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 condoms.

  1. 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 correctly.

  2. 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.

  3. 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 highly motivated.

  4. 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 it on.

    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. 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 national standards.

    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.

  6. Don't condoms have microscopic holes that allow HIV to pass through?

    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.

  7. Researchers studying surgical gloves made out of latex found "channels of 5 microns that penetrated the entire thickness of the glove."

    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 gloves.

  8. What about a University of Texas Medical Branch study that estimated condoms to be only 69% effective in preventing HIV in heterosexual couples?

    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 condoms.

  9. 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.

  10. Isn't abstinence the only foolproof way to prevent HIV infection?

    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 activity.

    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.

  11. 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.

  12. 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.

  13. 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 the public.

    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 consistently.

  14. 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 use.

  15. 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.

  16. 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.

  17. 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 effectiveness.

  18. Why are you promoting condoms even though they're not foolproof?

    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.

SOURCES

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,
May/June 1992
Richters, J, Donovan, B, Gerofi, J, Watson, L.  Low Condom Breakage
Rate in Commercial Sex [letter].  Lancet 2(8626): 1487-88. December
24/31, 1988
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;
21: 51-54
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.)

[email protected] (Thu Sep 15 13:26:23 1994)