Need Debunking: Heritage Foundation claims that condoms are 69% effective at preventing HIV, among other claims

TheNZThrower

Active Member
Hi everyone. The following (EDIT: Link included) Heritage foundation article attempts to articulate a factual case for abstinence only sex-ed, but are they successful? Or not?

Their first section on the risks of early teen sex activity is dedicated to the alleged increased risks of STD infection. They begin by listing the STD rates among the general population and teens as follows:
Today, there are more than 20 widespread STDs, infecting an average of more than 15 million individuals each year. Two-thirds of all STDs occur in people who are 25 years of age or younger. Each year, 3 million teens contract an STD; overall, one-fourth of sexually active teens have been afflicted.
Their first & second sources are from the webpage of the American Social Health Association circa April 8 2002, the publication date of the article. The citations from it claim that a statement of dissent has been published by the ASHA on their aforementioned webpage:
Shepherd Smith and Joe S. McIlhaney, M.D., "Statement of Dissent on The Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior," issued by the Medical Institute of Sexual Health, Austin, Texas, June 28, 2001, and American Social Health Association, Research Triangle Park, N.C., "STD Statistics,"
However, a glance at the archived webpage shows no such statement mentioned at all.

Screen Shot 2022-01-26 at 1.38.41 am.png

Searching Google likewise does not turn up any useful results

If we look at the 2001 edition of "The Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior,", we instead get a number of 12 million per year according to the Surgeon General's Letter contained within:

So we already have a number off the mark by about 3 million; though to be fair, the number could have increased within the year between the publishing of the call to action and the Heritage article. To be fair, the rest of the data appears to be accurate, and their 3 million figure for teen STDs comes from the Guttmacher Institute.

To be continued...

EDIT: See the post below by deirdre for an updated check on the figures of the Heritage Foundation.
 
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deirdre

Senior Member.
The following Heritage foundation article
what article? add: ok found it http://www.csun.edu/~vceed002/health/std/abstience_education.pdf
WARNING TO READERS: this article is 20 years old, so all data you read in this thread is 20 years old.

12 million per year according to the Surgeon General's Letter contained within:
CDC 2000

More than 25 diseases are spread primarily through
sexual activity, and the trends for each disease
vary considerably, but together these infections
comprise a significant public health problem.

The latest estimates indicate that there are 15
million new std cases in the United States each year (Cates, 1999).
Approximately one-fourth of these new infections are in teenagers.
Content from External Source
....


https://www.cdc.gov/std/trends2000/trends2000.pdf

the cdc has a std report for year 2001, but its all graphs and charts. https://www.cdc.gov/std/stats/archive/all-surv-2001.pdf


Searching Google likewise does not turn up any useful results
yea i cant find that "dissent" letter online either although the author:
1643172899314.png
so seems possible the dissent paper quoted the 2000 CDC report. ??? just guessing.
 

deirdre

Senior Member.
So we already have a number off the mark by about 3 million; though to be fair, the number could have increased within the year between the publishing of the call to action and the Heritage article. To be fair, the rest of the data appears to be accurate, and their 3 million figure for teen STDs comes from the Guttmacher Institute.
in August 2002 the Guttmacher also says 15 million and gives a different ASHA source
Article:
Sexually transmitted diseases (STDs) are a major public health problem in the United States. According to estimates by the American Social Health Association (ASHA), there are approximately 15 million new STD cases in this country each year (see table below)

....
Source: American Social Health Association, Sexually Transmitted Disease in America: How Many Cases and What Cost?, December 1998.

.



Article:
The Guttmacher Institute is a pro-choice[1][2] research organization started in 1968 that works to study, educate, and advance sexual and reproductive health and rights.[3][4] The organization works mainly in the United States but also focuses on developing countries.[4] The Guttmacher Institute uses studies to help support policy making and program reform.[4] The Institute is named after obstetrician-gynocologist and former president of Planned Parenthood Alan F. Guttmacher.[5]



a webMD article concurs
Article:
Feb. 21, 2002 -- How much do teenagers and young adults know about safe sex? Not much. In fact, many people are still in the dark when it comes to preventing sexually transmitted diseases, according to the latest research. But on the bright side, that same research shows that counseling can shed some light on the truth while dispelling dangerous old myths.

