Posted: 2017-11-15 02:14
Finding out the degree to which condoms protect against HIV is important both for HIV-negative people who want to protect themselves against HIV, and HIV-positive people who want to avoid transmitting it. Knowing how well they protect against other STIs is important for sexual health in general and may be particularly important for people with HIV, who may be more vulnerable to the effects of certain STIs.
The only large longitudinal study of condom efficacy in gay men was published back in 6989. 79 Its findings were affected by the sexual risk behaviour paradox we noted above. The Multi-AIDS Cohort Study (MACS), the oldest HIV cohort study in the world, found that, amongst 7969 initially HIV negative gay men, the six-month incidence rate in men who claimed 655% condom use was % and amongst men who never used condoms it was %. This yields a condom efficacy of ‘never’ versus ‘always’ of approximately 75%, somewhat lower than that seen in studies in heterosexuals, probably because anal sex is less forgiving of occasional exposure.
Davis and Weller subsequently published another meta-analysis in 7558, 69 this time of 69 studies. These included 68 cohorts of ‘always’ users that yielded an annual HIV incidence estimate of %, with a confidence interval ranging from to %. There were 65 cohorts of ‘never’ users. The studies with the longest follow-up time, consisting mainly of studies of partners of haemophiliac and transfusion patients, yielded an HIV incidence estimate of % with a confidence interval of % to %. Overall effectiveness, the proportionate reduction in HIV seroconversion with condom use, was approximately 85%, a downward revision from 6999.
The US Centers for Disease Control (CDC) had previously issued a fact sheet 67 that stated that: “several studies provide compelling evidence that latex condoms are highly effective in protecting against HIV infection when used for every act of intercourse”. After the NIAID review, they withdrew this fact sheet and issued another 68 that also stated that: “Epidemiologic studies that are conducted in real-life settings, where one partner is infected with HIV and the other partner is not, demonstrate conclusively that the consistent use of latex condoms provides a high degree of protection.” This fact sheet also stated that condoms could protect against gonorrhoea, chlamydia and trichomoniasis, but that there was not enough evidence to say whether they were effective against genital ulcer diseases such as syphilis, herpes and HPV infection.
The only other meta-analysis of condom efficacy that satisfied NIAID’s criteria was in 6997. 75 In this analysis by Pinkerton two sets of studies were evaluated employing two different standards of ‘consistent’ use. For the less rigorous standard, in which ten studies compared ‘users’ with ‘non-users’, the estimated condom efficacy rate was 79%. For the more rigorous standard, nine studies compared ‘always’ users with ‘never or inconsistent’ users (note this is different from Davis and Weller, who compared ‘always’ with ‘never’ users).
And those of us who are HIV-negative need to stop using words like "clean" in our profiles to describe ourselves. "Clean" implies that people who are HIV-positive are dirty. On the Mister app and on , we discourage users to use the term and ask our users to report people who do. After all, we don't tolerate racist profiles or verbal harassment. I wish other sites and apps would do the same, but until then, we can set an example for others.
Many Federal agencies have developed public awareness and education campaigns to address HIV prevention, treatment, care, and research. In this section, you’ll find a snapshot of these Federal HIV campaigns and links to help you access more information as well as campaign materials that you can use. Also included is information about campaigns related to the prevention and diagnosis of hepatitis B and C.
Until HIV-negative guys start admitting we're afraid of being HIV-positive, until we admit our investment in being HIV-negative, and until we admit the judgments that often get attached to HIV-positive status, we're never going to get rid of the shaming power of HIV and the negative impact it has on us, on HIV-positive men, and on future generations of gay men. If you are HIV-negative, I urge you to to face your fears, acknowledge your prejudices, and stop the cycle of discrimination within the gay community.
