Condoms, HIV/AIDS And You

[A Rejoinder To The Article, Nigeria’s Last Virgins] 

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By Dr. Anthony Odoh

Some time ago, I met a friend who had just come back from the National Youth Service Corps (NYSC) camp in Borno State, Nigeria. He had thoroughly enjoyed the vagaries of camp life and was eager to share his experience with me. At a point, however, he got a bit upset. Some representatives from UNICEF, he informed me, had come to the camp to address the corps members. His complaint: “They could not even bring some paracetamol for our headaches and pains from the drills; they only bombarded us with condoms…” 

This is indeed a sorrowful trend in the fight to curb the HIV/AIDS epidemic which has been ravaging the world for more than 2 decades now. According to the estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), 37 million adults and 2.5 million children were living with HIV at the end of 2003. This shows more than 50% higher values than those projected by WHO in 1991 using the data available then. In 2003 alone, some 5 million people became infected with HIV. At the end of 2005, an estimated 38.6 million people were living with HIV, with 4.1 new infections and 2.8 million deaths. In Nigeria, a greater percentage of HIV transmission results through sexual intercourse. The concomitant presence of Sexually Transmitted Diseases/Infections also increases the risk of spread since a disrupted skin surface offers a wider portal of entry for the virus.    

Condom production and distribution has also become commonplace today. The subtle message being passed across is that we are likely not to exercise self-control in the use of our sexual powers. The alternative, the “safety catch”, we are told, is “if you can’t hold body, use the condom”. Another slogan that is often mouthed is “With condom, I dey kampe”. The condom is thus lauded as a sure prophylactic, an easy escape route out of responsibility for sometimes living a loose life. How does this affect your life and mine? Why does the rate of spread of HIV still increase despite repeated “successes” recorded in getting more people to use the condom? 

It may be difficult to convey the various misconceptions about the condom and its effectiveness as a preventive measure for sexually transmitted infections as well as for HIV/AIDS but a joke I once heard may just be able to pass across the message: An armed robber enters a house, holding a gun and a syringe containing HIV-filled blood. He orders the house-owner to bring out all the money in his home under pain of being injected with the virus. The latter asks for permission to enter his room for a few minutes before making his decision. Coming out afterwards, he asks for the injection to be administered. When the robber had duly carried out his threat and left, the house owner burst out laughing, “Yeye armed robber, he didn’t even know I went into the room to put on a condom…”  

Groups like the UNICEF, the International Planned Parenthood Federation and the Society for Family Health which do an extensive job of pushing for the use of condoms, do so with the conviction that condoms are actually a panacea to the HIV problem. They bank on reports about the efficacy of condom which seem to give a near-100 percent mark to the condom. The Centre for Disease Control (CDC) in America, stated in July 1999 that “condom manufacturers in the US test each latex condom for defects, including holes, before it is packaged” They insist that for condoms to provide maximum protection, they must be used consistently (every time) and correctly and that studies have shown that a “properly used latex condom provides a high degree of protection against a variety of STD, including HIV infection” (italics mine). In 2001, they stated that when used correctly all the time, “condoms prevent most STI’s including HIV” (italics mine). All this sounds reassuring, doesn’t it? Well, not quite, not after you put other factors into consideration.

If we are truly concerned about our lives, we should want to know what is actually meant by a “high degree of protection”. Life is so precious and cannot be repeated after one passes on. It is fraught with risks but even a gambler knows the limits he can broach especially when the stakes are very high. In July 2001, the National Institute of Health (NIH) of the United States Government released its report on the “Scientific Analysis on Condom Effectiveness for STD prevention”.
The report, which is an analysis of 130 studies conducted over some decades, differentiates between condom efficacy (the protection which the users would enjoy under ideal conditions, this depending primarily on the properties of the condom) and condom effectiveness (protection offered under actual usage; dependent on the characteristics of the device and its user). The conclusions of the report? Apart from Gonorrhea (in men and not for women) for which there was some risk reduction, condom use for Chlamydia, trichomoniasis, chancroid, syphilis, genital herpes and Human papilomavirus showed no clinical proof of effectiveness from the available studies (more studies are necessary to determine its effectiveness).

According to the studies, “condoms provided an 85% reduction in HIV/AIDS transmission risk when infection rates were compared in always versus never users” What about the remaining 15%? Is that percentage alright for you? Since the condom has not been sufficiently proven to be effective in preventing some of the common STDs listed above, there is an added risk of infection with HIV if there is an STD present. In view of the findings of the report, the CDC has made some changes in its fact sheet, which says amongst other things that “The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and you know is uninfected. For persons whose sexual behaviors place them at risk for STDs, correct and consistent use of the male latex condom can reduce the risk of STD transmission. However, no protective method is 100 percent effective, and condom use cannot guarantee absolute protection against any STD … In order to achieve the protective effect of condoms, they must be used correctly and consistently. Incorrect use can lead to condom slippage or breakage, thus diminishing their protective effect. Inconsistent use, e.g., failure to use condoms with every act of intercourse, can lead to STD transmission because transmission can occur with a single act of intercourse” 

