TRENTON, NJ – Sexually active adults who use condoms have come to accept that they are an effective way to protect against unplanned pregnancy and the spread of STDs. But debate still rages about precisely how effective the simple sheaths are – and now that debate is holding up the appointment of a new federal drug agency chief.Republican Sen. Tom Coburn is an Oklahoma physician who wants the FDA to require labels on condoms to provide information about their “effectiveness or lack of the effectiveness in preventing STDs.” In order to make sure that happens, he is insisting that Food and Drug Administration nominee Lester Crawford authorize the label change, thus obeying a 2000 law that Coburn sponsored. Crawford was slated to being work as the agency’s chief on June 15, but has been unable to do so because of opposition from Coburn and other abstinence advocates.
While safer sex advocates don’t disagree that condoms provide varying levels of protection against different STDs, they are concerned that more cautious labels might discourage people from using them at all, mistaking the potential for transmission – however small – as a sign that condoms are ineffective.
Current research shows that condoms are exceptionally good at reducing transmission of the most serious sexually transmitted disease, AIDS, and at reducing the chance of unintended pregnancy. Unfortunately, exact numbers supporting their effectiveness against diseases other than AIDS and gonorrhea is confusing due to poorly developed and sometimes contradictory studies.
According to the National Institute of Health, condoms provide solid protection against even the smallest viral particles and slip or break a mere one to two percent of the time. These numbers increase in the general population, however, due to incorrect or irregular use which can then contribute to the 12 million new cases of American STD transmissions each year. When used properly and consistently, condoms reduce the risk of pregnancy during a one-year period to three-percent, compared to 85-percent when no birth control is used. Further, they cut HIV infection risk by 80-percent – to less than a single percentage chance per year.
When the NIH convened its expert panel in 2001 at Coburn’s request, it examined dozens of published and peer-reviewed studies, ultimately reporting that condoms decrease the risk of gonorrhea transmission by somewhere between 50 and 100-percent, but that their exact value against other STDs was uncertain since study results ranged from 18 to 92-percent, depending on the specific disease. STDs such as genital herpes and the human papilloma virus (HPV) can be transmitted by contact with infectious areas of skin not covered by condoms, which is the reason individuals such as Coburn and Medical Institute for Sexual Health board chairman Dr. Tom Fitch believe that a change to the condom labels is necessary.
The information pointed out by Coburn and Fitch may be accurate, but there is great skepticism within the medical community about the actual motivation for their activism on the issue. The fact that Fitch’s organization promotes abstinence and monogamy, and trains teachers in abstinence only education programs, makes some people suspicious of his ultimate intent. James Trussell, a board member for the Guttmacher Institute and director of Princeton University’s Office of Population Research, believes, “All of this is ideologically motivated. What they’re really concerned about is people who are not married having sex.”
Heather Boonstra, a public health official for the Guttmacher Institute, accuses Coburn and Fitch’s group of “manipulating this data to drive home their own anti-condom, anti-contraceptive message” and points out that “they do not provide 100-percent protection, but for people who are sexually active they are the best and the only method we have for preventing these diseases.”
Current FDA labels on condom boxes and packets state: “If used properly, latex condoms will help to reduce the risk of transmission of HIV infection (AIDS) and many other sexually transmitted diseases.” Many brands choose to include their high efficiency rate of preventing pregnancy on the box or packet, as well.
Although a spokesman for Coburn insists that FDA officials have promised a draft of new language soon, FDA representative Julie Zawisza says she cannot discuss policy issues.
