Condoms DO Help Prevent the Spread of HIV: Debunking 1Flesh, Episode 5

Photo courtesy of robertelyov.

Photo courtesy of robertelyov.

I’m a blogging machine folks, a BLOGGING MACHINE, I say! 😉  Two posts in as many days? Yeah, that’s right. I’m apparently just that awesome.

Actually, it’s more that I had started a few posts last week, then got busy protecting choice IRL, and finally got back to finishing them this week, but whatever – we can pretend I’m awesome for the day.

Anywho…on to today’s topic: CONDOMS!!!! 

Well, actually the topic is debunking 1Flesh’s laughable assertion that condoms aren’t helping to prevent the spread of HIV.

Go ahead laugh. I know I did.

Now prepare to go on a rollercoaster of anger/confusion and mirth as I show you their statements, then soundly debunk them.

Think this:

Then this:

As always, paragraphs in italics are taken directly from 1Flesh’s site.

The solution to the global AIDS crisis is NOT the provision of condoms. Why not?

Well, according to the UN AIDS council, condoms have a 10% failure rate in their prevention of HIV, even when used consistently.

Wait…so something that prevents the spread of HIV 90% of the time is considered a failure?  I mean, safety belts only prevent hospitalization of crash victims 83% of the time. Guess that means we should stop using them, too, yeah?

Also, did I mention that this statement is a lie? From the document 1Flesh links to:

The most convincing data on the effectiveness of condoms in preventing HIV infection has been generated by prospective studies undertaken on serodiscordant couples, when one partner is infected with HIV and the other is not. With regular sexual intercourse over a period of two years, partners who consistently used condoms had a near zero risk of HIV, whilst inconsistent use carried considerable risk averaging 14-21% (an incidence of 4.8-5.4 per 100 person years).

Maybe I’m crazy, but somehow I don’t equate “near zero risk” with 10%, do you?

Thinking the 10% figure might be elsewhere in the document, I did a search for it, and came up with TWO places where “10%” was mentioned:

“A large number of studies on condom breakage report rates that vary from less than 1% to more than 10%.”

and

“Most buyers budget between 6% and 10% of the cost of the condoms themselves for compliance testing.”

Nope, still no comment that condoms fail 10% of the time to prevent HIV infection. 1Flesh, care to share where you came up with that figure? Was this perhaps yet another case of you linking to the wrong document?

And, as shown in a study published in the American Journal of Epidemiology, they reduce risk of HIV posed by homosexual anal sex by just 47%.

First, I’m not really sure where 1Flesh is coming up with this number, particularly given that the risk of seroconversion is highly dependent upon whether or not the act is insertive or receptive.

According to the study you cite, for unprotected receptive anal sex (URA) partners, the risk of seroconversion per sex act was .27%; for unprotected insertive (UIA) partners .06%; for protected receptive partners (PRA) – .18%, and for protected insertive partners .o4%. Given those numbers, it would seem that for receptive individuals, use of a condom reduced the risk of seroconversion per sex act by 67%. For insertive partners, condom use reduced the risk of seroconversion by, again, 67%.

Second, is there a reason that you’re only concerned with homosexual anal sex here? You do know individuals claiming all sexual identities (straight, lesbian, gay, bisexual, transgendered, and queer) can be infected, and can infect others, with HIV, right? And that individuals other than gay men participate in anal sex? I’ll admit that as an LGBTQ-ally, this paragraph makes me incredibly uncomfortable. And as someone concerned with the increasing incidence of HIV in heterosexual communities, I’m angry that you would choose not to focus on them.

This would be bad enough, but condoms are rarely used consistentlyfurther reducing their already less-than-stellar effectiveness.

Please, please, please, please, please tell me you are NOT trying to equate HIV transmission rates and condom use rates from various countries / studies. No, seriously. Please tell me that’s not what you’re trying to do. Because if it is, I’m going to really stop believing that all of this misinformation is just indicating a need for further information on your part, and start believing that it’s an active ploy to dis-and-mis-inform the public.

Part of the problem is that the use of condoms leads to Risk Compensation – a phenomenon in which the use of risk-reducing technologies makes individuals more willing to take on greater risk. (For instance, the use of sunscreen makes us more willing to spend long hours in the sun, just as the use of seat-belts make us more willing to drive recklessly.) In a 2006 study published in the BMJ, it was shown that condom users may disproportionately erase the benefits of condoms with riskier behavior, that is, individuals may take greater sexual risks when using condoms, and thereby erase any protective benefit the condom may have provided.