It should be realized that the initial use for condoms was to prevent pregnancy. Still, couples who depend on this method as their only way of preventing pregnancy report some unintended pregnancy within one year of use. This can be as high as 14% during “typical” use. Some studies have found condom failure rates in protecting against pregnancies for teenagers to be as high as 22.5 %. If one remembers that a woman can only get pregnant within some days in the month, and that the HIV virus is much smaller than the human sperm cell, it boggles the imagination on what may be the case with HIV transmission when compared with the pregnancy rate.  The HIV virus is about 0.1 micron in size (compared with up the head of a spermatozoon which measures 5 x 3 microns).  Latex has some naturally occurring flaws (pores) which are of the order of 5 microns (Source: C.M. Roland, Ph.D., Editor, Rubber Chemistry and Technology and Head of the Polymer Properties Section, Naval Research Laboratory, in a Letter entitled “Do You Want to Stake Your Life On A Condom?”  published in Washington Times, April 22, 1992).

The HIV virus does not easily pass through because the effects of surface tension (the virus doesn’t usually move in isolation but suspended in fluids) can make it impermeable even in the presence of holes bigger than it when friction, corrosion or pressure forces are not in play. Also, condoms are usually “double-dipped”, i.e. most or all of the voids of one layer are covered by the second layer, making it impossible to see holes in the condoms when they are stretched and viewed under the electron microscope. Unfortunately, the various stresses which affect a condom when in use viz – lateral stress, pressure stress, shear stress, friction and corrosion – cannot be simulated while using the electron microscope. 

Condoms are usually subjected to air-burst and water leak tests. Curiously enough, they are not subjected to FRICTION tests. Even the medication for vaginal candidiasis which is common in women can also cause deterioration of the condom. Exposure to petroleum jelly, body creams and other oils can also affect the condom. They can also be snagged at by fingernails or rings.   

The main possibility, however, with transmission even with condom use lies in the failure rate from bursting, tearing or slipping off. Based on the results from 15 studies involving the use of 25,184 condoms, “Contraceptive Technology”  found out that 5.36 % of all of the condoms broke and 3.67% of them partially or completely slipped off, a total of 9.13 %. (Robert A. Hatcher, et. al. Contraceptive Technology (17th Revised Edition) [New York: Ardent Media, Inc., 1998]. Table 16-3, “Prospective Studies of Condom Breakage and Slippage,” pages 330 to 332.) 

Condoms, we are told, should be kept in a cool, dry place. This is due to the fact that they are sensitive to heat and cold. For such a fragile “life-saver”, one would expect that condoms should be transported under conditions that portray their importance. Instead, some samples taken of up to 72,000 trucks used for distributing condoms showed that the back sections of some of those trucks were so hot that eggs could be fried in them. (Collart, D. Ph.D., Clark Atlanta University: “Condoms: A Users Right To Know”, Impact, Issue 3, 1-2 (1993)) I am unsure if the situation has changed favourably since then. How certain are those who buy condoms that they are not purchasing an already-spoilt product.  
And by the way, some tests administered for strength and leaks are used to spot-check a batch of condoms as opposed to testing the condoms individually. If you just happen to be unlucky to use a condom from a batch that had fewer amount of defective condoms noticed from those selected, you may also place yourself in a vulnerable position to contract HIV if there are more defective ones. When all these facts are put into consideration, the fact of condoms offering “safe-sex” begins to look suspect. It would really be interesting to know the number of people who will continue using condoms if the information above related to its effectiveness were to be put on condom packets. If cigarette packs have a warning label attached to them, why shouldn’t condoms share a similar fate?   

Doctors are expected to give patients the best possible form of advice to help safeguard their lives. Some doctors are beginning to do just that with regards to condom use. One of my professors in Medical School once told us that if he had to operate on HIV patients, he normally asked for 3-5 pairs of gloves!!! (he would be wearing goggles to protect his eyes too) Yet, we are told to take off all our clothes and place all our trust in a piece of latex rubber! 

According to Dr Harold Jaffee, Chief of Epidemiology at the National Centre for Disease Control (in America), “You just can’t tell people it’s all right to do whatever you want so long as you wear a condom. It (AIDS) is too dangerous a disease to say that”. 
Just one more viewpoint: Dr Robert Renfield, Chief of Retroviral Research at the Walter Reed Army Institute says “Simply put, condoms fail. And condoms fail at a rate unacceptable for me as a physician to endorse them as a strategy to be promoted as meaningful AIDS protection”. It wouldn’t be a bad idea to ponder deeply on the above pronouncements.  
Beyond the elusive hope that condoms will definitely prevent HIV/AIDS, there lies something much deeper. It is that the condom approach gradually but surely erodes the meaning and value of love and sex. It leads people to lose their ability to exercise self-control, thus urging them to behave in an unrestrained sensual manner which is proper only to animals. This actually goes against our dignity as beings that can use their reasoning powers well. Sex is then seen primarily as a tool for pleasure with complete disregard for any form of responsibility for our actions. The use of condoms can pave the way to seeing others as objects of pleasure and thus needed only for our own selfish interests.   

