The
Newsletter
of
the World Health Organization Global Programme
on
AIDS
,
Year
1992 No 3, pp.15-16
An Interview
with Zbigniew
Halat
Dr Zbigniew
Halat, an outspoken
epidemiologist of 42,
grew up and
studied in the city of Wroclaw, close to Poland's border with Germany.
Involved
in the local organization of Solidarity in 1980-81, he left Poland
after the
declaration of martial law to study venereal and skin diseases in
Kenya. From
1982 to 1984 he organized a free clinic to treat sexually transmitted
diseases
- STDs) in Nyeri,
capital of Kenya's
Central
Province, where he saw patients with what he now believes were early
symptoms
of AIDS. After martial law was lifted in 1984, he returned to Poland to
work in
the public health system on allergies, skin disease and immunization.
In the
autumn of 1987 he launched one of Eastern Europe's first AIDS hotline counselling services (*), and since April
1991 he
has been
responsible for environmental health, disease prevention and control
and the
national health programme
in Poland as a
Deputy
Minister of Health and Social Welfare (**). Despite
considerable
opposition, Dr Halat
advocates (***)
condoms - not just abstinence - to
prevent AIDS, and he is training an army of midwifery and nursing
students to
spread the message of safe sex to boys, girls and fellow teenagers of
both
sexes, partly through the use of educational materials from GPA. (WHO
also
assisted Poland in setting up its short-term plan on AIDS in 1990, and
it is
helping to prepare a conference to reach a national consensus on AIDS.)
Dr Halat spoke to
Global AIDSnews
while on a recent visit to Geneva.
Dr Halat,
how prevalent are AIDS and HIV infection
in your
country?
Officially
there are said to be 2200 people infected with HIV, and 100 cases of
AIDS. In
both cases, about 70 per cent of them are attributed to drug abuse. I
think all
these figures are wrong. This is partly because male and female sex
workers,
and men who have sex with men, tend to get help in private clinics
which have
no procedures of notification. And there is a lot of misconduct in such
places
- people taking blood samples, for example, throwing it away and
telling people
they are uninfected. We need to strengthen our medical system and open
it as
much as possible to all groups in society. The true incidence of HIV
and AIDS
in Poland will bc seen
only when we can
fund a proper
study and can organize a top-quality unit. We do not have what is
needed to
make proper diagnoses. We don't have the equipment to conduct a bronchoscopy, for example, to
look for PCP. (Editor's
note: Pneumocistis carinii
pneumonia, a common AIDS related illness.) In my opinion,
most
transmission
of HIV in Poland is through heterosexual sex.
If so,
Poland would differ in this from other European countries. How do you
believe
this has come about?
It
goes
back to the 1970s, when the then communist government first allowed
Polish
citizens to travel to the West freely. Differences in the economic
levels of neighbouring
countries lead to
prostitution and infection.
And cheap sex brings with it an enormous danger of HIV. Living in
Poland is
like living in the Caribbean and being close to the USA. When Poles got
the
freedom to travel in the 1970s - I was earning $ 10 a month at the time
- many
of my fellow citizens went to Germany and sold sex to get money. Now,
many
people come here for sex. They pay girls and boys for unprotected sex.
Young
boys of 10 or 12 hang around outside buses from Germany offering sex
for very
little money. Unfortunately, there are men and women who find sex
boring unless
it is unsafe. And there are parts of western Poland where many young
people go
to Berlin to be prostitutes. Male prostitution is quite common, but not
as
common as female prostitution. Also, the spread of bloodborne
diseases in our country is very dynamic.
One
in
1600 Polish women between the ages of 20 and 29 get the hepatitis B
virus (HBV)
in hospital or outpatient clinics during their pregnancies. So HBV in
Poland is
more common in women than men, whereas in most countries, the reverse
is the
case.
Poland
is heavily Roman Catholic. Does this pose problems for you in spreading
the
message of safe sex?