Photo courtesy of moominmolly.

Photo courtesy of moominmolly.

AHEM.

Okay, first, the study you link to is not a study at all, but rather a review of literature.  So, no, it didn’t show “that condom users may disproportionately erase the benefits of condoms with riskier behavior.” It simply reviewed other literature.

Second, of the studies that it links to, NONE show an increase in HIV infection rates among population using condoms.

For instance, this study indicated that mandatory condom use had drastically decreased STI and HIV transmission rates in various countries. The major point of this article was that consistent condom use should be taught together with delayed onset of sexual activity and fewer partners.

Again, 1Flesh, please read the stuff you’re citing.

Now in theory, condoms should help. And no one would deny that in a single, isolated incident of sex they do reduce your risk of HIV. But life is not made up of single, isolated, laboratory-worthy incidents. In reality, and over time, the mass distribution of condoms has no effect on AIDS epidemics. This was confirmed by the study Reassessing HIV Prevention, in which 10 AIDS experts made clear that “consistent condom use has not reached a sufficiently high level, even after many years of widespread and often aggressive promotion, to produce a measurable slowing of new infections in the generalized epidemics of Sub-Saharan Africa.”

And some more half-truths. Even the article you cite says that, “Condom promotion is effective in epidemics spread mainly through sex work, as in Thailand and also, to some extent, among other high-risk groups such as MSM.” It seems like maybe what you SHOULD have said was consistent condom use in Sub-Saharan African has yet to reach levels that show a measurable impact in slowing generalized epidemics.

Photo courtesy of Ann Telenes/Women’s eNews

Though…even that statement is misleading. Promoting condom usage is one thing – making condoms accessible is quite another. In 2004, for example, Sub-Saharan Africa only received 10 condoms per man of reproductive age (15-59) annually – which is not nearly enough to meet demand.

While condom promotion and accessibility is not the ONLY solution to HIV and AIDS epidemics, pretending it has no impact is incredibly misleading, and puts lives at risk. Shame on you, 1Flesh.

James Sheldon of the US Agency for International Development notes this in his analysis Confessions of a Condom Lover, published in The Lancet: “In South Africa, for example, with 48 million people in 2004, public programmes provided 346 million condoms, and condom use at last sex was high, especially among single people aged 15—24 years (69%). Yet infection continues apparently unabated.”

You were so good at looking for the correspondence to the article showing that BCPs don’t cause breast cancer, I kind of assumed you’d look for the correspondence to this one, too. Sadly, it appears you haven’t. Other scientists (including Thomas Ellman) responded to Sheldon’s claims, stating:

A comprehensive response that reverses the tragic trajectory of the pandemic will not be based on the myth of a monolithic approach—behaviour change or any other—but on a coordinated, fully funded, multifaceted, context-specific, and evidence-based combination of all available strategies.

And then Sheldon responded:

I heartily agree that there is no one bullet for HIV prevention and no one driver. Moreover, clearly each of the ten “myths” has at least some truth…I fully agree with Thomas Ellman’s approach to prevention efforts.

Hmmm…seems to me that your author agrees with the concept that a multi-faceted approach (including both monogamy AND condoms – along with any other tactics that work) is what’s needed. Interesting….

Compare such results to the story of Uganda. Their government and religious leaders focused not on condom distribution, but on the promotion of monogamy. According to analysis published in Science Magazine, by 2004, “despite limited resources, Uganda has shown a 70% decline in HIV prevalence since the early 1990s, linked to a 60% reduction in casual sex.”

The ABC approach that international agencies and countries have been promoting – Abstinence, Be Faithful, and Use Condoms – is the best way to prevent the spread of HIV. Pretending that one of these alone is the answer to the AIDS epidemic is, again, dangerous and threatens lives.

While the B (monogamy) prong of the ABC method started the decline in HIV infections in Uganda, the C (condom usage) prong ACCELERATED the decline. Further, despite monogamy promotion, the 2006 HIV/AIDS Sero-Behavioral Survey by the Ugandan Ministry of Health found an apparent increase in multiple partnering:“The proportion of sexually active Ugandans who reported having had two or more sexual partners in the previous 12 months increased from 2 to 4 percent between 2000-01 and 2004-05 among women, and from 25 to 29 percent among men.”  Further, “among respondents aged 15-49 who were sexually active in the preceding 12 months, 15 percent of women and 37 percent of men engage in sex with a nonmarital, noncohabiting partner.”

