Prevention Strategy Condoms . are they
worth it? Compiled by Youth Alive Club, Uganda
When talking about AIDS prevention and the condom, there is a need to
clearly understand what we are talking about.
In simple terms, prevention means to hinder or to stop something from
occurring at any cost.
"Condom" on the other hand is a penile sheath made of rubber/latex rub-
ber.
These originated from the concept of the use of protective devices
which ranged form linen sheaths in 1564 to animal intestines in later
years. In the 18th century, they were popularised by the liberties of
the time as a means of "protection from venereal diseases and numerous
bastard offspring!"
Today, condoms are used as an artificial way of preventing pregnancy
and as a strategy to prevent sexually transmitted diseases (STDs), in-
cluding the human immunodeficiency virus (HIV).
Bearing in mind that the condom has a failure rate of about 15% - 30%,
how preventive is it? It has also been regarded as safer . safer than
what and how?
Need to define a condom
Original purpose
Prevention
Even the condom is not 100% guarantee of safety against AIDS, for the
same reason the condom is not 100% guarantee of safety against preg-
nancy. There is always the possibility of human or mechanical error.
Condoms can slip and break. They can also leak.
"Do you want safe premarital sex? I'd say there is no such thing. Sure,
the condom may make premarital sex less risky, but the risk is still
tremendous. The stakes are very high. It's your life. That's a big gam-
ble," says Rusty Wright a lecturer of Arrow Head Springs, Son Bernadino
USA.
In my mind, the safest kind of premarital sexual activity is absti-
nence.
After I had made these remarks at a University in California, one young
man asked me to explain what I meant when I said that condoms aren't
safe. Let me elaborate.
Condoms have an 85% (annual) success rate in protecting against preg-
nancy. That's a 15% failure rate. But remember a woman can get pregnant
only about six days per month. HIV can infect a person 31 days per
month.
According to CM Roland in his article on The Barrier Effectiveness of
Latex rubber, Latex rubber has tiny, naturally occurring pores or
holes, sometimes measuring 5 microns in diameter. (A micron is one
thousandth of a millimetre -- very tiny!) Latex condoms will generally
block the human sperm, which is much larger than the HIV virus. (A hu-
man sperm is about 60 microns long and 3-5 microns in diameter at the
head).
But the HIV virus is only 0.1 micron in diameter. A 5 micron hole is 50
times larger than the HIV virus. The virus can easily get through. It's
kind of like running a football play with no opponents on the field to
tackle you or shooting a soccer ball at an open goal. The hole is huge!
In other words, the many of the tiny pores in the latex condom are
large enough to pass the HIV virus (that causes AIDS) in its fluid me-
dium.
One study focused on married couples in which one partner was HIV posi-
tive. When couples used condoms for protection, after 1.5 years, 17% of
the healthy partners had become infected. 17% That's about 1 in 6, the
same odds as Russian Roulette.
One FDA study tested condoms in the laboratory for leakage of HIV-sized
particles. 33% leaked. (One in three).
One analysis of eleven studies on condom effectiveness found that con-
doms had a 31% estimated failure rate in protecting against HIV trans-
mission. In other words, as the report stated, "These results indicate
that exposed condom users will be about a third as likely to become in-
fected as exposed individuals practising unprotected sex. The public at
large may not understand the difference between "condoms may reduce
risk of" and "condoms will prevent" HIV transmission. It is a disserv-
ice to encourage the belief that condoms will prevent sexual transmis-
sion of HIV. Condoms will not eliminate the risk of sexual transmis-
sion, and in fact may only lower risk somewhat."
In Burlington County NJ, USA the County banned condom distribution at
its own AIDS counselling center. Officials feared the legal liabilities
if people contracted AIDS or died after using the condoms the County
distributed. They were afraid the County would be held legally respon-
sible for the deaths.
"Is the condom safe? Is it safer? Safer than what?"
Look at this way. If you decide to drive the wrong way down the Inter-
state, is it safer if you use a seat belt? You wouldn't call the proc-
ess "safe". Maybe it is somewhat "safer", but that completely misses
the point. It is still a very risky - and a very foolish - thing to do.
Remember that a national study found that condoms have a 15% failure
rate with pregnancy? Many of you have flown in airplanes. Suppose only
15 crashes occurred for every 100 plane flights. Would you say airline
travel was safe? Safer? Would you still fly?
According to Dr Redfield, when you're considering AIDS, "Condoms aren't
safe; they're dangerous."