Religious
problems are a real obstacle, a real interfering fact. According to
Catholicism, a man should not deposit his semen anywhere other than in
his
wife's vagina, so sexual fondling and masturbation to ejaculation are
out of
the question. But we need to adjust our advice sensibly to reality.
Promiscuity
exists in Poland as it does in other countries, and you have to admit
that
sexuality is an issue for young people and cannot be seen only as a sin.
So have
you run into problems with the Catholic Church?
If
you say
plainly that something endangers people, and if you repeat it enough
times, thc Church has
no objection. I say,
let a priest be a
priest, let a doctor be a doctor. But priests are not the only people
who pose
problems. In 1991, one of my fellow deputy health ministers said that
condoms
were only for deviants. He was fired by the prime minister of the time,
Mr Bielecki,
who was a liberal.
And an education minister said recently that there was no need for AIDS
education. I said his comment was "very exotic".
What is
the position on AIDS education?
The
older
generation does not want to talk to another generation about sex. There
are
some things which most mums and dads find it impossible to say. Doctors
are not
good at AIDS education because they tend to medicalize
the issue and use words of Greek and Latin origin. And teachers get red
faces
about condoms. In any case, in this time of transition from communism,
when
there has been a swing to the authoritarian right, it is not possible
to
incorporate AIDS education into the official curriculum. In my opinion
the best
way is to use peer educators.
Who
will these peer educators be?
We
have an
army of young women - 13 000 secondary nursing students, 3000 of them
doing
midwifery - who could be health educators. We started a peer training programme in 1988 in Wroclaw
with the headmaster
of the
local midwifery school. The midwife peer educators, who are usually 19
or 20
years old, go into local schools and talk to the pupils from the ages
of 11 up,
usually separating the sexes until they are 15. The system is now very
well-known in the area. Other schools are asking for it, and parents
too. We
find that young women can talk about sex much more easily than young
men with
their peers, male and female. The educators tell the group that it is
natural
for young people to have sexual urges, to masturbate, and to fantasize.
This
gets them all relaxed. And then the educators come in with the message:
"But when it comes to intercourse, use a condom and/or a virucide". And they tell the
girls it is
important to
know someone for more than one day, and that they should check whether
the
boyfriend can fulfil
his role not just as
a sex
partner, but as someone they can talk to and enjoy other leisure
activities
with. One aim is to delay first intercourse. I follow the idea of
abstinence as
an ideal, but at the same time realize that it can be too demanding.
How do
you plan to mobilize the whole army of nursing and midwife students?
We
have
set up a programme
called Sami Sobie
- "Ourselves for Ourselves". It is headed by Dorothy Czyrek and Ivonne Mackiewicz,
who were in the first group of peer
educators.
We hope to make a short-cut to a new generation of Poles using self
made
educational materials based on WHO and Red Cross models. Fifteen girls
from
Warsaw and Wroclaw went to Bristol in June to learn of British
experiences, and
with WHO support we organized summer camps for 60 midwifery students
and 60
nursing students in August to train them as trainers to go into the
schools.
They will go into the schools and show how to use condoms by putting
them on
their fingers, and so on. (I do that whenever I go on television.) The
girls
will also talk about general health promotion, including what tobacco
can do to
you, not just about AIDS and sex. The Polish population is dying from
smoking
and drinking and lack of physical exercise.
What
about condom supply in Poland?
For
many
years, there was a factory in Poland which produced condoms with holes
and
measured their elasticity with rulers. Now we have founded a new
Polish-German
joint venture with quality technology looked after by German
specialists. We
make all kinds of condoms, even flavoured
ones, for
oral, vaginal and anal sex. And they cost the equivalent of 18 US cents
for
three.
If your
plans for peer education come to fruition, the younger generation will
be well
educated on AIDS issues. What about the generation of people who came
before
them?
People are
shy of
picking up leaflets. It is easier for them to pick up a phone. That is
why I think
hotlines are very important. I first set up a counselling
service for pre- and post-HIV diagnosis in the autumn of 1987. We were
the
first in central and eastern Europe to have dialled
automatic information on AIDS. There are now about 10 or 11 hotlines in
Poland.
