The Briefing Room

Here’s an interesting but little-known fact about condoms that may just win you a meat tray down at the pub Thursday night: the use of condoms dates back at least as far as ancient Rome and Egypt. Not only that, but archaeologists have discovered early cave paintings that seem to suggest (appropriately enough) that pre-historic Frenchmen may have discovered the things thousands of years before the New York Times ran the first-ever print ad for ‘Dr. Power’s French Preventatives’.
Looking for more condom trivia? Before the latex condom was invented, condoms were made by hand-dipping molds into rubber cement (hence the slang term). But in 1919 an inventor in Ohio by the name of Frederick Killian figured out that latex was a much better material for the purpose, and by the mid-1930s, at the height of the Depression, American manufacturers were producing 1.5 million condoms a day.
Oh, and here’s one more interesting thing about condoms: contrary to popular belief, they are not hugely effective in preventing an incredible variety of sexually transmitted diseases – from HPV, or human papilloma virus, which is linked to more than 90 per cent of cases of cervical cancer and also cause infertility, to herpes.
How can this be? Since the mid-1980s and the discovery that AIDS could be prevented by condoms, ‘French letters’, ‘rubbers’, and ‘raincoats’ have stopped being something that people whispered and tittered about and instead become deadly serious business. Around the world public health authorities, looking for a way to keep AIDS from spreading out of control, have promoted condoms in earnest for nearly two decades now with a variety of advertising campaigns.
But all is not happy and healthy in New Zealand’s bedrooms. While the number of AIDS cases is low, new HIV cases are on the rise, and the rates of many other infections are climbing as well. And while none are necessarily the death sentence that an HIV infection represents, they have potentially huge consequences,
including cancer and infertility. Public health experts have seen a tremendous increase in cases of diseases like chlamydia and syphilis; in the Australian state of Victoria, the situation is so bad that Chief Health Officer was compelled this past March to issue a formal Health Alert to general practitioners telling them to watch out for the sudden uptick in syphilis cases. That sort of warning is not an everyday occurrence: the last time the Chief Health Officer issued such a bulletin was in 2003, warning doctors to be on the lookout for SARS.
But if you think the Victorian warning is bad, Auckland’s chlamydia epidemic is three times worse than Australia’s, and in the far north as many as 25% of young people have the disease. Overall, the upper North Island’s chlamydia rate is six times higher than the Australian average.
There are many factors behind the rise in various STDs, but one has gone all but unreported in a culture where, officially at least, condom use has taken on an almost sacramental nature: studies conducted over the past few years show that, far from being the be-all and end-all in sexual protection, condoms offer practically zero effective protection from most STDs apart from HIV, ironically.
In other words, when the emperor has no clothes on, a condom is of limited, if any, use in protecting him from a host of diseases.
Back in 2001, the United States’ National Institutes of Health published a series of findings that were shocking, both because they completely overturned long-held conventional wisdom on a very important topic, and also because they received virtually no media coverage. Indeed, the Washington Post at the time reported that ‘some health officials considered keeping the report private’, adding that ‘some family planning advocates said they feared that the new report would be used to put pressure on the FDA to change condom labels to reflect the conclusions.’
As one commentator puts it, ‘It’s like hearing that Grandma died and immediately asking if Grandma will be making brownies for the funeral. The reality of the loss just hasn’t sunk in yet.’
Among other things, the study found that when one partner is infected with herpes, using condoms cut the risk of transmission by only about forty percent. In other words, despite the condom, there’s still a 60% risk of passing on the herpes virus.
Meanwhile, with regard to human papilloma virus, by far the number one cause of cervical cancer, ‘the Panel concluded that there was no epidemiological evidence that condom use reduced the risk of … infection’.
In non-medical speak, there’s no evidence at all that condoms can prevent the spread of infection.
Follow-up studies in the past five years have only confirmed the worst fears of researchers – in the case of syphilis, for example, even consistent use of a condom will only give you 29% protection against the venereal disease – you still have a 71% chance of catching the pox, even with a condom.