Dr Theresa Crenshaw has been a member of the President's Commission on
HIV. She is past President of the American Association of Sex Educa-
tors, Counselors and Therapists. She is an MD and gives this illustra-
tion.
Once she gave a talk in Chicago to 500 marriage and family therapists.
She asked how many of them recommended condoms for AIDS protection. A
majority of the hands went up. Then she asked how many in the room
would have sex with an AIDS-infected partner using a condom. Not one
hand went up. These were marriage and family therapists, the "experts"
who advise others.
Many will depend on ignorance of the facts to try their luck.
Dr Crenshaw admonished them that "It is irresponsible to give students,
clients, patients advice you would not live by yourself because they
may die by it".
And, may I add: you, too, may die by it.
Please, don't use "condom sense" use common sense. It's your own deci-
sion, but if you want to be safe, wait.
An overall estimate, however, can be drawn from a recent analysis for
the World Health Organisation (WHO), combining data from nine published
studies. This analysis found that condom users faced a risk about two
thirds that of non-users of developing gonorrhoea, trichomoniasis, or
chlamydial infection (322). Condoms offer less protection against STDs
which as herpes simplex, that can cause lesions in places not covered
by condoms.
According to the Population Reports on Condoms Vol XVIII No 3, exposure
to ultraviolet light, heat, humidity, and ozone makes latex deteriorate
and weakens condoms (21, 115, 117, 118, 402). The longer condoms are
exposed to these conditions, the more easily they break, and once a
package is cracked or torn, deterioration is rapid. A 1986 study of In-
donesian volunteers found that 7% of newly made condoms broke during
intercourse compared with 20% of condoms that had been exposed to ul-
traviolet light for 10 hours and 49% of condoms that had been stored in
a tropical climate for 42 months (115).
Dr Ronald Carey, at the Food and Drug Administration, and other tested
th efficacy of condoms in protecting against the leakage of HIV-sized
particles. They tested 89 latext condoms purchased off the shelf at re-
tail establishments. Samples were chosen among many models of three ma-
jor US brands. The abstract of the study reveals that "leakage of HIV-
sized particles through latex condoms was detectable for as many as 29
of the 89 condoms.
Cates uses the same disclaimer for condoms that the CDC (Center for
Disease Controls) uses: "To be effective, condoms must be . used con-
sistently and correctly". (2/77) He concedes that condoms do fail, and
that "failure" is constituted by non-use, incorrect use, breakage,
slippage or leakage. Cates admits that the typical failure rate of con-
doms for contraception is at least 12%. The figures for failure rates
in preventing HIV and other STD transmission must logically be higher
than this, since infection can conceivably take place every time one
has sex, whereas conception can only occur during a few days, at most,
out of a menstrual cycle.
It has been observed by Konde-Lule and co-workers in Uganda that con-
doms contributed little in reducing the risk of HIV infection in the
patients they studied, as there was no difference in HIV sero-
positivity in those with a history of ever using condoms and those who
never used a condom.
The Weller study found that condoms had a failure rate of 31% in pro-
tecting against HIV. Dr Susan Weller reports that "since contraceptive
research indicates that condoms are about 90 percent effective in pre-
venting pregnancy, many people, even physicians, assume condoms prevent
HIV transmission with the same degree of effectiveness. However, HIV
transmission studies do not show this to be true. Effectiveness may be
as low as 46 percent or as high as 83 percent." Dr Weller goes on to
say that "new data indicate some condoms, even latex ones, may leak
HIV."
In recent family planning workshop organised by the Kenya Medical Asso-
ciation (KMA) in Machakos, many participants reported witnessing an in-
crease in the incidence of scrotal ulcers as an emerging variety of
genital ulcer syndrome in condom users. This would imply that those
parts of the male genitalia in close contact with vaginal secretions
but not covered by the condom, provide easy access routes for the mi-
cro-organisms. This underscores the fact that condom use does not con-
fer absolute protection.
Another study, which was published in the Journal of Acquired Immune
Deficiency Syndromes, states that "thirty-one percent of those who had
used a condom during anal intercourse reported at least one incident of
condom breakage."
Ahmed et al. in their study found that "the problem with condom use
most often identified by the respondents was breakage."
