Condoms and prevention of HIV
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7459.185 (Published 22 July 2004) Cite this as: BMJ 2004;329:185
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I have worked for 9 years as a medical officer in East African rural
hospitals and so have first hand experience of the appalling consequences
of HIV infection.
Noone would dispute that the proper use of a condom reduces the risk
of HIV transmission. Despite this and the constant promotion of condoms,
the AIDS epidemic continues to ravage the population of Africa and many
other parts of the world.
Let us get real about the situation: condom use, however well
promoted and taught, is a haphazard business. Those few who would agree to
use them regularly in developing countries, have frequent breakages,
slippages or just forget to appply them.
When we give education to groups we are giving a confusing and
possibly fatal mix of messages: "Try to abstain, remain faithful to one
partner or reduce the number of partners but if you cannot then use these
condoms".
The recipient of such a message, being all too human, will often
mentally choose the condom route as oppposed to any reduction in number of
sexual partners. Because frequent condom failure is inevitable, such folk
will continue to spread HIV or become infected.
A message that omits condom promotion and concentrates on ways of
reducing the number of sexual partners may, in the end, reduce HIV
transmission far more that if we add condom promotion.
Has Anna Foss, as a specialist in mathematical modelling, looked at
the outcomes in HIV transmission of either the usual mixed message
including condom promotion or a condom free method of education that
concentrates on strategies to reduce number of sexual partners?
Competing interests:
None declared
Competing interests: No competing interests
Condoms have been very successful in preventing the most dreaded
epidemic HIV/AIDS in addition to preventing other sexually
transmitted(STDs). What I have found is that being very cheap( made free
in public hospitals) most of the people have been using it both for the
means of contraception and to prevent themselves from the sexually
transmitted diseases including AIDS. As researches have shown that condom
was the most successful in checking the progress of HIV/AIDS in Thailand
with in very short time. Mainly in the developing countries where other
means to check the rapid progress of the disease is very limited the role
of condoms can't be underestimated. I suppose nothing can be as successful
as condoms in todays context in any part of world. Being very realistic,
condom has been accepted quite well. Still, importance of its use should
be made known to those who are still unaware of lethal cosequences of
HIV/AIDS personally ,in family and society as a whole and should be made
konwn that these troubles can be avoided by the use of condoms. People
don't use condoms if they don't know the importance of it. So, public
health regarding the importace of use of condoms and clearing the unwanted
myths that exist in societies related to it should be our target.
Otherwise it may be too early to mark that condoms have failed to control
HIV/AIDS.
Competing interests:
None declared
Competing interests: No competing interests
Use of condoms has been emphasized for a long time by government and
international agencies involved in the fighting against HIV/AIDS. The over
-emphasis only on condoms has conveyed misconception across the general
public. General people think that HIV/AIDS will go away with the use of
condom, which is very untrue. Ask small kids, who get HIV in his mother’s
womb, to wear condom. Ask innocents, who contract HIV/AIDS due to
transfusion of infected blood, to wear condom. Ask intravenous drug
abusers, who get HIV/AIDS by sharing of infected needles to wear
condoms.Condoms have been a failure to prevent HIV/AIDS as a whole.
Prevention of HIV/AIDS through other mode of transmission should be in
focus now. World has had enough of condoms. Now let’s have some change.
Competing interests:
None declared
Competing interests: No competing interests
In a workshop on HIV/AIDS at Athlone Hospital, Botswana in
1997, an elderly participant (grandmother) took me aside and
asked in earnest,"...Can I ask you a question my son?" I
told her to feel very free and to go ahead. That was the
beginning of a 'condom of worms' so to say.
She graphically asked about "...the worms seen in a condom
when you hold it up against the sun...you can see the small
white worms moving down the sides...after a while you can
see the worms collected at the bottom as a lump!" Was I
stunned or amazed at how we as health care workers take
things for granted! In her innocence she paraphrased for me,
"What is and in a condom?"
The question in vernacular or local language impacts more
than when translated into English.
In London, June 2004, there was a caption on the BBC 1 News
bulletin where a man in Uganda commented that "...we do not
use condoms because they have AIDS in them!"
Two genuine comments and concerns, almost eight years apart,
from the grassroots people on 'suspicions' of the condom
that is made by the West. The lubricant/oil in the condom
still has to be explained! Is the lubricant/oil part of the
health promotion message when educating and demonstrating on
condom use? Do we also mention not to use vaseline for
'another round' and to discard the condom properly and
responsibly after one use?
No one can dispute the scientific evidence of condoms as a
'barrier' and their role in preventing pregnancy and
sexually transmitted infections, including HIV/AIDS. Have we
sat down and explained to our potential users what a condom
is, how it is made and how it is used and not used?
In some western societies and a few communities in urban
Africa, condom use is synonymous to sexual intercourse. The
'flesh on flesh' notion is no longer there in the light of
HIV/AIDS. There are some success stories as we socialise our
people on serious condom use and safer sex.
In some traditional communities we still have to EDUCATE and
not simply inform and distribute the condom. We must teach
about the condom in relation to erection, ejaculation and
conception.
Myths are still in abundance about the condom and the
'hidden agenda' or 'conspiracy' behind condomisation. Worse
still when some key health workers, church people and now
the "abstinence only" movement in the United States (ab)use
their power and add their voices to the condom conspiracy
theories.
Will the "abstinence only" movement be surprised when they
turn a lot of heterosexuals into bisexuals? It is already
happening! Look in your backyard. What are the young
sexually active population doing to avoid pregnancy and
sexually transmitted infections?
Can you imagine what the "abstinence only" movement does to
that native village in Africa that believes that condoms are
'...deliberately contaminated with the virus/worms!' Can you
blame the people for thinking it is now an American failed
strategy and hence condoms are being 'recalled' to base.
