Sexual health suggests death of the condom culture?

Sexual health suggests death of the condom culture?

By Dave Hill

LONDON: Where have all the rubbers gone? The question,
unconnected with the provision of classroom equipment, might seem
unnecessary. Long past are the days when purchasing prophylactics
involved pharmacists reaching furtively under counters or coded
barbershop exchanges about "something for the weekend".

Today, condoms are everywhere. You're waiting for your piles
prescription and a rank of gleaming boxes speaks of ribbed
shafts, fruit flavors and "Xtra Pleasure for Him and Her". You're
in the supermarket perusing frozen peas, knowing that a phalanx
of French letters is just an aisle or two away.

But does this brazen visibility, now established so
thoroughly, necessarily mean that the condom is doing the good
work for which it emerged from the shadows in the first place?
The joint may be jumping with johnnies, but what effect has that
had on the perils they are designed to prevent? Does the condom
culture, so central to the promotion of safe sex, have quite the
force it did when it emerged in the early 80s in response to
AIDS?

The signs are not encouraging. For example, if the new
ubiquity of the everyman of contraception has had a limiting
effect on rates of teenage pregnancies it hasn't been enough to
knock the UK off the top of the European league.

Moreover, the latest data on HIV infection and other sexually
transmitted infections (STIs) make it tempting to conclude that
condom use is going radically out of style. Figures from the UK's
public health laboratory service (PHLS) for last year showed
2,868 new HIV diagnoses, with more likely to be added as
information continues coming in. This represents a 7 percent rise
in 1999 - which was itself a 10-year high. Other STIs are also
being diagnosed in larger numbers.

At the end of last year the PHLS also reported big rises since
1995 in diagnoses of genital warts (up 20 percent), syphilis (up
54 percent), gonorrhoea (up 55 percent) and, most spectacularly,
genital chlamydia (up 76 percent).

This data should be handled with appropriate care. Chlamydia
was almost unknown to the general public until a few years ago,
but has been vigorously targeted by providers of sexual health
services and information - hence the huge rise in its diagnosis
figure may partly reflect increased amounts of testing.

Similarly, many of the new HIV diagnoses have been of people
who were infected some years ago but have only recently come
forward for testing, perhaps encouraged in some cases by the
emergence of drug treatments which slow the development of the
virus. None the less the PHLS view is that "the rises in acute
STIs are likely to be associated with increasing unsafe sexual
behavior particularly among young heterosexuals and gay men".

The basic prevention message remains the same: use a condom.
So why does rejection of them appear to be strengthening,
especially among certain social groups?

Again, there is a need for circumspection. For example, Will
Nutland, a health promotion manager at British HIV/AIDS agency
Terrence Higgins Trust Lighthouse, cites research showing that
while there is some evidence that gay men are having more
unprotected anal intercourse, there is also evidence that many of
those who do so are aware of their own and their sexual partners'
HIV status and proceeding accordingly: if both partners are HIV
positive, a condom becomes redundant, as it does if both are free
from the virus.

But while this shows that the connection between condom use
and the incidence of infection is not straightforward in all
respects, no one doubts that the safe sex message in general is
at least as important as ever, or that the virtues of the condom
must remain integral to it. As Nutland points out, one effect of
more successful HIV treatment has been to enlarge the pool of
people surviving with the virus and therefore representing a
possible source of infection.

And Gwenda Hughes, a senior scientist at the communicable
disease surveillance center in north London, stresses that the
increased diagnoses of syphilis and gonorrhoea seem very directly
connected to unsafe sex practices. Hughes also emphasizes the
invisibility of chlamydia - "70 percent of cases show no
symptoms" - and the very serious consequences it can have for
women: infertility, ectopic pregnancy, chronic pelvic pain.

As ever, it is the young who are at the greatest risk from
STIs, especially girls and young women in their late teens, and
men in their early to mid-20s. So how can the young be taught to
love the condom more? It may not be easy.

-- Guardian News Service