Surgeon General C. Everett Koop, long a highly visible advocate of condom use to prevent the spread of AIDS, warned Monday that prophylactics have "extraordinarily high" failure rates among homosexuals and offer them no assurance of "safe sex."
Koop said the same warning applies to heterosexuals who engage in anal intercourse and to the spread of other sexually transmitted diseases in addition to AIDS.
The statements contradict what has become an article of faith among many gays who believe that, aside from abstinence, condoms offer the only effective protection against the AIDS virus.
In an interview, Koop said he intended to revise future editions of his report to the nation on AIDS to distinguish between the protective value of condoms for vaginal intercourse and for anal sex. He said the original report had never been intended to apply to condom use in anything but heterosexual vaginal sex.
The warnings--issued by Koop in an interview at UCLA, where he was keynoting a health conference--contradict a variety of assumptions about the protective value of condoms, which have increased in popularity among gays--the group hardest hit by the AIDS epidemic. Many homosexuals apparently believe that the use of condoms safeguards them against contracting the human immunodeficiency virus, the precursor of AIDS.
"I don't like to acknowledge mistakes, and I don't want to use the word 'mistake' in reference to that report," Koop said of his study, first issued last December. "But when I do it over, on the basis of information we have now and we (expect) to be getting, it will be much more explicit as to the expected failure rate in heterosexual (vaginal) and homosexual intercourse."
Koop said that since the initial report was written, he has been "surprised" to find a near-complete lack of research on condom failure rates and causes. He noted that the promotion of condoms as protection against AIDS, hepatitis B and herpes has occurred before the completion of any large-scale study to confirm their effectiveness in preventing the spread of viruses.
Research Just Starting
In addition, he said, little attention has been paid to the stresses anal sex--as opposed to vaginal intercourse--places on condoms. Only one study, a major research effort now in its initial stages at UCLA and USC, has ever been designed to explore the various issues of condom breakage and leakage rates as they relate to AIDS, he noted.
That study is not expected to produce preliminary results until next year.
Koop said he still believes it is better to use a condom than to engage in anal intercourse unprotected, but that for homosexuals and others who engage in such sex, condoms at the very least "should not be seen as a panacea."
Range of Problems
The surgeon general also:
--Reiterated previously reported research that condoms made of lamb membrane material cannot block the AIDS virus and other major sexually transmitted diseases. These so-called lambskin condoms are popular in some segments of the gay community because they resist tearing and breaking, but researchers say the membranes theoretically permit passage of the AIDS virus.
--Took the condom industry to task for failing to provide package inserts, marketing and advertising materials to support AIDS and other education efforts. Taking note of an advertising slogan used in one new condom ad campaign, Koop said: "I don't think that 'I love you, but not enough to die for' is a health message. You might be talking about motorcycles."
--Warned that Americans should avoid foreign-made condoms imported in bulk and repackaged by U.S. distributors, often as private-label brands. Uncertainties about foreign manufacturing and warehousing procedures make such products dangerous, he said.