Are Condoms the Solution to STDs?

The Centers for Disease Control (CDC) has reported that STIs are at all-time highs in recent years. For example, in 2009, about 25% of teenage girls had an STI, comprising almost 40% of those with “sexual experience.”1 A decade later in 2019, estimates were about the same.2 Total STI rates have reached record levels and are continuing to increase; nearly half of the 26 million new STIs in America in 2018 affected 15-to-24-year-olds, according to the CDC. This is up from about 19 million a decade ago.3

So maybe it’s time to tell the truth: the “solution” was never a fix to begin with.

condom packets

 

Condoms Don’t Block HPV, Herpes, and Syphilis

Condoms have been marketed so effectively as an all-around “solution” for those who want to embrace sexual activity without consequences, few stop to question whether condoms actually work. Those who think that condom usage will prevent any STIs are sadly mistaken. Let’s go point-by-point.

Even if a condom works perfectly, it is not effective at preventing exposure to infections that can be transmitted through skin-to-skin contact, or that affect areas not covered by the condom, such as HPV, herpes, and syphilis, as admitted by various sources, including the CDC.4 All these STIs can have very serious negative health outcomes. Here are just a few examples:

  • Genital warts are caused by human papillomavirus (HPV), the most common viral STD in the United States, accounting for three million new cases each year. HPV is present in an estimated 50% of all sexually active young women, and, as with other STDs, is associated with multiple sexual partners and with earlier intercourse. As of 2018, about 43 million people were infected with it.
  • Herpes genitalis is caused by the herpes simplex virus (HSV) and, by 2012 data, infects 30 million+ people in the United States, most of whom show no symptoms. Those who do show symptoms may have painful ulcers in the genital or mouth area.
  • Syphilis, one of the deadliest STIs, recently reached historic highs, with 133,945 people in the United States newly infected in 2020. Untreated syphilis can lead to rashes, lesions, paralysis, aneurisms, blindness and even death.5

For STIs that should theoretically be kept under wraps by a condom, such as HIV, we need to look at condom failure rates to assess the risk factor.

 

Condoms in the Real World Fail… A Lot

The oft-quoted statistic that condoms are 98% effective is misleading. The tests that produced that data were conducted under laboratory conditions which do not accurately reflect the real world.

According to Contraceptive Technology, 21st Edition, the real-world success rate of condoms in preventing pregnancy is 87% over one year for couples who use condoms 100% of the time.6 What does that mean?

If condoms permit pregnancy among at least 13% of women using them in one year, then there is an even higher risk of HIV exposure, since not every condom “failure” or malfunction results in pregnancy (but each one does result in exposure to diseases spread through fluid exchange). The 13% failure rate over one year increases with time, reaching 50% at five years and 75% at 10 years. But all throughout that, the disease exposure rate is even higher.

pregnanct expectant mom's baby bump

Correct condom use is uncommon because it is complicated and involves significant attention to detail in moments when one is strongly distracted. A 2012 synthesis of 50 studies on condom use errors identified more than ten potential user errors, in addition to the issues of fit, slippage and breakage that are inherent to the condom itself.2 Several user errors were found to be extremely common, including failure to lubricate the condom (16.0% to 25.8% of participants), incorrect withdrawal (43% to 57% of condom use events), and incorrect storage (3.3% to 19.1% of participants).7 These error rates are recorded from populations in the USA, Canada, and the British Isles, where education about correct condom use is widely accessible.

In the third world, where information dissemination is limited by illiteracy, underdeveloped infrastructures, and lack of cultural awareness of condoms, these error rates are probably much higher. Even in the (highly unlikely) scenario that condom use errors could be globally eliminated, there is still the issue of condom failure, which was reported by 25% to 47% of participants surveyed.8 According to a meta-analysis performed by HLI’s Dr. Brian Clowes, condoms either break or slip 6.06% of the time, which means there is an extremely high probability that a regular condom user will experience a catastrophic condom failure at some point, and with it the risk of exposure to any STI, including HIV.

the HIV virus

The HIV virus

 

Condoms Are Ineffective Against HIV

According to the CDC, an unbroken and properly used condom is 99% effective at blocking HIV. These sound like excellent odds, until we consider:

  • Condoms slip or break 6.06% of the time.
  • Incorrect use is common.
  • The integrity of a condom may be compromised before consumer purchase, especially in the third world, where manufacturing, shipping, and storage standards are lower.
  • The studies that found 99% effectiveness did not simulate realistic conditions of intercourse.

