New US government website attacked for comments on sexuality and effectiveness of condoms

A new US government website designed to help parents discuss abstinence with their adolescent children has drawn heavy criticism from advocates of comprehensive sex education, family planning organisations, and gay rights campaigners.

Launched earlier this month, the 4parents.gov website is designed to help parents to talk to their children about “difficult issues” including sex and sexuality. As well as providing information on nutrition, exercise, smoking and drug use it advises parents to tell adolescents that sexual “abstinence is the healthiest choice” as “they will not have to worry about getting pregnant or getting someone pregnant. They will not have to worry about sexually transmitted diseases, including HIV/AIDS.”

Delaying the initiation of sexual activity is an accepted part of HIV prevention strategies. However, it is generally argued by HIV and sexual health workers that information should also be provided about condoms as a means to prevent HIV, sexually transmitted infections and pregnancy.

In the US in recent years an increasing emphasis has been placed on a sexual health approach which stresses sexual abstinence until marriage as the only way to avoid HIV, sexually transmitted infections and pregnancy. This approach is now the only form of sex education which receives federal funding.

Advocates of comprehensive sex education in the US have expressed concern about this, pointing out that teenagers who are only provided with sexual abstinence education are less likely to know how to protect their sexual and reproductive health when they become sexually active. The 4parents.gov website is the latest government backed resource to cause concern.

Being gay or lesbian called “an alternative lifestyle”

Gay and human rights activists are also alarmed that being gay or lesbian is described by the website as “an alternative lifestyle”. There is also concern that the site implies that “impressionable” teenagers may be able to choose their sexual orientation. In addition, 4parent.com recommends to a parent who believes that their teenager may be gay or lesbian that they should find a family therapist “who shares your values to clarify and work through these issues”. This could be taken as a reference to religious ministries that claim to be able to alter sexual orientation.

Potentially misleading information offered on site about efficacy of condoms

The wording of information about condoms on the site is also potentially misleading. US abstinence education programmes usually only mention condoms when referring to their potential for failure. The 4parents.gov site suggests that condoms offer only “moderate” protection against HIV and gonorrhoea, “less” protection against Chlamidya, herpes and human papilloma virus, and that the ability of condoms to protect against syphilis “has not been well studied.” Although these claims are backed by reference to studies looking at the effectiveness of condoms, they do not acknowledge that the studies were, almost exclusively, conducted in populations with a high prevalence, or risk of sexually transmitted infections. Nor does the site point out that almost without exception, the studies found that condom use significantly reduced the risk of acquiring a sexually transmitted infection. In addition, the way the site represents statistics from these studies suggests that a 50% reduction in the risk of acquiring an infection with condom use means that condoms are only effective 50% of the time.

The site claims that even when used consistently and correctly condoms only reduce the risk of the sexual transmission of HIV by 87%. However, a European study conducted in 1994 (de Vinceni et al) found that consistent condom use offered 100% protection against HIV transmission. The study compared HIV transmission between one group of 123 HIV-serodiscordant couples who consistently used condoms and 122 discordant couples who did not. No cases of HIV transmission occurred in the couples who reported consistent condom use, however twelve cases of transmission occurred in couples who said that they did not always use condoms.

WHO study finds high level of condom efficacy

Studies have also demonstrated the ability of condoms to offer a high level of protection against other sexually transmitted infections. The World Health Organisation recently conducted a review of studies published since 2000, demonstrating condom’s efficacy.

Condom use as low as 20% in monogamous heterosexual couples reduced the risk of infection with herpes simplex virus-2 by 92% in women (Wald et al).

Studies amongst sex workers in Lima (Sanchez et al) and women at high risk of sexually transmitted infections in the US (Crosby et at) found that consistent condom use led to a statistically significant reduction in the risk of infection with gonorrhoea, Chlamydia and syphilis. Another study, which recruited individuals from an area of Uganda (Ahmed et al) with high background prevalence of HIV, syphilis, Chlamydia, and gonorrhoea found that consistent condom led to a significant reduction in the risk of contracting all the infections.

A study involving sexually active American teenage girls (Crosby et al) found much lower rates of any sexually transmitted infections amongst those who consistently used condoms.

Because human papilloma virus (HPV) can be transmitted by contact with skin outside the genital area, the use of condoms cannot guarantee that transmission of the virus will not occur. However, two Dutch studies published in 2004 ( Hogewoning et al and Bleeker et al) found that consistent condom use by couples where HPV is present was associated with the regression of both cervical and penile lesions.

The WHO Organisation review concluded that studies looking at the effectiveness of condoms “demonstrated the statistically significant effectiveness of condoms in protecting against HIV and most of the other sexually transmitted infections examined.”