The condom scam

Gonzalo Herranz Rodríguez.
Professor of Medical Ethics at the University of Navarra.

Commentary in the Diario de Navarra on the Spanish government's 1987 condom campaign under the slogan "Put it on, put it on", with the addition of some textual quotations and the corresponding bibliographical references. Despite the distance in time, it is still highly topical.

If a doctor or pharmacist judges, based on real, scientific, reliable data , that condoms do not provide acceptable protection against HIV, they are not obliged to recommend or dispense them. Their decision is rational and they should make this clear to their patients or clients. The risk rate is between 15 and 20%, i.e. they fail in one in five or six sexual contacts. As long as AIDS remains a fatal disease, that is an overwhelming risk. "That, by using a condom, one can have truly safe sex with an HIV-positive partner is a dangerous illusion," point out Danish researchers (Gotzsche PC, Hording M. Condoms to prevent HIV transmission do not imply truly safe sex. Scandinavian Journal of Infectious Diseases 1988;20:233-4). There is, moreover, reason to believe that ministerial propaganda in favour of condoms is fraudulent. It creates a false sense of security, particularly among young people, and it is reasonable to refuse to cooperate in such deception.

The government's campaign is irresponsible to say the least. It has grossly distorted the message of the leading experts on subject, the US Centers for Disease Control. It has silenced its fundamental part: "that abstinence and sex with a mutually faithful and uninfected partner are the only fully effective preventive strategies" (Condoms for prevention of sexually transmitted diseases. Morbidity and Mortality Weekly Report 1987;37,7-9). And it has given a voluntarist view of condom efficacy. As opposed to the naïve "put it on, put it on", that nothing happens, the Centres insist on the same article, that "appropriate condom use at every sexual act can reduce, but not eliminate, the risk of sexually transmitted diseases. Individuals who may have been infected with HIV, or who are already infected, should be aware that condom use cannot completely eliminate the risk of becoming infected or infecting others".

The government has shown itself to be an aggressive manipulator. It is inducing teenagers into permissiveness, inviting them to promiscuous behaviour. In order not to appear gauche, it has fallen into perversity. He has led many naive people to believe that condoms are the magic talisman of pleasure and invulnerability. I don't like to be a prophet of doom, we will have to take a look at the statistics in a few years' time and see how many people, between 20 and 25 years old, who will be HIV positive by then, have fallen victim to the "condom scam".

It is a pity that those who launched this campaign did not ask about the results of similar campaigns launched in EC countries three years ago. They would learn that, for example, according to a survey conducted by the high school Allensbach Demoscopy in the Federal Republic of Germany, many (more than 40%) boys and girls reproached the campaign for its obsessive fixation on mere sexual biology, the total absence of reference letter to moral values, to chastity, to faithful love. And that is also the opinion of serious educators. Dr. Theresa L. Crenshaw of San Diego, President of the American Sex Educators, Counsellors and Therapists association , stated in her testimony before the US congress in February 1987 that "for health reasons, casual and promiscuous sex must be abandoned. And while recognising that condoms in combination with spermicides can help in the fight against AIDS, we must insist on the need to emphasise the importance of behaviour change. It is irresponsible to resign oneself to the threat of AIDS and to be soft about slowing its spread. People need to be told clearly that they should avoid sexual activity with anyone other than a 'committed partner'". The message from Crenshaw and his group is that "sexual behaviour can change, but it won't if we don't trust it and don't recommend it" (Goldsmith MF. Sex in the age of AIDS calls for common sense. JAMA 1987;257:2261-4).

I have heard that the government intends not to accept conscientious objection from doctors and pharmacists who do not collaborate in its campaign and do not prescribe or dispense condoms. This seems to me to be abusive arrogance. It is, on the one hand, a sample of grave intolerance, unworthy of a modern state that respects individual liberties and that enshrines in its constitution the intangibility of consciences. On the other hand, it is the violent imposition of a partisan moral opinion by the administration, which, in turn, has branded non-collaborators as intolerant. No one, including doctors or pharmacists, can be forced, in a state governed by the rule of law, to disconnect their moral convictions from their technical actions, to have a double standard, to act against their conscience.

I don't think the AIDS epidemic can be curbed with the condom and subject from Education in the same package. It is too weak a patch to contain the enormous erotic pressure, the sexual habits, that uninhibited pornography is creating in society. In contrast to their energetic, albeit belated, policy of repression of drug trafficking, governments remain passively oblivious to this dangerous environmental pollution or actively participate in it with their media. It is hypocritical to think that the containment of AIDS will come from the simple Education in sexual physiology: sex is more than biology.

I think it must be emphasised that, from an epidemiological point of view, AIDS prevention needs to be taken much more seriously than the youthful Put it on, put it on campaign implies. "In the case of AIDS, prevention is not simply better than cure: it is the only cure. (...) The resources to prevent the spread of HIV are remarkably simple, and the list of strategies to be followed is very simple. But heterosexual and homosexual contact and intravenous drug abuse continue to catalyse the spread of the epidemic; unfortunately, prevention progress in these areas over the past year* has ranged from disappointing to downright irresponsible. Behaviour change is the sure way to protect, but it seems to have failed to be induced quickly and widely enough, even among high-risk groups. publishing house. Lancet 1989;1:1111.

I think the status has been very well summarised by Prof. W. E. Schreiner of the University of Zurich and Dr. K. April of the Swiss AIDS Information Office. In a work published this year (Zur Frage der Schutzwirkung des Kondoms gegen HIV-Infektionen, Schweizerisches medizinisches Wochenschrift 1990;120:972-978) they conclude that: "Condoms have been recommended in several countries as the most important protection against HIV infection, although there is no serious evidence that they are effective against sexually transmitted diseases (STDs). Before the HIV epidemic, condoms were used to prevent pregnancy and reduce the risk of STDs. To prevent a deadly infection such as AIDS, safe modes of protection are mandatory. The most recent programs of study on AIDS prevention shows that the assumption that condoms offer reliable protection against HIV is a dangerous illusion. programs of study Carefully planned employment condoms have been shown to reduce risk, but a residual risk remains, ranging from 13% to 27% and higher.

* (1988-1989, one year after the condom campaign).