Real-world analyses of condom efficacy in preventing HIV transmission are much less optimistic. One study, showed, for example, that in monogamous, HIV serodiscordant male-female couples, only an 80% to 94% transmission risk reduction is granted.27 This sounds like a lot, but this means there is still at least 6% and up to 20% of the original risk of transmission (which is not given in the study), and that risk increases cumulatively with each sexual act. Suddenly condoms don’t sound very “safe.” A 2002 synthesis of studies focusing on heterosexual couples shows 80% protection per person-year,28 while a 2016 study shows only 70% protection.29

The outlook is no brighter for homosexual men engaging in receptive “sex” (sodomy) with HIV-positive partners. Analyses of the available data show that people in this group have a 13.2% chance of contracting HIV in one year without condom protection, which drops to 3.8% for those who use condoms every time. That translates to 72% prevention per person-year.30

Another analysis calculated the risk factor per sexual act, and found that HIV is transmitted in 0.54% of acts unprotected by a condom, and 0.20% of acts with condom protection, translating to 63% prevention.31 The latest and most innovative analysis instead calculates condom effectiveness based on number of sexual partners, finding that for each partnership unprotected by a condom there is an 83% chance of infection, whereas for partnerships that are always protected by condoms the risk of infection is 7.3%, yielding a 91% condom effectiveness rate.32

This relatively high protection rate is creating some excitement in the condom-promotion world, perhaps due to a general misunderstanding of what it actually means.

Infection rates rendered per act and per person-year compound, similarly to the pregnancy rates explained above. With every condom-protected act of this type there is a 0.20% chance of infection. That sounds small, but with each additional act there is an additional 0.20% chance, which compounds to a significant risk for someone who engages frequently in sex—especially with multiple partners. There may be only a 3.8% chance of contracting HIV in one year, but who stops having sex after one year? The risk compounds year by year; at five years, you’ve reached a 17.6% chance of getting HIV.

The same is true of the per-partner analysis. There’s a 7.3% chance of infection with one sexual partner. But if the predominant practice were to have only one sexual partner, the AIDS epidemic would never have exploded. HIV infection compounds with every additional partner. That leads to a 20.3% infection rate after “only” three partners.

All this latest study has shown is that increasing the number of one’s sexual partners is as dangerous as we always knew it was, and that the solution is to live a monogamous lifestyle with a member of the opposite sex. This is because condoms do not eliminate risk of HIV when used by those who engage in high-risk behaviors such as promiscuity or sodomy, because the cumulative probability of disease transmission increases significantly with each sexual act, and promiscuity and sodomy multiply risk by adding to the number of partners and involving contact with areas more prone to transmitting disease.

 

Condom Promotion Endangering the Third World

The disparity between the perception and reality of condom effectiveness has led to an unconscionable number of deaths, mostly in the third world, where government and health organizations have aggressively pushed universal condom use as a solution to the AIDS crisis.

globe

 

Thailand

When the first HIV infections popped up in Thailand in 1991, the government enacted a “100% Condom Use Program,” which helped lead to an HIV infection rate of 9,072 per million in 2003, according to the Joint United Nations Program on HIV/AIDS.9 In 2021, it had an adult (ages 15 to 49) HIV prevalence rate of 1%, or 1 in 100.10 A decrease in new HIV infections in the last decade is likely due mostly to anti-retrovirals.

