Q & A ABOUT MALE LATEX CONDOMS
How effective are latex condoms to prevent transmission of HIV and other STDs?
The best way to prevent the sexual transmission of HIV (the virus that causes AIDS) and other sexually transmitted diseases (STDs) is to abstain from sexual intercourse or have sex with a mutually monogamous uninfected partner. In addition, the consistent and correct use of male latex condoms provides a high degree of protection from HIV and other STDs.
Laboratory studies show latex condoms are highly effective in preventing transmission of HIV and other STDs. And real-life studies of “discordant” couples — that is, couples in which one person is infected with HIV and the other isn’t — show the same thing.
Three recent studies (DeVincenzi et al., Saracco et al., and Deschamps et al.) followed 245, 305, and 177 discordant couples (respectively). Among those who did not use condoms every time (inconsistent users), there were 4.8, 7.2, and 6.8 seroconversions per 100-person years. In contrast, among those who used condoms consistently, there were 0, 1.1, and 1.0 seroconversion per 100-person years. These studies show latex condoms are highly protective, and point to the need to promote consistent and correct use.
What does “consistently and correctly” mean?
Consistently means using a condom every time you have sex — one hundred percent of the time — no exceptions. Correctly means following these steps:
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Be careful opening the package — your teeth or fingernails can tear the condom. Use water-based lubricants only. Oil-based lubricants, like petroleum jelly or lotions, will damage condoms. Heat also damages condoms. Store condoms in a cool, dry place, not in your pocket, wallet, or the glove compartment of your car. Use condoms before the expiration date on the box or individual package. Don’t use a condom if it’s sticky, brittle, discolored, or torn. |
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Put the condom on after the penis is erect and before it touches any part of your partner’s mouth, anus, or vagina. If the penis is uncircumcised, pull the foreskin back before putting on the condom. |
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To put the condom on, pinch the closed end so no air is trapped inside. Leave some room at the end for semen. Unroll it all the way down the penis. |
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If the condom breaks or slips while you’re having sex, stop, and put on a new condom. Be sure to follow the instructions. When condoms slip, break, or leak it’s usually not product failure — most times, it’s user error. |
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After ejaculation, withdraw from your partner before your penis becomes soft. Hold the condom on as you pull out so no semen is spilled. Be sure to properly dispose of used condoms (they shouldn’t be flushed down a toilet) and don’t reuse condoms. |
Isn’t it naive to think people can use condoms consistently?
No. Studies of hundreds of couples show that consistent condom use is possible when people have the skills and motivation to do so. One of the biggest motivations in deciding to use any product — whether it’s toothpaste or a condom — is the belief the product will work. Scientific studies have clearly demonstrated that condoms are highly effective in preventing transmission of HIV and other STDs. It’s very important to correct misinformation about condoms. People who are skeptical about condoms aren’t as likely to use them — but that doesn’t mean they won’t have sex. And unprotected sex may put them at risk for infection with HIV and other STDs.
In addition to believing the product will work (product efficacy), people have to believe they will be able to use the product correctly (self-efficacy). That’s why it’s important to teach people skills in using condoms, such as how to put them on the right way, as well as how to talk with sexual partners about condom use or to say no to sex if a partner refuses to use a condom.
What about condom failure rate?
The term “condom failure rate” isn’t very specific. Any assessment of condom effectiveness must distinguish between user effectiveness (or failure) and product effectiveness (or failure). “Condom failure rate” is often imprecisely used to refer to a percentage of women who become pregnant over the course of a year in which they reported using condoms as their primary method of birth control, even if they didn’t use condoms every time they had sex.
Studies that don’t distinguish between consistent, inconsistent, and non-user cannot adequately address the issue of condom effectiveness. A simple analogy would be to say that seat belts don’t work because there are accidents in which passengers are hurt because they are not wearing them. Clearly, seat belts don’t work unless they are used. Equally as clear, condoms don’t work unless they are used.
At other times, “condom failure rate” refers to the percentage of condoms that break during laboratory stress tests — a measure of product failure. Or it refers to the number of couples who report that a condom broke or slipped (typically the result of user error, not product failure).
