Condom Use Reduces Morbidity and Mortality

sharon sanders · Mar 19, 2009

Contraception and HIV infection in women.

Heikinheimo O, L?hteenm?ki P. Department of Obstetrics and Gynaecology, University of Helsinki, Finland. oskari.heikinheimo@helsinki.fi

BACKGROUND: More than 15 million women, many of reproductive age, were infected with human immunodeficiency virus (HIV) at the end of 2007. As the HIV epidemic evolves, heterosexual intercourse is increasingly risky: the risk of infection in exposed young women is 4- to 7-fold higher than in young men and nearly half a million newborns annually have HIV. This review aims to show the effect of contraceptive choices on risk of HIV and on the course of disease in women with HIV.

METHODS: Relevant citations were selected by agreement between the authors after a search of MEDLINE using the terms HIV/AIDS and contraception.

RESULTS: Risk of transmission of HIV varies from 1 in 200 to 1 in 10 000 coital incidents, depending in part on the integrity of the vaginal epithelium. Consistent use of male condoms has been proven to reduce horizontal transmission of HIV by 80% among HIV-serodiscordant couples. Hormonal contraception may increase the risk of HIV acquisition in high-risk women such as commercial sex workers, but not in women at low risk of HIV. While hormonal contraception did not affect progression of disease in two cohort studies involving 370 women, in a randomized trial among women not receiving antiretroviral medication, clinical disease accelerated in the oral contraception group (13.2/100 woman-years) compared with the copper intrauterine devices group (8.6/100 woman-years; hazard ratio, 1.5; 95% confidence interval, 1.04-2.1). Hormonal contraception does not interfere with antiviral drug effectiveness.

CONCLUSIONS: All the available reversible contraceptive methods can generally be used by women at risk of HIV infection and by HIV-infected women. Further studies are needed to investigate the safety and efficiency of hormonal contraception in women living with HIV/AIDS.

snip

Barrier methods are effective in reducing the risk of HIV transmission

 Male condoms

As of today, male condoms are the only means proven to significantly reduce the risk of HIV transmission in heterosexual intercourse (Cates, 2005). According to a recent Cochrane review, consistent use of male condoms results in 80% reduction in the risk of HIV transmission among HIV-serodiscordant couples (Weller and Davis-Beaty, 2002

). Of the studies including only HIV-negative women and their HIV-infected men, the efficacy of consistent condom use in prevention of HIV transmission was remarkable, with a relative risk varying from 0.1 to 0.2 (Saracco et al., 1993

; Musicco et al., 1994

). Morover, during the follow-up period of nearly 2 years, De Vincenzi (1994) among the 124 couples consistently using condoms. reported no seroconversions 
It is also noteworthy that a reduced risk of HIV transmission is associated only with consistent but not with occasional condom use. In fact, occasional condom use has been associated with an increased risk of HIV transmission in some studies (Saracco et al., 1993

; Musicco et al., 1994

). However, a major challenge in evaluation of condom use is that the data is self-reported and therefore, in many cases, its reliability may be questionable. This is related especially to consistency of use. 
Many of the studies involving assessment of the efficacy of male condoms in prevention of HIV transmission were carried out before the era of effective antiretroviral medication. The use of zidovudine monotherapy by the HIV-infected male partner has been reported to halve the risk of HIV transmission (Musicco et al., 1994

), and during the use of current combination therapy the rate of HIV transmission was even lower (Castilla et al., 2005

). No HIV transmissions were reported among serodiscordant couples if the HIV-infected partner received HAART and a condom was used every time the couple had sex (Castilla et al., 2005

). 
Given the efficacy of consistent use of male condoms in the prevention of HIV transmission in heterosexual intercourse, it is disappointing to note the low prevalence of condom use reported in many studies. In addition, the rate of reported condom use varies greatly in studies performed in different continents. The lowest rate of condom use is reported in studies carried out in Africa. Only 10% or less of African women participating in studies involving assessment of the safety of hormonal contraception among women at risk of HIV (Tables III and IV) reported the dual use of hormonal contraception and condoms (Kiddugavu et al., 2003