 

The Philippines

The AIDS crisis reached the Philippines at the same time, but by 2003, that country had an infection rate of only 113 per million.11 As of 2021, the HIV prevalence rate remains a low 0.2% of adults 15-49, according to the Joint United Nations Program on HIV/AIDS (UNAIDS)—Thailand’s infection rate is five times higher. 12 The difference was the result of policy: in the Philippines the government and the Church successfully encouraged young people to be abstinent before marriage, and married people to remain faithful to their spouses.13

The success of this abstinence-based prevention program is much greater than what we see in the United States, where correct condom usage is an expected part of the high-school health class curriculum. Here the HIV infection rate was 3,900 per million in 2006 and has since dropped only marginally to 3,362 per million in 2019 (the latest reliable data year due to the COVID-19 pandemic), despite all our “safe” sex education, first-world healthcare system, and widespread condom availability. It is estimated that at least 1,189,700 people older than 13 have AIDS in the United States.14

Countries that advocate “science” and “evidence” over “impractical” abstinence are suffering the consequences. Abstaining before marriage and faithfulness to one’s spouse are the best protection from STIs that exists.

 

Uganda

Local Market in Uganda - The Pearl of Africa

The abstinence approach also proved its effectiveness by reversing one of the worst HIV outbreaks in history. The ABC plan (Abstinence, Being faithful to one partner, Condoms if nothing else) cut the total HIV prevalence rate in Uganda from 15% in 1991 to 5% in 2001, the most positive trend in the world during that time.15 UNAIDS states that in 2018 there was a new infection rate of 1.4%. The total prevalence rate as of 2019 was 6.2%, including children born with AIDS, whereas as of 2021, the adult prevalence rate is still only about 5.4%.16 All in all, for a country in a region that has struggled more with AIDS than any other parts of the world (including Southeast Asia), these numbers are phenomenal.

Condom promoters sometimes cite this information as an example of the success of condom-based responses to the AIDS crisis, but the reality is that the ABC program placed very little emphasis on condoms, and only promoted them for certain high-risk groups, such as prostitutes. Though it is debated whether the ABC effort’s success was based on abstinence and fidelity primarily or only partly, the fact of the matter is that the “A” and the “B” mattered a lot: the average age of “sexual debut” increased among young men and women, and the average number of sexual partners decreased, throughout the years of the ABC program.17

 

Lesotho

Countries that emphasized condoms, however, had and still have the highest rates of infection.

An example is the case of Lesotho, which in 2021 had a 75.6% condom usage rate, the second highest among countries participating in the 4th HIV Research for Prevention conference hosted by the International AIDS Society in 2021.18 Despite this, Lesotho’s current average HIV prevalence among adults is an enormous 25.6%—the second highest in the world.19 This has been the level since about 2005.20

 

Eswatini

Even more so is Eswatini, the country with the highest condom use percentage in 2021 at 85% (!),21 which also has had the world’s highest HIV prevalence rate—over 25% (27.6% in 2010, 26.8% in 2020)—for a decade, despite a drop in new infections.22

 

Conclusions on Condom Promotion

Billboard sign of Marie Stopes International Uganda

In 2004, the journal Studies in Family Planning concluded, “No clear examples have emerged yet of a country that has turned back a generalized epidemic primarily by means of condom promotion.” This still holds true today. In fact, the primary reason why there has been a decline in AIDS transmission in Sub-Saharan Africa, from an estimated 2.2 million new infections (2005) to an estimated 1.5 million (2013), is the expanded use of anti-retroviral technology, not condoms.23 Yet the United Nations, the European Union and its member countries, some U.S. agencies, and international organizations continue to promote condom use as the primary method of combating the spread of HIV and other STIs.

Rather, the key to success is in behavior change. According to a 2004 synthesis of the results of third world AIDS prevention strategies, the main contributing factor reducing HIV infection rates among heterosexual couples was not condom use, but reduction in the number of sexual partners.24 For example, returning to Uganda, by 2000, the Ugandan Demographic and Health Survey found that 93% of Ugandans had changed their sexual behavior to avoid HIV/AIDS.