And this doesn’t even begin to take into account the misuse, or irregular use, of condoms: according to just one study of Australian high school students, 68 percent of those surveyed who said they were sexually
active admitted that they don’t use condoms every time they have sex, despite the fact that virtually every kid in the state’s schools is given lessons in how to use the things. And even among adults, condom usage can be irregular, or start too late in an encounter, to prevent the spread of many infections.
‘The term “safe sex” needs to be examined in detail’, says Dr. Caroline Harvey, Medical Director for Family Planning Queensland. ‘We give people many mixed messages depending on whether we are talking about preventing pregnancy or sexually transmitted infections or HIV. In my dealings with clients, I’ve found that when they ask about safe sex, you need to talk to them and pull apart what they’re talking about.’
‘Viral infections like herpes and HPV do spread from skin-to-skin contact’, she adds, something that many people who come into her office are unaware of. According to Harvey, depending on what the client is looking to prevent, the options may be very different – something that doesn’t always come through in media campaigns such as the NZ Ministry of Health’s ‘No Rubba, No Hubba-hubba’ effort.
In fact, the Ministry of Health website for ‘Hubba’ is so inaccurate there are sufficient grounds to shut it down. After identifying a range of sexually transmitted infections, including “chlamydia, genital warts, herpes, or gonorrhoea”, the website’s FAQ section then asks:
Q: How can I protect myself against STIs?
A: Use condoms. Correctly used and used every time you have sex, condoms are the most effective protection against most STIs, including HIV/AIDs.”
Now here’s what the most recent scientific studies* have shown about condom effectiveness for a number of the diseases listed on the Hubba site:
Chlamydia: still a 60% chance of catching it even if a condom is correctly used every time
Gonorrhea: still a 60% chance of catching it even if a condom is correctly used every time
Herpes: still a 60% chance of catching it even if a condom is correctly used every time
Genital warts: no published study has found condoms can protect against this at all
Either New Zealand Ministry of Health officials and Health Minister Annette King are woefully ignorant of the failings of new scientific data over the past five years, or the Ministry is delib-erately ignoring the facts, knowing that hundreds of thousands of school students have been misled about safe sex over that time, leading to now-record levels of sexually transmitted diseases in young people, at a cost of millions of dollars to taxpayers and the community.
The Hubba website doesn’t care that its “information” for young people is dangerously incorrect, judging from its arrogant Q&A on condom ‘safety’:
Q: Are condoms safe?
A: Condoms do protect you. Some people say it isn’t worth using condoms because they have holes big enough for viruses to get through, but that’s not true. Bacteria and viruses…cannot pass through an undamaged condom.”
Tell that to the international medical journals and research teams.
For the Hubba website to claim that condoms are “the most effective protection” against sexually transmitted diseases is incredible, especially if the 50% failure rate in condoms is not being disclosed to young people.
Nor is New Zealand’s influential Family Planning Association in the clear on this one. The Association’s resource kits blatantly state: “Condoms are known to greatly reduce the risk of catching other STIs such as chlamydia and gonorrhoea.”
In the course of researching the article, the revelations stunned many on the magazine’s staff and in the wider community as we gathered interviews.
“I can’t believe it,” one woman told us. “There are women who go through their pregnancies terrified
because they have a one in 600 risk of having a deformed child, and we’re talking here about a one in two risk of contracting serious and in some cases incurable sexual diseases even if we use a condom. Why on earth hasn’t anyone told us this before?”
While it is conceded that condoms can reduce your risk of catching an STD by around half, a one in two chance is still worse odds than a round of Russian Roulette, and hardly equates to “safe sex”. And if teenagers are not being told the grim full story in their school sex education classes, thanks to a Ministry of Health cover-up or botch-up, is it possible that kids have increased their sexual activity in the mistaken belief that a condom will somehow protect them?
Is that the real reason for the massive increase in STDs?