; Morrison et al., 2007

; Myer et al., 2007

). Similarly, condom use at any time was reported by <10% of HIV-infected women participating in a study in which the use of a Cu-releasing intrauterine device (Cu-IUDs) was assessed (Richardson et al., 1999

).

http://humupd.oxfordjournals.org/cgi/content/full/15/2/165

Giuseppe · Mar 20, 2009

Re: Condom Use Reduces Morbidity and Mortality

Condoms and HIV prevention: Position statement by UNAIDS, UNFPA and WHO

Condoms and HIV prevention: Position statement by UNAIDS, UNFPA and WHO

19 March 2009

[Originally published in 2004 updated in 2009]

Condom use is a critical element in a comprehensive, effective and sustainable approach to HIV prevention and treatment.
Credit: UNAIDS

Condom use is a critical element in a comprehensive, effective and sustainable approach to HIV prevention and treatment. Prevention is the mainstay of the response to AIDS. Condoms are an integral and essential part of comprehensive prevention and care programmes, and their promotion must be accelerated. In 2007, an estimated 2.7 million people became newly infected with HIV. About 45% of them were young people from 15 to 24 years old, with young girls at greater risk of infection than boys.

The male latex condom is the single, most efficient, available technology to reduce the sexual transmission of HIV and other sexually transmitted infections.

The search for new preventive technologies such as HIV vaccines and microbicides continues to make progress, but condoms will remain the key preventive tool for many, many years to come. Condoms are a key component of combination prevention strategies individuals can choose at different times in their lives to reduce their risks of sexual exposure to HIV. These include delay of sexual initiation, abstinence, being safer by being faithful to one?s partner when both partners are uninfected and consistently faithful, reducing the number of sexual partners, correct and consistent use of condoms(1), and male circumcision.

Conclusive evidence from extensive research among heterosexual couples in which one partner is infected with HIV shows that correct and consistent condom use significantly reduces the risk of HIV transmission from both men to women, and also from women to men(2). Laboratory studies show that male latex condoms are impermeable to infectious agents contained in genital secretions(3). To ensure safety and efficacy, condoms must be manufactured to the highest international standards. They must be procured according to the quality assurance procedures established by the WHO, UNFPA and UNAIDS and they should be stored away from direct heat sources. Prevention programmes need to ensure that high-quality condoms are accessible to those who need them, when they need them, and that people have the knowledge and skills to use them correctly.

Condoms must be readily available universally, either free or at low cost, and promoted in ways that help overcome social and personal obstacles to their use.Condom use is more likely when people can access them at no cost or at greatly subsidized prices. Effective condom promotion targets not only the general population, but also people at higher risk of HIV exposure, especially women, young people, sex workers and their clients, injecting drug users and men who have sex with men. UNFPA estimates that the current supply of condoms in low- and middle-income countries falls well short of the number required (the condom ?gap?)(4). Despite the gap, international funding for condom procurement has not increased in recent years. Collective actions at all levels are needed to support efforts of countries, especially those that depend on external assistance for condom procurement, promotion and distribution.

HIV prevention education and condom promotion must overcome the challenges of complex gender and cultural factors.

Young girls and women are regularly and repeatedly denied information about, and access to, condoms. Often they do not have the power to negotiate the use of condoms. In many social contexts, men are resistant to the use of condoms. This needs to be recognized in designing condom promotion programmes. Female condoms can provide women with more control in protecting themselves. However, women will remain highly vulnerable to HIV exposure, until men and women share equal decision-making powers in their interpersonal relationships.

Condoms have played a decisive role in HIV prevention efforts in many countries.

Condoms have helped to reduce HIV infection rates where AIDS has already taken hold, curtailing the broader spread of HIV in settings where the epidemic is still concentrated in specific populations.