Recorded messages directed at housewives, drug users or other groups
supply
other numbers to phone if the callers feel they are in danger. They
then reach
an operator from their own social group whom they can talk to. Usually
people
say they are ringing on behalf of a friend, but gradually we gain their
confidence and they come to visit a doctor, who is usually attached to
an STD
clinic. In my country, a typical problem might involve a young married
mother
who suddenly fears she might be infected after having a single sexual
encounter
with someone who has been abroad - her first love, perhaps,
unexpectedly met in
the street. She wants to have another child, she doesn't want to infect
her
husband, so she feels she needs condoms, or support. She worries, she
gets
psychosomatic symptoms. ... For such cases, I think it is inhuman not
to create
an anonymous counselling
unit. The same
goes for
homosexuals: why not invite them to a place with a gay doctor for pre-
and
post-test counselling?
I think we will
soon set up
that kind of facility.
_____
(*)
COPENHAGEN, DENMARK
AIDS HOTLINES FOR COUNTRIES
OF CENTRAL AND EASTERN
EUROPE 1992
Report on a WHO Workshop
Warsaw, 13-16 December 1991
This activity was organized by the WHO Regional Office for Europe to promote work aimed at achieving the following target in the health for all strategy.
OPENING SPEECHES
Zbigniew Halat,
M.D., Deputy Minister, Ministry of Health and Social Welfare, Poland
Hans
Moerkerk, M.D., Special Adviser on International Health Affairs,
Ministry of
Welfare, Health and Cultural Affairs, The Netherlands
Monique
Middelhoff, Ministry of Welfare, Health and Cultural Affairs, The
Netherlands
Richard Rector, WHO Temporary Adviser
Opening
statement, by
Zbigniew Halat, M.D.
I understand that this is the second such meeting in Europe, and the
third in the World, organized with financial support from the Dutch
Government. I wish to express my gratitude to the Government of The
Netherlands for their commitment in this respect. I also want to put on
record my ppreciation of the fact that so many participants from the
countries in Eastern and Central Europe have been able to come together
here, in spite of all the practical difficulties we know most of you
experience at present. Some sixty individuals from countries in central
and eastern Europe have gathered here today including facilitators and
temporary advisers from seven Western European countries.
The tremendous interest to participate in the workshop is an indication
of the correct decision of the Global Programme on AIDS in the WHO
Regional Office of Europe to give priority to the planning and
development of AIDS hotlines in countries in central and eastern Europe.
This is a field where a tremendous amount of experience has accumulated
recently in countries in western and northern Europe over a relatively
short period of time. There is need to share knowledge of the success
and the failures that has been gained, so that we in the countries of
central and eastern Europe may profit by the experiences in western and
northern Europe, and adapt your knowledge to our own realities.
<>It is often said that, at present, the only vaccine we
have
against transmission of HIV infection is information and education.
However, the AIDS pandemic has underscored what we have known for a
long time; that not every form of information influences people,
increases knowledge, changes attitude, or makes a difference in
changing behaviour. The AIDS pandemic has taught the world that there
are great differences between old-fashioned health propaganda and the
modern social marketing that is part of health promotion. It has
illustrated the importance of target groups having confidence and trust
in the source of the information. It has underlined that
representatives of target groups should have a say in how their peers
should be approached. It has shown the total superiority of one-to-one
transfer of information in a counselling setting, and targeted
campaigns should not be discounted as important consciousness-raising
elements of a total information, education and health promotion
strategy in HIV/AIDS prevention and control- However, before we start
attempting to transmit information to achieve behaviour change, we must
learn how to communicate effectively in a counselling situation.
Counselling in any setting demands listening skills and empathy.
Helpline counselling by telephone requires special skills. These skills
do not come naturally to most of us; they need to be learned.
When a person has overcome his or her reluctance to call an anonymous
telephone number and to start to talk to a stranger about sensitive
issues like HIV/AIDS, sex and drug use, they do not usually want to be
met by a person spewing out series of epidemiological statistics or
masses of biomedical facts. What they want to meet at the other end of
the telephone line is a sensitive, empathie person with active
listening skills; a person with ability to guide the caller to
decisions that are right for her or him.
