Quick question, do you have a condom in your wallet right now? How about a box somewhere near you? Take a moment to get it out, we’ll wait. Got it..great! (or, you can look to the left, just sayin’) Now, read the condom package. Does it say how effective it is in preventing HIV during gay male anal sex? Does it give you a percentage of how effective it is? No? That’s odd. Or is it?
During the last four (4) decades, give or take, we gays have been sold the line that condoms are a must for every sexual encounter we have. In the beginning of the Age of AIDS, many medical experts were able to convince a few terrified guys that even sucking dick required a wrapping in latex. More than a few of those guys are still walking the earth like Betamax, Atari and shell top Adidas. Of course, many will argue that it was our first and best line of defense and nothing, not even PrEP compares. But, is this true?
For the last decade we at GMJ, when working for other organizations have looked into the effectiveness of condoms, gay male anal sex, and the 99% effective rant that is spread all over the Internet by those totally apposed to new medications, treatment options, #UequalsU and of course, the big bad demon PrEP. These guys are convinced that condoms are able to stop not only the spread of HIV but also every single sexually transmitted disease and even the common cold better than my abuela’s chicken soup. The problem is that all of that is totally incorrect.
So, we wanted to begin with the basic argument for using condoms. “They are 99% effective in stopping the spread of HIV/AIDS”. Fact: Condoms were not, and are not created for gay male anal sex. They were created to prevent pregnancy with heterosexuals. Full. Stop.
The nations leader in information about pregnancy, Planned Parenthood has this to say about your 99% effective quote. “If you use condoms perfectly every single time you have sex, they’re 98% effective at preventing pregnancy. But people aren’t perfect, so in real life condoms are about 82% effective — that means about 18 out of 100 people who use condoms as their only birth control method will get pregnant each year.” They aren’t even 99% effective in stopping what they are created to stop.
Now, for you, pregnancy is not an issue, so even without condoms you are 100% safe. But, of course you say, but they still are 99% effective in stopping HIV! How do you know that? From studies like this?
Well, if you read between the lines, you will notice that none of these studies have gay males as subjects. They base their information on straight, vaginal sex, and just guess that the effects would be the same for us. Hell, they even specifically mention the “female partner”. Anal sex between men is not the same as vaginal sex.
T.J. Miller researched this very topic and wrote about it for Positivelite.com He was able to find the same two (2), yes only two, studies that we did regarding gay male sex and condoms. You are so going to want to sit down for this.
In order to understand the importance of these two studies we have to set a few facts and understand a few ground rules.
- Fact number one: No government agency in the United States, Canada, Europe or anywhere else in the world has ever certified condoms for use in anal sex. They are regulated as a method of birth control, and as such they are tested for that use and certified for that use.
Numerous other articles have been published about this fact, but just to make sure, I contacted the U.S. Food and Drug Administration and they referred me to a February 10, 1987 statement made by then Surgeon General of the United States Dr. C. Everett Koop before the Committee on Energy and Commerce of the U.S. House of Representatives.
In his statement Dr. Koop states that condoms have not been tested by the FDA, but that they have been tested in outside studies as to their ability to stop the transmission of the HIV virus.
- Fact number two: Every condom study that has been performed that I can locate in scientific literature, medical libraries and utilizing online resources, except for the two that I am relying on for this article, use observational data rather than measurable/quantitative data.
This means that the scientists that have published studies in these other studies did not use the actual product in real life situations OR they asked their test subjects to give the scientists their data after the event occurred, to the best of their recollection.
In other words, most of the studies tested condoms on mechanical devices that simulated sexual activities (mannequins) or their method of collecting data from human test subjects was to have their subjects fill out forms after they used the product, sometimes days/weeks/months after they used the product, or in the case of several studies where a test subject had a diagnosis of a sexually transmitted illness they had the client fill out the data form after the client was initially diagnosed.
Now, we know how you guys are, and Mr. Miller’s research is not going to be enough to get you to start thinking about what you’ve been told all of your adult life. So, let’s see what some other organizations in the HIV field had to say on the subject.
The Bodypro.com, a leader in HIV/AIDS information, answered the question this way:
So How Effective Are Male Condoms?
“The best evidence we have on the effectiveness of male condoms comes from an analysis of 14 observational studies that enrolled heterosexual serodiscordant couples (where one partner is HIV-positive and the other is HIV-negative). The analysis compared the rate of HIV transmission between couples who said they always used male condoms to the rate among couples who said they never used male condoms. The analysis found that the rate of HIV transmission was 80% lower among couples who reported always using condoms.”
aidsmap.com also took a stab at the question of condoms, gay anal sex, and HIV:
What about condoms’ efficacy against HIV in sex between men?