Condoms have also encouraged safer sexual behaviour more generally. Recent analysis of the AIDS epidemic in Uganda has confirmed that increased condom use, in conjunction with delay in age of first sexual intercourse and reduction of sexual partners was an important factor in the decline of HIV prevalence in the 1990s(5). Thailand?s efforts to de-stigmatize condoms and its targeted condom promotion for sex workers and their clients dramatically reduced HIV infections in these populations and helped reduce the spread of the epidemic to the general population. A similar policy in Cambodia has helped stabilize national prevalence, while substantially decreasing prevalence among sex workers. In addition, Brazil?s early and vigorous condom promotion among the general population and vulnerable groups has successfully contributed to sustained control of the epidemic.

Increased access to antiretroviral treatment creates the need and the opportunity for accelerated condom promotion.

The success of antiretroviral therapy in industrialized countries in reducing illness and prolonging life can alter the perception of risk associated with HIV(6). A perception of low-risk and a sense of complacency can lead to unprotected sex through reduced or non-consistent condom use. Promotion of correct and consistent condom use within antiretroviral treatment programmes, and within reproductive health and family planning services, is essential to reduce further opportunities for HIV transmission. Rapid scale-up of HIV testing and counselling is needed to meet the prevention needs of all people, whether they are HIV-positive or negative.

1 UNAIDS. 2004 Report on the global AIDS epidemic, page.72.
2 Holmes K, Levine R, Weaver M. Effectiveness of condoms in preventing sexually transmitted infections. Bulletin of the World Health Organization. Geneva. June 2004.
3 WHO/UNAIDS. Information note on Effectiveness of Condoms in Preventing Sexually Transmitted Infections including HIV. Geneva. August 2001.
4 UNFPA. 2007 report on donor support for contraceptives and condoms for STI/HIV prevention 2007.
5 Singh S, Darroch J.E, Bankole A. A,B, and C in Uganda: The Roles of Abstinence, Mongamy and Condom Use in HIV Decline. The Alan Guttmacher Institute. Washington DC. 2003.
6 Gremy I, Beltzer N. HIV risk and condom use in the adult heterosexual population in France between 1992 and 2001: return to the starting point? AIDS 2004;18:805-9.
-

<cite cite="http://www.unaids.org/en/KnowledgeCentre/Resources/FeatureStories/archive/2009/20090319_preventionposition.asp">Condoms and HIV prevention: Position statement by UNAIDS, UNFPA and WHO</cite>

sharon sanders · Mar 20, 2009

Re: Condom Use Reduces Morbidity and Mortality

FluTrackers endorses the use of condoms to help prevent disease.

BMJ 2008;336:184 (26 January), doi:10.1136/bmj.39402.488727.AD
Head to Head

Are condoms the answer to rising rates of non-HIV sexually transmitted infections? Yes

Markus J Steiner, senior researcher, Willard Cates, president, research

1 Family Health International, Research Triangle Park, NC 27709, USA
Correspondence to: W Cates wcates@fhi.org<script type="text/javascript"></script>

Related article: doi: 10.1136/bmj.39402.527766.AD

Consistent condom use can reduce the spread of HIV, and Markus Steiner and Willard Cates believe condoms are the answer to other sexually transmitted infections. But Stephen Genuis argues that a more comprehensive approach is needed

 

Condoms can and should play a central role in halting the rising rates of sexually transmitted infection other than HIV. For people who are sexually active, condoms remain our best solution to reducing risks of acquiring sexually transmitted infections (if uninfected) or transmitting these infections (if infected). 

Strong evidence from laboratory studies and mounting clinical studies shows that condoms effectively reduce the risk of transmission. In addition, for specific populations, increased levels of condom use have been associated with decreases in reported sexually transmitted infections. 

Condoms work

Condoms protect the wearer and his partner from infection by covering the penile glans and shaft, which are the major portals of entry and exit of sexually transmitted pathogens. Laboratory studies indicate that latex condoms are an effective physical barrier against passage of even the smallest sexually transmitted pathogens.1

 
When placed on the penis before any genital contact and used throughout intercourse, the condom prevents direct contact with semen; genital lesions and subclinical viral shedding on the glans and shaft of the penis; and penile, vaginal, or anal discharges. 

