AIDs Prevention

[jackofallgeeks]

From This article on an increasing trend in AIDs infections:

Simply focusing on treatment or politically uncontroversial prevention methods will not suffice. "You can't put all your eggs in the abstinence basket," said Hays. "We need a menu of strategies for real people," he said, adding that condom distribution as well as new methods, such as a vaccine, are needed.

OK, so we all know my personal stance here, but I'm honestly curious: I hear a lot of talk about condoms and the like as a means of 'safe sex,' but I've never seen any statistics on it. Generally I take all statistics with a grain of salt anyways (too many ways to bend the numbers, in my opinion), but I know there's still a chance of pregnancy when using condoms, so I'm just curious what things look like numerically on AIDs prevention.

And I'll be honest, what bothers me the most about the "can't put all your eggs in the abstinence basket" quip is the implication that we as humans generally lack the self-control to not sleep around. I mean, we're not really talking about a religious issue here any more -- the answer to "what's wrong with having sex" is no longer "God doesn't like it," it's "you could get AIDs and die." One would imagine that's a big enough stick to get most people to at least think about who they're sleeping with -- at the very least you shouldn't sleep with someone you know is sick, right? And you certainly shouldn't sleep with someone you can't trust is being honest about their sexual history. So... yeah. That's my thought for the moment.

Comments

[mmeubiquitous.livejournal.com]

I remember hearing about someone going to a conference on AIDS prevention, and after a presentation on condoms, he asked the roomful of doctors if they would have sex with someone they knew to be HIV positive while using a condom. No one raised their hand. This may well be apocryphal, so take it with a grain of salt.

There are also so many other reasons to practice abstinence than "God wants it" and "you'll get AIDS and die." Sadly they've just been all drowned in sacrifice to the Almighty Orgasm.

[starlight1184.livejournal.com]

Everything I've ever heard is that condoms only protect against pregnancy, not STDs. But, I'm no expert on the subject.

[jackofallgeeks.livejournal.com]

That's the impression I always got, which is why I'm curious about this. The quoted article isn't the first time I've heard condoms touted as an AIDs preventative, but as noted I haven't ever seen evidence to support why.

[tiel.livejournal.com]

Condoms are actually one of the only forms of birth control that can protect against STDs, since they keep bodily fluids from coming in to contact.

[mmeubiquitous.livejournal.com]

True, but not all of them...HPV, herpes and genital warts can, I'm fairly sure, be transmitted despite use of a condom, since it's not the fluid that transmits them but the skin to skin contact.

[tiel.livejournal.com]

I feel like the "Don't sleep around" arguement is alot like the "Doc, it hurts when I do this; Then don't do that," response. Sure, in a perfect world, people wouldn't sleep around, but the fact of the matter is that they do. I think the biggest problem is that the general public still isn't educated about HIV and AIDS. We're only just now realizing, "Hey! I don't have to be a black, gay, heroin addict to get AIDS!" so people honestly don't realize how true the "You could get AIDS and die" arguement is.

The really, really scary part about AIDS, of course, is that you don't have to sleep around to get it. Something like 1 in 3 people living with HIV has no idea that they're infected. So, the person you meet and marry at age 30 who slept with one steady boyfriend in college when she was 21 could have AIDS.

I'm not really sure about the statistics of condoms and AIDS prevention, but I know that if they're used properly, they're something like 98% effective against pregnancy, so I would have to assume that the odds are about the same for the transmission of STDs. The virus is transmitted through blood, semen, vaginal secretions, and breast milk, and the only way its caught is if the virus enters the blood stream through contact with mucous membranes (mouth, vagina, urethra, anus) or through direct contact (which is why medical needles are now disposable). So, by using a condom to prevent mucous membranes from being exposed, you're essentially cutting off the means of transmission. I'm sure the statistics are out there, but even without them, on paper, it seems like a pretty safe bet.

