Male Latex Condoms

Q
& A ABOUT MALE LATEX CONDOMS
PREVENTING SEXUAL TRANSMISSION
OF HIV

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:

	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.
	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.
	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.
	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.
	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:

	There was no evidence of sex education leading to earlier or increased sexual activity in the young people who were exposed to it.
	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.
	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