Condoms and Anal Sex: HPB’s bad advice

Anyone who indulges in high-risk sexual behaviour (e.g. unprotected sex with multiple partners) is at high risk of being infected with a STI, including HIV. Anal sex is associated with a higher risk of STIs/HIV transmission compared to vaginal or oral sex. As a result, anyone who engages in anal sex, whether homosexual or heterosexual, is at a higher risk of infection. Correct and consistent use of condoms during any form of sex is the most e ective (sic) way of preventing STIs/HIV transmission. (For more information about STIs please refer to www.dsc-clinic.sg) [Emphasis added]

It is quite clear that HPB is actually avoiding its own question.

But the single most culpable error lies in the fact that condoms are often not strong enough for anal intercourse.

Risk of condom breakage during anal intercourse
Anal intercourse carries with it such a high risk of condom breakage that it is simply not advisable.

The US Food and Drug Administration (FDA) has written in its brochure on Condoms and Sexually Transmitted Diseases:

Are condoms strong enough for anal intercourse?

The Surgeon General (C. Everett Koop, Surgeon General 1982-1989) has said, “Condoms provide some protection, but anal intercouse (sic) is simply too dangerous to practice”

Condoms may be more likely to break during anal intercourse than during other types of sex because of the greater amount of friction and other stresses involved.

Even if the condom doesn’t break, anal intercourse is very risky because it can cause tissue in the rectum to tear and bleed. These tears allow disease germs to pass more easily from one partner to the other.

The McKinley Health Center writes:

Remember to always use only water-based lubricants with latex condoms. The anus does not produce a sufficient amount of lubricant for comfortable intercourse and adding more lubricant reduces the risk of tearing anal tissue and having a condom break. A thicker lubricant may be needed for anal sex.

Likewise, condom manufacturer Durex has implicitly affirmed this in its FAQs on anal sex, echoing HPB’s habit of failing to answer a direct question:

Can I use condoms for anal sex?

There are currently no specific standards for the manufacturing of condoms for anal sex. For anal sex in particular, application of additional water-based or silicone-based lubricants to the outside of the condom once donned is recommended to help reduce the risk of breakage or slippage of the condom.

Contradicting the Government’s own stand

I would like to emphasise that the most effective way to prevent HIV infection is to remain faithful to one’s spouse/partner and to avoid casual sex, and sex with sex workers. Those who engage in high-risk sexual behaviour should use condoms consistently and correctly during every sexual encounter to reduce their risk of HIV infection.  To facilitate recall of the main principles of protection against HIV infection for everyone, we use the ‘ABCD’ approach – which refers to ‘A’ for Abstinence, ‘B’ for Being faithful, ‘C’ for the correct and consistent use of Condoms, and ‘D’ for early detection. [Emphasis added]

This is further reinforced by Health Minister Gan Kim Yong’s misguided defence of HPB’s FAQs:

The FAQs also provide specific information to young people at risk of engaging in sexual behaviours which expose them to STI and HIV. The statement that “A same-sex relationship is not too different from a heterosexual relationship” and the statement that follows: “Both require the commitment of two people” should be taken together. They highlight that relationships require commitment, and it is possible to remain faithful to one’s partner, regardless of one’s sexual orientation. This drives home a key STI and HIV prevention message to “Be faithful” to one’s partner, rather than to have multiple partners. This helps to protect individuals from STIs and HIV, minimize transmission risks, and thereby safeguarding public health. [Emphasis added]

(See also “Welcome to the Animal Farm: MOH’s response to HPB FAQs on Sexuality”)

Conclusion: HPB’s bad advice 
Health Minister Gan claimed that the FAQs “provide a one-stop resource of factual information from a public health perspective on sexuality, STI and HIV prevention”. Yet the most glaring failure of the HPB FAQs lies in its erroneous advice about the use of condoms and its concomitant failure to warn about the fact that condoms are often not strong enough for anal intercourse. This omission is so serious it is actually negligent.

This also serves as another example of the Government’s doublethink.

At the height of the HPB FAQs debate, various groups and individuals were calling the information presented “unbiased”, “accurate and factual”, “unprejudiced” and “objective”. Yet most of these completely failed to engage with the medical evidence or the content of the FAQs, focusing instead on ideological positions about homosexuality and sexual orientation, while on the other hand making various comments about how “prejudiced” religious people are.

If there is anything to be learnt from the HPB FAQs controversy, it is to learn to focus on the merits of the arguments, rather than meaningless labels and ad hominem remarks which are carelessly and irresponsibly thrown about in such debates, too much and too often.