Companies that sponsor condoms in HIV/AIDS programs

Apologetics Moral Theology
#1

Hi All,

Unfortunately the multinational company that I work for sponsors HIV/AIDS programs that give out condoms. I knew I had to write to the program co-ordinator, but I agonized over and over what point to make, knowing that it was likely my email would be ignored. Wise or not, the following is the fight I chose to fight. Maybe it will empower you to find out if your company is sponsoring, and write a similar letter (for example Global Business Coalition, gbcimpact.org/)).

Hi

World AIDS day came and went recently, and seeing Company XYZ’s involvement in this troubling epidemic, my interest in the topic was peaked. I started reading several of the links provided on the Company XYZ’s site. I’m very glad to see that Company XYZ is interested in helping to stem the HIV/AIDS epidemic in Africa (and elsewhere).

I am writing this email concerning a important pillar in most (and all of Company XYZ’s ) HIV/AIDS programs, the distribution of condoms. On the surface, the strategy should work, given the behavior of infected individuals does not change (except for proper condom use) and given condoms having any degree of protection against infection. However, while looking at Company XYZ’s resources, and outside resources, I could not find one sociological study claiming that increased condom availability resulted in fewer new HIV infections. While my search is not comprehensive, I am finding claims that new infections are on the rise where condom availability is increased. Needless to say, this is not what one would expect.

It seems that there is a problem with the way condoms are integrated into these programs, and this problem is widespread, not just in the initiatives Company XYZ supports. Because this is the status quo (and as I will suggest the common paradigm) I ask you to consider the merits of my point without any previous stereotypes.

Issue 1: Dangerously Ambiguous Message About Condom Effectiveness

When I read about the education these programs give out, in every case, unless one goes and reads the scientific studies on condom effectiveness (in preventing HIV infection), you are left with the impression that condoms are 100% effective. Using the reputable studies that Company XYZ provides, condoms when used perfectly, prevent HIV infection 90-95% of the time. In reality, with imperfect use (i.e. the current common application of condoms), studies say the number is around 80%! Given these facts, is it not negligent for Company XYZ to have condom dispensers without any warnings, or education programs without these facts? To sum up, it seems to me (please verify) that programs essentially say “condoms are effective in preventing HIV infection”. This is true, they are effective in the strict sense. Without a qualifier in the education programs, effective implies perfect (or close to perfect). To say condoms are effective is dangerously ambiguous when the current average effectiveness lies around 80%.

Issue 2: Condom Availability Not Showing HIV/AIDS Incidence Decline

My impression from the Company XYZ resources, is that every program mentions that condom availability is paramount to an effective HIV program. However, time and time again, no reference is given of a sociological study that shows HIV incidence going down with an increase in condom availability. Despite the lack of reference, time and time again, condom availability is touted as essential to any effective HIV/AIDS program. When one looks outside of the Company XYZ resources, the opposite seems to be the case. For whatever reason, the statistically expected result, that increasing condom availability/use would decrease the number of new infections (for the same time period), does not seem to be the case. Rather, abstinence/monogamy encouraging programs without condoms seem to be working (ex. Uganda).

Proposed Solution to Issue 1

Simply put, condom users must know the 20% chance of infection they are taking. This must be in the education program, and it must be on condom dispensing machines.

Proposed Solutions to Issue 2

It is unclear why condom availability isn’t working (please correct me if this conclusion is wrong). It is Company XYZ’s responsibility to step back and re-assess if this is infact true. If it is true, then radical changes to the manner condoms are integrated into programs need to be considered.

Perhaps the solution to Issue 1 will act as a solution to Issue 2 as well. In other words, with a true knowledge of condom effectiveness (and ineffectiveness), individuals will take less actual risks (that they previously did not perceive).

A more radical solution may be to withdraw condoms from HIV/AIDS programs altogether. The rationale behind this proposition, is that by distributing condoms, the irresponsible behavior is not challenged at its root (i.e. putting your partner at risk, when you know you have HIV), but rather the irresponsible behavior is in effect, encouraged.

These two solutions have different sociological reasons as their assumption; dangerous misinformation about condoms, or condoms encouraging irresponsible behavior. The real sociological reason for condom availability failing to reverse HIV/AIDS infection trends, may be a combination of the two sociological reasons.

Please contact me by phone or email to discuss this important topic. If my definition of the issues/problems has incorrect assumptions, please advise. Given that my research has led me to those conclusions, and that I am proposing a solution which could save millions of lives, I am compelled to follow through on these solutions; I cannot let them rest silent until I am convinced they will not help.

#2

the response glossed over my points. Here is my reply, I’m posting it, since I think reading it reworded (with references) may be useful as well.

Thank you for your response. Just to clarify, I am not disagreeing with all of Company XYZ’s approach in helping to fight this epidemic. I want to affirm the good and worthy work you are doing. However, I wanted to present a convincing argument and get straight to the point (and seeing you list of responsibilities convinces me again to keep it concise!); the point is, in Africa, the manner in which condoms are integrated in the programs needs to change; and by changing, many lives could be saved.

As a top priority, I will focus on Issue 1 (condoms aren’t perfectly effective, HIV is a deadly disease, and therefore people need this information). Below, my old email is in black. In the blue comments, allow me to quote the same resources you gave me, to support the fact that condoms aren’t completely safe, and people need to know the significant risk they are taking with condom use. Further, three of the resources give examples of acceptable disclaimers with regards to condom effectiveness.