< style="font-weight: bold;">Various ways have been
chosen in
various countries and different settings to meet the needs and demands
of the hotline callers or "customers". In some cases great stress has
been put on the counsellors with professional training in health or
social sciences or services. In other cases the stress is on volunteers
with non-professional backgrounds; simultaneously stressing the need
for the helpline to enable the non-health (or social service)
professional to be really a professional counsellor rather than a
counsellor with a professional background» and achieving this through
intensive and extensive training» and on-the-job supervision.
Participants at this workshop will have the possibility to discuss the
pros and cons of various solutions to a number of challenges and
problems that have accumulated over the years of running AIDS helplines
and other specialist telephone hotlines in western and northern Europe.
< style="font-weight: bold;">In this, let us remind each
other,
however, that the solution we choose for our own ventures must build on
acknowledgement of the cultural and traditional sensitivities that are
peculiar to each group targeted* Such sensitivities exist and need to
be recognized. Breaking down social, legal, cultural, religious and
traditional barriers may be needed concerning sexuality, sexual
orientation and sexual practices, as well as concerning illicit use of
alcoholj drugs and other substances. But in breaking down these
barriers we must be willing to acknowledge that they exist and respect
them for what they are, and on the other hand not be over afraid of
breaking taboos. The very fact that there exists in the countries of
Europe such variety of social» legal» cultural» religious and
traditional attitudes is in itself one of the things that make Europe
an exciting continent, and with increase in personal liberty in so many
-more countries» even more so at present than a few years ago. However,
in.relation to the AIDS epidemic the very expressions of freedom
paradoxically..put the population at risk calling for a firm public
health and social policy response with concerted action of voluntary
activities and statutory actions and duties.
There is an impressive array of participants and of advisers at this
workshop. I am convinced that together you will be able to find answers
on how to respond to this paradox of personal freedom and
health-endangering behaviour. You will not give us the ultimate answer,
but you cannot fail to give us important guidance. I wish you every
success in your deliberations.
(**)
"the quixotic and controversial deputy minister of health, government
sanitary inspector, and chief environmental health officer, Zbigniew
Halat MD is engaged in a
personal crusade
to shake
the health service out of the spiritual atrophy induced by 45 years of
communism. Hard working, self reliant, aggressive, and abrasively
masculine,
this man of Promethean energies put me in mind of a nineteenth century
northern
mill owner"
Karin Chopin, Letters from Poland, Pollution most foul, British Medical Journal, June 6, 1992
Karin Chopin, Letters from Poland, Post-totalitarian medicine, British Medical Journal, June 13, 1992
CONDOMS DEADLY
DELUSIONS
http://www.ehn-online.com/cgi-bin/news/newsfocus6/NewsFocus6-archive-12-5-2002.html
Condoms always
have and
always will pose a great use-effectiveness problem. In fact, the FDA requires
the manufacturer to list
the ideal use-effectiveness rates of approved contraceptives in the
package
inserts for oral contraceptives, which are even more easily controlled
in use.
Combining the ideal and the use-effectiveness rates, condoms are listed
at
90-70 percent, which translates to a failure rate of 10-30 percent.
These rates
are based on birth prevention, not disease prevention.
This
distinction is
critical when safety and protection are honestly considered and
evaluated. For
example, a woman's window of fertility is 7 days out of an average
28-day
cycle. Infections such as AIDS, however, can occur every day at any given
minute,
depending on the immune system. This means that there are at least four
times
as many days during which disease can be transmitted as opposed to the
occurrence of fertilization - the simple transmission of a sperm into
an
egg.(1, 2, 3) Some claim that condoms will cut down on the spread of
many sexually
transmitted diseases,
including AIDS.
