WASHINGTON, April 21 (UPI) -- Armed with alarming statistics about unplanned pregnancies and sexually transmitted diseases among sailors and Marines, the U.S. Navy's doctors are advocating that commanders promote the use and availability of condoms, and even offer them for free to their troops.
The Navy office's advocacy of condom use as a means of combating disease and pregnancy appears to be at odds with the White House's embrace of abstinence as the best means of preventing disease and pregnancy, and the Centers for Disease Control and Prevention's recent revisions to its stance on condoms.
According to Navy data, since 1985 more than 5,000 sailors and Marines have been infected with HIV, the virus that causes AIDS, costing the Navy healthcare system $12,000 per patient or $6 million a year to treat them. In 2004 there were 106 new cases of HIV in the Navy and Marine Corps. Each year the Navy assumes a lifetime healthcare cost of $20 million for sailors and Marines infected with HIV.
There were about 4,500 unplanned pregnancies -- nearly 70 percent of all enlisted pregnancies are not planned. Their total healthcare cost for the Navy was about $16 million, about $3,200 per pregnancy.
In response, the Navy Environmental Health Center's Sexual Health and Responsibility Program in its June 2005 Message for Commanders encourages Navy and Marine leaders to establish a climate of sexual responsibility, including ensuring their crews know how to use condoms and have access to them.
The guidance to commanders is not put forth as official Navy policy, but rather as suggestions for ensuring the health and the readiness of the fleet.
"We often hand them out overseas, with everyone coming off the ship picking them up going ashore in foreign ports. I'd always say, 'Take one for your buddy so he doesn't get in trouble,'" a senior commander told United Press International. "Now that the story is coming out in the press, we will no doubt get some 'helpful guidance' from our political masters."
The program -- known by its initials SHARP -- suggests that condoms be available for free as standard protective gear on par with earplugs -- an attempt to destigmatize condoms and get them in the hands of those who need them.
And many do. According to the latest Defense Department numbers, in 2002 46 percent of Navy service personnel reported using a condom in their last sexual encounter. Marines reported 43.3 percent use of condoms. The Army reported 39.6 percent use and the Air Force 40.2 percent use.
The Navy Environmental Health Center recognizes that ensuring crew access to condoms is an emotionally charged issue "requiring thoughtful planning and leadership courage." SHARP provides commanders a lengthy document discussing ways to increase condom use and availability.
Not only is the issue emotionally charged, it is increasingly politically charged. Once widely embraced as the best means of preventing the transmission of HIV and several other diseases, condom use has fallen out of favor with the Bush administration which advocates abstinence as the best approach to control AIDS, particularly among youth and the unmarried, according to a government official who follows the issue closely.
President George W. Bush's 5-year strategy to reduce the HIV infection rate overseas will provide at least $133 million annually to abstinence-until-marriage programs in 15 countries in Africa, the Caribbean and in Vietnam, totaling at least $665 million.
The plan does promote condom distribution "as appropriate," but it singles this out as a strategy for "those who are infected or who are unable to avoid high-risk behaviors," rather than for the otherwise healthy populations.
At a Berlin AIDS conference in 2004, the U.S. Global AIDS Coordinator Randall Tobias said that promoting abstinence and monogamy are "far more effective" than distributing condoms for preventing the spread of HIV.
"Statistics show that condoms really have not been very effective," Tobias said. "It's been the principal prevention device for the last 20 years, and I think one needs only to look at what's happening with the infection rates in the world to recognize that has not been working."
While funding abstinence education abroad, the White House is proposing to cut $4 million from the CDC's HIV and AIDS, STD and tuberculosis-prevention program, according to the Sexuality Information and Education Council of the United States, an advocacy organization that promotes sexual education.
The White House also supported Congress' appropriation of nearly $170 million in federal funds for abstinence-only education for students in the United States. By law the programs funded cannot discuss the role condoms play in preventing the spread of sexually transmitted diseases.
