Thursday, June 4, 2009

The Many Uses of Condoms

Sometimes the use of condoms to prevent infection with HIV is emphasized to such an extent that their use to prevent other sexually transmitted infections (STI) and to prevent unwanted and unplanned pregnancies is forgotten. Many STIs are easier to contract and transmit than HIV, some are difficult to treat and some increase the risk of being infected with or of transmitting HIV.

The consequences of contracting STIs other than HIV can be grave. In addition to serious illness, some STIs also affect fertility. But the consequences of unwanted or unplanned pregnancies can often be more serious, especially for younger people.

Many women who get pregnant unintentionally try to terminate the pregnancy. This is illegal in a lot of countries so they must resort to untrained abortionists or to carrying out the abortion themselves. The result can be injury, reduced fertility or death.

Many women, more than half a million a year and mainly in developing countries, die during pregnancy and childbirth. Some of them may have tried to terminate the pregnancy but there are all sorts of complications that can result in maternal death. Most of the deaths could have been averted with better and more accessible health services but also, many of these pregnancies could and should have been averted.

Certain religious and political groups have objected to the use of contraception and even to sex education. Others object to sex education for young teenagers. They feel that ready availability of contraception and widespread knowledge about sex only promotes promiscuity. However, there is plenty of evidence to show that these claims are unfounded. On the contrary, children who get comprehensive sex education are more likely to delay their sexual debut and more likely to use contraception.

Older people, married or single, need information and advice about sex, sexuality and family planning too. They need access to health services, contraception, etc. But more importantly, they need to be empowered to the extent that they are able to use contraception, whether it is to prevent conception or to avoid HIV or other STIs. Too many people say they didn’t know about contraception (or even about sex!) when they became sexually active. By the time they find out it can be too late, they may already be pregnant or already infected with an STI.

A lot of HIV money goes into ‘treatment and care’; but this really means that a lot of money goes into drugs. You need more than drugs to treat people suffering from a chronic illness like AIDS. Similarly, a smaller but still considerable amount of money goes into preventing mother to child transmission (PMTCT), also called vertical transmission. This also involves the use of drugs but again, it takes more than drugs to identify HIV positive mothers, to monitor them through pregnancy and delivery and then to monitor and care for the child.

It is estimated that 900 babies a day are born with HIV in developing countries because health services are not reaching women or because those health services are simply inadequate. Kenya, Tanzania and Uganda account for a large percentage of this figure. Pregnant women need to be tested and followed up, as do their children; drugs alone are not enough.

But to return to the condom and family planning point, many of the women giving birth to HIV positive babies didn’t want to get pregnant in the first place. Some hadn’t planned to get pregnant for all sorts of reasons, but some wanted to avoid pregnancy because they knew they were HIV positive. So, even many instances of vertical transmission could be averted by the use of condoms and other family planning techniques.

PMTCT, better maternal health and child health and many other health areas are compromised by poor health systems, shortages of trained personnel, low availability of the most appropriate drugs, etc. But maternal deaths, both from unsafe abortions and other causes, as well as vertical transmissions of HIV, could be reduced by the relatively cheap strategy of family planning.

Why throw large amounts of money at intractable problems when you could avert many of those intractable problems using relatively small amounts of money?

As always, the message from this blog is that HIV is serious. But there are other serious issues that people in developing countries face. Crucially, if some of these issues got a little more attention the question of HIV, in at least some cases, would not even arise.



Andruid said...

Nice post. I began to feel that in some way the condom's traditional contraceptive purpose was being lost in the fight against HIV/AIDS late lst year when there was the launch of the special contraceptive Femiplan condom.

Simon said...

Thank you for your comment. Yes, as well as objecting to their use for protection against HIV and other STIs, I suspect a lot of men would prefer to ignore the fact that condoms prevent conception.

Interestingly, although some women are quite opposed to female condoms, others say they are great because men don't even realise they are there. But they are presently expensive and are not given out free of charge, like male condoms.

I think there needs to be more information about female condoms and better access to them. If take up was good the price should drop, eventually.