However, a
study published
in Sexually Transmitted Diseases fails to show any reduction in newly
acquired
STDs among those who are described as "always users" of condoms. (4)
S. duBose Ravenel,
M.D.,
comments that "the obvious possibility that condoms do not provide
significant protection was not even discussed by the authors." (5)
According to Joe S. McIlhaney,
Jr., M.D.,
there is
clinical evidence to show that "the same rate of chlamydial
infection occurs in those who use condoms and those who do not." We can
conclude that the condom also fails to protect women from chlamydia
trachomatis, "the most
common bacterial
sexually
transmitted disease in the United States." (6) Doctors Zelig
Friedman and Liliana Trivelli
of the HIV/AIDS Advisory Council of New York City's Board of Education
express
grave concerns about condom effectiveness and write:
Although no
one would argue
that condoms may help reduce the risk of pregancy
and
of some diseases if used perfectly, a closer look at the circumstances
of
failure renders this option unacceptable. Condoms have a poor track
record as
contraceptives (15% failure for youngsters in the first year of use),
offer no
protection for chlamydia
or HPV [human papiloma
virus] and have a 2Đ4% rate of tearing,
breakage and slippage. With regard to HIV they are not impermeable. (7)
THE
SPERM VS. THE AIDS
VIRUS
A paper in the
February
1992 issue of Applied and Environmental Microbiology reports that
filtration
techniques show the HIV-1 virus to be 0.1 micron (4 millionths of an
inch) in
diameter. It is three times smaller than the herpes virus, 60 times
smaller
than the syphilis spirochete, and 50 to 450 times smaller than sperm.
(8)
THE
FLAWED CONDOM
Naval Research
Laboratory
(NRL) researchers, using powerful electron microscopes, have found that
new
latex, from which condoms are fabricated, contains "maximum inherent
flaw[s]"
(that is, holes) 70 microns in diameter. (9) These holes are 700 times
larger
than the HIV-1 virus. There are pores in latex, and some of the pores
are large
enough to pass sperm-sized particles. Carey, et al., observed leakage
of
HIV-sized particles through 33%+ of the latex condoms tested. In
addition, as
Gordon points out in his review, the testing procedures for condoms are
less
than desirable. United States condom manufacturers are allowed 0.4%
leaky
condoms (AQL). Gordon states, "The fluctuations in sampling permits
many
batches not meeting AQL to be sold." In the United States, 12% of
domestic
and 21% of imported batches of condoms have failed to meet the 0.4%
AQL. (10)
CONDOMS
FAIL TESTING
In a 1988
study sponsored
by the National Institutes of Health, Bruce Voeller
of the Mariposa Foundation in Topanga, California, a non-profit
organization
dedicated to preventing the spread of sexually transmitted diseases,
ranked 31
brands of latex condoms according to how well they met the U.S. and
international
quality assurance standards designed to ensure that condoms provide an
effective barrier against human sperm. "Many of the condoms now on the
market would not get FDA approval if they were required to meet today's
standards," says Voeller.
Although all
condoms
sold in the U.S.are
supposed to pass
quality
assurance tests, those marketed before 1976 need not meet the more
stringent
requirements necessary to win FDA marketing approval. (11)
Dr. Collart
reports that "Gotszche
and Hording in their
study
of in vivo [real life] condom failure rates concluded 'Condoms to
prevent HIV
transmission do not imply truly safe sex.' In addition Steiner, et al.,
observed newer lots of condoms had actual breakage rates of 3.5-8.8%,
while
actual breakage rates for older lots ranged from 9.8-18.6%. In a study
conducted by Ahmed, et al., 29%-42% of those who had used condoms
experienced
at least one breakage. In a survey conducted by the University of
Manchester,
52% of those who had obtained condoms from their family planning clinic
had one
or more either burst or slip off in the 3 months before the survey. In
studies
by Albert, et al., and by Wright, et al., 36% and 38% of their
respondents
reported condom failures respectively." (12)
CONDOM
+ SPERMICIDE
Some have
advocated the use
of spermicide
containing nonoxynol-9 in
the
prevention of HIV
infection.
