Are condoms the answer to rising rates of non-HIV sexually transmitted infection? No

The data from Alberta reported by Dr. Genuis (massive promotion of condoms followed by upsurges in gonorrhoea and chlamydia) are mirrored by the situation in our country.

Spain, together with Greece, stands out as the European country with the highest levels of condom use among young people, with 90% of sexually active young people reporting using a condom the last time they had sexual intercourse (Health Behaviour in School-aged Children survey: http:// www.hbsc.org / publications/reports.html). Nevertheless, our rates of sexually transmitted infections (STI) are on the rise (44 and 81 percent higher rates for gonorrhoea and syphilis, respectively during 2006, the last available data, (1-2)). Year after year we are facing increasing rates of STI precisely after more than a decade of intensive official educational campaigns transmitting to young people the only message apparently considered to be politically correct and officially acceptable in our country. This message contains a naive and simple concept: condoms and only condoms are the magical bullets to prevent all STI and unintended pregnancies. There is no room for dissent, no consideration for the accrual of persuasive scientific evidence strongly supporting that other behaviour changes, such as partner reduction, should be promoted as a priority (3-4). The ideologies, prejudices, stigma, and social agenda of some governing officials seem to precede the scientific evidence when building public health policies. The escalating figures for youth pregnancy and abortion in Spain (5) also demand a higher level of critical attitude towards the apparently sacred icon of "condoms and only condoms" dogma. The failure of this simplistic one-size-fits-all strategy in our country calls for a more comprehensive policy. Rather, different approaches or combinations of approaches may be optimal for particular individuals in diverse life circumstances. In addition, recent advances made in behavioural, social, and biomedical sciences need to be incorporated. Determinants of disease are multi- factorial and prevention strategies should not rely on a single "magical" solution (male condoms).

References

(1) Instituto de Salud Carlos III. Ministerio de Sanidad y consumo. Estado de las enfermedades de declaración obligatoria. Boletín Epidemiologico semanal 2006;14:256-9 (available, [in Spanish] in http://www.isciii.es/htdocs/centros/epidemiologia/boletin_semanal/bes0652.pdf).

(2) Instituto de Salud Carlos III. Ministerio de Sanidad y consumo. Comentario epidemiológico a las enfermedades de declaración obligatoria y sistema de información microbiológica. Boletín Epidemiologico semanal 2006;15:109-15. (available, [in Spanish] in http://www.isciii.es/htdocs/ centros/epidemiologia/boletin_semanal/bes0719.pdf).

(3) Shelton JD, Halperin DT, Nantulya V, Potts M, Gayle HD, Holmes KK. Partner reduction is crucial for balanced "ABC" approach to HIV prevention. BMJ 2004;328:891-3.

(4) De Irala J, Alonso A. Changes in sexual behaviours to prevent HIV. Lancet 2006;368:1749-50.

(5) Ministry of Health. IVE 2006. Officials statistics of abortion in Spain. Available [Spanish] in http://www.msc.es/profesionales/saludPublica/prevPromocion/embarazo/home.htm.

Competing interests: None declared