Thus, condoms reduce the risk of infections that are transmitted primarily to or from the penile urethra such as HIV, gonorrhoea, chlamydia, trichomoniasis, and hepatitis B.

Condoms also reduce the risk of infections that are transmitted primarily through skin or mucosal surfaces when these areas are covered by the condom, such as genital herpes, syphilis, chancroid, and human papillomavirus infection.

 
Although clinical studies have shown inconsistent protective effects for most sexually transmitted infections other than HIV,2 much of this can be attributed to limitations in study design. Limitations in measurement of self reported condom use and exposure to infected partners complicate interpretation of results.3 Moreover, the levels of protection from condoms are likely to differ between infections because of variations in their routes of transmission, infectivity, and prevalence.

 
Despite these limitations, a recent systematic literature review of 45 published studies of condom use and gonorrhea and chlamydia provides strong evidence that condoms reduce risk in both men and women.3 Many of these studies did not measure critical factors such as exposure to infected partners, consistent and correct condom use, or incident infection. The observed protective effects are therefore likely to be underestimates. When one of the 45 studies was adjusted for infection status by using a case crossover analysis, the protective effect of condoms increased dramatically.4


Recent well designed studies have also shown consistent and correct use of condoms can reduce herpes simplex virus5 and cervical human papillomavirus infection.6 

One problem with relying on condoms to halt the rising rates of infection is that the promotion of condoms remains controversial in many countries, including the United States. The data are clear, however. Other than abstinence, which is difficult to achieve, condoms are the most effective means of stopping the spread of sexually transmitted infections. We need to focus on ensuring consistent and correct condom use rather than denigrating condoms as being less than perfect.

 
Two recent reviews,7 8 show that behavioural interventions featuring condom promotion are associated with increases in reported condom use and, to a lesser extent, decreases in incidence of sexually transmitted infection. One theoretical concern is that condom promotion could lead to risk compensation?men who use condoms may feel safer and consequently engage in more frequent sex or sex with more partners, thus increasing the risk of transmission. 

The most recent review of 174 condom related prevention approaches, however, concluded that sexual risk reduction interventions do not increase unsafe sexual behaviour.9

In addition, a recent systematic review showed adding condom promotion to interventions focusing on abstinence does not undermine the abstinence message.10 Despite this reassurance, we must continue to be vigilant when promoting the use of condoms to avoid giving users a false sense of security; we should refer, for example, to safer sex rather than safe sex. 

Condoms in context

Like any prevention tool (such as seat belts, airbags, smoking cessation programmes, virginity pledges) condoms are not 100% effective. Preventing sexually transmitted infection, just as with other health conditions, requires incremental, partially effective steps to produce collectively effective (but not perfect) prevention programmes.11 Controlling the spread of infection will require different, mutually reinforcing techniques.

 
Although combined prevention strategies can greatly reduce the spread of sexually transmitted infections,12 they need to be carefully designed and implemented. Accurate messages about condoms must build on a wide range of risk avoidance and risk reduction approaches. These approaches include delayed initiation of sexual intercourse, mutual faithfulness, and selection of low risk partners.

 
Together with condoms, these reinforcing epidemiologic truisms have been labelled both now and in the past as an ABC strategy: abstinence, be faithful to one partner, and use condoms.13 Moreover, a full alphabet of prevention strategies is needed for an optimal effect on HIV transmission, as well as other sexually transmitted infections (box).

Condoms have a pivotal role in this larger armamentarium of strategies. 

