{"id":606,"date":"2012-03-23T20:52:36","date_gmt":"2012-03-23T20:52:36","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=606"},"modified":"2012-03-23T21:11:10","modified_gmt":"2012-03-23T21:11:10","slug":"the-real-life-sti-prevention-potential-of-the-male-condom-hard-to-fulfil-hard-to-evaluate","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2012\/03\/23\/the-real-life-sti-prevention-potential-of-the-male-condom-hard-to-fulfil-hard-to-evaluate\/","title":{"rendered":"The real-life STI prevention potential of the male condom: hard to fulfil, hard to evaluate"},"content":{"rendered":"<p>In the face of 340 million incident cases of STI worldwide each year, UNAIDS in a recent statement deemed the male latex condom \u201c&#8230; the single most efficient, available technology to reduce the sexual transmission of HIV and other sexually transmitted infections\u201d.\u00a0 Sadly, though the condom may be effective <em>in vitro<\/em>, this potential proves hard to realize use in real life.\u00a0 Sustained condom use requires levels of commitment such that, even in the case of discordant heterosexual HIV couples, studies indicate fewer than half of participants report regular use.\u00a0 In the light of this, the Australian journal <em>Sexual Health<\/em> has devoted a special issue to condom use \u2013 recognizing it to be a \u201ccomplex behaviour embedded in the fabric\u201d of social relationships.\u00a0 Attention is given both to data regarding the behaviour itself (including errors and problems of condom use), and to the methodological problems affecting its evaluation by recent research.<\/p>\n<p>Individual reviews cover China, Central and Eastern Europe and Sub-Saharan African.\u00a0 There are also papers on the female condom and on the issue of \u201crisk compensation\u201d \u2013 i.e. where the introduction of one preventative method (e.g. vaginal microbicides) impacts on the use of another (e.g. condoms).<\/p>\n<p>Two systematic review papers, reflecting the two-fold concern of this special issue with the behaviour itself and methodological issues around its evaluation, offer a global perspective on condom use. \u00a0The first of these \u2013 a review of the literature regarding condom use errors and problems (Stephanie A. Sanders et al.) \u2013 leaves the reader with a bewildering sense of the disparity in the importance assigned by studies to the various causes of \u201ccondom failure\u201d.\u00a0 Statements abound such as that \u201cbreakage rates ranged from 0.8% to 40.7% of participants across 15 studies\u201d.\u00a0 The reader may wonder what there is to learn from such data, other than that condom use is indeed a complex behaviour and difficult to evaluate scientifically.<\/p>\n<p>The other systematic review paper (Richard A. Crosby &amp; Sarah Bounse) is complementary to this.\u00a0 It deals specifically with the methodological problems of evaluating the link between condom use and STI, focussing exclusively on prospective studies. \u00a0Forms of misclassification bias are rife, the authors claim.\u00a0 The most serious derive from the difficulty of determining, when infection takes place within the recall period, whether events of condom-protected sex occurred before infection, or after infection.\u00a0 Other sources of misclassification bias involve failing, where figures are given for number of infections for a given level of condom use, to control for \u201cuse errors\u201d such as breakage, slipping, or incomplete use.<\/p>\n<p>Ultimately the critical question facing policy formers is this: whether protective effect of condom use warrants the full support of public health efforts to keep condoms to the forefront of STI prevention?\u00a0 It should be borne in mind that all the potential forms of study bias regarding condom use tend towards the nul hypothesis (i.e. they underestimate the effectiveness of condoms).\u00a0 In the light of this, the authors affirm that the threshold for sufficient protective effect has probably already been crossed.\u00a0 Yet clearly more definitive findings would greatly assist the cause of deploying condoms as part of public health efforts.\u00a0 To this end, the paper seeks to explain, and thereby avert, the causes of \u201cerror variance\u201d between studies of condom effectiveness (variance not determined by real differences of the relation between condom use and STI).<\/p>\n<p><em>Sexual Health<\/em> 9: 1, 2012<\/p>\n<p><a href=\"http:\/\/www.publish.csiro.au\/nid\/164\/currentissueflag\/1.htm\">http:\/\/www.publish.csiro.au\/nid\/164\/currentissueflag\/1.htm<\/a><\/p>\n<p>Stephanie A. Sanders, Robin R. Milhausen et al., <em>Condom Use Errors and Problems: A Global View<\/em>, pp.81-95<\/p>\n<p>Richard A. Crosby and Sarah Bounse, <em>Condom Effectiveness: Where are we Now<\/em>, pp.10-17<\/p>\n<p>&nbsp;<\/p>\n<p>FOR FURTHER DISCUSSION OF THIS ISSUE \u00a0in this journal, see:<\/p>\n<p>R. Crosby, W.L. Yarber et al., \u00a0&#8220;Two heads are better than one: the association between\u00a0condom\u00a0decision-making andcondom\u00a0use\u00a0errors and problems&#8221;, S<abbr title=\"Sexually Transmitted Infections\">ex Transm Infect<\/abbr>\u00a02008;84:198-201\u00a0doi:10.1136\/sti.2007.027755<\/p>\n<p><a href=\"http:\/\/sti.bmj.com\/content\/84\/3\/198.full?sid=cae33837-335c-4d59-bb95-439830fe5e00\">http:\/\/sti.bmj.com\/content\/84\/3\/198.full?sid=cae33837-335c-4d59-bb95-439830fe5e00<\/a><\/p>\n<p>And for a perspective on promoting condoms through religious leadership, <cite> <abbr title=\"Sexually Transmitted Infections\"><em> Willms et al in<\/em> Sex Transm Infect<\/abbr> 2011;87:611-615 doi:10.1136\/sextrans-2011-050045<\/cite><\/p>\n<p><a title=\"Can interfaith research partnerships develop new paradigms for condom use and HIV prevention? The implementation of conceptual events in Malawi results in a \u2018spiritualised condom\u2019 \" href=\"http:\/\/sti.bmj.com\/content\/87\/7\/611.abstract?sid=d4d99386-88d5-4037-a7a1-64be1f1c1751\">http:\/\/sti.bmj.com\/content\/87\/7\/611.abstract?sid=d4d99386-88d5-4037-a7a1-64be1f1c1751<\/a><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In the face of 340 million incident cases of STI worldwide each year, UNAIDS in a recent statement deemed the male latex condom \u201c&#8230; the single most efficient, available technology to reduce the sexual transmission of HIV and other sexually transmitted infections\u201d.\u00a0 Sadly, though the condom may be effective in vitro, this potential proves hard [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2012\/03\/23\/the-real-life-sti-prevention-potential-of-the-male-condom-hard-to-fulfil-hard-to-evaluate\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2043,2784],"tags":[],"class_list":["post-606","post","type-post","status-publish","format-standard","hentry","category-behaviour","category-condoms"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - 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