Every year, more than 15 million new cases of STDs, or sexually transmitted diseases such as chlamydia, gonorrhea, and syphilis are reported. A study in the October 2000 issue of the American Journal of Preventive Medicine may explain why.
 
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deirdre

Senior Member.
I cannot find the thread title claim in the article. "69% effective for preventing HIV"


Article:
Meta-Analysis Soc Sci Med
. 1993 Jun;36(12):1635-44. doi: 10.1016/0277-9536(93)90352-5.
A meta-analysis of condom effectiveness in reducing sexually transmitted HIV
S C Weller 1
Affiliations expand
PMID: 8327927 DOI: 10.1016/0277-9536(93)90352-5
Abstract
Before condoms can be considered as a prophylaxis for sexually transmitted human immunodeficiency virus (HIV), their efficacy must be considered. This paper reviews evidence on condom effectiveness in reducing the risk of heterosexually transmitted human HIV. A meta-analysis conducted on data from in vivo studies of HIV discordant sexual partners is used to estimate the protective effect of condoms. Although contraceptive research indicates that condoms are 87% effective in preventing pregnancy, results of HIV transmission studies indicate that condoms may reduce risk of HIV infection by approximately 69%.



2004
Article:
But what does the evidence tell us? A recent review from the National Institutes for Health says that condoms are protective against HIV infection,4 reducing the probability of HIV transmission per sex act by as much as 95% and reducing the annual HIV incidence in serodiscordant couples by 90-95% when used consistently.5 However, the impact of inconsistent use of condoms is less substantial: a meta-analysis found that condom use of variable consistency among serodiscordant couples reduced the annual HIV incidence by 69%
 

TheNZThrower

Active Member
I cannot find the thread title claim in the article. "69% effective for preventing HIV"


Article:
Meta-Analysis Soc Sci Med
. 1993 Jun;36(12):1635-44. doi: 10.1016/0277-9536(93)90352-5.
A meta-analysis of condom effectiveness in reducing sexually transmitted HIV
S C Weller 1
Affiliations expand
PMID: 8327927 DOI: 10.1016/0277-9536(93)90352-5
Abstract
Before condoms can be considered as a prophylaxis for sexually transmitted human immunodeficiency virus (HIV), their efficacy must be considered. This paper reviews evidence on condom effectiveness in reducing the risk of heterosexually transmitted human HIV. A meta-analysis conducted on data from in vivo studies of HIV discordant sexual partners is used to estimate the protective effect of condoms. Although contraceptive research indicates that condoms are 87% effective in preventing pregnancy, results of HIV transmission studies indicate that condoms may reduce risk of HIV infection by approximately 69%.



2004
Article:
But what does the evidence tell us? A recent review from the National Institutes for Health says that condoms are protective against HIV infection,4 reducing the probability of HIV transmission per sex act by as much as 95% and reducing the annual HIV incidence in serodiscordant couples by 90-95% when used consistently.5 However, the impact of inconsistent use of condoms is less substantial: a meta-analysis found that condom use of variable consistency among serodiscordant couples reduced the annual HIV incidence by 69%
Thanks mate! I was rather sloppy in my research because I was half asleep late at night, and just wanted to get the first part of the post published. The first study you cited was the exact study in the Heritage article that was used to argue that condoms had a 31% failure rate in stopping HIV.

BTW, can you tell me how to find these articles, as I find it very hard to sift through all the academic data on a given topic to get to the good stuff?
 

Mendel

Senior Member.
condom use of variable consistency among serodiscordant couples reduced the annual HIV incidence by 69%
Translation: "If you don't always use condoms, you have a higher chance of transmitting HIV".
If you always use them, they're 95% effective.
 