What does this mean for clinicians who counsel patients about sexual health? Firstly, people who abstain from intercourse or who are uninfected and mutually monogamous eliminate the risk of infection entirely. Secondly, people who choose to be sexually active can be reassured that condom use reduces the risk of most infections. Thirdly, condoms, like any other prevention tool, work only when used properly? consistent and correct use is essential for optimal risk reduction.

http://www.bmj.com/cgi/content/full/336/7637/184

AlaskaDenise · Mar 21, 2009

Lancet Asks Pope to Retract Statement on Condoms

Lancet Asks Pope to Retract Statement on Condoms

Cambridge, Mass., Mar 21, 2009 / 10:11 am (CNA).- Pope Benedict’s recent brief remark against condoms has caused an uproar in the press, but several prominent scientists dedicated to preventing AIDS are defending the Pope, saying he was correct in his analysis. In an interview with CNA, Dr. Edward Green explained that although condoms should work, in theory, they may be “exacerbating the problem” in Africa.

Benedict XVI’s Tuesday comments on condoms were made as part of his explanation of the Church’s two prong approach to fighting AIDS. At one point in his response the Pontiff stressed that AIDS cannot be overcome by advertising slogans and distributing condoms and argued that they “worsen the problem.” The media responded with an avalanche of over 4,000 articles on the subject, calling Benedict a “threat to public health,” and saying that the Catholic Church should “enter the 21st century.”

Senior Harvard Research Scientist for AIDS Prevention, Dr. Edward Green, who is the author of five books, including “Rethinking AIDS Prevention: Learning from Successes in Developing Countries” discussed his support for Pope Benedict XVI’s comments with CNA.

According to Dr. Green, science is finding that the media is actually on the wrong side of the issue. In fact, Green says that not only do condoms not work, but that they may be “exacerbating the problem” in Africa.“

Theoretically, condoms ought to work,” he explained to CNA, “and theoretically, some condom use ought to be better than no condom use, but that’s theoretically.”

Condom proponents often cite the lack of condom education as the main culprit for higher AIDS rates in Africa but Green disagrees.

After spending 25 years promoting condoms for family planning purposes in Africa, he insists that he’s quite familiar with condom promotion. Yet, he claims that “anyone who worked in family planning knew that if you needed to prevent a pregnancy, say the woman will die, you don’t recommend a condom.”

Green recalls that when the AIDS epidemic hit Africa, the “Industry” began using AIDS as a “dual purpose” marketing strategy to get more funding for condom distribution. This, he claims, effectively took “something that was a 2nd or 3rd grade device for avoiding unwanted pregnancies” and turned it into the “best weapon we [had] against AIDS.”

The accepted wisdom in the scientific community, explained Green, is that condoms lower the HIV infection rate, but after numerous studies, researchers have found the opposite to be true. “We just cannot find an association between more condom use and lower HIV reduction rates” in Africa.

Dr. Green found that part of the elusive reason is a phenomenon known as risk compensation or behavioral disinhibition.

“[Risk compensation] is the idea that if somebody is using a certain technology to reduce risk, a phenomenon actually occurs where people are willing to take on greater risk.” The idea can be related to someone that puts on sun block and is willing to stay out in the sun longer because they have added protection. In this case, however, the greater risk is sexual. Because people are willing take on more risk, they may “disproportionally erase” the benefits of condom use, Green said.

Another factor that contributes to ineffective condom use in Africa, is the phenomenon where condoms may be effective on an “individual level,” but not on a “population level.” Green’s research found that “condoms have been effective” in HIV concentrated areas where high risk activities are already being conducted, such as brothels in countries like Thailand.

Claiming to be a liberal himself, Green asserts that promoting Western “liberal ideology” where, “most Africans are conservative when it comes to sexual behavior,” is quite offensive to them. Citing his new book, “Indigenous Theories and Contagious Disease,” Green described Africans as “very religious by global standards” who are offended by “trucks going around where people are dancing to ‘Rock ‘n’ Roll’, tossing out condoms to teenagers and the children of the village.”

Green also noted that there is an ideology called “harm reduction” that is being pushed by many organizations trying to prevent AIDS. The ideology believes that “you can’t change the underlying behavior, that you can’t get people to be faithful, especially Africans,” the HIV specialist explained.