Instead of telling teenagers the cold hard truth, they’ve been lulled into such a false sense of security that they’ve tripled or even quadrupled their “bonk-rate” over the past 20 years of “safe sex” campaigns, making the (at best) 50% effectiveness of condoms useless in practical terms. If you’re having four times more sex because you think condoms make it safe, in real terms you’ve actually doubled your risk of catching an STD.
And you won’t read that in the “No Rubba, No Hubba” material.
Naturally, we asked New Zealand’s Ministry of Health to justify the outrageously inaccurate data in the Hubba campaign.
“I’ve referred your question to one of our senior policy analysts,” said Hubba director Sally Hughes, “and they tell me that the Ministry of Health is satisfied that condoms are effective. We rely on the World Health Organisation’s Bulletin of June 2004 which includes a study of condom effectiveness.”
Again, naturally, Investigate checked up. Although the WHO Bulletin is bullish in its language and socially liberal in its conclusions, the Bulletin nonetheless concedes that every medical research study since 2001
has found condoms have only limited efficacy against venereal diseases.
“A meta-analysis of 20 studies found no evidence that condoms were effective against genital HPV (warts or cervical cancer) infection.”
So strike one against condoms in the very report New Zealand’s Ministry of Health is using to justify its
fatally-flawed “safe sex” message. If just one New Zealand woman contracts cervical cancer because she relied on the ‘No Rubba’ campaign, does that make the Ministry of Health criminally negligent?
But there’s more.
The WHO document also discloses that a study of teenagers in the US revealed that STD rates were virtually the same between those who always used condoms (a minority) and those who either used condoms intermittently or not at all.
Twenty one percent of those who always used condoms had caught STDs, compared with 23% of the “sometimes or never group”.
“So why are you continuing to push this condoms = safe sex message,” we asked a senior Ministry of Health official, “when clearly it’s the biggest load of old codswallop that’s ever been perpetrated in a PR campaign?”
“Well,” pondered the official after a moment, “perhaps the studies didn’t properly monitor whether people really did use condoms all the time.”
“Well, this is the WHO Bulletin that your own Hubba team referred me to…” we responded.
The WHO document also acknowledged and quoted the same studies we quoted earlier, showing (at best) a 40% reduction in the chances of a herpes or chlamydia infection.
Yet despite confirming that condoms are less safe than a six shooter revolver with one bullet loaded, the WHO seems to regard any reduction in STD risk as a good reason to keep promoting condom use.
‘Condoms are useful’, maintains Anna McNulty, Director of the Sydney Sexual Heath Centre, when asked about diseases that spread despite the use of condoms. McNulty adds that the increase in the rates of infection various sexual diseases – chlamydia rates have trebled in her state alone in the last five years according to one estimate – could come from a variety of factors including, she claims, the lack of access to health care among young people.
The problem, says McNulty, is that ‘people use them some of the time but not all of the time’, and admits that while a great way to prevent things like AIDS and unintended pregnancies, in terms of preventing herpes and the genital warts that can lead to cervical cancer, ‘they are not as effective.’
An added challenge is that fact that many diseases such as chlamydia can be asymptomatic, especially in men. ‘It can be silent for a long time, but it can cause significant damage’, says Dr. Harvey.
Despite this, many public health bodies are delivering a mixed message. While, for example, South Australia’s Health Department’s web site frankly states that ‘condoms will give you some protection from most sexually transmitted infections, but some, like herpes, crabs and genital warts, can spread through skin-to-skin contact’, it is a message that often gets lost when it is boiled down to a catchy slogan – such as ‘Safe Sex, No Regrets’, the message currently being pushed in an NSW Health ad campaign, or the aforementioned ‘No Rubba,
No Hubba’.
Featuring a variety of television and print ads, the ‘Safe Sex, No Regrets’ campaign shows groups of healthy, happy, good-looking young people – straight and gay and of various ethnicities – in different social circumstances. The copy on the print ads says things like, ‘Tonight I’m picking up chlamydia’ or some other disease, with the name of the disease crossed out and the word ‘condoms’ printed underneath it, the implication being that condoms are all one needs to have what the tag-line calls, ‘no regrets’. In one ad specifically targeting Aboriginals, readers are told that ‘sexually transmitted infections … can affect anybody who has unsafe sex.’