Miss VocalCord

Senior Member.
It indeed seems to come down to the consistent use of condoms (from 1997)
Although recent meta-analyses of condom effectiveness suggest that condoms are 60 to 70% effective when used for HIV prophylaxis, these studies do not isolate consistent condom use, and therefore provide only a lower bound on the true effectiveness of correct and consistent condom use. A reexamination of HIV seroconversion studies suggests that condoms are 90 to 95% effective when used consistently, i.e. consistent condom users are 10 to 20 times less likely to become infected when exposed to the virus than are inconsistent or non-users.
https://www.sciencedirect.com/science/article/abs/pii/S0277953696002584?via=ihub
 

deirdre

Senior Member.
Translation: "If you don't always use condoms, you have a higher chance of transmitting HIV".
If you always use them, they're 95% effective.
we don't know what the Heritage Foundation actually claimed because the OP didnt quote anything.
 

Miss VocalCord

Senior Member.
we don't know what the Heritage Foundation actually claimed because the OP didnt quote anything.
I think it comes from this part on their website:
Significantly, research shows that condom use offers relatively little protection (from "zero" to "some") for herpes and no protection from the deadly HPV. A review of the scientific literature reveals that, on average, condoms failed to prevent the transmission of the HIV virus--which causes the immune deficiency syndrome known as AIDS--between 15 percent and 31 percent of the time.[6] It should not be surprising, therefore, that while condom use has increased over the past 25 years, the spread of STDs has likewise continued to rise.[7]
https://www.heritage.org/education/...reducing-sexual-activity-among/#pgfId=1009659
 

deirdre

Senior Member.
BTW, can you tell me how to find these articles, as I find it very hard to sift through all the academic data on a given topic to get to the good stuff?
i've been using the "custom range" in Google under tools. think i picked 2000 thru 2001 or 2002 as my dates.
1643203707981.png
1643203814000.png
 

deirdre

Senior Member.
From Heritage Foundation article:
Article:
A review of the scientific literature reveals that, on average, condoms failed to prevent the transmission of the HIV virus—which causes the immune deficiency syndrome known as AIDS— between 15 percent and 31 percent of the time.[6] It should not be surprising, therefore, that while condom use has increased over the past 25 years, the spread of STDs has likewise continued to rise.[7 ]



6. Dr. Susan Weller, “A Meta-Analysis of Condom Effectiveness in Reducing Sexually Transmitted HIV,” Social Science and Medicine, Vol. 36, No. 12 (1993). See also National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, “Summary,” Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention, July 20, 2001, at http://www.niaid.hih.gov/dmid/stds/condomreport.pdf.

7. Centers for Disease Control and Prevention, Tracking the Hidden Epidemics 2000: Trends in STDs in the United States, 2000, at http://www.cdc.gov/nchstp/od/news/RevBrochure1pdftoc.htm.




edit: sorry @Miss VocalCord was looking stuff while you posted above.

edit 2: the source links above have typos.. ex the NIH link should read "nih" not "hih". so i havent found the report, not searching hard, but Guttmcher Institute wrote a bad review of the report:

The response to the report was immediate and polarized. A group of physicians held a press conference to proclaim that the report demonstrated the ineffectiveness of condom use.9These advocates saw themselves as exposing the "fact that condoms are ineffective in preventing transmission of most STDs. thus challenging the notion of 'safe sex' as championed by the CDC." Unfortunately. by inferring that absence of data meant condom ineffectiveness, the group did exactly what the report cautioned readers not to do. The group went even further in calling for the resignation of CDC director Jeffrey Koplan, alleging that his agency had" deliberately misrepresented condom effectiveness."
On the other side, some congressional representatives criticized the report for its "misleading statements regarding the effectiveness of condoms. n 10 These politicians felt that the report understated the strong epidemiologic evidence supporting the effectiveness of condoms against such infections as chlamydia. gonorrhea. trichomoniasis and genital herpes. Stating that the report was flawed and undermined public confidence in condoms. they feared that this could lead to "decreases in condom use and increases in risky behavior, and the spread of [SUs]."

