Tuesday, September 28, 2004

The war on condoms

The War on Condoms is rather more like a campaign in the larger War on Science now being waged in the United States. HIV/AIDS prevention relies, in part, on correct and consistent use of condoms, and can be seriously undermined if doubts about the effectiveness of condoms encourages people to opt for unprotected sex.

The latest issue of Science includes an opinion piece about the current state of science and public policy at the U.S. Centers for Disease Control:

Scientific Decisions, Including HIV/AIDS Policies, 'Subjected to Political Tests' by Bush Administration

The scientific community -- both in the United States and abroad -- has "expressed concern" over the fact that scientific decisions, including those concerning HIV/AIDS policies, are "subjected to political tests" by the Bush administration, David Baltimore, president of the California Institute of Technology, writes in a Science opinion piece.

The administration's "pattern of behavior ... is becoming clear," including its "abandon[ment]" of scientific rationale in favor of political policies influenced by "religious conservatism or economically based political caution," Baltimore says. Current U.S. HIV/AIDS policy is a "case in point," Baltimore says, adding that "[s]topping the spread [of HIV/AIDS] should be the highest international priority," because the disease is spreading at an "alarming rate" in Africa and Asia.

However, the Bush administration has prioritized abstinence as the most effective method of HIV prevention and has given "scant recognition to the protective value of condom use," despite the fact that "under most circumstances the only safe and effective protection is condoms," Baltimore says.

Although "complaints" led CDC to include a "positive statement" about the effectiveness of condoms in an online fact sheet and USAID now promotes condom use, the administration does not promote widespread use of condoms in HIV prevention, according to Baltimore.

Although complaints from the Union of Concerned Scientists and other individuals in the field have resulted in a "new posture" in the administration that is more "honest" about scientific facts, the implications of policy decisions are "still being ignored," Baltimore writes, concluding, "Our goal now should be to have the policies track the science" (Baltimore, Science, 9/24).

The War on Condoms is not just being fought abroad. There are battles in the U.S., as this excerpt from Scientific Integrity in Policymaking notes:

Cases: Public Health
Scientific Knowledge on HIV/AIDS Prevention Distorted

At the instigation of higher-ups in the George W. Bush administration, fact-based information on the Centers for Disease Control's (CDC) website has been altered to raise scientifically questionable doubt about the efficacy of condoms in preventing the spread of HIV/AIDS.

A fact sheet on the CDC website that included information on proper condom use, the effectiveness of different types of condoms, and studies showing that condom education does not promote sexual activity was replaced in October 2002 with a document that emphasizes condom failure rates and the effectiveness of abstinence.52 When a source inside the CDC questioned the actions, she was told that the changes were directed by Bush administration officials at the Department of Health and Human Services.53

[Footnote]52. A. Clymer, “U.S. Revises Sex Information, and a Fight Goes On,” New York Times, December 27, 2002. A comparison of the two versions of the CDC website about condoms can be seen online. The original website, CDC, Condoms and Their Use in Preventing HIV Infection and Other STDS (September 1999) is available at [broken link]; the current CDC fact sheet, CDC; Male Latex Condoms and Sexually Transmitted Diseases (October 2003) is available at www.cdc.gov/nchstp/od/latex.htm.

[Footnote]53. Author interview with current CDC staffer, name withheld on request, November 2003.

We've also noted here that the CDC is changing some of its policies regarding contract guidelines for prevention education. This will bring the War on Condoms down to the local level.

Not that we're not used to the War on Science in Texas. Any time the State Board of Education considers new textbooks, another battle (also here, here and here) ensues.

But here's the deal.

According to the Texas Department of State Health Services, on December 31, 2003, 48, 368 Texans were living with HIV or AIDS. In 2003, 4,802 new cases of HIV were reported. That's more than 13 new cases each day. In addition, 3,689 cases of AIDS were reported. While those reported cases showed a decline between 2002 and 2003 in the number of new infections by means of male-to-male sex, there was a slight increase in the number of new infections by means of heterosexual sex. The number of new HIV infections by means of heterosexual sex is comparatively low; however, they still constituted about 30 percent of new infections in 2003.

Moreover, talking about HIV infections doesn't include the other sexually transmitted infections that could have been prevented by correct and consistent use of condoms nor does it include the fact that Texas has the highest teen pregnancy rate in the nation.

The domino effect of the War on Condoms affects quality of life for families, not just individuals. It ultimately affects the cost of health care to the state and community, which translates to increased pressure on property and other taxes. For want of a nail, the shoe was lost . . .

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