Contrary to all expectations, young Ugandans widely embraced the pro-abstinence message. From 1989 to 1995, the percentage of unmarried young men having sex plunged from 60% to 23%, and the percentage of unmarried young women having sex dropped from 53% to 16%.25 This proves that teenagers are not helpless slaves of their “raging hormones.” In South Africa on the other hand, increases in condom availability were accompanied by increases in the number of persons who reported having more than one sexual partner.26 This is because condom promotion may lead to more risky behaviors by creating the illusion that sex with condoms is “safe.”

This illusion that a layer of latex removes all consequences from sexual activity is extremely dangerous because condoms do not provide anything close to complete protection from HIV exposure.

 

How to Actually Prevent STDs

The only acceptable prevention that is 100% effective is also Catholic-approved! Abstain from sexual activity before marriage, and if you marry, be faithful for life to your spouse.

You care about your physical welfare. The Catholic Church, knowing the science, isn’t trying to spoil your fun but teach the Truth; that is, respect yourself and your spouse if you have one, because everyone is made in the image and likeness of God. Sexual intimacy is not for selfish gratification, but rather it unifies husband and wife and invites the gift of children.

hands of a newly married couple wearing wedding rings

The human family is so beautiful that the only way to preserve it is to care for the soul as well as the body. We have many, many articles explaining why contraception is not only unhealthy but also spiritually harmful. Remember, if there is no such thing in life as a free lunch, do you honestly believe sexual gratification would come without consequences?

If you are single, or in the religious life, please respect your own human dignity; live a life of chastity and abstinence. Many today buy into the secular lie that this is impossible; it’s not. Advocates for sexual “freedom” often forget that humans also have the freedom and the ability not to have sex. It’s a choice. No one “dies” of abstinence. Faithful Catholics have been engaging in abstinence or chaste behavior according to their state in life for millennia. And waiting for the right spouse is not only healthier physically, it’s spiritually beneficial to your soul.

young happy couple

 

Dr. Brian Clowes’ research contributed to this report. 

 

Endnotes

[1] Jennifer Warner, “1 in 4 Teen Girls Has an STD,” WebMD, 23 November 2009.

[2] C. L. Shannon and J. D. Klausner, “The Growing Epidemic of Sexually Transmitted Infections in Adolescents: A Neglected Population,” Current Opinion in Pediatrics 30, no. 1 (February 2019), 137-143.

[3] “Adolescents and Young Adults,” Centers for Disease Control and Prevention.

[4] “Syphilis – CDC Fact Sheet (Detailed),” Centers for Disease Control and Prevention; “Genital HPV Infection – Fact Sheet,” Centers for Disease Control and Prevention; “Genital Herpes – CDC Fact Sheet,” Centers for Disease Control and Prevention; Warner et al., “Condom Use and Risk of Gonorrhea and Chlamydia: A Systematic Review of Design and Measurement Factors Assessed in Epidemiologic Studies,” Sexually Transmitted Diseases 33, no. 1 (January 2006): 36-51.

[5] “Syphilis – CDC Fact Sheet (Detailed),” Centers for Disease Control and Prevention; “Genital HPV Infection – Fact Sheet,” Centers for Disease Control and Prevention; “Genital Herpes – CDC Fact Sheet,” Centers for Disease Control and Prevention; United States Department of Commerce, Bureau of the Census, Reference Data Book and Guide to Sources, Statistical Abstract of the United States 2012 (132nd Edition) (Washington, D.C.: United States Government Printing Office, 2012), Table 184, “Selected Notifiable Diseases―Cases Reported: 1980 to 2009.”

[6] Robert Hatcher et al., Contraceptive Technology (21st Edition; New York: Ayer Company, 2018), 100.

[7] S. A. Sanders et al. “Condom Use Errors and Problems: A Global View,” Sexual Health 9, no. 1 (17 February 2012): 81–95.

[8] Ibid.

[9] Alfonzo Cardinal Lopez Trujillo and Brian Clowes, The Case against Condoms: the Scientific and Moral Basis for the Teaching of the Catholic Church on Preventing the Spread of Disease (Front Royal, Virginia: Human Life International, 2006).