The average published condom breakage rate is around 3 percent. The majority of breaks do not result in exposure, and it is clear that most breaks occur as the result of incorrect use. A recent study (Albert, Warner, Hatcher, Trussell, and Bennett) suggests that regular condom use may lead to condom mastery and the development of techniques to reduce the likelihood of breakage and slippage.
What about holes in latex?
Although natural membrane condoms do have holes, latex condoms typically do not. Latex condoms, which are regulated by the Food and Drug Administration (FDA) as a medical device, must undergo stringent tests, including tests for holes, before they’re sold. These tests are performed by the manufacturers.
How are condoms regulated and tested?
The FDA regulates latex condoms as medical devices and governs their manufacture according to stringent national standards. Condoms made in the United States undergo strict quality testing throughout the manufacturing process. Before packaging, every condom is tested electronically for defects, as mentioned above. In addition, the FDA tests samples from every batch using water leak-tests, and through air burst tests. If any defects are found, the entire product batch is thrown out. The FDA randomly tests both domestic and imported condoms to be sure they meet quality control standards. Samples representing millions of condoms have been tested, and the average batch tests better than 99.7 percent defect-free.
Some people believe some brands of condoms are more reliable than others. Do some condoms have higher quality standards?
All condoms are subject to the same quality control standards. The studies published to date aren’t adequate to judge the relative quality of various brands — various studies have ranked the same brand differently, because they used different methods to judge. Consumers should look for the word “latex” on the package. Latex condoms offer greater protection against HIV and other STDs than do natural membrane condoms. Color, shape, size, and other qualities (like ribbing) are personal preferences and don’t affect reliability. All condoms labeled “For Disease Protection” are effective.
Can nonoxynol-9 prevent HIV infection?
Although laboratory studies show that N-9 kills sperm in test tubes, available data on the efficacy and safety of N-9 spermicide to prevent sexual transmission of HIV in real life situations are inconclusive and inconsistent. For this reason, CDC does not recommend the use of N-9 alone to prevent the sexual transmission of HIV. CDC recommends the use of male latex condoms, with or without spermicide. Nonoxynol-9 has been shown to provide some protection against two bacterial STDs, gonorrhea and chlamydia.
Do education programs about condoms make adolescents more sexually active?
No. Several studies have shown that sexual activity among young adults actually decreased, or at least stayed the same, after sex education programs that included information about condoms. In a recent Swiss study of 16- to 19-year-olds, a sex education program did not increase either the level of sexual activity or the number of sex partners. Importantly, though, among those who were sexually active, condom use did increase. A 1992 study reported in Family Planning Perspective found the same thing — that AIDS education resulted in decreases in both the number of sex partners and sexual activity, but with increases in condom use among those who were sexually active.
Moreover, the World Health Organization (WHO) has conducted comprehensive reviews of the scientific literature on sex and AIDS education. In 1993, at the IX International Conference on AIDS, WHO presented a review of 19 studies that considered the effect of sex education on reported age at first intercourse and on levels of reported sexual activity. There were several clear trends:
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There was no evidence of sex education leading to earlier or increased sexual activity in the young people who were exposed to it. |
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In fact, six studies showed that sex education led either to a delay in the onset of sexual activity or to a decrease in overall sexual activity. |
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Ten of the studies showed that sex education programs increased safer sex practices among young people who were already sexually active. |
In addition to the evaluation of school-based education programs, the WHO report concluded that the two public information programs evaluated showed no effect on age at first intercourse and no increase in sexual activity in young people, despite a large increase in the use of condoms and contraception.
In September 1995, the Office of Technology Assessment (OTA) of the 103rd Congress examined the effectiveness of prevention programs and found no scientific evidence that curricula focusing only on abstinence delay the onset of sexual intercourse. The report further concluded that programs that include discussion of abstinence and contraception in combination with other topics such as resistance skills do not lead to earlier initiation of sex and, in fact, result in lowered incidence of sexual intercourse in some cases.
The OTA report further concluded that among individuals already sexually active, these programs lead to fewer sexual partners and greater use of contraception. This report underscores the need for comprehensive programs and a balance of prevention messages.
Source: Centers for Disease Control and Prevention: April 1997
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