One country, Uganda, recognized these issues and said, “Listen, if you have multiple sex partners, you are going to get AIDS.” What worked in Uganda, a country that has seen a decline by as much as 2/3 in AIDS infections, was that officials realized that even aside from religious and cultural reasons, “no one likes condoms.” Instead of waiting for “American and European advisors to arrive,” Ugandan officials reacted and developed a program that fit their culture; their main message being “stick to one partner or love faithfully.”

However, in 2004, Uganda’s AIDS infection rates began to increase once again, due to an influx of condoms and Western “advice”, Green recalled. Western donors also came to Uganda and said behavioral change doesn’t work and that, “most infections nowadays are among married people.” Green said these claims are “misleading,” pointing out that “married people always have lower HIV infection rates than single or divorced people of the same age group.”

Green’s new book, “AIDS and Ideology,” to be completed in the next few months, will describe the industry in Africa that is “drawing billions of dollars a year promoting condoms, testing, drugs, and treatment of AIDS” and is clearly resistant to the idea that behavioral change is the solution.

Yet the two countries that have the highest infection rate of AIDS in the world, Botswana and Swaziland, have recently launched campaigns to promote fidelity and monogamy, the Harvard researcher said. These countries “have learned the hard way” about the failure of condoms in preventing AIDS, he said, noting that “Botswana has probably had more condom promotion” than any other county on a per capita basis. Green said he had no problem “having condoms as a backup to fidelity-based programs.”

According to Green, the Catholic Church should continue to “do what it is already doing,” avoid “arguing about the diameter of viruses” and cite scientific evidence in connection with scripture and moral theology.

http://catholicnewsagency.com/new.php?n=15445

sharon sanders · Mar 22, 2009

Re: Harvard Researcher agrees with Pope on condoms in Africa

Re: Harvard Researcher agrees with Pope on condoms in Africa

Thanks AlaskaDenise for posting.

Unbelievable and how very unfortunate.

This is the best case I have seen for separating religion and public health.

Condoms are one of the most effective public health tools available.

Many studies prove this.

For instance, this statement is not true -

"...Dr. Green found that part of the elusive reason is a phenomenon known as risk compensation or behavioral disinhibition.

“[Risk compensation] is the idea that if somebody is using a certain technology to reduce risk, a phenomenon actually occurs where people are willing to take on greater risk.” The idea can be related to someone that puts on sun block and is willing to stay out in the sun longer because they have added protection. In this case, however, the greater risk is sexual. Because people are willing take on more risk, they may “disproportionally erase” the benefits of condom use, Green said..."

As shown by this study:

"...Two recent reviews,7 8 show that behavioural interventions featuring condom promotion are associated with increases in reported condom use and, to a lesser extent, decreases in incidence of sexually transmitted infection. One theoretical concern is that condom promotion could lead to risk compensation—men who use condoms may feel safer and consequently engage in more frequent sex or sex with more partners, thus increasing the risk of transmission. 

The most recent review of 174 condom related prevention approaches, however, concluded that sexual risk reduction interventions do not increase unsafe sexual behaviour.9

In addition, a recent systematic review showed adding condom promotion to interventions focusing on abstinence does not undermine the abstinence message.10 Despite this reassurance, we must continue to be vigilant when promoting the use of condoms to avoid giving users a false sense of security; we should refer, for example, to safer sex rather than safe sex. ..."

I am so disappointed in these recent statements against the value of condoms. They are part of a strategy of less risky behavior. Condoms are not 100% effective and they are not the entire answer to disease transmission.

But - they are a very useful public health aid.

Used properly and consistently, they save lives.

tropical · Mar 22, 2009

Re: Harvard Researcher agrees with Pope on condoms in Africa

Re: Harvard Researcher agrees with Pope on condoms in Africa

#2
#1: "Green said he had no problem "having condoms as a backup to fidelity-based programs.""

Giuseppe · Mar 26, 2009

Re: Condom Use Reduces Morbidity and Mortality

WHO | Condoms an important form of protection from HIV

Condoms an important form of protection from HIV

25 March 2009 --

Do condoms help in the prevention of HIV/AIDS transmission?

We find out in this episode.

