NIH Report Opens Debate on Effectiveness of Condoms Against STDs

An NIH report to be released today says that there is "insufficient evidence" that male latex condoms prevent transmission of "most" STDs beyond HIV and gonorrhea, giving advocates of "abstinence-only" sex education "fresh ammunition," the Washington Post reports (Connolly, Washington Post, 7/20). The 30-page report, which grew out of a June 2000 meeting of officials from NIH, CDC, FDA and USAID, concludes that more research is needed to determine whether condom use can effectively protect against transmission of human papillomavirus, chlamydia, syphilis, chancroid, trichomoniasis and genital herpes. However, the reports states that evidence "clear[ly]" supports condom use for preventing the spread of HIV and gonorrhea in males. More than 65 million Americans are infected with an STD and about 15 million new infections occur annually, the report states (McGinley, Wall Street Journal, 7/20).

'Squabbling' Over Sex Education
The report, requested by retired Rep. Tom Coburn (R-Okla.), has already "sparked bitter squabbling and markedly different interpretations," the Post reports. Conservatives such as Coburn, who support federal funding for abstinence-only sex education over traditional family planning education, said yesterday that the report is "proof that the term 'safe sex' is a myth" (Washington Post, 7/20). Coburn, who is also a physician, said yesterday in a statement, "For decades, the federal government has spent hundreds of millions of dollars to promote an unsubstantiated claim that promiscuity can be safe. We all now know for a fact that that is a lie. Who can ever know the true toll in human lives and health care costs that have resulted from the misinformation that has been propagated by the CDC, Planned Parenthood and the rest of the 'safe' sex lobby?" (Coburn release, 7/19). However, Jeff Spieler, an official with USAID who was one of the 28 members of the panel that worked on the report, said that the report "doesn't make clear enough" that when used correctly condoms "should be close to 100% effective in preventing gonorrhea in women, chlamydia and trichomoniasis." He added that while the "evidence is not as strong" for STDs other than HIV and gonorrhea, there is "no reason" to believe condoms do not offer protection against those as well. "There is an opportunity for some people to read the report and say, inappropriately, that even the HHS admits we don't know if condoms prevent many STDs. As somebody who is completely devoted to improving public health, I know that any message that minimizes the role and importance of correct and consistent condom use can have an extremely negative effect on preventing HIV and other STDs," he said. Another unnamed person "close" to the report process told the Post, "It is extremely important that the public understand the difference between data being inadequate and condoms being inadequate" (Washington Post, 7/20). Some members of the panel also pointed out that studies on which the report's conclusions are based had several "problems." Some did not have a large enough sample size to be considered accurate, while "many" of the studies were done among "high-risk" groups such as sex workers and STD clinic patients. "For most studies the ability to document exposure to disease in relationship to condom use was uncertain," the report says (McQueen, Associated Press, 7/19).

Effect on Sex Education
Wary of the possible, some health officials considered not releasing the report to the public since Coburn had retired, but "pressure" from conservative groups and the "threat" of being asked for the report under the Freedom of Information Act prompted today's release (Washington Post, 7/20). In a draft statement to accompany the report, HHS Secretary Tommy Thompson, who last month announced $17 million in abstinence-only education grants, emphasized the role of abstinence in STD prevention, saying, "Sexually transmitted disease is a serious health problem in America, but it is almost entirely preventable through behavior choices, especially abstinence and commitment to a mutually monogamous relationship with an uninfected partner." However, Thompson also acknowledged that "we need to keep learning more about condom effectiveness" (Sternberg, USA Today, 7/20). AIDS activists, who distributed draft copies of the report yesterday, warned that the administration would use the report to "promote" an abstinence-based sex education policy that they said is "not as effective" at preventing STDs and asked government agencies to support sex education efforts. Michael Cover, a spokesperson for the Washington, D.C.-based Whitman-Walker Clinic, said, "The fact is young people are having sex. Accurate information about condoms has to be made available" (Associated Press, 7/19). The American Social Health Association also cautioned against using the report as a basis for altering guidelines. "The NIH report is inconclusive, and flies in the face of other, recent studies which indicate that condoms do reduce the risk of a person getting an STD," an ASHA release said, adding, "Abstinence is one tool, latex condoms are another. Neither is effective unless used consistently and correctly, forever" (ASHA release, 7/19). Freya Sonenstein, an official with the Urban Institute added that even if condoms are not effective against all STDs, "[g]iven that condoms do protect against some devastating diseases, we certainly need to encourage people to use condoms" (Washington Post, 7/20). Dr. Joe McIlhaney, president of the Austin, Tex.-based Medical Institute for Sexual Health, said, "America's youth have been lulled into a false sense of security about premarital sexual activity, believing that, as long as they use a condom, they are protected from sexually transmitted diseases. As the NIH report makes clear, there is no such thing as safe sex outside of marriage" (Medical Institute for Sexual Health release, 7/19).

Calling on CDC for More Stringent Warnings
Coburn, who wrote a law -- the "HPV Education and Prevention Law of 2000" -- requiring federal agencies to provide "medically accurate information regarding the effectiveness or lack of effectiveness of condoms" while he was a member of Congress, has called on the government to "reexamine" condom labels in light of the NIH report's findings (Washington Post, 7/20). "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.' Condoms may reduce risk for HIV infection and gonorrhea for men, but it is medically inaccurate to say that condoms prevent STDs. In fact, this report is quite clear that there is no evidence that condoms can prevent HPV infections," which have been linked to cervical cancer, Coburn said. On Wednesday, Coburn sent Thompson a letter in which he outlined how the CDC has "failed to implement" the law and asked Thompson to "take appropriate actions to properly enact the law and educate the public with the truth about HPV so we can start saving lives" (Coburn release, 7/19). Additional information regarding condoms is available from the Kaiser Family Foundation at http://www.kff.org and the KFF Media Resource for Reproductive and Sexual Health Information at http://www.kmrp.org.