Issue 1: Dangerously Ambiguous Message About Condom Effectiveness

When I read about the education these programs give out, in every case, unless one goes and reads the scientific studies on condom effectiveness (in preventing HIV infection), you are left with the impression that condoms are 100% effective.

For example, your statement “Safe behaviours include: abstinence, being faithful, correct and consistent condom use,” would lead one to believe there is no chance of getting HIV with “correct and consistent condom use”; ‘safe’ implies no danger. This is consistent throughout most* of Company XYZ’s Regional policies, and the resources provided on the XYZ site; namely, sex with a condom is called safe. (*exception is noted at bottom of email)

However studies on condom effectiveness [in preventing HIV transmission], show that “correct and consistent condom” use has a ~95% efficacy (ref. 1, ref. 3). That means condoms will not prevent HIV transmission 1/20 times with “correct and consistent” condom use. That is not ‘safe sex’; it is close, but people need to know the 1/20 chance they are taking contracting a deadly disease. In other words, **people deserve this accurate information so that they can make informed decisions about the risk they are taking. **

Using the reputable studies that Company XYZ provides, condoms when used perfectly, prevent HIV infection 90-95% of the time. In reality, with imperfect use (i.e. the current common application of condoms), studies say the number is around 80%!

Being realistic, instruction on “correct and consistent” condom use is not effective, and in current practice that leaves condoms at ~80% effective in preventing HIV transmission! This is far short of ‘safe sex’, and makes the matter all the more urgent; people need to know the risks they are taking, especially since condoms are not used correctly/perfectly.

Studies quoted by the CDC (regarding only consistent condom usage), state

“condom’s effectiveness at preventing HIV transmission is estimated to be 87%, but it may be as low as 60% or as high as 96%” (ref. 1)

“This review indicates that consistent use of condoms results in 80% reduction in HIV incidence. Consistent use is defined as using a condom for all acts of penetrative vaginal intercourse. Because the studies used in this review did not report on the “correctness” of use, namely whether condoms were used correctly and perfectly for each and every act of intercourse, effectiveness and not efficacy is estimated.” (ref. 2)

“condoms are 90 to 95% effective when used consistently, i.e. consistent condom users are 10 to 20 times less likely to become infected when exposed to the virus than are inconsistent or non-users.” (ref. 3)

All of the above references are also cited in WHO Bulletin (ref. 4)

You mentioned that Company XYZ will be following reputable world health leaders in this matter. One way Company XYZ can respond to this urgent need to provide accurate information is to post disclaimers such as the CDC: (post disclaimers on condom dispensers, etc.)

“correct and consistent use of the male latex condom can reduce the risk of STD transmission. However, no protective method is 100 percent effective, and condom use cannot guarantee absolute protection against any STD… Incorrect use can lead to condom slippage or breakage, thus diminishing their protective effect. (ref. 5)

“Condoms can substantially reduce the risk of the sexual transmission of HIV.” (ref. 6)

*In my opinion, an even better and more concise statement can be found in Company XYZ’s resource which states:
“Condoms are in most cases effective in preventing HIV transmission.”

Given these facts, is it not negligent for Company XYZ to have condom dispensers without any warnings, or education programs without these facts?

To sum up, it seems to me (please verify) that programs essentially say “condoms are effective in preventing HIV infection”. This is true, they are effective in the strict sense. Without a qualifier in the education programs, effective implies perfect (or close to perfect). To say condoms are effective is dangerously ambiguous when the current average effectiveness lies around 80%.

#3

In conclusion, I want to convey the urgency of providing people with accurate information about condom effectiveness so that they can make informed decisions about the risk they are taking. Disclaimers such as the three noted above should be provided each time with condom intervention (dispensers, educational materials and programs). As I said, my impression from the Company XYZ materials is that this critical information is missing in Company XYZ’s approach (educational materials, etc.), leaving people to take risks while perceiving themselves ‘safe’. Therefore, with proper disclaimers about condom effectiveness, I believe there is an opportunity to save many more lives in Africa.

ref. 1 - Davis KR and Weller SC. The effectiveness of condoms in reducing heterosexual transmission of HIV. Fam Plann Perspect 1999;31:272-279.

ref. 2 - Weller S, Davis K. Condom effectiveness in reducing heterosexual HIV transmission (Cochrane Review). In: The Cochrane Library, Issue 2, 2004. Chichester, UK, John Wiley & Sons, Ltd.

ref. 3 - Pinkerton SD and Abramson PR. Effectiveness of condoms in preventing HIV transmission. Soc Sci Med 1997; 44:1303-1312.

ref. 4 - KK Holmes, R Levine, M Weaver. Effectiveness of condoms in preventing sexually transmitted infections. Bulletin of the World Health Organization, 2004;82:454-461

ref. 5 - CDC, 2002 Male Latex Condoms and Sexually Transmitted Diseases; Atlanta, GA: CDC; cdc.gov/hiv/pubs/facts/condoms.htm, last accessed 07/25/2008.

ref. 6 – 2008 Report on the global AIDS epidemic, UNAIDS; unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/, last accessed 07/30/2008

Refs. 1,2,3 are listed on the CDC website at cdc.gov/hiv/resources/qa/condom.htm

#4

I’m hoping people know that I’m not you, and that your not me!!!

#5