[10] UNAIDS Data 2021, UNAIDS (2021), 220.

[11] Trujillo and Clowes, Case against Condoms.

[12] UNAIDS Data 2021, 212.

[13] Trujillo and Clowes, Case against Condoms.

[14] “HIV Surveillance Report,” Centers for Disease Control and Prevention, 6 September 2019.

[15] Trujillo and Clowes, Case against Condoms; Elaine M. Murphy et al., “Was the ‘ABC’ Approach (Abstinence, Being Faithful, Using Condoms) Responsible for Uganda’s Decline in HIV?” PLOS Medicine 3, no. 9 (September 2006): e379.

[16] “12th Annual Joint AIDS Review (JAR) Final Report, July 2018 – June 2018: Empowering Young People to Champion the End of New HIV Infections,” Uganda AIDS Commission and UNAIDS, September 2019, 1; UNAIDS Data 2021, 90.

[17] Murphy et al., “Was the ‘ABC’ Approach Responsible?”

[18] “Condom Use, HIV Testing: African Countries Off Track 2030 Targets,” The Herald (Zimbabwe), 26 January 2021.

[19] “Lesotho 2019 HIV and AIDS Progress Report Submitted to Southern African Development Community Secretariat of Social and Human Development“, Lesotho National AIDS Commission, 2020.

[20] “HIV and AIDS in Lesotho,” Avert.

[21] “Condom Use, HIV Testing,” The Herald (Zimbabwe).

[22] UNAIDS Data 2021, UNAIDS, 64.

[23] Ayesha B. M. Kharsany and Quarraisha A. Karim, “HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities,” Open AIDS Journal 10 (2016): 34–48.

[24] Norman Hearst and Sanny Chen, “Condom Promotion for AIDS Prevention in the Developing World: Is It Working?Studies in Family Planning 35, no 1 (2004).

[25] Joint United Nations Program on HIV/AIDS (UNAIDS), “Uganda: Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Diseases,” 2000.

[26] Khangelani Zuma et al., (2016) “New Insights into HIV Epidemic in South Africa: Key Findings from the National HIV Prevalence, Incidence, and Behaviour Survey, 2012,” African Journal of AIDS Research 15, no. 1 (March 2016): 67–75.

[27] Warner et al., “Condom Use and Risk of Gonorrhea and Chlamydia: A Systematic Review of Design and Measurement Factors Assessed in Epidemiologic Studies,” Sexually Transmitted Diseases 33, no. 1 (January 2006): 36-51.

[28] Susan C. Wellerand Karen Davis-Beaty, “Condom Effectiveness in Reducing Heterosexual HIV Transmission,” Cochrane Database of Systematic Reviews, January 2002.

[29] F. K. Giannou et al., “Condom Effectiveness in Reducing Heterosexual HIV Transmission: A Systematic Review and Meta-Analysis of Studies on HIV Serodiscordant Couples,” Expert Review of Pharmacoeconomics and Outcomes Research 16, no 4 (August 2016): 489–499.

[30] D. K. Smith et al., “Condom Effectiveness for HIV Prevention by Consistency of Use among Men Who Have Sex with Men in the United States,” Journal of Acquired Immune Deficiency Syndromes 68, no. 3 (March 2015): 337-344.

[13] H. M. Scott et al., “Age, Race/Ethnicity, and Behavioural Risk Factors Associated with Per-Contact Risk of HIV Infection among Men Who Have Sex with Men in the United States,” Journal of Acquired Immune Deficiency Syndromes 65, no. 1 (January 2014): 115-121.

[32] Wayne D. Johnson, Ann O’Leary, and Stephen A. Flores, “Per-Partner Condom Effectiveness against HIV for Men Who Have Sex with Men,” AIDS 32, no. 11 (July 2018): 1499-1505.



1 Comment

  1. Samrat on July 27, 2021 at 7:43 PM

    Great work…

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