African HIV Pandemic: Do Condom Manufacturers Worry About Bad Press?

I've asked the question a number of times, most recently on my other blog about pre-exposure prophylaxis (PrEP): why are condom manufacturers not worried about some of the bad press they are getting in one of their biggest markets in the world, sub-Saharan Africa?

Several microbicide trials that have shown the gels to be of little or no use have also shown that people who don't have sex very often, don't engage in much 'unsafe' sex and almost always use condoms, still become infected with HIV. Heterosexual sex is not a very efficient transmitter of HIV, so why do condoms seem to fail so badly during these trials?

For those who reject the behavioral paradigm, the claim (it's not a belief, those who make the claim know it's not true) that almost all HIV is transmitted through heterosexual sex in African countries, there is no conundrum. Those who become infected with HIV under the circumstances listed above were unlikely to have been infected sexually.

There are a number of other ways they could have been infected. They are unlikely to have been intravenous drug users, unless the trial screening process was highly flawed! But they probably received some kind of invasive medical treatment, such as injections.

Unsterile medical injections are a very efficient means of transmitting HIV and other blood-borne viruses, especially in high HIV prevalence areas, where these trials tend to be carried out.

The problem is that the trial protocol didn't involve investigating how participants became infected. The protocol could have attempted to determine the risks that people in the area faced because if people were being infected by any other route aside from sexual intercourse, that would invalidate the results of the trial.

This is where the condom manufacturers should be coming in. Trial results show that rates of HIV infection are very high, even among people using condoms. But if people are being infected via unsafe medical injections, cosmetic procedures such as tattooing, or anything else, this does not indicate that condoms have failed.

The denial that non-sexual HIV transmission could play a part in high prevalence countries leads to a lot of confusion. A group of people in Nigeria, along with a HIV research foundation, are suing the government for promoting condoms because they 'didn't work'. Members of the group used them but still ended up HIV positive. They are demanding $50 billion in compensation and an order against further promotion of condoms.

They should be demanding an investigation into how they might have become infected. Condom manufacturers should also be demanding such an investigation. Because every country in the world is, at least to some extent, promoting condoms as a means of preventing HIV transmission. Few seem to realise the non-sexual risks they face, even though they may be aware that condoms will not protect them from these.

As a result, HIV is still spreading quickly and will continue to do so for the forseeable future. Condoms are not the problem. They have a pretty high success rate when it comes to preventing sexually transmitted HIV. But they are not relevant when it comes to non-sexually transmitted HIV and it's important that this be made clear.

Condom manufactures should be very worried about the misrepresentation involved here. Their products are being promoted in circumstances where they are guaranteed to fail. Some day other people, like this small group of Nigerians, will start to ask why they are HIV positive even though they have not been exposed to any possibility of sexual transmission.

Of course, it's not the business of condom manufacturers to inform people that condoms won't prevent non-sexual HIV transmission; that should be pretty obvious already. But unless people are informed of the probability of their being infected non-sexually, the probably currently being unknown, it will continue to appear as if the billions of condoms being supplied to African countries are not having much impact.

Condoms are about the only hope that people in African countries have when it comes to preventing HIV transmission through sexual intercourse, whether vaginal or anal. They are vital in the overall public health goal of cutting transmission. But there is also a need to establish levels of non-sexual HIV transmission and to implement public measures to prevent it. If condom manufacturers wish to continue to receive billions of dollars of public money, they should help to make the distinction between sexual and non-sexual HIV transmission clear.

People need to know the whole story about HIV: it is not just transmitted sexually and they will not be protected if they think it is. They need to know that HIV can also be transmitted through unsafe health care and cosmetic procedures; they need to know how to avoid this sort of risk; and the risks people face in medical and cosmetic facilities need to be reduced. There is nothing to be gained from emphasizing sexual risks and completely ignoring non-sexual risks.