Sorry about the Serious Thoughts

[jackofallgeeks.livejournal.com]

Very useful information -- that's what I was thinking per the usefulness of condoms, bodily fluids (now I've got that Dr. Strangelove 'vital essence' bit running through my head...)

You're right about people not being educated, but there's a difference between giving people an 'easy' solution and educating them, and I generally think education is the better plan. yeah, people sleep around; I don't really expect them not to, but I've personal experience that shows it's possible. "People can, they just won't" seems like a weak argument to me, and while we should plan for the faults of humanity, I don't really think it's right to cater to them.

Even aside from all that, though, it's a matter of prudence, I think, to at least know who you're sleeping with an what their health is -- and I wouldn't leave it up to good faith, either. Get tested to be sure. Knock on wood, and all (that's the impression that I get, anyways).

And it's notable that your definition of 'sleep around' and mine are ever-so-slightly different, which does at least stem from my religious convictions. Even at that, though, it's been my understanding that blood tests are routine for pending marriages, and if they're not I think they ought to be.

Re: Sorry about the Serious Thoughts

[tiel.livejournal.com]

"People can, they just won't" seems like a weak argument to me, and while we should plan for the faults of humanity, I don't really think it's right to cater to them.

I agree with that completely. The real reason I think we need to get with the program as far as AIDS prevention and research goes is because, while in the US it may have a lot ot do with young people not being able to keep their pants on, in other countries, it has much more to do with true lack of education, modern cultural norms, and the like. In Africa, for instance, an unreasonable number of children are born with AIDS. I feel like those babies deserve to be able to be treated for a disease that was completely not their fault, and that they're who we should be planning for. And, if other people can benefit from that, well, bully for them.



Even at that, though, it's been my understanding that blood tests are routine for pending marriages, and if they're not I think they ought to be.
Anymore, that seems to be the exception and not the norm. I know that in Maryland, for instance, there are no blood tests, and that there's testing in DC, but it just makes many people choose to get married in Virginia. I"m still not sure how I feel about that issue, but I agree that it could probably go a long way towards making a difference.

[jackofallgeeks.livejournal.com]

I"m still not sure how I feel about that issue, but I agree that it could probably go a long way towards making a difference.

Mind, I don't think it should be legislated necessarily, but it should be routine. People should quirk their eyebrows in that "oh, well, ok" kind of way when they hear that you didn't or aren't getting blood tests done. More often than not, I really do just want the government out of my hair.

You're right on the African nations, but I'm at even more of a loss on solutions for them as I am on solutions for us. True, condoms will keep children from being born with AIDs, but only because it'll keep them from being born (or even conceived) at all. Until there's some other 'fix', those that are still born will be at the same risk for AIDs (generally speaking -- cleaner parents make for cleaner children, but I'm unsure how much of an impact wider use of condoms would have on that issue).

Re: Sorry about the Serious Thoughts

[dikaiosunh.livejournal.com]

There's plenty of lack of education in the US, too. Anecdotally, I can tell you that the lack of knowledge about sex shown by some of my friend's students when she taught middle-school (and yeah, the kids are young, but a bunch of them were already sexually active - 14-15 year olds) was shocking. We're talking things like, "oh, you can't get pregnant if you have sex standing up" and "only gay people get AIDS."

I've just spent way too much time tracking down studies for my other comment, so you'll have to trust my anecdote for the moment. :)

[mmeubiquitous.livejournal.com]

Thing is about pregnancy vs. HIV - there are three days per cycle (so roughly per month) that having sex can result in a woman getting pregnant (the egg is only able to be fertilized for roughly 24 hours, while the sperm can live in a woman's body waiting for said egg for those three days). So to get a 2% pregnancy rate on a condom, that condom has to be failing was more often than that, since for 26+/- days out of the month a torn condom will not lead to pregnancy because it can't. There is, however no comparable good or bad time for HIV exposure.

