Questions & Answers about 'Barrier Protection'
These are answers from the Centers for Disease Control and
Prevention (CDC) to questions concerning a report in the CDC
Morbidity and Mortality Weekly Report [Editor's Note: See "Update:
Barrier Protection Against HIV Infection and Other Sexually
Transmitted Diseases" reprinted in Part II (1994 July 8) of this
series or MMWR. 1993;42(30):589-591,597.] on the effectiveness of
- What about studies that suggest condoms have as high as a
15.7% contraceptive failure rate?
These studies do not distinguish between inconsistent and
consistent condom use. Recent studies show that pregnancy rates
are estimated to be as low as 2% for couples who use condoms
consistently and correctly. (Trussell)
Similarly, in two studies involving extremely high-risk couples in
which one partner was HIV-infected and the other was not, condoms
were found to be highly effective when used consistently and
- What does highly effective mean?
We know from the discordant couple studies that in extreme risk
situations the consistent use of condoms provides a significant
reduction in risk.
- Isn't it naive to think that people can use condoms
consistently and correctly?
No, people can use condoms correctly by following a few simple
steps. Discordant couple studies clearly demonstrate that
consistent and correct condom use is possible if the couple is
- Can't condoms break?
Condoms rarely break. In those cases where breakage occurs, it is
usually related to user error rather than condom quality.
Using old condoms is a leading cause of breakage. Other common
reasons for breakage include fingernail tears, exposure to heat or
sunlight, reusing condoms, or unrolling the condom before putting
Use of oil-based lubricants such as baby oil, vegetable oil,
petroleum jelly, and cold cream can weaken latex condoms
considerably and cause them to break. Mineral oil, a common
ingredient of hand lotions, can cause a 90% decrease in condom
strength after as little as 60 seconds of exposure. (Voeller)
- 5. How are condoms regulated and tested?
Condoms are classified as medical devices, regulated by the Food
and Drug Administration (FDA), and manufactured according to
Every condom sold in the United States is tested by the
manufacturer electronically for defects, including holes or areas
of thinning, before it is packaged. During the manufacturing
process, condoms undergo stringent quality testing.
In addition, the FDA randomly tests condoms using the water- leak
test, in which a condom is filled with 300 ml of water. If the FDA
finds that more than four per 1,000 condoms leak, the lot is not
allowed to be sold here.
- Don't condoms have microscopic holes that allow HIV to pass
Condoms are required to undergo demanding tests, including tests
for holes, before they are sold. If any holes are found, the
condoms are discarded.
Laboratory studies show that intact latex condoms provide a
continuous barrier to microorganisms as well as sperm.
- Researchers studying surgical gloves made out of latex found
"channels of 5 microns that penetrated the entire thickness of the
The quality of latex condoms is higher than that of latex gloves.
Condoms are made differently than gloves. Condoms are
double-dipped in latex while gloves are only single-dipped. Condoms
also undergo much more stringent quality control procedures than
- What about a University of Texas Medical Branch study that
estimated condoms to be only 69% effective in preventing HIV in
The University of Texas did not conduct a new study. It is a
meta-analysis of existing studies. That is, it applied statistical
methods to previously published studies. This method has several
flaws. First, the study only cites data collected prior to July
1990, overlooking recent studies that provide some of the most
compelling evidence that condoms are effective. Second, the study
did not distinguish between consistent and inconsistent use of
- Why did the FDA approve the female condom if it has proven to
be only 74% effective in recent studies?
The female condom is the first barrier method of contraception
available within the control of the female partner which provides
some level of protection against pregnancy and STDs, including HIV.
As a very new product, limited studies have been conducted on its
effectiveness against STDs and HIV. However, the clinical data do
suggest that female condoms provide some level of protection
against some STDs and HIV.
The U.S. Public Health Service (PHS) is currently undertaking
additional studies to assess the effectiveness of female condoms
against HIV and other STDs, as well as to develop additional
methods of contraception for women.
- Isn't abstinence the only foolproof way to prevent HIV
Refraining from intercourse with infected partners is the most
effective HIV prevention strategy. This is an especially important
message for young people.
There is little disagreement that premature initiation of
sexual activity carries health risks. We need to strive for a
climate supportive of young people who are choosing to delay sexual
Periodic abstinence, however, carries with it certain risks. A 1988
National Survey of Family Growth found abstinence to have a
contraceptive failure rate of 26% when not practiced consistently.
So, in abstinence--as in condom use--consistency is key.
Why are you changing your position on the effectiveness of
condoms used in conjunction with a spermicide?
Scientific studies show that condoms are more effective than many
people previously thought and that spermicides may be less
effective than had been hoped.
CDC recommendations actually are not changing significantly. We are
reinforcing the recommendation to use condoms. We don't encourage
the use of spermicides except as an adjunct to condoms and for
those whose goal is contraception.
- Is the federal government advocating/condoning sexual
intercourse outside of marriage?
There are many sound public health reasons to abstain from sexual
intercourse, such as preventing STDs, including HIV, and unwanted
pregnancy. However, the federal government does not determine what
is or is not morally acceptable behavior.
From a public health perspective, if a person chooses to have
sexual intercourse, using condoms correctly every time during sex
is the best way to prevent HIV infection.
- Why are you releasing his information now? Aren't people
already using condoms?
