Letter from The Catholic Medical Guild of Singapore (Published in an edited form in CN03/06, Feb 05)
WE REFER TO Christopher Yeo's letter "Preach message of abstinence with proper understanding" (CN, Jan 22).
A few points require clarification. Some others require correction.
Mr Yeo claimed that "lab studies show that using a latex condom to prevent transmission of HIV is more than 10,000 times safer than not using a condom."
This is an unfortunate misrepresentation of the data. In the study cited by Mr Yeo, it was found that under laboratory conditions, the amount of fluid that leaked through the condom was estimated to be 10,000 times less than the usual amount of ejaculate in each act of sexual intercourse. Exposure to infected fluid was certainly reduced by that factor, but it did not by any means imply that using the condom is "10,000 times safer". It is interesting to note that, in the same study cited, published in 1992, R.F.Carey et al also reported that particles the size of the HIV virus were found to have been able to leak through 29 of the 89 condoms tested.
In any case, we know that conditions in the laboratory are quite different from real life conditions in actual use. This is why studies of the effectiveness of the condom in actual use show a very different picture.
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Lab does not equal life
In a workshop summary published in July 2001, the National Institute of Health (NIH), USA, reported that the condom was not proven to be effective in preventing the transmission of a number of Sexually Transmitted Diseases (STDs) like syphilis, genital herpes, human papilloma virus (HPV) and Chlamydia. HPV is the virus that causes genital warts and is a major risk factor for the development of cancer of the cervix (neck of the womb). Chlamydia is the organism that causes some forms of genital discharge disease and pelvic inflammatory disease, a major cause of infertility in the modern world. Because it is often silent (that is, without obvious symptoms), many women do not know they have the disease until they seek treatment for other problems like infertility or pelvic pain.
In the same report, it was found that the condom was effective in reducing the risk of HIV transmission by 85 percent, but that only if used consistently and correctly. For many reasons, and human nature being what it is, this "ideal" scenario is in reality hardly the case. In the British Medical Journal (Vol 328:892, 10 April 2004), Dr James Shelton was emphatic in stating that "even though prospective studies have shown that condoms reduce risk by about 80-90 percent when always used, in real life they are often used incorrectly or inconsistently." This is what is known as "user failure".
On top of that, we also have to take into account the fact that the condom may break or slip. This contributes to what is known as "method failure". Davis and Weller found that breakage of the condom could happen up to 6.7 percent of the time, and slippage could occur up to 16.6 percent of the time. (Davis and Weller, "The Effectiveness of Condoms in Reducing Heterosexual Transmission of HIV", Family Planning Perspectives. Vol 31, No. 6, November/December 1999: pages 272-279)
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Based on these findings, the medical community no longer refers to sex using the condom as "safe sex". It is now referred to as "safer sex" since it is not absolutely safe.
Does increasing condom knowledge and availability reduce HIV and STD transmission? Taking a look at some developed countries suggests otherwise. In countries like the United States and United Kingdom, where condom knowledge and availability have been promoted, these rates have gone up.
Health experts estimate there are now 19 million new cases of sexually transmitted diseases in the United States each year, up from 15 million about ten years ago. In the United Kingdom, a report by Britain's Health Protection Agency found that nearly 700,000 new STD diagnoses were made in 2004, up 62 percent from a decade ago.
In contrast, Uganda experienced a drop in HIV prevalence from 15 percent in 1991 to 5 percent in 2001. This was achieved through a programme that stressed behavioural change, namely abstinence and faithfulness, rather than condoms. Unlike Uganda, in other African countries such as Botswana and South Africa, which have among the highest rates of condom use in that continent, HIV rates have continued to rise.
Finally, seen with the eyes of faith, to suggest that it is not realistic to expect the unmarried to abstain from sex, or the married to remain faithful to their spouses, is a denial of one of the most basic tenets of our faith: that the redemptive act of Christ is able to redeem our fallen nature.
As the late Pope John Paul II once said, "[What] are the â€˜concrete possibilities of man'? And of which man are we speaking? Of man dominated by lust or of man redeemed by Christ? This is what is at stake: the reality of Christ's redemption. Christ has redeemed us! This means he has given us the possibility of realising the entire truth of our being; he has set our freedom free from the domination of concupiscence. And if redeemed man still sins, this is not due to an imperfection of Christ's redemptive act, but to man's will not to avail himself of the grace which flows from that act". (Veritatis Splendor, â€˜The Splendor of Truth', n. 103) The Catholic Medical Guild of Singapore