Those programs came under fire last year by Democrats charging scientific inaccuracies. Senate Majority Leader and physician Sen. Bill Frist, R-Tenn., asked to defend the programs on ABC News in December, said they merit review and that the government has an interest in providing accurate information about public health challenges, including AIDS, the flu and condoms.
Frist also said, "We know that there's about a 15-percent failure rate" with condoms.
Used correctly -- which requires user education -- the CDC states the failure rate is between 2 and 3 percent.
The CDC has also taken steps in the last two years to de-emphasize condom use, embracing instead an approach to HIV prevention that focuses first on abstinence and monogamy.
In December 2002, the CDC removed from its Web site instructions on how to properly use condoms and data from studies showing that making condoms available to young people does not result in their having sex at an earlier ages, The Los Angeles Times reported.
The new fact sheet also emphasizes condoms' limitations.
"No protective method is 100 percent effective, and condom use cannot guarantee absolute protection against any STD," it reads. An earlier version said abstinence was the only guaranteed way to prevent HIV and STD infections but using condoms was "highly effective" at protection.
In June 2004, CDC issued new draft guidelines to organizations that are seeking federal grants and provide HIV counseling and sexual education that require groups to discuss condoms' "lack of effectiveness."
Official CDC policy holds that the "best choice is abstinence and mutual monogamy, but correctly used condoms are highly effective against HIV," said spokeswoman Jessica Frickey.
Another CDC official who works on HIV issues told UPI Wednesday that the Navy policy and the White House policy on condoms appeared to be "mutually exclusive."
It is a clash between competing interests. For both moral and political reasons, the White House seeks to publicly discourage casual sex which it links to condom use. The Navy, seeking to protect the health and readiness of the fleet, skews toward the practical.
The Navy material does highlight abstinence and mutual monogamy as the only guaranteed method of prevention, but it endorses condom use -- a reflection of the reality of its experiences, a Navy official told UPI.
SHARP also provides a Power Point presentation for chaplains to use, encouraging abstinence, especially during shore leave.
A 1991 survey of 1,700 sailors and Marines on a six-month deployment showed 42 percent had contact with prostitutes and had a new sexually transmitted disease infection rate of 10 percent. But the contraction of STDs does not just occur in exotic ports of call from sex workers.
Most infections -- 97 percent in the Atlantic Fleet in a 1998 study -- are acquired in the United States.
The Navy has promoted "targeted" condom access for decades as a way to prevent disease and pregnancy, findings borne out by a 2001 study sponsored by the National Institutes of Health that determined latex rubber condoms were effective against both.
SHARP's "condom access" document offered to commanders cites scientific studies that show making condoms available does not encourage sexual activity or hasten its onset.
"Making condoms easy to get at strategic times and places may increase the likelihood that people who choose to have sex will do so with a condom rather than without a condom," the March 2005 document states.
Availability of condoms may be key. A 2003 survey showed that 31 percent of enlisted male sailors said if no birth control is available, they just take a chance and hope that pregnancy does not occur; 15 percent of female sailors responded the same way. It says commanders should consider buying condoms in bulk and pay for them from the same account used to buy earplugs for protection against loud noises.
People who have access to free condoms are more likely to use them than people who pay as little as 25 cents per condom according to a 1999 study.
"Access to free condoms is an effective public health strategy," the report states.
Free condoms do not suggest the commander is promoting sexual activity, according to SHARP.
"Just as easy access to earplugs does not imply that people should expose themselves to loud noise, condom access does not imply people should have sex. By making access to earplugs and condoms easy, it is implied that safety is desired and expected," the report states.
According to Pentagon spokesman Jim Turner, the Defense Department does not have a department-wide condom policy.
Like the Navy, the Army tells deploying troops abstinence is the only 100 percent effective method for preventing sexually transmitted diseases. It also tells soldiers to always use latex or polyurethane condoms during sex, regardless of other birth control measures.
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