Content from External Source
https://pdf.usaid.gov/pdf_docs/pnacp791.pdf
 
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Mendel

Senior Member.
I think it comes from this part on their website:
Significantly, research shows that condom use offers relatively little protection (from "zero" to "some") for herpes and no protection from the deadly HPV. A review of the scientific literature reveals that, on average, condoms failed to prevent the transmission of the HIV virus--which causes the immune deficiency syndrome known as AIDS--between 15 percent and 31 percent of the time.[6] It should not be surprising, therefore, that while condom use has increased over the past 25 years, the spread of STDs has likewise continued to rise.[7]
Content from External Source
https://www.heritage.org/education/...reducing-sexual-activity-among/#pgfId=1009659
This is infuriating me because that "therefore" is completely unsupported and probably wrong, and it's especially rich coming from an organisation promoting "abstinence-only" sex ed.
Article:
SmartSelect_20220126-150037_Samsung Internet.jpg

Their idea of sex ed involves leaving kids in the dark about how to deal with STDs, which seems like the opposite of education to me. I have no doubt that these abstinence programs in place of proper sex ed do harm.

These people are selling a moral belief as a health concern.

Article:
Outreach efforts can help, the CDC researchers said, including STD express clinics that provide testing and treatment without a full clinical exam, and partnerships with pharmacies and health clinics that can create new places for STD services like testing and treatment. Telehealth services can also bridge gaps in testing and treatment, especially in rural areas.

[..]

She said that, barring sexual abstinence, tried and true barrier methods such as condoms and dental dams can slash your odds for a sexually transmitted disease.

And "getting the HPV vaccine will help protect you against cervical and penile cancer," Rabin added. "This is approved for up to age 46 for both men and women."

She said the latest grim statistics from the CDC "speak to the fact that people are simply becoming more lax. Twenty years ago we almost eradicated syphilis, and gonorrhea rates were at their lowest. Our defenses are down and we need to catch up quickly."

The first paragraph of that quote is the kind of work that Planned Parenthood is doing.
and I wonder what help bring STDs down 20 years ago
 

Miss VocalCord

Senior Member.
and I wonder what help bring STDs down 20 years ago
Just a very wild guess; I think for part of it it has to do with the AIDS epidemic back in the 80/90's. There was much attention to safe sex and there was the threat of getting HIV/AIDS in those days. AIDS has become a disease which isn't as deadly as it was and for which very good treatments exist.
 

FatPhil

Senior Member.
I think it comes from this part on their website:
...It should not be surprising, therefore, that while condom use has increased over the past 25 years, the spread of STDs has likewise continued to rise.[7]
Content from External Source
https://www.heritage.org/education/...reducing-sexual-activity-among/#pgfId=1009659

I was wondering about the truthiness of the "the spread of STDs has likewise continued to rise" - wondering if they might be massaging or otherwise abusing statistics (such as forgetting about the population itself rising). Reference #7 is
7. Centers for Disease Control and Prevention, Tracking the Hidden Epidemics 2000: Trends in STDs in the United States, 2000, at http://www.cdc.gov/nchstp/od/news/RevBrochure1pdftoc.htm.
Content from External Source
which is a dead link but a websearch finds https://www.cdc.gov/std/trends2000/trends2000.pdf

And scanning through that I couldn't find anything that explicitly supports their precise assertion, and plenty that in part contradicts it. E.g.:
(and forgive this if this is part mangled - text select from the pdf was completely broken so I've had to do a hatchet job - there could be missing lines, or other lines from other columns of the page):

Are stds increasing or decreasing in
the United States?


It depends on the disease. The latest scientific data
suggest that chlamydia has declined in areas with
screening and treatment programs, but remains
at very high levels. For the first time in nearly two
decades, gonorrhea is on the rise, increasing more
than nine percent from 1997 to 1999, after a 72
percent decline from 1975 to 1997. An increase in
drug-resistant gonorrhea has been seen in Hawaii
and in small clusters in other states. Syphilis, in
both adults and infants, has declined overall and is
now at an all time low, presenting an opportunity
for elimination of the disease. In October 1999, cdc
launched the National Plan to Eliminate Syphilis in
the United States. Chancroid also has declined
steadily since 1987 (dstdp, cdc, 2000).

