Condoms and AIDS: a woman's perspective – 2

For many women and men it is much easier to have sex than talk about it.  An honest exchange about past experiences that may involve several sexual partners, injecting drug use, a period of time in prison, or gay sex is not the usual conversation before sex that many women or men can realistically expect.(1)

Yet such past experiences increase the chances that a potential sexual partner has HIV.  Other than abstinence, the first line of defense in heterosexual sex, as in gay sex, is to insist on the use of a condom.

Studies have shown that latex condoms are effective barriers to HIV and other sexually transmitted diseases (STDs).  Spermicides, used without a condom, do not the same protection.(2)  Nor do other methods of birth control, such as contraceptive pills, surgical sterilization, or contraceptive diaphragms.

The effectiveness of condom protection against HIV is most evident from studies of couples in which one member is infected with HIV and the other is not.  In three such studies involving 700 couples:(3)

With consistent and correct condom use, from 0 - 2 percent of the uninfected partners became infected.

With inconsistent or no condom use, from 12 - 14 percent of uninfected partners became infected.

Female anatomy makes women much more vulnerable to HIV infection during heterosexual sex than men.(4)  In one study, female partners of HIV-infected men were 15 times more likely to become infected than male partners of infected women.(5)

The most commonly used condom, the male condom, requires the active cooperation of the man.  A man might be willing to use a condom, because it protects him too.  Or he might wish to use a condom because it can make sex last longer by preventing premature ejaculation.(6)

But when the man is not willing to use a male condom, what options does a woman have?  Apart from refusing to have sex, there is the female condom. 

The female condom is made of polyurethane. It fits inside the vagina and covers some of the area outside the vagina as well.(7)

Women's organizations must help put women in charge of their own protection by publicizing the existence of the female condom!(8) 

Footnotes

(1)

A 2-hospital study of 203 HIV infected patients found that 4 of every ten people infected with HIV failed to inform their sex partners about their condition, and nearly two-thirds of those did not always use a condom.  Most of the people surveyed had low incomes and were high school dropouts; many were also drug users.  The researchers expressed the belief that the withholding of information about HIV infection is widespread.  New York Times. 1998. "Sex Partners Often Silent About HIV," February 9. page A10.  
(2)

Researchers have hoped that spermicides might be effective without a condom reducing the spread of HIV and other STDs. There is some research to indicate this is possible.

Knut M. Wittkowski, Ezra  Susser, and Klaus Dietz, 1998 "The protective effect of condoms and nonoxynol-9 against HIV infection." American Journal of Public Health, April. vol.88, no.4, pages 590-596.

J. D'Cruz Osmond and others. 1999. "WHI-05, a novel bromo-methoxy substituted phenyl phosphate derivative of zidovudine, is a dual-action spermicide with potent anti-HIV activity," Contraception, May, vol. 59, no. 5. pages 319-331. 
(3) Consistent and correct condom use includes the use, from start to finish, of a new condom with each act of vaginal, anal, or oral intercourse. It includes all of the following steps:

  • Use a new condom for each act of vaginal, anal, or oral intercourse.

  • Use the condom throughout sex - from start to finish.

  • Put on the condom as soon as erection occurs and before any vaginal, anal, or oral contact with the penis.  Hold the tip of the condom and unroll it onto the erect penis, leaving space at the tip of the condom, yet ensuring that no air is trapped in the condom's tip.

  • Adequate lubrication is important to prevent condom breakage, but use only water-based lubricants, such as glycerine or lubricating jellies (which can be purchased at any pharmacy).  Do not use oil-based lubricants such as petroleum jelly, cold cream, hand lotion, or baby oil, which can weaken the condom.

  • Withdraw from the partner immediately after ejaculation, holding the condom firmly at the base of the penis to keep it from slipping off.

Latex condoms for men are a highly effective barrier to sperm and micro-organisms, including HIV and the much smaller hepatitis B virus.  Their effectiveness has been proven over many years.  For people who are allergic to latex, several new types of materials are being used to make condoms.  Lab tests have shown both polyurethane, a soft plastic, and Tactylon, a synthetic latex, to be effective against sperm, bacteria, and viruses such as HIV.  

Unlike latex condoms, synthetic condoms such as male and female polyurethane condoms can be used with either water-based or oil-based lubricants.

Although not as thoroughly tested as latex condoms, synthetic condoms likely provide similar protection.

Protection for oral sex.  Even though their risk is less than unprotected anal and vaginal sex, people who engage in oral sex can reduce their risk of getting HIV or another STD by placing a barrier over the vagina or anus.  In addition to the male condom, a product (the Sheer Glyde Dam) designed to reduce the risk of acquiring an STD during oral sex is now being sold in the United States.  Plastic food wrap, dental dams (pieces of latex used by dentists), and condoms that have been cut open all have been used to cover the vagina or anus during oral sex, although there is no information about how well these materials work.  

Centers for Disease Control and Prevention. 2001. "Condoms and Their Use in Preventing HIV Infection and Other STDs." January. 4 pages.

New research indicates that the chances of contracting HIV during an unprotected heterosexual encounter is about one if 588.  "Chances of HIV infection." 2001.  Washington Post. February 9. page A5.
(4) The anatomy and physiology of the female lower genital track contributes to women's risk of infection.  The entire vagina is a mucosal surface (HIV is able to penetrate mucus membranes), as compared to men, where the penis has a more limited mucosal surface (the urethra).  Disruption of the vaginal mucosa increases the risk of HIV infection and can be caused by trauma during intercourse, inflammation from other STDs, the use of tampons, and the use of vaginal barrier contraceptives.  Semen carries larger quantities of lymphocytes than do vaginal and cervical secretions, thus carrying more HIV, increasing the risk of transmission.  HIV is not viable in the normal acidic pH of the vagina. However, with ejaculation, semen neutralizes the vaginal pH for a period of time, increasing the ability of HIV to survive, and the chances are that transmission will occur.  Susan W. Gaskins, 1997. "Heterosexual Transmission of HIV in Women," Journal of the Association of Nurses in AIDS Care, November/December, vol. 8 no. 6, pages 84-87.  
(5) Priscilla DeRemer Abercrombie, 1996. "Women Living with HIV Infection," Nursing Clinics of North America, March, vol. 31, no. 1, pages 97-106.  
(6) The Planned Parenthood Women's Health Encyclopedia. 1996. New York: Crown Trade Paperbacks. page 359. 
(7)

The CDC is collaborating with scientists around the world to evaluate the prevention effectiveness of the female condom.  Centers for Disease Control and Prevention. 2001. "HIV/AIDS Among US Women: Minority and Young Women at Continuing Risk." January.   
(8) The female condom was invented in the 1980s by a Danish doctor who wanted women to have a barrier method that they could control.  It won the approval of the United States Food and Drug Administration in 1993 and is sold in the United States by the Female Health Company of Chicago under the name Reality for about $2.25. Most retailers stock the female condom near the male condoms or in the female hygiene section.  For a help in finding a local source, go to the Female Health Company website. Donald G. McNeil, Jr. 1999. "Condoms for Women Gain Approval Among Africans." New York Times. July 24, page 1. 
For a list of other materials used on this website, see References.