Thursday, November 30, 2006

World AIDS Day 2006, Part One

Tomorrow is World AIDS Day. The theme is "Stop AIDS. Keep the Promise."

It reminds that we have not -- that I have not. I remember giving a talk back in 1985 at a CDC conference on AIDS where I said that every new HIV infection would be a failure of will to educate, protect, and motivate. That was tens of millions of cases ago.

Today there are 65 million people in the world who live with AIDS. There have been 25 million deaths. The numbers are staggering. One adult in a hundred in the world is living with HIV. In parts of Africa, it is one in three.

People around the world continue to fight about how to prevent AIDS -- abstinence still wins over condoms, needle exchange is still forbidden in many places, homophobia and sexism still keep people from being able to protect themselves.

The good news is that AIDS is no longer a liberal/conservative issue. Such organizations as Christianity Today, Catholic Relief Services and the Ecumenical AIDS Alliance had information about World AIDS Day on their web sites. Tomorrow, Senator Obama will be preaching at Rev. Rick Warren's Saddleback Church.

What more can you do to get involved? How can you "keep the promise?" I hope you'll publish those promises here.

Tomorrow, I plan to post my memories of people who I have lost in this epidemic. I hope you will add your own tributes.


ncdave4life said...

"...about how to prevent AIDS -- abstinence still wins over condoms."

Thank you, Debra, for acknowledging that condoms do not offer adequate protection against HIV. Only abstinence offers good protection against the transmission of HIV.

Condoms do better protecting against HIV than against some other STDs, but since most studies have found that condoms fail catastrophically 2-5% of the time, depending on condoms for protection while having sex with an HIV+ partner can be deadly. To do so twice per week for a year is roughly equivalent to having completely unprotected sex with that HIV+ partner 2-5 times. In other words, it is safer than having unprotected sex all 100 times, but it is still insanely risky.

Please help spread the word, Debra. The widespread myths exaggerating the effectiveness of condoms at preventing STDs are killing people.

-Dave Burton
Cary, NC
dave at burtonsys dot com

Rev. Debra W. Haffner said...

Dave, you misunderstood my point. I think it's immoral for example that a third of the US global prevention money must go to abstinence only programs.

And again, your statistics are wrong. I've asked colleagues to post the correct information -- Condoms do protect against HIV, although you are right, not perfectly. But there are many studies that shown if used consistently and correctly the transmission of HIV with serodiscordant partners is close to zero. We know that the use of condoms has been very effective around the world.

Would you prefer people with HIV simply give up all sexual contact with their loved one?

Can we at least agree that this is why it is so important to be tested and know one's HIV status -- and share it with one's partner(s)?

Cassandra said...

I would happily give up all sexual contact with my husband if I were HIV positive. I would seem to be the most charitable and prudent thing to do.

Joan Garrity said...

From the CDC website:
"Latex condoms, when used consistently and correctly, are highly effective in preventing heterosexual sexual transmission of HIV, the virus that causes AIDS." "The ability of latex condoms to prevent transmission has been scientifically established in laboratory studies as well as in epidemiologic studies of uninfected persons at very high risk of infection because they were involved in sexual relationships with HIV-infected partners. The most recent meta-analysis of epidemiologic studies of condom effectiveness was published by Weller and Davis in 2004. This analysis refines and updates their previous report published in 1999. The analysis demonstrates that the consistent use of latex condoms provides a high degree of protection against heterosexual transmission of HIV."
Yes Dave, you're right -- complete abstinence from any sexual behavior that might result in the transmission of HIV is the most effective protection. But in all the history of humankind, abstinence has failed, because people have sex. They have sex because they want to, they have sex to survive, they have sex because they are forced to, and sometimes they have sex with someone who is not honest about his/her own sexual behavior, so even monogamy -- the assumption of monogamy -- is not without risk. Living is full of risks. And there is no doubt that condoms are effective in reducing risk -- even our current, conservative government had to admit that on the CDC website!

ncdave4life said...

No, Debra, my statistics are not wrong.