Remarkably, despite gay men being the first and still the largest at-risk population in the developed world, and themselves largely responsible for the ‘safer sex’ movement, there has been no similar meta-analysis of the extent to which using condoms actually prevents HIV infection in gay men. This may be because the majority of HIV transmission amongst gay men occurs in casual sex situations, where the HIV serostatus of partners cannot be assessed, and so the degree of HIV exposure risk cannot be ascertained.
The only data we have relating HIV incidence among gay men to condom use come from retrospective studies of gay men diagnosed with HIV who were asked about their condom use. In a 2006 study, gay men diagnosed with HIV in the main HIV clinic in Seattle were asked about whether they had consistently used condoms and also whether they had tried to ‘serosort’, i.e. restricted unprotected sex to men they knew or were sure were HIV-negative. The rate of new HIV diagnosis among men who attempted always to use condoms was 1.5%, among patients who had unprotected sex but tried only to do it with same-status partners was 2.6%, and among men who had unprotected sex regardless was 4.1%. Adjusting for the number of partners (though not for their HIV status), attempted consistent condom use was 76% effective in preventing new HIV infections. This is a retrospective epidemiological study with nothing like the same degree of rigour as the studies of HIV serodiscordant couples, but it does yield an estimate of condom efficacy.
One ongoing problem in assessing the effectiveness of different HIV prevention methods is that anal sex is under-studied. We do not have enough data on rectal viral loads and their effect on transmission, or on whether HIV treatment reduces transmission via anal sex as well as it does for vaginal sex.
We are also unclear about to what extent condoms actually prevent HIV transmission in anal sex. This last fact may seem surprising, given that condoms have been recommended since the mid-1980s as the only effective HIV prevention method for gay men who have anal sex.
In fact, there is only one large study in gay men, dating from 1989. In this study of 2914 gay men, HIV incidence among those who said they used condoms 100% of the time was 70% lower than in men who did not use them at all. There has been one small study in the era of antiretroviral treatment (ART), which found an efficacy of approximately 75%.
And finally, From the CDC comes this hidden gem:
At the 2013 Conference on Retroviruses and Opportunistic Infections (CROI), Dawn K. Smith, MD, MPH, an epidemiologist at the Centers for Disease Control and Prevention, presented results of research she and CDC colleagues conducted about the effectiveness of condoms among MSM. (“Effectiveness” is synonymous with condoms’ success rate, or how well they reduce HIV risk.) Those MSM who always use condoms, she reported, have a 70 percent lower risk of HIV than those who always bareback (condomless/natural sex to those of us who don’t believe in stigma).
Smith says she is “very confident” about the 70 percent figure, saying it is “the best estimate we have” of the actual real-world effectiveness of condoms in preventing HIV among MSM who use them consistently and correctly.
Others are less confident. “It is important to highlight that the 70 percent estimate of condom effectiveness is precisely that, an estimate, and is not set in stone,” says Alfonso C. Hernández-Romieu, MD, MPH, a research associate in the department of epidemiology at Emory University in Atlanta, who recently published a study in the journal Sexually Transmitted Infections about the considerable rates of condom failure and misuse among MSM. “As our capacity to measure condom use grows, we will likely revise [the estimate].”
We at GMJ, of course, aren’t trying to scare you. The point of this article is to get most of you to start thinking critically when you read about some new study or repeat numbers and figures that you didn’t research yourself. Many of you have been holding up that 99% effective number like a shield without any research to back it up. You proudly allow it to block any new information about other methods to protect yourself from HIV, like PrEP, that have been studied and verified dozens of times over, to be given any serious consideration. Worst of all, some of you have used that number as a sword to attack your brothers that make different decisions than you. All the while, you have been the one wrong.
Yes, condoms must logically provide some level of protection from HIV (it is a latex barrier) but to what exact extent, we don’t know. But we do know that is is nowhere near 99% or even 70% and that’s before we factor in human error, breakage and just plain ole bad luck. As for other sexually transmitted diseases, we stand at the same point. Until our community is allowed inside of these tests, until our particular type of sex is studied and analyzed we will be basing our choices off of heterosexual, vaginal encounters which are estimated for our population. And that’s not cool.