Listen to this episode - duration 00:06:40 [mp3 3.6Mb]

Transcript of the podcast

Veronica Riemer:
You?re listening to the WHO podcast, and my name is Veronica Riemer. In this episode, we ask: do condoms help in the prevention of HIV/AIDS transmission?

[AMBIENCE SOUND]

In a remote village in Malawi, community volunteers discuss HIV/AIDS transmission and its prevention. At the end of 2007, there were about 33 million people living with HIV/AIDS: 2.7 million people were estimated to have acquired the HIV infection that year. Although the epidemic has stabilized, it remains a leading challenge for global health.

Condoms are one of the main forms of protection from sexually transmitted diseases such as HIV/AIDS. Dr Kevin De Cock from WHO's HIV/AIDS department tells us why it is vital to promote their use.

Dr Kevin De Cock:
The evidence around use of male condoms to prevent HIV transmission is that latex condoms if used consistently and correctly are highly effective in preventing the transmission of HIV. They are not the only important prevention strategy but they are an important component of comprehensive prevention efforts worldwide in association with other interventions. Importantly, there is no scientific evidence that promoting the correct and consistent use of condoms has led to alterations in sexual behaviour or increased risk taking.

Veronica Riemer:
Studies have shown that using condom is effective in controlling HIV transmission.

Dr Kevin De Cock:
The best information on the effectiveness of condoms comes from looking at large numbers of couples where one person is infected and the other is not, and following those over time and comparing the rates of transmission of infection in those groups. Comparing high condom users and people who did not use condoms. Such studies suggest that condoms are at least 80%, and possibly more, effective in reducing the transmission of HIV for co-habiting couples.

Veronica Riemer:
One of the main reasons for the rapid spread of HIV in Asia is the high transmission rate among sex workers and their clients. In the 1980s, the Thai government introduced a programme to promote the practice of ??No condom ? No sex??. This meant that sex workers were able to refuse unprotected sex. The result was a major reduction not only in HIV transmission, but also in other sexually transmitted infections. Dr Wiwat, currently working as the WHO Representative in Mongolia, was in Thailand at the time. He explains the results of the programme.

Dr Wiwat:
When the programme started in 1989 in one province, it was a surprise that the sex worker who usually had a very high level of sexually transmitted infection (STI), the STI became almost zero. So it was very effective. Because of that effectiveness, the government scaled up the programme to become nationwide in 1991. and it was very clear that sexually transmitted infections, which is a very good indicator for HIV, it was clear that STIs dropped more than 95%, and subsequently HIV decline was also observed. The Prime Minister of Thailand Thaksin Shinawatra reported to one international conference that this programme had prevented more than 5 million HIV infections in Thailand from 1991 up to 2003.

Veronica Riemer:
Although condoms play an important part in HIV/AIDS prevention, there are other approaches. Dr Kevin De Cock tells us more.

Dr Kevin De Cock:
Condoms are an important component of a comprehensive prevention programme but only one component of what today we refer to as combination prevention. And, I think other factors that are important are reducing numbers of sex partners, abstinence is an important strategy for certain age groups, and for those who choose it, some choose that method of protection.
But there are additional prevention approaches: testing and counselling so that one knows one's HIV status and that of one's regular sex partner. The control of other sexually transmitted infections, particularly in high risk groups such as sex workers and men who have sex with men, is important. In heterosexual epidemics, male circumcision protects against the acquisition of HIV in men in those who are circumcised.

Veronica Riemer:
Among the other prevention methods are a number of new technologies that are coming along.

Dr Kevin De Cock:
Microbicides are compounds used by women, applied in the vagina, usually prior to sex and such products are now being studied and actually the first successful result has just been achieved. And then antiretroviral drugs themselves have preventive benefit, either in HIV infected people taking the drugs, lowering the amount of virus so that they become less infectious themselves or use of drugs by HIV negative people taking it before they are exposed to HIV.

