The other night on the evening news, there was a piece about condoms. Someone wanted to provide free condoms to high-school students. A perky, fresh-faced teenage girl interviewed said everyone her age was having sex, so what was the big deal about giving out condoms? Her principal replied that giving out condoms set a bad example. Then two experts commented. One was a lady who sat very straight in her chair, white hair in a tight perm, and, in a prudish voice, declared that condoms didn’t work very well; teenagers shouldn’t be having sex anyway. The other expert, a young, attractive woman, said that since teenagers were sexually active, they shouldn’t be denied the protection that condoms afforded. I found myself agreeing with the prude.
What do I know about all this? I’m an infectious-diseases physician and an AIDS doctor to the poor. Passing out condoms to teenagers is like issuing them squirt guns for a four-alarm blaze. Condoms just don’t hack it. We should stop kidding ourselves.
I’m taking care of a 21-year-old boy with AIDS. He could have been the model for Donatello’s David, androgynous, deep blue eyes, long blond hair, as sweet and gentle as he can be. His mom’s in shock. He called her the other day and gave her two messages. I’m gay. I’ve got AIDS. His lover looks like a fellow you’d see in Sunday school; he works in a bank. He’s had sex with only one person, my patient (his second partner), and they’ve been together for more than a year. These fellows aren’t dummies. They read newspapers. You think condoms would have saved them?
Smart people don’t wear condoms. I read a study about the sexual habits of college women. In 1975, 12 percent of college women used condoms when they had sexual intercourse. In 1989, the percentage had risen to only 41 percent. Why don’t college women and their partners use condoms? They know about herpes. They know about genital warts and cervical cancer. All the public-health messages of the past 15 years have been sent, and only 41 percent of the college women use condoms. Maybe your brain has to be working to use one. In the heat of passion, the brain shuts down. You have to use a condom every time. Every time. That’s hard to do.
I can’t say I’m comforted reading a government pamphlet called “Condoms and Sexually Transmitted Diseases Especially AIDS.” “Condoms are not 100 percent safe,” it says, “but if used properly will reduce the risk of sexually transmitted diseases, including AIDS.” Reduce the risk of a disease that is 100 percent fatal! That’s all that’s available between us and death? How much do condoms reduce the risk? They don’t say. So much for Safe Sex. Safe Sex was a dumb idea anyway. I’ve noticed that the catchword now is “Safer Sex.” So much for truth in advertising. Other nuggets of advice: “If you know your partner is infected, the best rule is to avoid intercourse (including oral sex). If you do decide to have sex with an infected partner, you should always be sure a condom is used from start to finish, every time.” Seems reasonable, but is it really helpful? Most folks don’t know when their partner is infected. It’s not as if their nose is purple. Lots of men and women with herpes and wart-virus infections are having sex right now lying their heads off to their sexual partners - that is, to those who ask. At our place we are taking care of a guy with AIDS who is back visiting the bars and having sex. “Well, did your partner use a condom?” I ask. “Did you tell him that you’re infected with the virus?” “Oh, no, Dr. Noble,” he replies, “it would have broken the mood.” You bet it would have broken the mood. It’s not only the mood that gets broken. “Condoms may be more likely to break during anal intercourse than during other types of sex.” Condoms also break in heterosexual sex; one study shows a 4 percent breakage rate. “Government testing can not guarantee that condoms will always prevent the spread of sexually transmitted diseases. " That’s what the pamphlet says. Condoms are all we’ve got.
Nobody these days lobbies for abstinence, virginity or single lifetime sexual partners. That would be boring. Abstinence and sexual intercourse with one mutually faithful uninfected partner are the only totally effective prevention strategies. That’s from another recently published government report.
What am I going to tell my daughters? I’m going to tell them that condoms give a false sense of security and that having sex is dangerous. Reducing the risk is not the same as eliminating the risk. My message will fly in the face of all other media messages they receive. In the movie “The Tall Guy,” a nurse goes to bed with the “Guy” character on their first date, boasting that she likes to get the sex thing out of the way at the beginning of the relationship. His roommate is a nymphomaniac who is always in bed with one or more men. This was supposed to be cute. “Pretty Woman” says you can find happiness with a prostitute. Who are the people that write this stuff? Have the ’80s passed and everyone forgotten sexually transmitted diseases? Syphilis is on the rise. Gonorrhea is harder to treat and increasing among black teenagers and adults. Ectopic pregnancies and infertility from sexually transmitted diseases are mounting every year. Giving condoms to high-school kids isn’t going to reverse all this.
That prim little old lady on TV had it right. Unmarried people shouldn’t be having sex. Few people have the courage to say this publicly. In the context of our culture, they sound like cranks. Doctors can’t fix most of the things you can catch out there. There’s no cure for AIDS. There’s no cure for herpes or genital warts. Gonorrhea and chlamydial infection can ruin your chances of ever getting pregnant and can harm your baby if you do. That afternoon in the motel may leave you with an infection that you’ll have to explain to your spouse. Your doctor can’t cover up for you. Your spouse’s lawyer may sue him if he tries. There is no safe sex. Condoms aren’t going to make a dent in the sexual epidemics that we are facing. If the condom breaks, you may die.
