Condom and Nonoxynol-9 use and the incidence of HIV infection in serodiscordant couples in Zambia

Abstract

We aimed to measure the effectiveness of latex condoms and of nonoxynol-9 [N-9] spermicides, in preventing HIV transmission in heterosexual serodiscordant couples in Lusaka. Each couple was examined at clinic visits scheduled at 3-month intervals for one year or more per couple, or until seroconversion or discontinuation. Couples were given condoms and their choice of 3 N-9 products and advised to use both at every intercourse. Sexual exposure was ascertained from coital logs that recorded coitus and barrier method use. HIV serological testing was done at each clinic visit (ELISA and Western blot if positive). One hundred and ten discordant couples were followed for a mean of 17.6 months. Seventy-eight per cent of coital episodes were protected by condoms, 85% by spermicides and 6.4% were unprotected. Fourteen seroconversions occurred (8.7 infections per 100 couple-years [c-y]). The rate was higher among seronegative men than seronegative women. Among couples who reported using condoms at every intercourse the infection rate was 2.3/100 c-y, compared with 10.7/100 c-y among couples using condoms less consistently (rate ratio [RR] 0.2; 95% confidence interval [CI] 0-1.6). Among couples who reported using N-9 at every intercourse, the seroconversion rate was 6.9/100 c-y; among couples who reported less than full-time N-9 use, the rate was 8.9/100 c-y (RR 0.8; 95% CI 0.2-2.8). Among the subset of female seronegatives, the N-9 RR was 0.5 (95% CI 0.1-3.8). But when we calculated HIV rates according to N-9 consistency in coital acts when condoms were not used, there was no evidence of protection with higher N-9 use. Consistent use of latex condoms reduces the incidence of HIV infection, but the association between N-9 spermicides and HIV is less clear. The current study could not provide compelling data on the impact of N-9 spermicide use on risk of HIV infection. The study's small size, as well as the consistency of concurrent condom use, limited our inferences. Available spermicide products must be studied further.

Condom Use by Adolescents

“…49 Of concern, however, were the following facts: 1) no studies ever definitively demonstrated a beneficial effect of spermicides on STD or HIV transmission with condom use; 2) spermicide use may have adverse effects (although earlier concerns about birth defects and possible urinary tract colonization have not been confirmed) 62,63 ; and 3) spermicides have been shown to cause vaginal irritation in some studies, leading to an increased risk of genital ulcers and a potentially increased risk of HIV infection. 49,64 This last concern has now been confirmed in a study performed in Africa by the Joint United Nations Program on AIDS, which found in a controlled study of more than 1000 women that those who used a condom and a spermicide with nonoxynol-9 became infected with HIV at about a 50% higher rate than those who used a condom and a placebo gel. 65 The CDC therefore issued a letter in August 2000 recommending against the use of nonoxynol-9 as a means of preventing STDs and HIV infection.…”

Crusading for change in the Catholic Church

“…3 Could this really be the "better system" of publishing that Aronson describes 4 -a system in which the results of the global research enterprise are a commodity, owned by publishers and sold to those who can afford access, instead of being a global public good? A Wellcome Trust report concluded that the subscription based, restricted access system "does not operate in the long term interests of the research community" 5 and that it is hard to see how it is serving the public.…”

Sexual Risk Intervention In Multiethnic Drug And Alcohol Users

“…Similarly, the majority of HIV infection in sub-Saharan Africa occurs in marital and cohabiting relationships [3][4]. Typically, condom use increases following a seropositive diagnosis or intervention, but is not sustained over 6 months [5][6][7] and couples do not protect the uninfected partner [8].…”