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.

[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.

[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.