We are releasing this information now because recently presented
scientific data sheds new light on this important public health
issue. We feel the public needs this information, and the MMWR is
the most rapid means to disseminate it to health professionals and
Most sexually active people are not using latex condoms every time
they have sex. For example, in San Francisco, only 6% of
heterosexual males with multiple sex partners reported always using
condoms. In another study, only about 20% of sexually active
American women reported that their male partners used condoms. A
national survey of heterosexual adults with multiple sex partners
found only 17% used condoms all of the time. (Catania)
One of the key determinants of condom use is the belief that
they work. Therefore, it is important for sexually active
individuals to get the message that latex condoms can provide
effective protection from HIV if they are used correctly and
- Don't education programs about condoms result in increased
sexual activity among adolescents?
No. Several studies have shown that levels of sexual activity
among young adults decreased or remained the same after sex
education programs which included information about condoms.
In a recent Swiss study of 16-19 year olds, an AIDS prevention
effort focusing on condom use did not increase the level of sexual
activity or the number of sex partners of young people. However,
condom use did increase among those already sexually active.
A 1992 study reported in Family Planning Perspectives found that
AIDS education and sex education resulted in decreases in the
number of sex partners and the frequency of intercourse. Having
received education was also associated with more consistent condom
- In choosing a condom, is there any way to know which brand is
best? Do some condoms have higher quality standards than others?
All of the condoms marketed in the United States today meet federal
quality assurance standards. The CDC recommends latex condoms for
the prevention of HIV and STDs. Consumers should look for the word
"latex" on the package. Color, shape, and packaging are all issues
of personal preference. All are effective.
- What are you going to do now that you have this information?
Is the government going to start a condom promotion campaign? Are
you going to release ads on condoms?
The CDC is now planning the next stage of its HIV Public
Information Program. It will include the implementation of a
5-year prevention marketing program to prevent the sexual
transmission of HIV among sexually active young Americans.
The CDC is faced with opposition regarding condoms from both sides
of the issue. Some people want the CDC to promote only abstinence
as a strategy to prevent HIV and not to discuss condoms at all.
Others say the CDC is not talking enough about condoms.
The CDC's education programs are driven by science. As the
nation's leading prevention agency, our mission is to prevent
disease and protect the health of all Americans. For people who
are sexually active, it is our duty to provide them with accurate,
scientific information about the effectiveness of condoms against
STDs, including HIV, when they are used correctly and consistently.
CDC-supported public health and education programs provide young
Americans with information about the actions they can take to
reduce their risk of acquiring HIV infection, including delaying
and abstaining from sexual activity.
- Why are you promoting this information now?
Two recent studies--especially the discordant couple studies--have
provided the data to make a compelling new case for condom
- Why are you promoting condoms even though they're not
Because they substantially reduce the risk of HIV infection during
vaginal, anal, or oral sex. Similarly, we promote many other
health behaviors that significantly reduce risk, but do not entire
eliminate it. For example, we promote wearing bicycle helmets,
which are 85% effective at reducing injury or death, and wearing
seat belts, which are 40-55% effective at reducing injury.
Catania, et al, Prevalence of AIDS-related Risk Factors and Condom
Use in the United States. Science Magazine, November 13, 1992
Consumer Reports, Can You Rely on Condoms? March 1989
DeVincenzi I, and the European Study Group on Heterosexual
Transmission of HIV. Heterosexual Transmission of HIV in a
European Cohort of Couples. Abstract WSC02-1. IXth International
Conference on AIDS. Berlin, June 9, 1993
Dubois-Arber F, Jeannin,A, Zeugin P. Evaluation of AIDS Prevention
in Switzerland: Behavioral Change in the General Population.
Presented at the Eighth International Conference on AIDS, July
19-24, 1992; Amsterdam, The Netherlands, Abstract PoD5140.
Hausser D., Michaud PA. Condom promotion does not increase sexual
intercourse among adolescents. Presented at the Eighth
International Conference on AIDS, July 19-24, 1992; Amsterdam, The
Netherlands, Abstract TuD0575
Ku, LC, Sonenstein, FL, Pleck, JH. The Association of AIDS
Education and Sex Education with Sexual Behavior and Condom Use
Among Teenage Men. Family Planning Perspectives, Vol. 24, No. 3,
Richters, J, Donovan, B, Gerofi, J, Watson, L. Low Condom Breakage
Rate in Commercial Sex [letter]. Lancet 2(8626): 1487-88. December
Roper, WL, Peterson, HB, Curran, JW. Commentary: Condoms and
HIV/STD Prevention-Clarifying the Message, American Journal of
Public Health, April, 1993, Vol. 83, No.4
Saracco A, Musicco M, Nocolos, A, et al. Man to woman sexual
transmission of HIV: Longitudinal study of 343 steady partners of
infected men. JAIDS 1993, 6:497-502
Trussell J, Hatcher RA, Cates W, Stewart FH, Kost K. Contraceptive
failure in the United States: an update. Stud. Fam. Plann. 1991;
Voeller, B. Coulson AH, Berstein GS, et al. Mineral Oil Lubricants
Cause Rapid Deterioration of Latex Condoms. Contraception. 1989;
39 (1): 95-102.
(Centers for Disease Control and Prevention. Training Bulletin #60.
August 4, 1993.)
(Thu Sep 15 13:26:23 1994)