UHS To Phase Out Spermicidal Condoms

Based on information from the Centers for Disease Control suggesting spermicide-coated condoms may increase risks for contracting certain Sexually Transmitted Diseases (STDs)—including HIV—Harvard’s University Health Services announced this week that it is “phasing out” its distribution of those condoms on campus.

But the UHS-affiliated student group Peer Contraceptive Counselors (PCC) will continue to make spermicidal condoms available to students to “provide [students] with the widest possible range of contraceptive options,” even continuing to order them through UHS, said PCC Co-Director Elizabeth T.B. Murphy ’03 yesterday.

Previously, students could choose from three types of condoms offered for free by UHS and PCC—lubricated, unlubricated and spermicidal—in their Houses or on the second and fifth floors of UHS’ Holyoke Center building.

Under the new decision, UHS will place no new orders for spermicidal condoms, though it will continue to distribute its remaining supply, Christine Johnson, UHS health promotion and education specialist, said yesterday.

“We did not throw out any condoms. The CDC did not think the risks warranted that,” Johnson said.

She added that students should not be wary of using spermicidal condoms, since the report does not mandate their use be discontinued altogether. Instead of becoming alarmed, she said students should consider their contraceptive practices.

“I think what is perhaps most important about this is that we might heighten student awareness of condoms,” Johnson said. “So perhaps [any resulting scare] will be a good thing if it leads to a discussion of what type of condoms to use. Students might think more just about using condoms.”

The spermicide nonoxynol-9 (N-9) had long been assumed to have the added benefit of protecting against the transmission of STDs. But, citing studies described in the Journal of the American Medical Association (JAMA) this March, the CDC report concludes that the purchase of N-9 coated condoms is inadvisable.

None of the studies cited in the JAMA article found N-9 to protect against HIV, and few found that it reduced rates of chlamydial or igonococcal infection.

Moreover, several trials reported an increased incidence of the STDs in the presence of N-9. Researchers conjectured that genital ulcers or lesions, vulvitis and the irritation with which the studies found the spermicide to be associated were responsible for the increase.

“N-9 can damage [cells], thus providing a portal of entry for HIV and other sexually transmissible agents,” the CDC’s Morbidity and Mortality Weekly Report explained in May.

The report also referred to the higher cost and shorter shelf -lives of spermicidal condoms in recommending that once existing, unexpired supplies of such condoms have been distributed, no more be purchased.

Although Murphy said medical and pharmaceutical communities have been aware of this information for some time, UHS administrators said the CDC report marked the first time the drawbacks of N-9 came to their attention.

When she learned of the CDC report, Johnson said she checked the trend in reaction and then complied with the report’s suggestion.

“I determined what the Massachusetts Department of Health were doing, and they were actually returning all spermicidal condoms,” she said. “So we’re following the CDC’s guidelines.”

But PCC says it is continuing to offer spermicidal condoms because it, in part, takes issue with the studies on which the report, and its recommendations, are based.

“Our concern is that a lot of these studies were done on prostitutes, so we have concerns about their applicability to the general populace,” Murphy said. “Not that they don’t mean anything, but with prostitutes there may be other factors in increased HIV transmission.”

The JAMA article itself acknowledges such a possibility, although it does not refer to prostitution in particular.

“The populations in which each of these studies was conducted had various rates of sexual activity and thus various rates of [N-9] use. Frequent use of [N-9] results in toxicity such as genital ulceration and irritation that in turn may lead to higher rates of HIV-1 acquisition, whereas consistent but less frequent use does not,” the article, authored by Barbra A. Richardson, reads.

But the article also cites a recent study in which all the subjects had sex with moderate frequency, defined as an average of three times a week, and were still found to have slightly higher rates of the STDs being examined when they used condoms coated with N-9.

Given the recent nature of the change, which is being advertised on dining hall table-tents, student reaction has been limited.

PCC has actually had more requests for spermicidal condoms than usual, Murphy said. And aside from a few questions from regular visitors to its Wellness Center, which distributes condoms, UHS has had an overall increase in the volume of its condom distribution.

Although PCC successfully placed an order for spermicidal condoms last week, both Murphy and Johnson said they think manufacturers are rethinking the product.

“It may be back to the drawing board for a lot of the companies, but Trojan isn’t going to just pull all the spermicidal condoms. If they are available, we will continue to offer them,” Murphy said.

She added that she hoped this will create a dialogue between students and contraceptive educators.

“I think people certainly might be concerned initially, but we at the PCC are hoping they will respond by coming in to talk to us,” Murphy said.

“People don’t need to stop using spermicidal condoms because of this study. The CDC doesn’t say that. They could choose to, but they need to know that using spermicidal condoms won’t make them go out and get HIV the next day.”

One other campus group, also affiliated with UHS, distributes free condoms. Campus Health Initiative officers could not be reached last night.