Moreover, if one has a false sense of security with the condom, self-restraint will definitely be lost, paving the way to promiscuity. According to an article published some years ago, “Promoting condoms as a sure-fire way to prevent AIDS has led many people to engage in riskier sexual behaviours than they otherwise might have” (“Condoms And Seat Belts: The Parallels And The Lessons”, The Lancet, vol. 355, Jan. 29, 2000).  What training will we be giving the younger ones in order to prepare them for a life-long commitment in marriage? At their age in life, they are prone to experimentation. What guarantees are there that someone who was promiscuous before marriage will, overnight, become faithful to his/her spouse. Even within marriage, its use can lead to mutual distrust amongst the spouses.   

I felt really sad on hearing of a seminar in which the participants lodging in a hotel were given condoms along with the usual seminar bags and jotters! Knowing that the men who were there for the seminar were not accompanied by their wives, what did the organizers have in mind by giving them condoms? The same occurs when some NGOs give money to some students’ organizations in the university in order to take care of some of their functions with the caveat that they must distribute condoms during those occasions. Do not these activities lead to an even more-widespread decay and decline in morality?

 Are abstinence from sex before marriage and fidelity within marriage realistic options in the battle against HIV/AIDS? Is it possible for a normal, healthy person to resist sexual urges until marriage and then maintain a commitment to faithful, monogamous marriage? And, seemingly even more incredible by today’s standards, can an entire nation dramatically reduce its AIDS incidence rates largely as a result of abstinence before marriage and fidelity within marriage?   

Uganda appears to have done just that and has become the “success story”, the model for other countries in the world to emulate in the fight against AIDS. The country was one of the worst hit by the disease in the 1980’s but recent surveys have documented a decrease in the prevalence of HIV infection (amongst pregnant women in Kampala, it dropped from 29% in 1992 to 14% in 1998). By 2001, WHO had put the HIV prevalence at 5% of the adult population. This decline was mainly through the efforts of President Yoweri Musevini and his wife to stem the epidemic.   

In 1991, the president noted, “I have been emphasizing a return to our time-tested cultural practices that emphasized fidelity and condemned premarital and extramarital sex….” At the United Nations Child Summit in 2002, Uganda’s First Lady bluntly asserted: “The young person who (is) trained to be disciplined will, in the final analysis, survive better than the one who has been instructed to wear a piece of rubber and continue with ‘business as usual.’” Little wonder then, that from the experience garnered from his country, President Museveni, during this year’s 15th International AIDS Conference in Thailand, told the delegates that sexual abstinence, not condom use, was the message governments should spread. 

Some people dismiss abstinence and fidelity to one’s spouse as unrealistic modes of living in these times. They even look at these issues as religious impositions which have to be shed in this era of “unbridled freedom”. The impression they want to put forward is that “everybody is doing it” (which is not truly the case). This, in turn, pressurizes young people to engage in pre-marital sex in order not to feel out of place among their peers.  

Abstinence and chastity are not impossible concepts to practice. It may be difficult to maintain such a lifestyle, bearing in mind the unhealthy influence that some books, magazines, television programmes, films and pornography on the internet have on peoples’ behaviour. However, nothing good comes easy.  The habit of self-control, once acquired, can lead one to channel his/her energies into activities that are more productive in life.

Teenagers can discipline themselves over matters that they are firmly convinced are of benefit to them (it’s not difficult to see young men going to gymnasiums in order to develop their muscles). The same can apply if they are given logical reasons to practice self-discipline with regards to sex. It is quite ironical to tell young people that they cannot live  self-control and abstinence and, at the same time, expect them to practice self-control when it comes to using the condom correctly.  

According to a four-year study, released in the April 2003 issue of the Journal, Adolescent And Family Health, “sexual abstinence — not condom use — is the principal reason for the decline in the birth and pregnancy rates to teenage girls. In fact, abstinence accounted for 100 percent of the decline in the teen birth-rate and 67 percent of the decline in the pregnancy rate to single teens”. If in America, of all places, the trend is more towards abstinence, then what are we doing here in Nigeria by promoting condom use and not conduct change?  

A lifetime of happiness can be (and has been, on countless occasions) shattered by misplaced dependence on a condom. I have helped to run a clinic which was involved in clinical trials for a drug meant for HIV/AIDS patients. The stories the patients narrated were heart-wrenching and filled with regrets. Your life is most precious. Not just to you alone; your family, your friends and the society have very high expectations of you. Do not cut your dreams short. Be safe and don’t try to play safe. 

Dr. Teresa Crenshaw, member of the US Presidential AIDS Commission and former president of American Association of Sex Education, Counselors and Therapists once mentioned that “saying that the use of condoms is “safe sex” is in fact playing Russian roulette. A lot of people will die in this dangerous game”. She recounts speaking to over 800 of her colleagues who teach sex education (including the use of condoms as “safe sex”).

She said, “I asked them if they had available the partner of their dreams and knew that person carried the (AIDS) virus, would they have sex, depending on a condom for protection? No one raised their hand!” If those who are advocating condoms are not willing to stick out their own necks, then why should you? Remember, AIDS no dey show for face.  

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Dr. Anthony Odoh, a Nigerian physician, resides in Spain, and could be reached with tonyodoh@gmail.com

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