June 05, AU Edition

In America, it’s ‘no glove, no love’. Across the Tasman, the rule is, ‘no rubba, no hubba’. In parts of Australia, the message is, ‘safe sex, no regrets’. So with all the money being spent pushing the message that condoms are a cure-all, why are many sexually transmitted diseases on the rise? As JAMES MORROW finds out, the safe sex ad campaigns are only telling half the story – which begs the question,
IS SAFE SEX REALLY SAFE?
Here’s an interesting but little-known fact about condoms that may just win you a meat tray down at the pub Thursday night: the use of condoms dates back at least as far as ancient Rome and Egypt. Not only that, but archaeologists have discovered early cave paintings that seem to suggest (appropriately enough) that pre-historic Frenchmen may have discovered the things thousands of years before the New York Times ran the first-ever print ad for ‘Dr. Power’s French Preventatives’.
Looking for more condom trivia? Before the latex condom was invented, condoms were made by hand-dipping molds into rubber cement (hence the slang term). But in 1919 an inventor in Ohio by the name of Frederick Killian figured out that latex was a much better material for the purpose, and by the mid-1930s, at the height of the Depression, American manufacturers were producing 1.5 million condoms a day.
Oh, and here’s one more interesting thing about condoms: contrary to popular belief, they are not hugely effective in preventing an incredible variety of sexually transmitted diseases – from HPV, or human papilloma virus, which is linked to more than 90 per cent of cases of cervical cancer and also causes infertility, to herpes.
How can this be? Since the mid-1980s and the discovery that AIDS could be prevented by condoms, ‘French letters’, ‘rubbers’, and ‘raincoats’ have stopped being something that people whispered and tittered about and instead become deadly serious business. Around the world public health authorities, looking for a way to keep AIDS from spreading out of control, have been promoting condoms in earnest for nearly two decades now with a variety of advertising campaigns.

And at least in terms of AIDS prevention, it seems to have worked, especially in Australia: since the all-time high of 953 newly-diagnosed AIDS cases in this country in 1994, the number of new patients has been steadily trending downwards. In 2003, the latest year for which figures are available, there were just 290 diagnoses of new AIDS cases. With an incidence rate of just 1.5 people stricken per 100,000 population – compared to far higher rates in many other Western countries, including the United States, where the rate is ten times higher – Australia could truly seem like the lucky country, sexual-health wise.
But all is not happy and healthy in Australia’s bedrooms. While the number of AIDS cases is admirably low, the rates of many other infections are on the rise – and while none are necessarily the death sentence that an HIV infection represents, they have potentially huge consequences, including cancer and infertility. Public health experts have seen a tremendous increase in cases of diseases like chlamydia and syphilis; in the state of Victoria, the situation is so bad that Chief Health Officer was compelled this past March to issue a formal Health Alert to general practitioners telling them to watch out for the sudden uptick in syphilis cases. That sort of warning is not an everyday occurrence: the last time the Chief Health Officer issued such a bulletin was in 2003, warning doctors to be on the lookout for SARS.
There are many factors behind the rise in various STDs, but one has gone all but unreported in a culture where, officially at least, condom use has taken on an almost sacramental nature: studies conducted over the past few years show that, far from being the be-all and end-all in sexual protection, condoms only offer limited protection.
In other words, when the emperor has no clothes on, a condom is of limited, if any, use in protecting him from a host of diseases.
Back in 2001, the United States’ National Institutes of Health published a series of findings that were shocking, both because they completely overturned long-held conventional wisdom on a very important topic, and also because they received virtually no coverage. Indeed, the Washington Post at the time reported that ‘some health officials considered keeping the report private’, adding that ‘some family planning advocates said they feared that the new report would be used to put pressure on the FDA to change condom labels to reflect the conclusions.’
As one commentator put it, ‘It’s like hearing that Grandma died and immediately asking if Grandma will be making brownies for the funeral. The reality of the loss just hasn’t sunk in yet.’
Among other things, the study found that when one partner is infected with herpes, using condoms cut the risk of transmission by only about forty percent. Meanwhile, with regard to human papilloma virus, by far the number one cause of cervical cancer, ‘the Panel concluded that there was no epidemiological evidence that condom use reduced the risk of … infection’.
And this doesn’t even begin to take into account the misuse, or irregular use, of condoms: according to just one study of high school students in NSW, 68 percent of those surveyed who said they were sexually active admitted that they didn’t use condoms every time they have sex, despite the fact that virtually every kid in the state’s schools is given lessons in how to use the things. And even among adults, condom usage can be irregular, or start too late in an encounter, to prevent the spread of many infections.