Unfortunately, condoms do fail, and many studies have attempted to measure the frequency with which they fail. American studies have generally found rates of complete condom failure between 2% and 5%. Complete failure means that the condom either breaks catastrophically or comes completely off during sex. When that happens, you are having unprotected sex.

Here's a study on PubMed which found a 4-6% rate of complete condom failure: That's a fairly typical result.

Condoms are quite effective at preventing HIV transmission, except when they break or slip off during sex. (They are less effective at preventing the transmission of some other STDs.) It goes without saying that they are completely ineffective at preventing transmission of HIV or anything else when they break or slip off.

Except for a study of condom use by sex workers (who have much greater than usual experience using them), every study ever done has found condoms to have a failure rate of MORE than 1%.

But even a 1% failure rate would be poor protection, if you are having sex repeatedly with an HIV+ partner. Even if you are unusually successful using condoms, so that you have only a 1% chance of condom failure each time you use them, if you have sex at least 70 times (once every 5 days for a year), the chances are greater than 50% that you will experience at least one complete condom failure. (You can calculate the probability of no failures as 0.99 raised to the 70th power.)

Have you ever heard the male complaint that "sex with a condom is like showering in a raincoat?" Well, as almost any man who has used condoms a lot can tell you, once in a while sex with a condom becomes like showering in a hula-hoop.

Note: When a condom fails, the male partner always knows, but the female partner might be unaware of it unless the male partner tells her - which would be an awkward conversation, to put it mildly. So if a woman has had sex with condoms many times, and she thinks they have never failed, it is probably because her partner didn't tell her about it when it happened.

If you depend on condoms to protect you 100 times, you will most likely end up unintentionally having unprotected sex 2 to 5 times out of the 100. That means that, in answer to your question, YES, it is absolutely essential that an HIV+ person give up sex with an HIV- loved one. To do otherwise is insanely risky.

Widespread unawareness of the riskiness of dependong on condoms for protection against HIV and other STDs is killing people. Please spread the word!

-Dave Burton
Cary, NC
dave at burtonsys dot com

Rev. Debra W. Haffner said...

Cassandra, That's a decision that presumably you and your husband would make together. In my exeprience working with people with HIV, some couples choose abstinence from intercourse. Some couples choose abstinence from any sexual contact. Some couples choose to continue to have intercourse with diligent use of condoms. No doubt others make other decisions.

You would agree that that choice is their's, yes?

I do believe that people who are HIV positive have a moral obligation to share that with a potential partner and then discuss how to proceed, if at all. Too many people don't know their HIV status; that's why it's so important to be tested.

Rev. Debra W. Haffner said...

Re; Dave's latest post.

Dave -- We agree, condoms are not 100% effective. But neither are vows of abstinence. In fact, I remember reading a study that showed that vows of abstinence are much more likely to fail than condoms do.

The fact is, as Joan pointed out, that people have sex, condoms or no condoms. You and I probably agree that we need to tell people that there is no such thing as safe sex with a person with an STD, just safer sex. But IF sex is going to occur (whether you would make that decision yourself or not), I can't hope but believe Dave that you think a condom should be used to protect both partners.

Anonymous said...

Hmmm. Intresting thread. It seems helpful to point out that in studies of sero-discordant partners condoms have been highly effective. Here are some summaries:

**In a two-year study of sero-discordant couples (in which one partner was HIV-positive and one was HIV-negative), no uninfected partner became infected among couples using condoms correctly and consistently at every act of vaginal or anal sex versus 10 percent of those using condoms inconsistently.[1,6]

**In a similar two-year study, two percent of uninfected partners who used condoms consistently became HIV-infected versus 12 percent among those who used condoms inconsistently or not at all.[1]

The full document is found here:

When you compare and contrast the failure rates of abstinence to condoms it seems like condoms are the clear and logical choice, at least to me.



Cassandra said...

Rev. Debra, (I'm sorry for using "Rev. Deb" in the past as I now understand you do not favor it) of course the choice is their's to make. People are can play Russian Roulette if they like. I believe in free will and acknowledge that consequently, some people will make bad choices.