Genital herpes continues to increase, spreading
across all social, economic, racial and ethnic
boundaries, but most dramatically affecting teens
and young adults (Fleming, 1997). With an esti-
mated 20 million people in the United States cur-
rently infected with human papillomavirus (hpv),
this viral std also continues to spread. An esti-
mated 5.5 million people become newly infected
with hpv each year (Cates, 1999).
Content from External Source
The graphs later in the document show plenty examples of drops in prevalence during the prior 25 years too. Looks like the data is dominated by genital herpes, which is described as increasing (but over an unknown timescale), perhaps that's the support for their claim. However, as the only cure for herpes seems to be death, the statistics effectively have a 70 year moving average smearing the data. A peak of new infections due to unsafe behaviour in the past that has disappeared will not disappear from the statistics despite the change to better behaviour - the stats can't go down until that peak generation cacks it en masse, which would make it disingenuous abuse of statistics. They really ought to be considering only new cases, and I don't see that stat in that reference.

So, no firm conclusion yet drawn, it certainly remains plausible.
 

deirdre

Senior Member.
I have no doubt that these abstinence programs in place of proper sex ed do harm.
well since the question is condoms...
2019
Article:
However, recent decreases in condom use have been documented, and the proportion of adolescents using condoms with more effective methods of contraception has been consistently low, with recent national estimates of approximately 9% of sexually active high school students (10).

...
Prevalence of any condom use at last sexual intercourse was 54.3%,


teenagers, who abstinence programs would be targeting, weren't especially keen to use condoms (shyness issues, imo). and look like that still holds somewhat true in recent years..54% is lower than i would expect for modern kids.
although i must say that if i was forced to put a condom on a banana in highschool, that would traumatize me enough (ie. ew!) to avoid sex for quite a while.
 
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deirdre

Senior Member.
(such as forgetting about the population itself rising)
that would also apply to the use-of-condoms numbers.

certainly the Heritage Foundation, who seems keen on using reputable sources to look good, is going to spin their wording a bit...and i'd go so far as to say perhaps cherry pick data... as their goal for teenagers is (my words) "learning about sex in a mentally healthy way and how it relates to love and respect and marriage and all that jazz". It's not like they are trying to hide that fact. And if scaring the hell out of you about STDs is one of their chosen tactics, i think that would help their ultimate goal of the "mentally healthy view of sex" thing.
 

deirdre

Senior Member.
Just a very wild guess; I think for part of it it has to do with the AIDS epidemic back in the 80/90's. There was much attention to safe sex and there was the threat of getting HIV/AIDS in those days. AIDS has become a disease which isn't as deadly as it was and for which very good treatments exist.
interesting article on the topic (which is off topic, but this thread is a mess anyway :) ) the last paragraph adds another "reason" things are possibly regressing. I've been saying that for years, that schools have too much to teach and should drop classes whose topics are already well covered in the entertainment media teens are consuming. ex: i learned not to do heroin ever, not from school ....who did tell me that, but from seeing the movie Christiane F. in my early 20s.


Article:
When condom-usage rates were on the upswing in the ’90s, America was in the midst of an AIDS epidemic that was claiming young lives daily. The fear of the disease gave heft to safe-sex campaigns. Today, public-health officials are partly a victim of their own success; contemporary teenagers grew up after the terror had subsided, thanks to antiviral drugs and those messages that helped bring infection rates down. “The young people today know HIV as a manageable, chronic disease,” Kann says. “It’s not something that can kill you in their eyes. So that leads, most likely, to an attitude that it’s not something that they have to protect themselves from.”

In Oregon’s Lane County, senior health official Patrick Luedtke is in the midst of confronting an ongoing gonorrhea outbreak, with rates jumping as much as 40% in recent years. Like Kann, he believes complacency is a large part of the problem. “People don’t have the fear of death from sex like they had 15 years ago,” he says. “For the teenagers, that fear is gone, and people are not practicing safe sex as much as they used to.”

Other research collected by the CDC shows that some schools aren’t hammering away at the safe-sex lessons like they once did. In Alabama, Alaska and Florida, for instance, fewer public schools are teaching teenagers how to obtain condoms and why it’s important to use condoms. “Schools have competing health issues that they’re asked to deal with, things like tobacco use, bullying, the obesity epidemic. It’s been hard to keep attention focused on HIV and STD prevention,” Kann says.
 