[dikaiosunh.livejournal.com]

Incidentally, condoms are roughly 98% effective in the US, but that's not with perfect use. Failure rates with perfect use are significantly lower, at least in theory (since no one uses them perfectly) - US laws mandate standards, such as only 1-in-400 (so about .25%) failing a "leak test" (and even condoms that would fail a leak test reduce STD transmission and pregnancy chances).

Data's in the CDC study I cite below.

[dikaiosunh.livejournal.com]

Of course, if you're going to disbelieve statistics, I can't really help you, but:

On condoms preventing STDs: Fact Sheet for Public Health Personnel: Male Latex Condoms and Sexually Transmitted Diseases (from the Centers for Disease Control, updated under Bush's tenure, so if the data is spun, it's likely spun in an anti-condom direction)

The CDC fact sheet contains a link to the summary of a workshop with lots more numbers. The key finding re: condoms and HIV was that individuals who reported always using condoms reduced their HIV transmission rate by 85%. Note that that's an 85% *reduction in the rate*, not that condoms are 85% effective (a mis-report I've seen on several right-wing sources). I.e., the finding is not that you have a 15% chance of contracting HIV from a partner if you use a condom - it's that if the chance of getting HIV from unprotected sex were, say, 10%, using a condom would reduce that to 1.5% (even if you know you're having sex with an HIV+ individual, it's not a 100% risk - the studies cited in the CDC report were of "serodiscordant" couples - where only one partner has HIV - and showed a reduction of infection from 6.7 per 100 person-years to 0.9 per 100 person-years).

On combating HIV/AIDS in Africa: A, B, and C in Uganda: The Roles of Abstinence, Monogamy, and Condom Use in HIV decline (from the Guttmacher Institute)

Condom use in Africa reduces prevalence rates of HIV, not just HIV in kids.

Incidentally, there's no really good data that I know of on the impact of ab-only programs (though a large study concluded in 2001 by the National Campaign Against Teen Pregnancy concluded that while ab+ programs delayed the onset of sexual activity - still not until marriage, but some - the available data on delay of onset for ab-only programs didn't look promising - you can get the summary or the full report online.) Mathematica is currently undertaking a multiyear review of Title V abstinence-only programs in the US, but its results aren't due out until the end of the year.

[dikaiosunh.livejournal.com]

Last comment, I promise:

On a non-empirical note, I feel like the "just don't have sex" solution isn't one that can be justified aside from your moral convictions about abstinence, despite STDs, etc. Let's leave aside things like trying to keep 12 year olds from having sex for the moment (which I'd like to do, too - it's just that ab-only stuff doesn't seem to work that well).

You could make a similar argument about, say, driving cars. I know that I could get killed driving a car. But it would be unreasonable for someone to say: "don't want to get in a car crash? Don't drive! Problem solved!" We do things with varying degrees of risk all the time because we desire the benefits, and that's perfectly reasonable. Otherwise we'd all sit in our armored bunkers all day. I think it would also be unreasonable to say, e.g., "the government shouldn't provide traffic enforcement, road repair, etc. - if people want to drive, we shouldn't indulge their risk-taking."

For those of us who don't think that extramarital sex is inherently wrong, STDs are a risk. I minimize the risk for myself, and want to help others minimize their risks. Given the levels of risk involved, and the availability of means to reduce them, I don't think that's unreasonable.

Now, if you add in the "extramarital sex is inherently wrong," claim, sure, we should be encouraging abstinence and (maybe) not suborning risk-reduction (though, to paraphrase Nick Kristof, you could make people drive more carefully by putting a big steel spike in the center of the steering wheel instead of an airbag, but that doesn't seem like a good idea). But I don't think you can get there without it.

[jackofallgeeks.livejournal.com]

You make good points in all your comments. As far as "abstinence only" goes as a national policy, I'm not sure how I stand mostly because I'm not sure how 'only' it's intended. that is to say, I'm certainly not against educating kids, and I like to at least imagine that I'm not draconian in my beliefs, despite how right I may think I am. -smirk- it's fact that not everyone stays abstinent until marriage -- in fact, most people *I* know haven't, so that says something. Like I said, though, we ought to plan for failings without catering to them -- don't put a spike in the steering wheel, but do set up radar-enforced speed limits, for example (neglecting, for the moment, any sort of traffic-law based discussion I might bring up).

