Am J Epidemiol 2003; 158:193.
Copyright © 2003 by Johns
Hopkins Bloomberg School of Public Health
LETTERS TO THE EDITOR |
THE AUTHORS REPLY
1 Family Health International, P.O. Box 13950, Research Triangle Park, NC 27709.
2 AIDS Research Institute, University of California, San Francisco, San Francisco, CA 94105.
3 Center for Reproductive Health Research and Policy, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94143.
4 Department of Epidemiology and Public Health Biology, University of California, Berkeley, Berkeley, CA 94720.
We appreciate the letter by Drs. Mann and Stine (1) regarding our recent commentary on condom effectiveness (2). The exchange illustrates that we agree on most of the facts. Specifically, for sexually transmitted infections (STIs) that are transmitted solely by the exchange of body fluids, including human immunodeficiency virus (HIV), the efficacy of condoms is not seriously in question. Furthermore, any measure of condoms’ effectiveness will be far from perfect and will be variable, for the reasons cited by Mann and Stine. In addition, we agree that accurate and precise communication is important.
The measurement challenges we describe in our commentary highlight the difficulties faced when attempting to quantify the degree of disease risk reduction provided by barrier methods. Thus, establishing an objective body of evidence for the degree of protection against all STIs will be time-consuming and expensive. In the meantime, crafting accurate and precise counseling messages poses challenges. Our conclusion that "condoms are the best STI/HIV prevention approach for sexually active persons who either have infected partners or do not know their partners’ infection status" is both accurate and precise (2, p. 300).
Finally, we agree with Mann and Stine that we must be careful not to either discourage condom use by understating the effectiveness of condoms or encourage sexual risk-taking by instilling a false sense of security. Condom effectiveness messages must be tailored to their intended audiences. For example, different messages are needed for adolescent girls in the United States than for commercial sex workers in Kenya. In terms of the "ABC" approach to risk reduction (Abstinence; Be faithful; Condom use), the former cohort should receive messages emphasizing the A of "abstinence," whereas the latter should receive messages emphasizing the C of "condoms." Rigorous research is needed to provide empirical evidence as to which particular combination of the ABCs is the most effective in reducing risk in various settings.
REFERENCES
- Mann JR, Stine CS. Re: "Invited commentary: condom effectiveness—will prostate-specific antigen shed new light on this perplexing problem?" (Letter). Am J Epidemiol 2003;158:000–00.
- Steiner MJ, Feldblum PJ, Padian N. Invited commentary: condom effectiveness—will prostate-specific antigen shed new light on this perplexing problem? Am J Epidemiol 2003;157:298–300.
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