The editor of Rubber Chemistry & Technology CM Roland admits that he
has "little stomach for the politicised brouhaha surrounding the AIDS
phenomenon, but in matters of life and death, attention to reality is
essential." He explains that "the rubber comprising latex condom has
intrinsic voids about 5 microns (0.0002 inches) in size. Since this is
roughly 10 times smaller than sperm, the latter are effectively blocked
in ideal circumstances . Contrarily, the AIDS virus is only 0.1 microns
(4 millionths of an inch) in size. Since this is a factor of 50 smaller
than the voids inherent in rubber, the virus can readily pass through
the condom should it find a passage." (CM Roland Letter to the Editor,
The Washington Times, Wednesday April 22, 1992, p. G2).
This confirms the warning of Dr Richard Gordon: "Since the pressure in-
side a condom in use is likely to be higher than outside, transfer of
HIV from male to female through holes in condom occur at a greater rate
than from female to male."
In conclusion, it is not worth saying that condoms are a preventive
strategy in the face of AIDS. And may be the term safer had better be
revised when regarding the condom.
However, each individual has the full responsibility of their life in
their hands.
Bibliography
1. STD/HIV/AIDS Lecture Notes, Rusty Wright, Arrow Head Springs San
Bernadino CA 92414.
Source
a) Elise F Jones and Jacqueline Darroch Forrest: "Contraceptive Rates
Basel - The 1988 NSFG (National Survey of Family Growth)" Family
Planning Perspective
b) Richard W Smith "Is the condom really safe sex?" Smith is a public
health professional with more than twenty combined years experience
in the epidemiology of Sexually Transmitted Diseases and AIDS pre-
vention and control.
c) CM Roland "The Barrier effectiveness of Latex Rubber" Rubber World:
The Technical Service magazine for the rubber industry 208: 3 June
1993 pg. 15-18 (Roland holds a PhD, is Editor of Rubber Chemistry
and Tech. and also head of the Polymer Properties Section, Naval Re-
search Laboratory, Washington DC.
d) William R Hensyled Stedman's Medical Dictionary, 25th Ed. (Balli-
more: Williams 1990).
2. Population Reports: Condoms - Now more than ever (1991) Published by
the Population Information Program, Centre for Communication Pro-
gram, The Johns Hopkins University, 527 St Paul Place, Baltimore, in
21202 USA Vol. XVIII Number 3 Series H, Number 8.
3. Glenn T Stanton: Background on condoms views of condoms and their
use in preventing HIV infection and other STDs. A report by the Con-
doms for Disease Control, July 30th 1993.
Morbidity and Mortality . Report; August 6th, 1993 Vol. 42 No. 30
Update . Protection Against HIV infection and other sexually trans-
mitted diseases (As it appears in JAMA, August 1993 Vol. 270 No.8,
933-934).
Colorado Department of . News Release, October 18, 1993; Widespread
condom misinformation puts Coloradians at risk for HIV. 8605 Colo-
rado Springs, CO 90920.
a) Caray Ronald F et al Effectiveness of Latex Condoms a Barrier to Hu-
man Virus sized particles under conditions of Sexually Transmitted
Diseases Vol. 19 July/August 1992, 230-234.
b) The Journal of The American Medical Association, August 25, 1993
Vol. 210
c) Weller Susan, A Meta-Analysis of Condom Effectiveness in Reducing
Sexually Transmitted HIV, social Science and Medicine Vol. 36, No.
12 June 1993, 1635-1644.
d) Roland CM The Barrier Performance of Latex Rubber World Vol. 208,
No. 3, June 1993, 15-20.
e) Susan Golombok, John Sketchley, and John Rust, Condom Failure Among
Homosexual Men: Journal of Acquired Immune Deficiency Syndrome Vol.
2, 1989.
f) Richard Gordon: A critical review of the Physics and Statistics of
condoms and their role in individual versus societal survival of the
AIDS epidemic; Journal of Sex and Marital Therapy Vol. 15 No. 1
Spring 1989, 5-29.
g) G Ahmed, E Liner N Williamson and W Schellsede: Characteristics of
Condom Usage and Associated Problems: Experience in Bangladan Con-
traception Vol. 42 No. 5, 1990. 523-533.
4. William Lore: Reassessing condom efficacy (Guest Column) Gender
view, July-September 1995.
End of quotation
--
Andrew Hobbs
c/o Project Concern International (Zambia)
Box 32320, Lusaka, Zambia
Tel: +260-1-221-314 / 229-326-7.
Fax: +260-1-225-741
mailto:andhobbs@zamnet.zm
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