However, the protective effects of
nonoxynol-9 have not been established in vivo for any of the viral
STDs. Some
reports suggest that spermicides
(including
nonoxynol-9) may be associated with irritation and ulceration of
genital and
rectal epithelia, side-effects that may actually facilitate HIV
infection. In a
study with Nairobi prostitutes, a higher rate of new HIV infections was
found
among women using nonoxynol-9 than among those not using it.
Additionally, in a
study of rhesus monkeys who were exposed to a high dose of simian
immunodeficiency virus following vaginally inserted nonoxynol-9 foam,
half the
monkeys developed an infection. (13, 14, 15, 16)
CONDOM
CLIMATE CONTROL
Condoms are
sensitive to
heat and cold, yet they are not normally transported in
climate-controlled
vehicles. Vesey, in his study of condoms,checked
72,000 trucks and has actual photographs of eggs frying in the backs of
trucks
used for condom distribution. Partly due to Vesy's
study, Burlington County, NJ, banned the distribution of condoms at the
county's AIDS counselling
center, because
they
concluded that the risk of liability for condom failures was too great.
(17)
DEADLY
DELUSIONS
In a 1990
review article by
April and Schreiner, the authors summarize recent studies on HIV
infection and
conclude, "Recent studies on HIV prevention show the assumption that
condoms provide reliable protection against HIV to be a dangerous
illusion." The studies reviewed by the authors showed that the rate of seroconversion (HIV infection)
associated with
condom use
ranged from 13% to 27% and more. (18) Frosner
concludes that "Available data now indicate that efficacy of condoms
has
been largely overestimated." (19) In a study in Florida, where
heterosexual couples used condoms, 17% of partners of AIDS patients
became infected within 18
months, (20) despite the frequency of sexual relations being lower if
one
partner is HIV-positive.(21) Detels,
et
al., (22)
observed a risk reduction of only 3.3:1 for those who used condoms with
all of
their partners, and a 1.8:1 increase in risk for those who used condoms
for some
of their partners as opposed to using condoms for none of their
partners.
This would
indicate that
condoms are ineffective for prolonged or lifelong protection from AIDS.
(23) In
addition, since 100% condom use is difficult if not impossible to
obtain, the
realistic number to look at would be the risk while using condoms some
of the
time. It is more realistic to expect teens to be abstinent (which is
100%
effective in preventing sexual transmission
of HIV)
than it is to expect them to
use
condoms 100% of the time (which has an HIV failure rate approaching
100% with
life-long use.) Joffe,
et al., (24) state:
"The
association between categories of condom use and history of an STD were
not
statistically significant at conventional levels after adjustment for
number of
partners." Cohen, et al., (25) conducted a study in which patients who
had
contracted an STD were given a condom education course. Within nine
months
"19.9% of the men and 12.6% of the women returned with new STD," some
multiple times. The STD reinfection
rate
actually
increased for women. Frosner
states the
U.S.
government has withdrawn a $2.6 million grant to study condoms because
"An
unacceptably high number of condom users probably would have been
infected in
such a study."
PANACEA
OR PLACEBO?
In conclusion,
Herbert Ratner, M.D.,
offers the best summary of all
when he says,
Actually, the major accomplishment of the condom campaign to prevent
AIDS is to
impress
the promoters, politicians and the public at large that something is
being
done; and although well-intentioned, it offers more of a placebo than a
panacea. Publicizing the condom to the four winds is, for the most
part, the
bravura of a puritan who is trying to prove to the world that he is not
a
puritan. To concentrate on the mechanical aspects of the sex act to the
exclusion of the emotional and psychological aspects (which the condom
campaign
ignores) is the essence of Puritanism. The only difference between the
new and
the old is that whereas the traditional puritans were alleged to
believe that
sex was something to be isolated and repressed, neo-puritans accept sex
as
something to be isolated and exercised. (28) Reviewed by Joel McIlhaney, M.D., of the Medical
Institute for
Sexual Health
NOTES
1.Weller,
Susan C., "A
Meta-Analysis of Condom Effectiveness in Reducing Sexually Transmitted
HIV," Social Science and Medicine, Vol. 36, #12, June 1993, pp.