‘The term “safe sex” needs to be examined in detail’, says Dr. Caroline Harvey, Medical Director for Family Planning Queensland. ‘We give people many mixed messages depending on whether we are talking about preventing pregnancy or sexually transmitted infections or HIV. In my dealings with clients, I’ve found that when they ask about safe sex, you need to talk to them and pull apart what they’re talking about.’
‘Viral infections like herpes and HPV do spread from skin-to-skin contact’, she adds, something that many people who come into her office are unaware of. According to Harvey, depending on what the client is looking to prevent, the options may be very different – something that doesn’t always come through in media campaigns such as NSW Health’s recent ‘Safe Sex, No Regrets’ effort.
Still, ‘condoms are useful’, maintains Anna McNulty, Director of the Sydney Sexual Heath Centre, when asked about diseases that spread despite the use of condoms. McNulty adds that the increase in the rates of infection various sexual diseases – chlamydia rates have trebled in NSW alone in the last five years according to one estimate – could come from a variety of factors, including the lack of access to health care among young people.
The problem, says McNulty, is that ‘people use them some of the time but not all of the time’, and admits that while a great way to prevent things like AIDS and unintended pregnancies, in terms of preventing herpes and the genital warts that can lead to cervical cancer, ‘they are not as effective.’
An added challenge is that fact that many diseases such as chlamydia can be asymptomatic, especially in men. ‘It can be silent for a long time, but it can cause significant damage’, says Dr. Harvey.
Despite this, many of Australia’s state governments and other public health bodies are delivering a mixed message. While, for example, South Australia’s Health Department’s web site frankly states that ‘condoms will give you some protection from most sexually transmitted infections, but some, like herpes, crabs and genital warts, can spread through skin-to-skin contact’, it is a message that often gets lost when it is boiled down to a catchy slogan – such as ‘Safe Sex, No Regrets’, the message currently being pushed in NSW Health ad campaign.
Featuring a variety of television and print ads, the ‘Safe Sex, No Regrets’ campaign shows groups of healthy, happy, good-looking young people – straight and gay and of various ethnicities – in different social circumstances. The copy on the print ads says things like, ‘Tonight I’m picking up chlamydia’ or some other disease, with the name of the disease crossed out the word ‘condoms’ printed underneath it – the implication being that condoms are all one needs to have what the tag-line calls, ‘no regrets’. In one ad specifically targeting Aboriginals, readers are told that ‘sexually transmitted infections … can affect anybody who has unsafe sex.’
Which is absolutely true, but again fails to mention that condoms are not foolproof against disease – and that ‘no regrets’ is a pretty broad statement that implies something close to 100 per cent reliability. Yet very little is ever 100 per cent when health and medicine are involved (and in the sense that condoms are used to prevent the spread of disease, they have a medical component). If the maker of any other device with as many caveats as condoms have attached to them ever tried to advertise in a similar way, they would be shut down by the authorities sooner than the casual couples featured in NSW Health’s campaign could wake up the following morning with a splitting headache and serious misgivings.
But while the campaign does not tell the whole truth about condoms, McNulty says that ‘you have to keep the message simple, and the “Safe Sex, No Regrets” campaign did a good job as it targeted both young heterosexuals and gay men.’ She concedes, though, that even with 100% condom usage, people are not fully protected against skin-to-skin infections.
So what to do about all this? A national strategy on sexually transmitted diseases is due to be released in July, and according to McNulty, it will definitely have an emphasis on chlamydia and the sudden spike in infection rates, and will push for increases in screening. Easy tests now exist to detect the infection, and treatment is normally a simple antibiotic treatment. But the campaign will also continue to emphasize ‘safe sex’ – something which is far as it goes, but which is not a be-all and end-all solution. The problem is that sex is a much more complicated thing than people on all sides of the debate care to acknowledge, which is why diluting information about condoms to a happy, easily-digestible slogan that inspires false confidence is an irresponsible position for public health authorities to take.
Yet that is exactly what campaigns such as ‘Safe Sex, No Regrets’ does by telling young people that using a condom is as simple a way to have a good time while preventing misery down the road as, say, advising them to only drink bottled water when they’re backpacking up some gorgeous Third World coastline.
While it may not be as sexy a message, so to speak, states should instead work to tell people of all ages in the community that despite their best efforts, behaviours – especially risky ones – can have consequences. The campaign wouldn’t have to be prudish or paranoia-inducing, either, but simply give people the facts: condoms are great for certain things, but there are still risks involved with having sex with people you are not sure the history and health status of. No one would dream of running an ad implying that wearing a helmet was all one needed to stay safe when riding a motorbike; there are plenty of other factors involved that keep one safe on the road, and people are well aware of this. The same sort of truth needs to be told about condoms.