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25 January 2008
Question Mark Over Condoms Preventing Non-HIV STDs
by George Atkinson

In this week's British Medical Journal, health experts debate whether consistent condom use can reduce the spread of non-HIV sexually transmitted infections.

The article notes that for people who are sexually active, condoms remain the best solution for reducing the risk of acquiring sexually transmitted infections or transmitting these infections. The researchers add that studies show that condoms are an effective physical barrier against passage of even the smallest sexually transmitted pathogens.

There is strong evidence, say one group of researchers, that condoms reduce the risk of gonorrhea and chlamydia in both men and women. Studies have also shown consistent and correct use of condoms can reduce genital herpes and human papillomavirus infection.

But the promotion of condoms remains controversial in many countries, including the United States. Another concern is that condom promotion could lead to risk compensation and an increase in unsafe sexual behavior.

It is therefore imperative, notes the article, that accurate messages about condoms must build on a wide range of risk avoidance and risk reduction approaches, such as the ABC strategy: abstinence, be faithful to one partner, and use condoms. They suggest that clinicians reassure people who are sexually active that condom use reduces the risk of most infections, while emphasizing the importance of consistent and correct use for optimal risk reduction.

But nay-sayer Stephen Genuis, from the University of Alberta, argues that a more comprehensive approach is needed. Condoms cannot be the definitive answer to sexually transmitted infection, he writes, because they provide insufficient protection against many common diseases. Intercourse generally involves skin to skin contact in the external genital area not covered by a condom. But the main problem with condoms, he says, is that average people, particularly teenagers and young adults, do not use them consistently, regardless of knowledge or education.

He points to numerous large studies where concerted efforts to promote use of condoms has consistently failed to control rates of sexually transmitted infection - even in countries with advanced sex education programs like Canada, Sweden, and Switzerland.

Data also suggest that changes in sexual behavior (fewer partners, less casual sex, and less use of sex workers) rather than widespread condom use is reducing infections in countries such as Thailand and Cambodia. The World Health Organization estimates that two thirds of sexually transmitted infections worldwide occur in teenagers and young adults. Yet innumerable adolescents saturated with condom focused sex education end up contracting sexually transmitted infections, Genuis argues.

Although factual information should be included in any discussion of sexually transmitted infections, narrow condom focused initiatives should be replaced with comprehensive evidence-based programs, he concludes.

Condom Availability Doesn't Increase Sexual Activity
Condom Usage Not Telling Whole Story On HIV Risk
STDs Preferable To Condom Use For Many Men
Errors In Condom Use Behind Increased STD Infections?

Source: British Medical Journal

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