As a note, though my religious and philosophic convictions certainly play a part (they made up a significant portion of my self-identity), I think there are more-practical reasons beside and behind them. Put simply, there's a lot of actual harm, emotionally as well as physically, that can come as a result of it, for the sake of an unknown good. Just for me, that's too much risk for too little gain, though I accept this is personal opinion. And as far as that goes, I think it's right and good that people be free to form their own opinions and make their own decisions, but now I'm getting off topic.

[dikaiosunh.livejournal.com]

Well, ab-only programs are pretty much what they sound like - they're school sex-ed programs that encourage kids to abstinence and don't discuss other ways of preventing STDs or pregnancy. The more-widely-supported (at least by the medical profession, most of the anti-STD groups, international agencies, etc.) programs are "ab-plus" or "comprehensive sex ed" - i.e., they encourage abstinence (until marriage or serious committment, depending on the program) but also discuss contraceptive use, etc.

There are really a few separate issues that folks like me have with the ab-only programs, in rough order of good-faith-ness:

1. Abstinence *only* doesn't seem to work that well as a strategy for preventing teen pregnancy and STDs. The big longitudinal studies are still in progress (since widespread public ab-only education in the US is largely a product of the Bush administration), but preliminary data indicates that kids who get ab-only education seem to delay the onset of first sexual activity a *little* but then are much less likely to use protection (or use it properly) when they *do* have sex. M can rattle off all sorts of data on this, so if you really want numbers I can ask her for some links tonight. Basically, ab-only programs don't succeed in getting kids to wait long enough to only have sex with one partner for their whole lives, and then you get all the other problems in spades because the system doesn't fail gracefully.

2. *Some* ab-only programs have church/state issues. That is, some of them put out materials that say things like, "Jesus doesn't want you to have sex." A lot of the stuff getting Title V federal funding has turned out to have this problem. There's a big debate about the faith-based initiatives in general, how far is too far, etc. But basically, folks like me don't like having federal money used to teach kids Christianity in school. The response from most of the programs that do it has fanned the flames - there's a lot of "Christ is the only way to purity and this is a Christian country so STFU g-dless Hollywood secularists" sort of stuff. And then of course the ACLU gets involved and everyone is shouting.

3. Some (a distressing amount) of the ab-only programs not only don't provide accurate information about contraception, etc. but actively provide medically inaccurate information. This ranges from relatively grey-area stuff like, "condoms are only 85% effective, so that means that you're running a 15% chance of getting an STD every time you use one" (OK, maybe they misread the stat) and "abortions increase your risk of breast cancer" (pretty well debunked, but not everyone reads the JAMA) to really out-there things like "condoms don't prevent any STDs at all" (see one of the above comments) and "abortion will definitely give you breast cancer."

There's a lot of rhetoric on both sides, to be sure. Some folks on my side can be pretty hair-trigger about any mention of abstinence, e.g. But most folks (at least most policy-wonk folks, the people I know) are in favor of encouraging abstinence for younger folks, but want to equip them with the knowledge of how to protect themselves when/if they do have sex. To return to the car analogy - I don't want my 14 year old driving, but refusing to teach her how to use a seat belt is probably not the best response.

And so, I'm not saying that there are no potential harms from going out and having sex, especially emotional ones for younger people who have a less-sturdy sense of themselves. All I was saying is that, minus a moral conviction that extramarital sex is in-itself an evil, protecting people from harm indicates both encouraging them to avoid dangerous behavior and helping them mitigate the risks of that behavior if they don't avoid it because they decide that they would like the potentially-risky good (like skiing, or driving, or eating sushi), and so "just don't have sex" isn't an adequate basis for public policy. It might be a perfectly acceptable way to live one's own life.