Condom Failure Rates: Are They Really Safety Equipment ?

A former US Surgeon General warned that condoms may have such a high rate of failure which would make them inadequate as a barrier protection device.  The Los Angeles Times quoted U.S. Surgeon General C. Everette Koop in February 1987 when the HIV/AIDS epidemic was at its height. Prior to that declaration Koop was a long time advocate of condom use. Here are his statements as provided to the Los Angeles Times during an interview at UCLA;

“[Koop] warned Monday that prophylactics have “extraordinarily high” failure rates among homosexuals and offer them no assurance of “safe sex.”

Koop said the same warning applies to heterosexuals who engage in anal intercourse and to the spread of other sexually transmitted diseases in addition to AIDS.”

He went on to state;

“I don’t like to acknowledge mistakes, and I don’t want to use the word ‘mistake’ in reference to that report,” Koop said of his study, first issued last December. “But when I do it over, on the basis of information we have now and we (expect) to be getting, it will be much more explicit as to the expected failure rate in heterosexual (vaginal) and homosexual intercourse.”

Koop said that since the initial report was written, he has been “surprised” to find a near-complete lack of research on condom failure rates and causes.”

Koop worried about the potential for condom breakage and leakage;

In addition, he said, little attention has been paid to the stresses anal sex–as opposed to vaginal intercourse–places on condoms. Only one study, a major research effort now in its initial stages at UCLA and USC, has ever been designed to explore the various issues of condom breakage and leakage rates as they relate to AIDS, he noted.

You can read more here -> http://articles.latimes.com/1987-09-22/news/mn-9637_1_condom-ad

Later that year condom standards underwent a revision. Koop convened a panel. The 14-member task force included Food and Drug Administration, the condom industry, independent research experts and the American Society for Testing and Materials, a private organization that sets standards for hundreds of products and processes, academic researchers, two experts on product testing from the Consumers Union and medical-device manufacturers.

Michael Free, vice president of the Program for Appropriate Technology and a member of the task force stated;

“[…]You can say for sure that condoms do give some protection. What it boils down to is: Are they perfect? And of course they’re not. You grasp at remedies according to the risk at hand[…]”

Free went on to state;

“We don’t even know for sure if breakage is far more important than (detecting leaks), but we believe it is. Manufacturers will tell you that breakage doesn’t amount to a hill of beans,”

Two years later the study that Koop referred to in 1987 was published. Koop convened a panel of experts that included representatives from U.S. Food and Drug Administration, the Centers for Disease Control and the National Institutes of Health. The panel released the following statement about condom use and AIDS;

“And it cautioned that–even with a condom–any type of intercourse with a person known to be infected with the AIDS virus is so dangerous to an uninfected partner that anyone in such a situation should “consider alternative methods of expressing physical intimacy.”

You can read more here -> http://articles.latimes.com/1989-02-18/news/mn-2240_1_condom-failure

The question now turns to where are we in the year 2012 in regards to reliability of condoms. It is a widely held belief that condoms are an acceptable method of preventing STI transmission. Widely held beliefs are not always reliable indicators of truth. Polls show that 34% of Americans believe in ghosts and UFOs and 48% believe in ESP while a mere 19% believe in witchcraft (Please see: http://articles.cnn.com/1997-06-15/us/9706_15_ufo.poll_1_ufo-aliens-crash-site?_s=PM:US ).

Thus, for true data you cannot rely on widely held beliefs. You must turn to science. It appears that between 1987 and 2005 the manufacturing and testing standards were raised in the condom industry. In 2005, Consumer Reports (Consumers Union whose experts were members of Koops panel in 1987) published a comprehensive report on their findings on the testing of major condom brands. The report issued by Consumer Reports cannot be found on line at this time (Note: If someone can find their report I would be most interested in reading it). However, it appears that Consumer Reports indicated that condoms have a failure rate of 15% based upon their testing regiment. This failure percentage seems to be confirmed by the University of California San Francisco’s AIDS Research Institute in their pamphlet “What is the Role of the Male Condom in HIV Prevention?” (Please see: condomFS-1), According to the pamphlet;

“When used consistently and correctly, latex male condoms can reduce the risk of pregnancy and many sexually transmitted infections (STIs), including HIV by about 80-90%.”

I am not aware of any recent changes to the manufacturing or testing of condoms that would significant change the rates as noted by Consumer Reports and the UCSF’s pamphlet from 2005. Thus we are left with a condom failure rate of 10-20% based upon brand.

In the medical device industry a 10-20% failure rate results in a recall of the product. In 2011, pharmaceutical giant Johnson & Johnson was forced to recall their artificial hip implant when failure rates were shown to be 12-13%, which is far greater then the usual less then 5% failure rate that is acceptable to the FDA ( Please see: http://thesafetyreport.com/2011/02/a-cautionary-tale-the-fda-medical-devices-and-patient-safety/ ).

In 2007 another medical device manufacturer suspended sales of a heart defibrillator unit when it was discovered to be defective. In that matter the device was shown to only have a defect rate of 3.75% ( Please see: Tolley Report ).

In the adult industry, performers and producers will be required by Ballot Measure B to use a device that has been proven to have a failure/defect rate of 10-20%. In any other instance of a medical device or a safety device with a failure rate of that magnitude there would be recalls and lawsuits may follow.

There is no doubt that condoms have been an effective measure against the prevention of STIs and HIV transmission on a personal use basis. AHF has touted condoms as being an effective worker safety device based on the fact that there has not been a single HIV transmission in a Nevada brothel since mandatory condom use began in 1987. (Note: This statement should be looked at with a discerning eye since in the Nevada brothel system ONLY 50% of the community is tested – the prostitute. Testing is not required for the clients. In adult entertainment all performers are tested regularly, both male and female.)

It should be further noted that anal sex is rare in Nevada brothels. During an August 13, 2010 meeting of the Nevada State Board of Health, Ms. Spaulding, Manager of Nevada’s Office of Epidemiology stated;

“During initial discussions, universal rectal screening of all brothel workers was discussed. The representatives for the brothels noted that anal intercourse is rare and screening should be offered only if that service was provided to clients, but unnecessary if it was not allowed at that brothel.” (Please see: NevadaDeptHealthMeeting )

Therefore, as compared to the adult entertainment industry, the prevalence of condom use in the brothels of Nevada for vaginal and/or oral sex and their safety record is not an reasonable comparison to how effective condoms could be as a safety device in adult entertainment. There is little anal sex occurring in brothels while in the straight adult entertainment industry there are many anal scenes being produced every year.

Instead of Nevada brothels, perhaps a better example of how well condoms could be used as a worker safety device would be comparisons to the gay adult entertainment industry since condoms are frequently used in the filming of anal scenes. However that is impossible since the gay content production companies do not require testing and therefore there is no comparable STI or HIV transmission data.

The assumption that condoms may protect performers just as well as they protect the general population and/or sex workers in brothels may be a flawed assumption.

Before condoms are forced on performers more studies should be performed. More research on their breakage for anal sex should be gathered. There is little doubt that condoms for vaginal and oral sex do help with preventing the transmission of STIs and HIV however, there is little hard data available to indicate a condom’s reliability as a worker safety device for all forms of sex and for prolonged use that would be required in a commercial production environment.

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