-
1 of 10
-
2 of 10
-
3 of 10
-
4 of 10
-
5 of 10
-
6 of 10
-
7 of 10
-
8 of 10
-
9 of 10
-
10 of 10
Fighting an epidemic with wishful thinking
Archive
Comments
Story
An epidemic of sexually transmitted diseases is striking America’s young people.
Tragically, the public health establishment seems wed to one primary response, condoms, even though the science is telling us this approach has failed.
More than 15 million new sexually transmitted diseases occur every year in the United States. One-fourth of these new infections occur in teens, and two-thirds occur in individuals less than 25 years of age.
Thirty years ago, there were only two significant sexually transmitted diseases, syphilis and gonorrhea, and both could be treated with penicillin. Today, according to the Institute of Medicine, there are more than 25 sexually transmitted diseases, many of which are viral with no cure.
We hear plenty about HIV but there are other sexually transmitted diseases that are having at least as great an impact. Human papillomavirus, or HPV, for example, is the most common viral sexually transmitted disease.
It causes nearly all-abnormal Pap smears and more than 90 percent of cervical cancer, which, in 2001, killed 4,100 women in this country. Chlamydia, so common that one Johns Hopkins researcher has recommended testing every sexually active teen-ager in the United States every six months, is a leading cause of infertility.
The dominant public health response is the “safe/safer sex” approach. It is based on the premise that young people will inevitably engage in non-marital sexual activity and that condoms will “protect users” from the consequences of sexual activity. From the World Health Organization to the Centers for Disease Control and Prevention, the “safe/safer sex” model has driven policy and interventions worldwide. Unfortunately, far too few have asked whether this approach actually works.
When The Medical Institute for Sexual Health reviewed all of the significant research and data regarding the ability of condoms to keep young people safe from sexually transmitted diseases, what we found was shocking. The “safe/safer sex” approach is built upon a wishful house of cards. Based on the science and the science alone, there is only one conclusion: condoms do not make sex safe enough.
Our findings reveal that while condoms can provide some risk reduction, they still often leave individuals vulnerable to sexually transmitted disease infection. How much risk reduction provided by condoms depends on a number of factors, including the number of sex acts with an infected individual, slippage and breakage, and the type of sexually transmitted disease. For HIV, for example, if condoms are used correctly and 100 percent of the time, the answer is that condoms can provide significant risk reduction.
For HPV the answer appears to be no, condoms do not provide risk reduction. And for other sexually transmitted diseases, such as chlamydia, syphilis, gonorrhea and herpes, condoms can provide some but far from 100 percent risk reduction, and even this limited risk reduction requires 100 percent condom use, except for herpes.
One of the scariest aspects of this epidemic is that most people who have a sexually transmitted disease don’t even know it. Up to 85 percent of women infected with chlamydia, for example, have no symptoms. Yet in 20 percent to 40 percent of women who are untreated, the infection will progress into their upper genital tract and can damage their fallopian tubes, causing infertility and ectopic pregnancies.
To appropriately battle this epidemic the CDC needs to reorder its priorities. Instead of relying so heavily on condoms, the public health establishment needs to promote abstinence education. Research is showing that abstinence education programs are helping young people delay sexual activity-the longer a person waits to start sexual activity, the fewer lifetime sexual partners he or she will have and, therefore, a decreased risk of ever contracting a sexually transmitted disease.
It would be a mistake to say that condoms never help anyone. Among high-risk populations such as prostitutes, IV-drug users and promiscuous individuals, condoms can offer some risk reduction if they are used 100 percent of the time. But we need to do much more than just promote condoms. Otherwise, the epidemic will continue unabated.
-Joe S. McIlhaney Jr. is president and founder and Thomas Fitch is chairman of the board of The Medical Institute for Sexual Health (www.medinstitute.org) in Austin, Texas. Readers may write to them at: The Medical Institute, P.O. Box 162306, Austin, Texas 78716.
Joe S. McIlhaney Jr. and Thomas Fitch, KRT Forum