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LETTER |
The author is with the Office of Women's Health, Centers for Disease Control and Prevention, Atlanta, Ga.
Correspondence: Requests for reprints should be sent to Yvonne Green, MSN, CNM, RN, Office of Women's Health, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mail Stop D-51, Atlanta, Ga 30333 (e-mail: ygreen{at}cdc.gov).
Erica Gollub wrote, in her commentary in the September 2000 issue of the Journal, "[T]he CDC [Centers for Disease Control and Prevention] lags considerably . . . in promoting [the female condom]. . . . This has contributed to the undermining of confidence in this method."1
Acceptable and effective prevention methods are desperately needed to fight the global pandemics of HIV and sexually transmitted diseases (STDs). The CDC first recommended female condoms for HIV and STD prevention in 1993 for couples who do not abstain from sex, are not mutually monogamous with an uninfected partner, or do not use male condoms.2 At that time, only 1 small trial showed that consistent female condom use prevented reinfection with Trichomonas.2
In 1998, the CDC reiterated the 1993 recommendation after experts reviewed the relevant new data.3 One Thai trial described the female condom's "marginal effectiveness": women who were offered female and male condoms were less likely to become infected with STDs than women who were offered male condoms alone.4 In the only US trial of female condom effectiveness in preventing STD transmission, few women consistently used female condoms; most preferred male condoms for long-term use.5 Effectiveness data from this study are not yet published. The CDC disseminated the 1993 and 1998 recommendations in print (including consumer fact sheets and provider training materials), electronic format, and hotline messages to thousands of governmental and nongovernmental prevention programs, health care providers, and consumers.
The CDC has provided at least $5 million in funding for female condom research and has actively sought new funds to evaluate female-controlled prevention methods.6 Research has addressed determinants of condom use, slippage, breakage, and leakage and comprehension of hierarchical HIV/STD prevention messages. For more than a decade, the CDC has also funded HIV/STD prevention programs to purchase and distribute female condoms and to counsel clients about the condoms' use.7
Available data indicate that for many women who do not abstain from sexual intercourse, do not have a mutually monogamous relationship with an uninfected partner, or do not use male latex condoms consistently and correctly, the female condom is the most effective HIV and STD prevention method. In the face of devastating epidemics of HIV and STD, the CDC will continue to promote female condoms and other methods for HIV/STD prevention and will support development of other HIV/STD prevention strategies for women.
References
1.
Gollub EL. The female condom: tool for women's empowerment. Am J Public Health.2000:90:1377–1381.
2. Centers for Disease Control and Prevention. Update: barrier protection against HIV infection and other sexually transmitted diseases. MMWR Morb Mortality Wkly Rep.1993;42:589. Available at: http://www.cdc.gov/mmwr/PDF/wk/mm4230.pdf. Accessed September 4, 2001.
3. Centers for Disease Control and Prevention. 1998 guidelines for treatment of sexually transmitted diseases. MMWR Morb Mortality Wkly Rep.1998;47(RR-1). Available at: http://www.cdc.gov/mmwr/PDF/RR/RR4701.pdf. Accessed September 4, 2001.
4. Fontanet AL, Saba J, Chandelying V, et al. Protection against sexually transmitted diseases by granting sex workers in Thailand the choice of using the male or female condom: results from a randomized controlled trial. AIDS.1998;12:1851–1859.[Medline]
5. Macaluso M, Demand MJ, Artz LM, et al. Female condom use among women at high risk of sexually transmitted disease. Fam Plann Perspect.2000;32:138–144.[Medline]
6. Topical microbicides for prevention of sexual transmission of HIV. Mission and Research Agenda, FY 2000–2005. Atlanta, Ga: Centers for Disease Control and Prevention; 2001.
7. Stone FM, O'Meara G, Gibson P. Distribution of female condoms by STD programs—half full or half empty? In: Abstracts of the 127th Annual Meeting of the American Public Health Association; November 7–11, 1999; Chicago, Ill:170.
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