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Condom Label Flap Stirs Controversy

Health experts counter conservatives over effectiveness against STDs

THURSDAY, June 30, 2005 (HealthDay News) -- Saying they are reacting to a push by a conservative legislator to "discredit" condoms, a group of experts in contraception and reproductive health gathered in New York City Wednesday to clarify just what condoms can and cannot do in preventing unwanted pregnancy and sexually transmitted diseases.

Condoms do a great job in protecting sexually active people from contracting HIV and unintended pregnancy, the experts said. They also reduce risks for gonorrhea infection in men.

However, they are less effective in preventing other sexually transmitted diseases, said experts at the press briefing, which was sponsored by the Alan Guttmacher Institute, a Washington-based non-profit focused on reproductive health research and policy.

Clarifying what condoms do well is especially important right now, the experts said, because there is a growing support for abstinence-only programs that downplay the importance of condom use.

Spearheading that movement is Republican Sen. Tom Coburn, an Oklahoma doctor who in 2000 sponsored a bill requiring that the FDA mandate more specific, "medically accurate" condom labeling. That effort has also been supported by groups such as the abstinence-supporting Medical Institute for Sexual Health. On June 15, Coburn announced he would block the appointment of nominee Lester Crawford as new FDA commissioner until Crawford pledged to make these labeling changes -- a stance opposed by many at Wednesday's conference.

Reacting to critics who have charged that the senator's stance is part of a wider crusade against sex outside of marriage, Coburn's spokesman John Hart told the Associated Press Wednesday that the senator's only concern is that condom labeling be changed to state their "effectiveness or lack of effectiveness in preventing STDs."

But the experts gathered in New York worry that these types of changes will undermine public confidence in a simple, potentially lifesaving product.

"There are a remarkable number of people who say that condoms don't work, and you have the establishment pushing the same message, but right now they're all we have to reduce the risk of HIV," said Lori Heise, a director of the Global Campaign for Microbicides, a non-profit coalition of 200 organizations supporting research into HIV protection.

Current condom labeling reads "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 also note that condoms are highly effective in preventing unwanted pregnancy.

"Condoms don't do everything," said James Trussell, director of Princeton University's Office of Population Research, "but they do protect against HIV." One National Institutes of Health (NIH) study made available at the conference reported that condoms prevent unintended pregnancies, HIV infection and gonorrhea in men. The report went on to note that there is insufficient evidence that they prevent a number of other sexually transmitted diseases.

That may include the human papillomavirus (HPV) family of infections, some strains of which are thought to greatly raise a woman's risk for cervical cancer. Both HPV and the herpes family of virus can be transmitted by contact with skin not covered by a condom. It is the omission of this type of information on condom labels that has riled legislators like Coburn.

But Heather Boonstra, a senior public policy associate at the Alan Guttmacher Institute, pointed out that, unlike many other STDs, "HPV is highly curable and can be monitored." She also noted that about 70 percent of HPV clears up on their own within the first year, and 90 percent within two years.

"Condoms are not perfect, but are still key to preventing many sexual diseases, and the last thing we need is for government to undermine their use," she added.

Also discussed at the conference were mixed messages surrounding the use of the spermicide nonoxynol-9 (N-9), used for the last 50 years as a contraceptive ingredient in lubricants, condoms or other products. During the height of the AIDS epidemic, scientists thought N-9 might prove effective against HIV. Unfortunately, subsequent research proved that no spermicide protects against the virus.

The health professionals gathered at the New York briefing added that, because N-9 acts by disrupting cell membranes, it can also damage the walls of the vagina and especially the rectum during intercourse, actually increasing the risk of viral spread. Because of this, almost all lubricants now sold no longer contain N-9, and the experts recommended that people avoid using condoms containing N-9, as well. Many condom manufacturers have stopped selling N-9 products, the experts said, although the popular Trojan and Lifestyle brands still make products containing the spermicide.

Gay men cannot safely use N-9 because of the damage to the rectum, but women who use it once daily or less can still safely use the spermicide, Heise advised.

Overall, there is a tremendous need for accurate information about contraception and protection against STDs, said Dr. Katharine O'Connell, a gynecologist at New York City's Columbia University Medical Center.

"I'm amazed by the lack of education [among women] about birth control methods, who get more information from friends and the Internet than from doctors," said O'Connell. "I've had patients who think a diaphragm protects against pregnancy and HIV; that condoms last forever; and that birth control pills cause cancer and infertility."

"The best method of contraception is one that fits into their lifestyle, and that they will use consistently and effectively," she said.

More information

For more on HPV, head to the U.S. Centers for Disease Control and Prevention.

SOURCES: Heather Boonstra, senior public policy associate, Alan Guttmacher Institute, Washington, D.C.; James Trussell, Ph.D., professor, economics and public affairs, and director, Office of Population Research, Princeton University, Princeton, N.J.; Lori Heise, director, Global Campaign for Microbicides, Washington, D.C.; Katharine O'Connell, M.D., MPH, assistant clinical professor, Columbia University Medical Center, New York City; June 28, 2005, press conference, Alan Guttmacher Institute, New York City
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