It is frequently stated that condoms are the solution to the AIDS epidemic. We have had condoms for a long time, and they are plentiful, cheap, and their use is advocated to virtually every school student in the country many times before they leave school.
In addition to this, we now have very effective medications for HIV positive people. They are capable of reducing the amount of the HIV in their blood to levels so low that they become undetectable. And when the viral load in their blood reduces to these levels, these people are considered to be virtually non infective.
So you could be forgiven for thinking that the AIDS epidemic is a problem solved, and it will soon just be another entry in the history books.
Except that in 2011 (the last year we have records for) the number of people newly diagnosed with HIV was higher than for any year during the 1990’s. And that number is a substantial drop from 2010. So why isn’t condom promotion stopping the epidemic in New Zealand and around the world? After all, it’s regularly said that condom use reduces the risk of becoming infected with HIV by 85%.
One answer to this question can be found in the same research papers that give us the efficacy of condoms.
There are some serious ethical (and moral) issues with medical testing. The standard method is to divide a sample of people randomly into 2 groups, and only treat one group. Then compare the disease or condition between the group that received treatment or intervention, to the other, or control group. But if the intervention is potentially life saving, then there are serious ethical issues in withholding that intervention from the control group.
As HIV was (and still is) a terminal disease, so if a researcher thinks using condoms will save the lives of people in the study, they ethically can’t withhold them from anyone. So they need an ‘ethical’ way of testing condom effectiveness. The standard method is to find a group of people that are going to be exposed to HIV infection, train them in condom use, and then record the condom usage and infection rates.
The usual group to study are couples where one has tested HIV positive, and one has tested HIV negative. These couples must be mutually monogamous, heterosexual, not be using intravenous drugs, and have not received unscreened blood products. They are all given intensive ‘safer sex’ instruction, usually on a regular basis. These studies frequently supply condoms too. Not surprisingly, a large number of couples simply stop having sex. The risk is too great. It’s the ones who continue that interest the researchers the most.
The researchers regularly survey condom use of the people in their study, and compare HIV infection rates of those who consistently use condoms to those who use them inconsistently or not at all.
Did you read that bit right? There are couples in the studies who don’t use condoms consistently or at all. And that is after receiving intensive and ongoing ‘safer sex’ education. It’s not just a small minority. Frequently those who do not use condoms at all or inconsistently number 50% or more of those taking part in the study. It’s hard to think of a group of people who might be more motivated to use “safer sex”, and yet this ‘safer sex’ approach isn’t keeping the majority ‘safe’. Add to that the real world failure rate of condoms, and you have a ‘safer sex’ strategy that isn’t that safe.
The condom and lube promotion is the main strategy here in New Zealand, and in many places around the world.
The sad irony is that although half of these people in these studies wouldn’t use condoms, all of them were prepared to be a faithful couple. If only this was advocated from the start, none of those people in the studies would have ever been infected with HIV.