1635-1644.
2.Smith,
Richard W., The
Condom: Is It Really Safe Sex? (unpublished, October 1990) pp. 8-9.
3.Collart,
David G., M.D.,
Condom Failure for Protection From Sexual Transmission of the HIV: A
Review of
the Medical Literature, Feb. 16 1993.
4.Zenilman,
Jonathan, et
al., "Condom Use to Prevent Incident STDs: The Validity of
Self-Reported
Condom Use," Sexually Transmitted Diseases, Jan.-Feb. 1995, pp.15-21;
5.Ravenel S. duBose,
M.D., "Comments and Observations," Aug.
5, 1995.
6.Joel McIlhaney,
Jr., M.D., "Chlamydia Trachomatis;
The
Most
Common Bacterial Sexually Transmitted Disease in the United States,"
Medical Institute for Sexual Health Sexual Health Update, Vol. 3, #3,
Fall,
1995.
7.Friedman and
Trivelli,
"Condom Availability for Youth: A High Risk
Alternative," Pediatrics, 2/97, p. 285.
8.Lytle, C.
D., et al.,
"Filtration Sizes of Human Immunodeficiency Virus Type 1 and Surrogate
Viruses Used to Test Barrier Materials," Applied and Environmental
Microbiology, Vol. 58, #2, Feb. 1992.
9."Anomalous
Fatigue
Behavior in Polysoprene,"
Rubber Chemistry
and
Technology, Vol. 62, #4, Sep.-Oct. 1989.
10.Collart,
David G., M.D.,
loc. cit.
11.Nowak,
Rachel,
"Research Reveals Condom Conundrums," The Journal of NIH Research,
Vol. 5, Jan. 1993, pp. 32, 33.
12.Collart,
David G., M.D.,
op. cit.
13.Bird, K.D.,
AIDS, Vol.
5, pp. 791-796, 1991.
14.Voeller,
B., AIDS, Vol.
6, pp. 341-342, 1992.
15.Kreiss, J.;
Ruminjo,
I.; Ngugi, E.; Roberts,
P.; Ndinya-Achola, J.;
and Plummer, F.,
1989 V
International Conference on AIDS, Montreal.
16.Miller,
C.J.; Alexander,
N.J.; Sutjipto, S.; et
al., J. Med. Primatol,
Vol. 19, pp. 401-409, 1990.
17.Vesey,
W.B., HLI
Reports, Vol. 9, pp. 1-4, 1991.
18.April, K.,
and
Schreiner, W., Schweiz.
med. Wschr.,
Vol. 120, pp. 972-978, 1990.
19.Frosner,
G.G., 1989,
Infection, Vol. 17, pp. 1-3.
20.Fischl,
M.A.; Dickinson,
G.M.; Segsl, A.;
Flanagan, S.; and
Rodriguez, M.;
Presentation THP. 92, III International Conference on AIDS in
Washington D.C.,
1-5 June, p. 178, 1987.
21.Klimes, I.,
et al., AIDS
Care, Vol. 4, p. 151, 1992.
22.Detels, R.;
English, P.;
Visscher, B.R.;
Jacobson, L.; Kingsley,
L.A.; Chmiel, J.S.;
Dudley, J.P.; Eldred,
L.J.; and Ginzburg, H.M.;Journal
of
Acquired Immune Deficiency Syndromes, Vol. 2, pp. 77-83, 1989.
23.Gordon, R.,
loc. cit.
24.Joffe,
G.P.; Foxman,
B.; Schmidt, A.J.; Farris, K.B.; Carter, R.J.;
Neumann, S.; Tolo,
K.-A.; and Walters,
A.M.; 1992,
Sexually Transmitted Diseases, Vol. 19, pp. 272-278.
25.Cohen,
D.A.; Dent, C.;
MacKinnon, D.; and Hahn, G.; Sexually Transmitted Diseases, Vol. 19,
pp.
245-251, 1992.