Veronica Riemer:
Use of antiretroviral drugs and microbicides for prevention of HIV is now being studied, so they are not yet recommended by WHO. But these are emerging areas to watch.If you would like to learn more about this subject, look for the links on the transcript page of this episode. You can find the link to the podcast on the home page of our web site, at www.who.int

That's all for this episode of the WHO podcast. Thanks for listening.

If you have any comments on our podcast or have any suggestions for future health topics drop us a line.

Our email address is Podcast@who.int.

For the World Health Organization, this is Veronica Riemer in Geneva.

-

<cite cite="http://www.who.int/mediacentre/multimedia/podcasts/2009/hiv_condoms_20090325/en/index.html">WHO | Condoms an important form of protection from HIV</cite>

sharon sanders · Mar 27, 2009

Lancet Asks Pope to Retract Statement on Condoms

Lancet Asks Pope to Retract Statement on Condoms

FluTrackers supports the use of condoms to prevent disease.

The Lancet, Volume 373, Issue 9669, Page 1054, 28 March 2009
<Previous Article|Next Article>
doi:10.1016/S0140-6736(09)60627-9

Redemption for the Pope?

Original Text
The Lancet

The Vatican felt the heat from an unprecedented amount of international condemnation last week after Pope Benedict XVI made an outrageous and wildly inaccurate statement about HIV/AIDS. On his first visit to Africa, the Pope told journalists that the continent's fight against the disease is a problem that “cannot be overcome by the distribution of condoms: on the contrary, they increase it”.

The Catholic Church's ethical opposition to birth control and support of marital fidelity and abstinence in HIV prevention is well known. But, by saying that condoms exacerbate the problem of HIV/AIDS, the Pope has publicly distorted scientific evidence to promote Catholic doctrine on this issue.

The international community was quick to condemn the comment. The governments of Germany, France, and Belgium released statements criticising the Pope's views. Julio Montaner, president of the International AIDS Society, called the comment “irresponsible and dangerous”. UNAIDS, the UN Population Fund, and WHO released an updated position statement on HIV prevention and condoms, which said that “the male latex condom is the single, most efficient, available technology to reduce the sexual transmission of HIV”. Amidst the fury, even the Vatican tried to alter the pontiff's wording. On the Holy See's website, the Vatican's head of media, Father Federico Lombari, quoted the Pope as having said that there was a “risk that condoms…might increase the problem”.

Whether the Pope's error was due to ignorance or a deliberate attempt to manipulate science to support Catholic ideology is unclear. But the comment still stands and the Vatican's attempts to tweak the Pope's words, further tampering with the truth, is not the way forward.

When any influential person, be it a religious or political leader, makes a false scientific statement that could be devastating to the health of millions of people, they should retract or correct the public record.

Anything less from Pope Benedict would be an immense disservice to the public and health advocates, including many thousands of Catholics, who work tirelessly to try and prevent the spread of HIV/AIDS worldwide.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60627-9/fulltext?_eventId=login

sharon sanders · Jul 29, 2009

Re: Condom Use Reduces Morbidity and Mortality

The Pope, condoms, and the evolution of HIV

Original Text
Samuel Ponce de Leon a, Maria Eugenia Jimenez-Corona a, Ana Maria Velasco b, Antonio Lazcano b

The unjustifiable nature of the Vatican's opposition to condoms in the face of the spread of HIV has been underlined by many. 1 Moreover, the claims made by Pope Benedict XVI during his recent trip to Africa that the AIDS epidemic is a tragedy that ?cannot be overcome through the distribution of condoms; on the contrary, they increase it? 2 reveal, among other issues, a very poor understanding of the evolutionary future of HIV and the emergence of new strains.
The epidemic has led to the development ...

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(09)70185-9/

Condom Use Reduces Morbidity and Mortality

sharon sanders

Editor-in-Chief & President

Giuseppe

Emeritus

sharon sanders

Editor-in-Chief & President

AlaskaDenise

In Memoriam

sharon sanders

Editor-in-Chief & President

tropical

Well-known member

Giuseppe

Emeritus

sharon sanders

Editor-in-Chief & President

sharon sanders

Editor-in-Chief & President