New CDC condom fact sheet invites criticism
New CDC condom fact sheet invites criticism
What role did politics play in changes?
An ongoing debate over the facts about condoms still is not settled, even though the Centers for Disease Control and Prevention (CDC) has posted an updated version of its on-line condom fact sheet.
The update was posted Dec. 5, and distributed at the HIV Prevention Summit in Atlanta. While there are no major changes in the facts about condoms, differences are seen in emphasis and placement of existing information. Also, the new sheet is now twice as long and includes a kind of preamble stating that abstinence and monogamy are the only sure ways to avoid sexually transmitted diseases (STDs). For example, the added length of the document comes mainly from a new section that prefaces what made up the old document — a discussion of condom effectiveness in three areas: HIV/AIDS, discharge diseases, and genital ulcer diseases.
A new category, titled "STDs, Including HIV," discusses reasons why condom protection can vary among different STDs, as well as the limitations in studies for non-HIV STDs.
On Dec. 18, a group of 14 Democratic lawmakers sent a letter to Health and Human Services Secretary Tommy Thompson accusing the Bush administration of "playing politics" by eliminating key information on condom use in the new fact sheet and putting more emphasis on abstinence.
David Fleming, MD, the CDC’s deputy director for science, defended the actions of the Bush administration, saying that the CDC chose a more neutral introduction for the condom fact sheet because of the "mixed evidence" on the issue. "We specifically tried not to nuance it in the direction of either encouraging or discouraging use of condoms," Fleming told the Associated Press.
The most significant message change is the inclusion of a warning that condoms lubricated with spermicides are no more effective than other lubricated condoms in protecting against STDs. It also emphasizes reasons why condoms are not 100% effective, including incorrect and inconsistent use.
Another change is the emphasis on the ineffectiveness of condoms in protecting against human papillomavirus (HPV) infection, which causes cervical cancer. While the old version mentions HPV only in the last section under genital ulcers and HPV infections, the new update states up front that "while condom use has been associated with a lower risk of cervical cancer, the use of condoms should not be a substitute for routine screening with Pap smears. . . ."
Under the HPV section, the update notes that "while some epidemiological studies have demonstrated lower rates of HPV infection among condom users, most have not."
According to one study, condoms do appear to increase protection against HPV disease.1 "Avail-able data are too inconsistent to provide precise estimates," the authors wrote. "However, they suggest that while condoms may not prevent HPV infection, they may protect against genital warts and cervical cancer." The findings suggest that condoms may help prevent warts and other HPV-related problems, possibly by cutting down on the amount of the virus transmitted, "but perhaps not actual infection by HPV," the researchers said.
The changing emphasis of the condom update parallels a recent change in the United States’ position on population-control language. The U.S. delegates at the Fifth Asian and Pacific Population Conference requested the removal of a phrase advocating "consistent condom use" as a way to prevent HIV infection.
Instead, the Bush administration wants language inserted into the agreement that promotes "natural" family planning methods. As one delegate put it, the administration prefers "abstinence over condoms."
The emphasis on condom failure also can be seen in new state laws on sex education. Last year, for example, New Jersey passed legislation stating that any instruction, including class lectures and pamphlets, which deals with contraceptive use "must include information on their failure rates for preventing pregnancy, HIV infection, and other STDs in actual use among adolescent populations." Those instructions also must stress abstinence as "the only certain method to prevent pregnancy and sexually transmitted diseases."
(Editor’s note: An on-line copy of the updated CDC fact sheet on condoms can be found at: http://weblink.cdc.gov/hiv/pubs/facts/condoms.htm.)
Reference
1. Manhart L, Koutsky L. Do condoms prevent genital HPV infection, external genital warts, or cervical neoplasia? A meta-analysis. Sex Transm Dis 2002; 29(11):725-735.
Language Highlighted in New Fact Sheet
Here is the new language put up front and bolded in the new Centers for Disease Control and Prevention’s condom fact sheet released Dec. 5:
"The surest way to avoid transmission of STDs 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 male latex condoms can reduce the risk of STD transmission. However, no protective method is 100% effective, and condom use cannot guarantee absolute protection against any STD. . . ."
An ongoing debate over the facts about condoms still is not settled, even though the Centers for Disease Control and Prevention (CDC) has posted an updated version of its on-line condom fact sheet.Subscribe Now for Access
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