Condoms and Partner Choice are Important in Containing HIV

29 May 2003

Tony Floyd,
Medical Student
Newcastle University, Newcastle Australia 2308

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Re: Condoms and Partner Choice are Important in Containing HIV

I had previously cited de Vincenzi's longitudinal study published in the New England Journal of Medicine(1) which found that:

--- "Consistent use of condoms for heterosexual intercourse is highly effective in preventing the transmission of HIV." ---

Various comments were made about this study such as:

> For de Vincenzi (1) to make the above claim, she had first to prove that heterosexual (vaginal) transmission of HIV takes place. She did not.

Another triumphant non-proof (deja vu?). The Padian Study was similarly misused above, with claims that it tried 'vigorously' to prove heterosexual transmission (whilst somehow failing to state that objective whatsoever in the paper!). This is analogous to, having sailed across the atlantic with no other stated intention, you are greeted after a successful journey with cries of 'AHAH! You set out to prove that the Earth was round and FAILED!!!'. Whatever.

de Vincenzi did not 'have to prove' anything other than present her findings that condom use were an effective way of reducing the transmission of HIV.

> In the de Vincenzi study there was a significant loss (19.5%) to followup.

Significant?

In a study of several hundred couples over a 20 month period, wouldn't you suggest that to retain just over 80% of those who commenced the study be a good thing?

Or are you suggesting that the loss of this 19.5% somehow distorted the result?

Or was this comment just a bit of 'padding'?

de Vincenzi did of course state that the

--- "proportion of couples lost to follow-up was not significantly associated with the center ... or with any of the sexual, demographic, or medical characteristics documented at the time of enrollment" ---

Another comment was:

> According to US researchers ... the data analysis is flawed.

I'm not sure that Ambati's Letter(2) qualifies as representing 'US researchers' in general, although he does challenge de Vincenzi's figures as suggested. If his questioning of the statistics is valid, then for the sake of consistency we should also note his conclusion:

--- "Choosing a partner who is not in any high-risk group provides a degree of protection that is at least three orders of magnitude higher than that afforded by condom use." ---

Or are you ignoring his conclusion and hoping to ride high on the 'flawed' comment?

de Vincenzi challenges his figures in her reply. Regardless of that, one author champions partner choice as more important than condoms, the other vice versa. Neither entirely DENY the importance of either condoms or partner choice in the transmission of HIV.

I doubt de Vincenzi or Ambati would be too upset at having their work misused to support alternative AIDS theories.

There's a lot of it going around.

References:

(1) de Vincenzi I. A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. European Study Group on Heterosexual Transmission of HIV. N Engl J Med. 1994 Aug 11;331(6):341-6. PMID: 8028613 [Abstract]

(2) Ambati J, Ambati BK, Rao AM. Heterosexual transmission of HIV. N Engl J Med. 1994 Dec 22;331(25):1717-8; author reply 1718-9. PMID: 7969368

Competing interests: None declared