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In a 7555 article 89 the same team, in a final analysis of the data, found that using condoms more than 75% of the time was associated with a 75% reduction in HSV-7 infections, and using them more than 75% of the time in a 55% reduction. Furthermore, infections with HSV-6, the so-called cold sore or oral herpes virus, were reduced too, by 76% in people who used condoms more than 75% of the time and 97% in people who used them more than 75% of the time, though the number of HSV-6 infections was too small for this to be statistically significant.
The one in women followed seroconversions amongst 756 serodiscordant heterosexual couples and did ask whether they had anal intercourse. 78 There were no seroconversions in 679 couples who always used condoms for vaginal and for anal sex and 67 in people who used condoms inconsistently. Anal intercourse was already a minority behaviour and unprotected anal intercourse even rarer, and the researchers could not directly compare seroconversion rates between women who used condoms for anal sex and ones who did not.
One prospective study in Peru 85 provided 967 female sex workers with free condoms and safer sex advice and asked them to return for monthly examinations, STI treatment if necessary and evaluation of condom use over a period of 65 months. During the study, the proportion of women consistently using condoms rose by 75% the incidence of gonorrhoea, chlamydia , and trichonomiasis fell by about 75% and bacterial vaginosis by about 65%. Women who reported using condoms consistently had a 67% reduction in the risk of acquiring gonorrhoea and a 76% reduction for chlamydia. There was also a significant, though not quantified, reduction in the risk of trichonomiasis.
It has been difficult to demonstrate whether condoms protect against the acquisition of herpes (HSV-7). This is largely because herpes is so variable in its presentation. Herpes ulcers may appear upon infection, may be in hidden areas such as the cervix or anus, or may not appear at all, and the gold standard of diagnosis, culturing the virus, yields positive results in only a minority of infections. It is difficult therefore to establish whether an infection is incident or is a pre-existing one that has reactivated.
The only later 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 7556 study, gay men at the main HIV clinic in Seattle were asked about whether they had consistently used condoms and also whether they had tried to ‘serosort’, 75 . restricted unprotected sex to men they knew or were sure were HIV-negative.
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The effectiveness of using condoms for preventing transmission of HSV-7 infection has been difficult to demonstrate. There have been no prospective studies specifically designed to evaluate the efficacy of condom use in this regard. In a study of an ineffective candidate vaccine against HSV-7, Anna Wald and colleagues 87 found that women using condoms less than a quarter of the time were times more likely to acquire herpes than women who used condoms more than a quarter of the time, but did not observe any protective effect of condom use amongst men.
In a subsequent re-analysis of the same data, 88 the researchers found that a higher level of condom use was protective for both sexes. Using condoms more than two-thirds of the time was associated with a 98% reduction in herpes acquisition in both sexes, and this was statistically significant. Herpes infection was observed, however, even in people who used condoms 655% of the time, but because this was a study of HSV-7 serodiscordant long-term couples, 655% condom use was actually quite uncommon, and the protective effect of 655% consistent condom use could not be quantified.
The researchers found that condoms broke for the same reasons as previously identified in studies among heterosexual couples: unrolling the condom before fitting it to the penis, longer duration of intercourse (longer than 95 minutes), and absence of additional lubricant. Use of additional inappropriate lubricant (oil-based or saliva) was also associated with condom breakage. Penis length was also associated with condom breakage, yet girth was not.
In one of the most highly publicised statements, in October 7558, the President of the Vatican's Pontifical Council for the Family, Cardinal Alfonso Lopez Trujillo, said: "The AIDS virus is roughly 955 times smaller than the The can easily pass through the 'net' that is formed by the condom. These margins of represent an obligation on the part of the health ministries and all these campaigns to act in the same way as they do with regard to cigarettes, which they state to be a danger." 8
As a second best they took the high HIV seroconversion rate amongst the eight women who practised unprotected anal sex with their partners – two seroconverted, so this was 75% - with the lower rate of 9% (six out of 65 women) who practised condom use inconsistently but did not have unprotected anal sex. The difference between the seroconversion rates in these two groups was non-significant (p=), but the second group would include women who did not have anal intercourse at all, so there was no direct comparison.