Which is absolutely true, but again fails to mention that condoms are not foolproof against disease – and that ‘no regrets’ is a pretty broad statement that implies something close to 100 per cent reliability. Yet very little is ever 100 per cent when health and medicine are involved (and in the sense that condoms are used to prevent the spread of disease, they have a medical component), and if the maker of any other device with as many caveats as condoms have attached to them ever tried to advertise in a similar way, they would be shut down by the authorities sooner than the casual couples featured in NSW Health’s campaign could wake up the following morning with a splitting headache and serious misgivings.
But while the campaign does not tell the whole truth about condoms, McNulty says that ‘you have to keep the message simple, and the “Safe Sex, No Regrets” campaign did a good job as it targeted both young heterosexuals and gay men.’ She concedes, though, that even with 100% condom usage, people are not fully protected against skin-to-skin infections.
So what to do about all this? In Australia, national strategy on sexually transmitted diseases is due to be released in July, and according to McNulty, it will definitely have an emphasis on chlamydia and the sudden spike in infection rates, and will push for increases in screening. Easy tests now exist to detect the infection, and treatment is normally a simple antibiotic treatment. But the campaign will also continue to emphasize ‘safe sex’ – perpetuating the lie.
“Take the example of NSW’s ‘Safe Sex, No Regrets’ campaign,” Investigate put to Hubba director Sally Hughes. “That campaign features a poster on chlamydia.”
“I’ve seen it, yes,” she confirmed.
“Which, based on the scientific evidence now pouring in, is totally and utterly untrue!”
And yet the Hubba website makes pretty much the same claims online about using condoms to prevent chlamydia.
There is another aspect to consider. A generation ago, couples were getting married in their early 20s, entering stable relationships and generally avoiding promiscuity. As a result, STD rates were much lower in the seventies and eighties. But today, most people are not settling into long term relationships until their late 20s or early 30s. They now have multiple sexual partners before marriage, and a corresponding huge rise in sexual disease rates. By the time many women now get around to having children, age and their exposure to STDs have played havoc with their fertility. Just another price that Generation-X will have to pay for the safe-sex myth the liberal Baby Boom generation lumbered them with.
The problem is that sex is a much more compli-cated thing than people of all stripes care to acknowledge, which is why diluting informa-tion about condoms to a happy, easily-digest-ible slogan that inspires false confidence is an irresponsible position for public health authorities to take. Yet that is exactly what campaigns such as ‘Safe Sex, No Regrets’ and ‘No Rubba, No Hubba’ do by telling young people that using a condom is as simple a way to have a good time while preventing misery down the road as, say, advising them to only drink bottled water when they’re backpacking up some gorgeous Third World coastline.
The danger of “safe sex”, or “safer sex” as a slogan is that it cons people into thinking there is either no risk, or minimal risk. Yet a 71% chance of catching syphilis through a condom is hardly “safe” or even “safer”.
Yet the resistance to telling the truth about condoms is so thick you can cut it with a knife.
“What do you want us to do?” growled one sexual health campaigner spoken to by Investigate’s Sydney
office, “preach abstinence?”
It is as if the sex education lobby is so wedded to pushing the “free sex, no consequences” message that they regard the scientific facts as a mere inconvenience, and have no intention of changing their advertising campaigns.
Case in point? As this article was about to go to press, TV1’s award-winning Close Up programme ran as lead story some Ministry of Health propaganda about a new survey that “…shows a lack of awareness among
the young about the need to use condoms to prevent sexually transmitted infections,” presenter Susan
Wood intoned.
“What researchers say is noticeable in the survey is the way teenagers seem to think they’re invulnerable when it comes to sexually transmitted infection. According to the stats, 74% of students agreed that it was likely young people their age would get some kind of sexually transmitted infection. But only 23% thought that it could happen to them. When students did use condoms the reasons were more likely to be a fear of pregnancy than of sexually transmitted diseases. That comes at a time when STDs nationally are showing an alarming increase. The latest national figures from the sexual health clinics show that chlamydia rates are up 28% and gonorrhea is up 44%.