TheNZThrower

Active Member
So to continue after a few paragraphs of sloppy research that has been corrected by others above, the Heritage article proceeds to comment the following on the efficacy of condoms in STD prevention:
Significantly, research shows that condom use offers relatively little protection (from "zero" to "some") for herpes and no protection from the deadly HPV. A review of the scientific literature reveals that, on average, condoms failed to prevent the transmission of the HIV virus--which causes the immune deficiency syndrome known as AIDS--between 15 percent and 31 percent of the time. It should not be surprising, therefore, that while condom use has increased over the past 25 years, the spread of STDs has likewise continued to rise.
The first issue is that the first statement has no citations backing it up. But even if we do assume that condoms are ineffective in protecting against herpes and HPV, it still ignores the fact that the primary and most effective protection against it is via the HPV vaccine.

To be fair, the CDC does note that HPV can infect areas that the condom does not protect, as it is primarily transmitted through infected genital surfaces, including those not covered by the condom:
HPV infections are transmitted through contact with infected genital skin or mucosal surfaces/secretions. Genital ulcer diseases and HPV infection can occur in male or female genital areas that are covered (protected by the condom) as well as those areas that are not... Thus, consistent and correct use of latex condoms would be expected to protect against transmission of genital ulcer diseases and HPV in some, but not all, instances.
The same CDC article also appears to confirm that condoms are only slightly effective in preventing one of the varaints of herpes:
Epidemiologic studies that compare infection rates among condom users and nonusers provide evidence that latex condoms provide limited protection against syphilis and herpes simplex virus-2 transmission.
The claims about the 31% failure rate of condoms in preventing HIV stem from a 1993 study by Susan C. Weller. However, assuming that the methodology of the study is sound, Weller had the following to say in the discussion:
An aggregated estimate of condom effectiveness from in vivo studies suggests a 69% reduction in risk, but true effectiveness may be as low as 46% or as high as 82%. This effectiveness is less than that suggested by contraceptive studies and is conceivable, because condoms may leak HIV and HIV may be transmitted through orogenital and anal routes. Such a meta-analysis. however, needs to be viewed tentatively. Most in vivo studies suffer from design problems, such as not controlling for degree of exposure, source of exposure, and time of seroconversion. Furthermore, this analysis provides only an estimate of the ‘crude’ risk ratio, without stratifying or controlling for confounding variables.
So without assessing whether the methodology is valid, we can already observe several limitations of the study in question regarding controlling for confounding variables. The authors expand upon this further:
An obvious limitation in many of these studies is in the definition of condom use. What is ‘regular use,’ ‘consistent use’ vs ‘any unprotected vaginal intercourse?’ Are condoms being used correctly? Is recall of sexual behavior over 6 months, 1 year, or 2 year period accurate? Could infection by HIV have occurred prior to initiation of condom use? In addition, there may be other sources of HIV exposure confounding the results, e.g. parenteral (needlestick) exposure or other non-vaginal (oral, anal) sexual contact. Results also may be confounded by degree of exposure, e.g. degree of intermittent condom use, degree of infectivity in the HIV positive partner, duration of sexual relationship, frequency of sexual contact, or presence of a genital ulcerative conditi. Confounding can occur when condom use is associated with any of these factors for example, if couples with relationships of longer duration tend to use condoms less.
So we can already infer that a major flaw with the meta analysis is that most studies don't control for correct condom use, or whether HIV infection occurred before condom use began, or other HIV risk factors confounding the results such as relationship duration, injection drug use, frequency of sexual contact, other avenues of sexual transmission etc... Which means the 69% effectiveness figure is suspect.

In addition, the authors note that even the few longitudinal studies in the meta analysis suffer from a lack of proper blind controls:
Longitudinal designs, on the other hand, are vulnerable to biases resulting from multiple testing procedures. If HIV tests and sexual behavior interviews are repeated it is unlikely that participants will be blind to their HIV status when responding to condom use questions.
So that's that for now. I still am a noob at interpreting data, so if anyone else can clarify the results of Weller 1993, please do so. If I missed out on something or got anything wrong, please point it out.
 
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