26.Fršsner,
G.G., loc. cit.
27.Byer, C.O.,
and Shainberg,
L.W., Dimensions of Human Sexuality, Wm. C.
Brown Publishers, 1991.
28.Ratner,
Herbert, M.D.,
"Condoms and AIDS," ALL About Issues, Feb. 1989, p. 36
ENVIRONMENTAL
HEALTH NEWS
http://www.ehn-online.com/cgi-bin/news/newsfocus6/NewsFocus6-archive-12-5-2002.html
Tanzania - Ten
million condoms
fail checks
Thursday, May 16 2002
The
Tanzanian
government has announced that it is to destroy a shipment of 10 million
condoms
imported by the United Nations for free distribution, after tests
revealed that
they were defective.
After testing samples from three containers of Singaporean condoms –
worth
approximately $800,000 – officials from the Tanzanian Bureau of
Standards
claimed that the prophylactics had failed “the water test” and should
be destroyed.
The government has issued public assurances that the quality of condoms
would
not be compromised in its fight against Aids and that it was
investigating how
the consignment could be destroyed in an environmentally friendly way.
But, according to UN officials, the test applied by the bureau was too
rigorous. World Health Organisation
specifications
state that condoms should be filled with water, while hanging
vertically, to
check for leaks. None of the consignment would have failed this test,
claims
the UN. But the condoms did fail when filled with water to check for
visual
defects, suggesting weak points.
The United Nations Fund for Population Activities imported the condoms
in a bid
to reduce the spread of Aids.The
UN
estimates that
one in 10 Tanzanians are living with HIV/Aids. In some areas, rates of
44 per
cent have been recorded among pregnant women. Unofficially,
the rate is
thought to be
far higher.
BBC News, 20
January, 2004
Durex withdraws
condom
lubricant
The
makers of Durex
have ceased production of condoms containing a
controversial lubricant amid doubts about its ability to prevent
infection.
The lubricant,
nonoxynol-9
(N-9), was originally thought to provide a high level of protection
against
infections such as HIV.
However,
recent studies
have shown that it may actually increase the risk.
Concerns had
been raised by
the World Health Organization, UNAIDS and the US Centres
for Disease Control.
The UK
National Aids Trust,
which has campaigned for the removal of N-9 from condoms, applauded the
decision.
Keith Winestein,
campaigns manager, said: "This is a very welcome decision.
"A raft of
agencies
and organisations agree
that N-9 is
harmful and it
needs to be removed from any products that might put the consumer at
risk."
Call
on the government
Mr Winestein
said the government should re-double its efforts to ensure N-9 is
removed from
all condoms manufactured in the UK, as well as those sent overseas.
N-9,
originally developed
as a detergent, has been used for nearly 50 years as a vaginal cream
that
rapidly kills sperm cells.
Research
indicated that N-9
can act to break up or irritate the cell lining, or epithelium, of the
rectum
and the vagina - the first line of defence
against
HIV and other diseases.
Such
irritation can make it
easier for a virus or other infective organism to invade.
The danger in
anal sex is
especially significant because the rectum has only a single-cell wall.
The
vagina has a wall that is about 40 cells thick.
When it comes
to condoms,
many of which are treated with N-9 inside and out, there is more HIV
risk if the
condom slips, breaks or is misused.
But there is
also possible
danger of N-9 breakdown of the anal or vaginal epithelium whether the
condom
breaks or not.
Durex condoms are manufactured by SSL
International Plc.
In a
statement, the company
said: "SSL is anticipating a material reduction in demand for spermicidally-lubricated condoms
following a
recent WHO
report which questioned the level of additional protection provided by
such
condoms when compared to non-spermicidally
lubricated
condoms.
"In light of
this, SSL
decided to discontinue using the spermicide
N9 in our
condom manufacturing process.
"As a result
of this
action, SSL will stop offering spermicidally
lubricated condoms for sale and distribution."
Other
companies, such as Johnson and Johnson, have already ceased making
products
containing N-9.
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PREVENTION PROGRAM
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