Higher risk sex is STILL happening in Uganda, 1Flesh – which means that we can’t abandon the “C” part of the ABCs.

Moreover, even the Ugandan government has stated, “Although, there are National Condom promotion guidelines, risk is still perpetuated by limited targeting of services to MARPs and low levels of condom use and promotion in long standing relationships. Less than half of risky sexual acts are protected by condoms.” Read: Infections are still occurring partly because condoms aren’t being promoted and provided in the right sectors.

And finally, it doesn’t do you any good to be monogamous if your partner is already infected. Approximately 43% of new HIVinfections were occurring in mutually monogamous relationships.

Or to the story of Kenya. According to Sheldon, the country’s rate of infection dropped throughout the 1990’s at the same time the number of men with multiple sexual partners dropped. The evidence seems to suggest that it is the promotion and practice of monogamy, not condom distribution, that will rid our world of the scourge of AIDS.

Okay, where to start here.

First, here’s the full article.

Second, are you talking about prevalence, or incidence? One (prevalence) means the rate of existing infections; the other (incidence) means the rate of new infections. Both prevalence and incidence declined, but the declines started at different points. And it’s fairly clear that intervention efforts had no impact at least the beginning of the decline of prevalence.

Third, nowhere in this article does it talk about the number of men with sexual partners dropping. Would you care to cite where you got that information?

Finally, when you go to the author’s citation on Kenya, you find the following article with this quotation:

Surveys indicate that both age at first sex and use of condoms are rising and that the percentage of adults with multiple partners is falling.

Once again, we see that the ABC approach is working, NOT just the B part of it. Are you guys set on endangering people’s lives, or what?

Thus the answer to the problem of AIDS is neither the “conservative” response — “Abstinence or you’ll die!” — nor the “liberal” response — “More free condoms!” No, the answer to the problem of AIDS is a human one: Live an awesome, monogamous sex life with your spouse, and you’ll save the world.

Ohemgee. Did I really just read that? “Live an awesome, monogamous sex life with your spouse, and you’ll save the world.” Really? Did I really just read that?

Perhaps you missed my comment above where 43% of new HIV infections in Uganda were occurring among mutually monogamous couples?

And “saving the world”? I’m sure you were being hyperbolic, but still. Wow.

Further, monogamy is NOT the answer here. Practicing monogamy can certainly make sex safer. But so can condom use. So can delaying the onset of sexual activity. So can knowing the sero status of your partner. So can being tested yourself. But monogamy isn’t the answer for everyone, nor should it be.

Again, the ABC approach IS having an impact in slowing the spread of HIV and other STIs, and should be continued. Clinging to one facet of the approach doesn’t work, and endangers lives.

For further reading, check out the senior research scientist at the Harvard School of Public Health, Edward C. Green’s op-ed in the Washington Post.

Gotta love these lines from Mr. Green’s piece:

“”Closed” or faithful polygamy can work as well.”

and

“Don’t misunderstand me; I am not anti-condom. All people should have full access to condoms, and condoms should always be a backup strategy for those who will not or cannot remain in a mutually faithful relationship.”

Yup, seems like the ABC approach is still the best approach. And that includes promoting condom usage for each and every sexual encounter, including encounters in monogamous relationships.

Till next time,

– H

© Heather Parker and Antigone Awakens, 2012-2013.

3 thoughts on “Condoms DO Help Prevent the Spread of HIV: Debunking 1Flesh, Episode 5

  1. Wissen

    Hey Heather, this is the same Wissen from the 1Flesh comments section (yikes right?). I just wanted to say thank-you for helping call out the BS and false claims on their site. It's nice to know that there are others out there fighting for truth.

    Reply
  2. Heather

    Thanks, Wissen! And thanks, too, for continuing to fight the good fight, even in the face of insanity. I suppose you might have noticed by dedication at the top of this, eh? 😉 Poor form, I know, but sometimes you gotta let a little emotion out. 🙂

    Oh, and for 1Flesh supporters (or anyone else) reading – I TOTALLY and ENTIRELY support YOUR personal decision to use the Creighton Model, or any other form of birth control you so desire. What I do NOT support is lying about forms of birth control you aren't using in order to get others to use your preferred form of contraception.

    Reply
  3. Wissen

    Yep, I'm sure Mike appreciates it 🙂

    And I totally agree with your sentiment Heather. Advocating a certain kind of birth control method or lack thereof is totally fine. But to spread misinformation for your own purposes is irresponsible, dangerous, and immoral.

    Reply

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