“With the survey showing a cavalier attitude to condom use amongst teenagers, the concern is that sexually transmitted diseases will only continue to increase, despite the message: if you don’t use a Rubba there’ll be no hubba hubba.”
That message, as we’re now revealing, is a complete fraud. Nonetheless, both the NZ Herald and the Christchurch Press ran the propaganda as the front page lead story the next day.
In another fascinating aside, a study in the British Medical Journal measured the effectiveness of a condom promotion strategy, much like the Hubba and No Regrets campaigns, but targeted at gay men. The survey found that while the condom promotion resulted in fewer cases of unprotected sex, inexplicably the rate of sexually-transmitted diseases “significantly increased”.
Perhaps, conned into thinking condoms were “safe”, the men indulged in more sex and thus increased their overall risk of infection.
While it may not be as sexy a message, so to speak, health authorities should instead work to tell people of all ages in the community that despite their best efforts, behaviours – especially risky ones – can have consequences. The campaign wouldn’t have to be prudish or paranoia-inducing, either, but simply give people the facts: condoms are great for certain things, but there are still high risks involved with having sex with people whose history and health status you’re not sure of. No one would dream of running an ad implying that wearing a helmet was all one needed to stay safe when riding a motorbike; there are plenty of other factors involved that keep one safe on the road, and people are well aware of this. The same sort of truth needs to be told about condoms.

WHAT THE STUDIES SAY
WORLD HEALTH ORGANISATION BULLETIN, June 04: “No published prospective study has found protection against genital human papillomavirus (cervical cancer/warts/HPV) infection”
JOURNAL OF SEXUALLY TRANSMITTED DISEASES, 2003; 30: 273-9: A study of 917 female sex workers in Lima, Peru, were re-examined monthly for STDs. Those women who consistently used condoms still had a chlamydia infection rate of 74% compared to the infection rate of women who didn’t use condoms
AMERICAN JOURNAL OF PUBLIC HEALTH, 2003; 93: 901-2: A study of 380 American girls aged 14 to 18 over six months revealed that 30% of the girls who did not use condoms had caught a sexually transmitted disease by the end of six months, as had 17.8% of the girls who always used condoms
AIDS, 2001; 15: 2171-9: A study of 17,264 adults in the town of Rakai, Uganda, over four years, measured STD infection rates in the population and the effectiveness of condoms. Only 4.4% (760 people) had always used condoms. Of those people, consistent condom use only resulted in a 29% reduction in syphilis infections, and a 50% reduction in chlamydia and gonorrhea. The prevalence of the STDs trichomoniasis and vaginosis “were not reduced”. Even with HIV, the disease the condoms are most effective at preventing, the infection rate was still 37% of the rate of those who didn’t use condoms
JOURNAL OF SEXUALLY TRANSMITTED DISEASES, 2002; 29: 725-35: A meta-analysis of 20 studies “found no evidence that condoms were effective against genital HPV infection”, warts or cervical cancer
AMERICAN JOURNAL OF EPIDEMIOLOGY, 2003; 157: 218-26: A study of 444 female university students found “that consistently using condoms with a new partner was not associated with significant protection against HPV”
AMERICAN JOURNAL OF EPIDEMIOLOGY, 2004; 159: 242-51: A study of 4314 participants who visited STD clinics found consistent use of condoms still resulted in an infection rate of 82% compared against those who didn’t use condoms
JOURNAL OF INFECTIOUS DISEASES, 1999; 180: 1624-31: A study followed the progress of 484 adolescents at four STD clinics over six months, and found 21% of those who always used condoms had caught a sexually transmitted disease, compared with 23% of those who sometimes or never used a condom (a 91% risk of infection, group vs group)
JOURNAL OF SEXUALLY TRANSMITTED DISEASES, 1995; 22: 15-21: A study of 598 people attending an STD clinic in Baltimore found infection rates were almost the same, regardless of whether a condom was always used or not