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Associate Professor School of Pharmacy and Allied Health Sciences Clinical Pharmacy Specialist, Curry Health Services The University of Montana Missoula, Montana
| Published by The Medical Institute for Sexual Health, Austin, Texas, 2002.
A Monograph Pamphlet, 32 pp. (28 x 21.5 cm), $10.
www.medinstitute.org
|
Published Online, October 1, 2003. www.theannals.com, DOI 10.1345/aph.1D120
There have been many recent attempts to shed light on this very controversial issue. The Institute of Medicine's book, The Hidden Epidemic: Confronting Sexually Transmitted Diseases, published in 1997, is a very comprehensive review of this topic from a public health perspective. Healthcare providers benefit from the CDC's Sexually Transmitted Diseases Treatment Guidelines last updated in 2002. The National Institutes of Health (NIH), with members from other government agencies, convened a workshop in 2000 to address the issue of condom effectiveness for STD prevention. It is true that, when released in July of 2001, the NIH report received relatively little public attention. That report, however, acknowledged that most of the epidemiology literature available to review at that time was inadequate to draw definitive conclusions regarding the effectiveness of male latex condoms in reducing the transmission of STDs other than HIV and gonorrhea.
The goal of the monograph reviewed is to definitively answer the question, "Do condoms make sex safe enough?", using the most up-todate scientific literature. A secondary goal is to provide complete and accurate information about the risks of STDs and condom use in order for individuals to make informed decisions. The monograph summarizes the findings of the NIH reports and adds additional data from more recent research. It answers questions such as: Do condoms give substantial protection against HIV? Are condoms used consistently and correctly? Do condoms offer substantial protection against the majority of non-HIV STDs?
The authors did an excellent job in presenting facts in a clear, concise format. The monograph was well referenced. They took the effort to explain scientific language in lay terms. They defined and gave real-life examples of terms such as "protect," "relative risk," and "statistically significant." Sections of the monograph were well written and deserve special attention. The section on the STD epidemic is straightforward, factual, and very timely. Included in this segment is a brief discussion of the common STDs and their impact both as a public health issue and on an individual. A table of 8 STDs (chlamydial infection, gonorrheal infection, chancroid, trichomoniasis, genital herpes, genital HPV infection, HIV/AIDS) illustrates how they are unique diseases with respect to their mode of transmission, infectivity, symptoms, and complications.
Throughout the monograph, there were undertones of a political nature and this clearly biased the document. The information presented had a slant emphasizing abstinence. Sexual activity outside of the institution of marriage is a real phenomenon and authors and policy makers have to acknowledge this and present information in a non-biased, nonpolitical manner. Educators, clinicians, and parents truly need a document that presents facts concerning STDs and their devastating complications and ways to prevent them. The epidemic of STDs must be recognized and the US needs coordinated efforts in STD prevention strategies.
While this monograph provided concise and easy-to-read information summarizing the effectiveness of condoms in reducing the risk of STDs, the authors' recurrent theme of abstinence imparted bias, thereby preventing a complete and impartial discussion of this health issue.
Footnotes
EDITORS' NOTE: An earnest emphasis on abstinence has been widely embraced and successful among the youth and adults of Uganda. The country has gone from having one of the highest HIV prevalence rates among African nations in the 1980s, to the lowest in continental Africa in 2001.1
References
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