Can condoms really do the job?

Sir,

In the past two weeks, the Times has been loaded with information on ways to prevent HIV transmission. On the 17th and the 24th, we were treated to nearly full-page stories about the role of condoms in stopping AIDS.

The 24th carried Martin Dlamini’s account of his trip to Uganda and how they have dealt with HIV/AIDS, and numerous issues of the Times have featured a post-coital couple in facing-page adverts for Trust studded condoms.
Can condoms really make the crucial difference in bringing down the AIDS rate? If not, what can? Swaziland has one of the highest, if not the highest, AIDS rates in the world. The life of the nation rests on the answers to these questions.

On the 24th, HIV specialist Dr. Kevin De Cock was quoted as saying that “if used consistently and correctly (condoms) are highly effective in preventing the transmission of HIV”. A few concerns arise from this comment.
First, what is ‘highly effective’? No percentage followed his statement. Another article on the same page said that ‘condoms are at least 80%, and possibly more, effective in reducing the transmission of HIV for co-habitating couples’.

Other reliable sources support this figure. Well, okay; 80% is a great rate if you are swatting flies or repelling mosquitoes; but the issue here is HIV/AIDS, a lethal disease. Something that protects you from a getting lethal infection four out of five times-but may fail one time in five-is not a good gamble.

Condoms have been successful in preventing HIV transmission within very specific groups of people, the most prominent case being prostitutes in Thailand. Condoms have not, however, been successful in curbing HIV rates in situations like Swaziland’s.
Edward Green, senior research scientist at the Harvard University (USA) School of Public Health and the Director of the AIDS Prevention Research Project at that university, writes “Promotion of condoms alone has not been shown to be an effective strategy to lower infection rates in generalised epidemics, such as those found in Africa. As a 2003 study concluded, “There is little evidence that sometimes (but not always) using condoms provides any protection as compared to not using condoms at all.’” 

In the same report, Green writes “No country in Africa has ever had rates of consistent condom usage above 5% among married people or regular sexual partners, and usage rates at last intercourse with any type of partner remain relatively low”. Green quotes the British medical journal The Lancet: “Massive increases in condom use world-wide have not translated into demonstrably improved HIV control in the great majority of countries where they have occurred.”
In short, condoms don’t get used. Even if they were consistently used, what constitutes the correct use of a condom?

Dr. Patrick Dixon’s book ‘The Truth about AIDS’ contains a description of how a condom must be correctly used in order to be effective. The description is graphic, so I will not include it in this widely-read newspaper. Trust me when I say that correct use of condoms goes against all human instincts of a couple engaged in the sexual act; no sober mind would conclude that all the correct steps are likely to be taken to ensure the condom’s effectiveness.
If you would like to know the details, contact me at the email address below and I will send you the relevant portion of Dixon’s book.

What about other methods for curbing HIV transmission? Doctor Green again: “A great deal of resources have gone into primarily biomedical-based interventions (i.e., VCT, STI treatment, condoms) in South Africa, Botswana and other southern African countries, yet without apparent impact on national HIV infection rates”.
So what will work? The HIV rate among 15-19 year-old pregnant women in Uganda was cut from roughly 34% in 1991 down to 10% in 1997. How did they do it?

Edward Green one more time: “While we may never fully know ‘what really happened in Uganda,’ the available evidence, bolstered by more recent and similarly encouraging findings from places such as Kenya, Addis Ababa  Zambia, and Zimbabwe, suggests that a comprehensive, behavior change-based strategy, ideally involving high-level political commitment and a diverse spectrum of community-based participation, may be the most effective prevention approach.”
May I suggest, based on Uganda’s stunning success story, that Swaziland’s way out of the HIV/AIDS death swamp is for everyone to emphasize, practice and expect no sex before marriage and sex only with one’s spouse after marriage.

If this sounds simple, that is because it is simple. So much of the world seems convinced that we enjoy a universal human right to consequence-free sex. Sex is not consequence-free, and neither popular opinion nor any amount of medical intervention (surgical, pharmacological, or condomological) will ever make it so.

For adults to practice and teach the youth to save sex for marriage will not only slash the number of new HIV infections, it will build a citizenry armed with self-control and discipline. Young men and women who can control themselves will be spared not only the physical harm that often comes from non-marital sex, but also from the emotional scars that sex taken out of season so often inflicts.

Such men and women will also have the character traits needed to make sacrifices for their spouses and children; and as any happily-married couple will tell you, such sacrifices are critical to the success of a marriage and family. And, of course, the ‘save sex for marriage’ approach to killing HIV is very inexpensive.
May Swaziland build generations of virtue. May all of us in this beautiful Kingdom save our bodies for our spouses only, whether we are married to them now or are still waiting to meet and marry them. May Swaziland build, through keeping sex only in marriage, a culture of life and love.
Ed Green’s research is available at http://www.harvardaidsprp.org

Rudy Poglitsh
rpoglitsh@live.com
Via email

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