Masks & Condoms, In Real Life

You have to find humor wherever you can, especially in the midst of a global pandemic. For me, a great source of humor has been the masks and vaccine mandates. This isn't meant in any way to diminish the loss of loved ones or the impact COVID had on businesses, families and kids. I fully acknowledge the suffering it has caused. But stay with me, this isn't political.

"No one wants COVID, so everyone be safe, just wear a masks." Exactly what people have been saying for years about CONDOMS. But how effective are condoms at achieving their goals?

In the LABORATORY studies, condoms are 99% effective at preventing fluid exchange -- that means they retain water or other fluids when you fill them up. The studies used to prove condoms prevent pregnancy are done with couples who have been together for an extended period of time, who are motivated to avoid pregnancy. They need established couples (as opposed to couples who just met) because they want consistent behavior patterns -- sex a certain number of times a week, in an environment conducive to using condoms versus sex-on-the-fly with multiple partners wherever there is opportunity -- just to eliminate the factors which might contribute to poor or questionable results. Who does that describe? Certainly NOT teenagers or hooking-up college students! Basically married or cohabiting couples who are motivated to avoid pregnancy and willing to have sex only using condoms, as a condition of the study. So couples who already have as many children as they intend -- very likely females closer to 35 years old than 25, and, hence, much less likely to have an unexpected pregnancy!

So the takeaway is, Condoms are 98% effective at preventing pregnancy in a controlled situation. But In Real Life, it's a different story. One out of 4 teens using condoms to avoid pregnancy will GET PREGNANT in the first year, that's failure rate of 25%! Mostly because of "user error." Teens use condoms like they clean their rooms - they put them on too late, take them off too early, use them incorrectly and inconsistently. So In Real Life, the takeaway is, Condoms are only 75% effective in the group society would most like to NOT get pregnant.

What about disease transmission? There are no definitive studies on the effectiveness of condoms against STIs. Let me repeat that in case you missed it... There are no definitive studies on the effectiveness of condoms against STIs. Two decades ago, they used to say "97% effective against disease transmission," but that was based on those fluid exchange studies In The LAB. In Real Life, there are too many factors to pin it down so the answer is "it depends." On what?

  • The type of STI. Some are passed in fluids (HIV) and some by contact with infected skin (Herpes, HPV).

  • Which partner is infected. Some STIs are more easily transmitted from male-to-female than from female-to-male or vice versa.

  • The type of sexual activity. Anal sex is highly transmissible for most STIs compared to oral or vaginal sex, for example.

  • Where the condoms come from. Not all condoms are alike! Imported condoms have lower effectiveness rates than domestic condoms. They can be impacted by storage, transportation, and temperature.

  • Consistent and correct usage. And that never happens. According to the most recent data (2019 Youth Risk Behavior Risk Surveillance) 61% of of high school freshmen used a condom at their last intercourse. For high school seniors, the percentage drops to 50.3%. And only 38% of college students say they "always" use condoms. To be effective at stopping transmission, that number has to be 100%.

So even the CDC doesn't give a direct answer, they say, condoms "can reduce (though not eliminate) the risk of sexually transmitted diseases (STDs)." Reduce? What does that mean? By how much? One percent? Fifty? Roll the dice, I guess. "Trust us: protection protects! Science says 'Condoms work!'" Sound familiar?

According to the most recent data (2019 Youth Risk Behavior Risk Surveillance), the highest rates of condom use was among high school Freshmen (9th graders). Why? Students have to take Sex Ed in 7th and 9th grade in most states. They finish that course highly motivated not to make babies or get infected. But by the time that student is a Senior, a majority of parents have put their daughters on birth control, and everyone has dismissed their risk of infection. Probably because, unlike pregnancy, no one "looks" infected. Condom usage never goes up from there. And, it turns out, the people engaged in the most risky behaviors with the highest number of partners are the least likely to use condoms at all.

So, let's put that data into perspective. The group MOST likely to use condoms are the least likely to have the negative outcome (not as many 9th graders are having sex and the pool of infected people is smaller), but even then, it's far less than 100% participation. The group MOST likely to have a negative outcome (college students casually hooking up with multiple sexual partners whose infection status is unknown) are the least likely to use condoms. Furthermore, in spite of spending billions of dollars to promote birth control use through "sex education," the teen birth rate in the United States remains higher than all other countries keeping comparable statistics. The pregnancy rate among 15-to-19-year olds in the United States is 57 pregnancies per 1,000 females, compared to Switzerland's 8.

Why? Because In Real Life, human behavior can't be 100% controlled.

This is where comparing it to coronavirus policy struck me as comical. Think of the vaccines like long-term birth control, monoclonal antibodies like the Pill, therapeutics like emergency contraception, and natural immunity like sexual self-control. COVID tests are like getting tested for STIs: they just tell you if your strategy failed. They don't actually "prevent" anything. The parallels are hilariously identical!

First the government required everyone to wear masks, but the virus spread like wildfire. Then the vaccine was rolled out, huge numbers of people got vaxxed and boosted, but it didn't stop the virus from spreading. It turned out people could still "get pregnant" with the virus even if they were vaxxed, and the virus could still be transmitted even if with mask-condoms.

Society has been saying, "Be safe, get tested, and use protection!" to control inconvenient sexual outcomes for over 20 years, with marginal effectiveness. How comically foolish to trust the same strategy to stop the spread of something as highly contagious as COVID. "Be safe, get vaxxed, get tested and wear a mask" was never going to work!

Even with a billion dollar marketing campaign promoting masks, testing and vaccines, it was inevitable that people would still "get pregnant" with the virus. Because people use masks the way kids clean their rooms, and vaccine effectiveness is dependent on a variety of factors such as age, co-morbidities and viral variants. But more than anything else, because In Real Life, human behavior can't be 100% controlled.


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