The "abstinence only" movement should travel to Africa and
spend ONLY a month living with people infected and dying
with HIV/AIDS in the villages. Not in the five star hotels
of Africa. 'Shadow' a potential orphan during the daytime to
understand what the less privileged communities go through.
At night 'shadow' a district medical officer on call as he
looks after the health of the village and waits to
be called in to certify the dead, and waits for more who
are gasping to finally give their last breaths.
Stay with the nurses as they carry out the last offices and
shut the eye-lids of the dead for their final sleep. Help
the porters to take the bodies/corpses to the mortuary. You
can even go into the mortuary and see how these bodies/
corpses are stacked on top of each other, for collection and
burial the following day, if you can trace the relatives who
might live miles away and must be given time to prepare for
the funeral.
AIDS RELATED DEATHS ARE AN EVERY DAY AND NIGHT OCCURENCE IN
HUNDREDS OF HEALTH FACILITIES ACROSS THE CONTINENT OF
AFRICA.
What has happened to the once great UUnited States of
America with its respected principles and concern for
mankind?
The Public Health HIV/AIDS disaster of sub-Saharan Africa
should make all of us on this earth hold our heads down with
shame for allowing it to happen.
Do we need Koffi Anan and Mandela to honestly and frankly
tell the international community about the obvious, about
what is right and wrong, when we can all see it!
AIDS is in the village. Every positive prevention and
intervention strategy makes a difference in the villages of
Sub-Saharan Africa and that includes the condom.
Competing interests:
None declared
Competing interests: No competing interests
There is a politically correct position that the use of condoms does
not reduce the pleasure of sexual intercourse. This appears to be an
implicit assumption of Foss et al, who seem to suggest only ignorance and
symbolism prevent condom use in 100% of sexual couplings. The challenge,
it follows, is to improve the efficacy of pro-condom interventions.
Presumably this assumption is true for some couples, who use condoms
as their primary method of contraception.
However, it is not true for all couples or for all women. I do not
have more than anecdotal data, but the possibility exists that it is false
for a large proportion of couples. This is indirectly supported by the
heavy preference for oral contraceptives in the west.
This introduces a set of complications not addressed by Foss et al.
Since the primary reason for engaging in sexual intercourse is pleasure,
it's hard to see why a couple who have committed to monogamy and find
condom-free sex more pleasurable should use them. If either partner were
to suddenly request the use of condoms, suspicions would be raised about a
continued commitment to monogamy. In most societies, this would likely
bring unpleasant consequences.
Of course promises of monogamy are frequently not matched in
practice, with particularly tragic consequences in the case of HIV. While
imposing universal condom usage is a mathematically elegant solution to
the problem, it is a solution that depends on reality being other than it
is.
Perhaps pro-condom interventions would be more successful if they
acknowledged reality?
Competing interests:
None declared
Competing interests: No competing interests
Re: Condom promotion may increase HIV transmission
Antony C Latham stated: "I have worked for 9 years as a medical
officer in East African rural hospitals and so have first hand experience
of the appalling consequences of HIV infection. No one would dispute that
the proper use of a condom reduces the risk of HIV transmission. Despite
this and the constant promotion of condoms, the AIDS epidemic continues to
ravage the population of Africa and many other parts of the world."
I would dispute the contention that: “the proper use of a condom
reduces the risk of HIV transmission” for the fact that there is still no
evidence that ‘HIV’ is a transmissible entity. There is no scientific
proof that 'HIV' is a sexually transmitted retrovirus but merely assumed
to be by the abuse of the non-specific and non-standardised ‘HIV’ tests.
Conditions in Africa such as TB, malaria and diseases related to poverty
make these arbitrary tests run ‘positive’.
Condoms cannot prevent ‘AIDS’. How can condoms prevent the 29 ‘AIDS’
diseases/conditions such as: Pneumocystis carinii pneumonia, Kaposi's
Sarcoma, Tuberculosis, Toxoplasmosis, Fungal infections, Malignancies,
malaria, wasting, etc? The key fact to remember is that cell-free
infectious 'HIV' viral particles have never been recovered from fresh
donor semen or blood.
Regarding ‘AIDS' in Africa, Etienne de Harven, MD, makes the
following critical comments:
"How can we best help Africa? How can we set priorities aimed at
bringing under control what is described as an AIDS epidemic? For twenty
years, all AIDS research has been based on the HIV hypothesis. Do we now
have reasons to question this hypothesis? Yes, because there is a major
problem with isolation and purification of HIV. The major problem being
that, in spite of innumerable claims to the contrary, this retrovirus has
never been isolated nor purified in a scientifically acceptable manner
that would satisfy the classic requirements of virology... Consequently,
priorities for medical assistance to sub-Saharan Africa should, most
urgently, be revised as follows:
1) Treat all endemic tropical diseases with their specific
treatments.
2) Stop all use of antiretroviral drugs until the isolation of HIV
and its pathogenicity are scientifically established.
3) Stop using highly crossreacting serological tests, the HIV
specificity of which is far from demonstrated.
4) Provide African people with means do combat malnutrition, clean
drinking water, proper housing and sanitation, and efficient health-care
infrastructures.
Indeed, HIV has never been properly isolated, nor purified, and,
consequently, the HIV/AIDS hypothesis has to be fundamentally
reappraised."
(Problems with isolating HIV, Brussels – European Parliament,
December 8th, 2003).
So-called ‘AIDS’ in Africa can only be solved if ‘HIV’ is removed
from the equation and the ‘AIDS’ defining diseases/conditions are treated
autonomously.
Competing interests:
None declared
Competing interests: No competing interests