AIDS-Condom Study Grant Cut Off by U.S.

The federal government has cut off funding to a UCLA study of the effectiveness of condoms in preventing the spread of AIDS because of concern that the AIDS infection rate among Los Angeles homosexuals is so high that condoms may be incapable of providing reliable protection to study participants.

The action, disclosed in documents obtained Tuesday under the Freedom of Information Act and in interviews, appears to represent a major shift in the federal government’s attitude toward the use of condoms in preventing AIDS among gay men in cities with high infection rates. In the past, federal health officials have repeatedly described condoms as the single best weapon, aside from celibacy, against the spread of the deadly disease.

But now federal officials say that the effectiveness of condoms in blocking the spread of AIDS through anal sex has been seriously compromised in five U.S. cities with high infection rates--Los Angeles, San Francisco, New York, Miami and Washington.

The federal decision cancels $2.6 million in grant money that was to have paid for a large-scale trial of condoms by homosexual men in Los Angeles. The trials were designed to measure how effective condoms are in stopping the spread of the human immunodeficiency virus (HIV), specifically in anal sex. HIV is the virus that causes AIDS.

‘Ethical Problems’

But in a July 11 letter to the head of the UCLA study, the National Institutes of Health warned of “potential ethical problems” if the study were allowed to proceed. The project, begun two years ago, has received slightly more than $1 million in federal funding and already has produced exhaustive laboratory test results of the abilities of condoms in general and specific brands, in particular, to inhibit AIDS transmission.

The study thus far has not involved testing condom use with people.

The head of the UCLA study, Dr. Roger Detels, refused Tuesday to discuss the government action.

But Dr. Jeffrey Perlman, chief of of contraceptive evaluation for the National Institute of Child Health and Human Development, a branch of the NIH, said the cutoff stemmed from concern that the chances of transmission of the virus were made unacceptably great by the high prevailing infection rates, combined with the risk of condom failure.

‘Supersaturated With Virus’

“What has happened in the last two years is that gays in Los Angeles became supersaturated with the virus so that to (go ahead with) this study (would mean that) there is going to be a large proportion of the recruits who would have become infected,” said Perlman, who is project officer for the grant. “On that basis, it really came to an ethical issue.”

Perlman said it would be premature to call condom use futile in controlling AIDS infection among gays who practice anal sex. But he said that in Los Angeles and the four other cities, the risks in such sex, even with condom use, appear overwhelming.

“In a low-incidence area, you could say that condoms are almost foolproof,” Perlman said. “In a place like L.A., in the gay community, one would really be talking about delaying infection rather than preventing it. I certainly didn’t feel that this was true a couple of years ago, but I do feel it is true now.”

Better Than No Protection

Perlman added that the new findings, which grew out of a statistical model he developed for presentation last month at an international AIDS conference in Stockholm, do not apply to use of condoms among heterosexuals practicing vaginal sex. And he and others emphasized that condom use remains better than no protection at all.

But in urban areas with high infection rates, Perlman said, the only remaining effective strategy for avoiding AIDS is complete abstinence from anal sex.

The funding cutoff represents a significant setback to U.S. research on condoms, since the UCLA project was the only major study to evaluate the effectiveness of condoms in relation to AIDS, and it remains the largest condom-failure study ever conducted.

In a June 29 discussion, according to both Perlman and the documents, Perlman told UCLA’s Detels that the NIH now fears that the risks of condom failure and subsequent AIDS transmission to study volunteers were unacceptably high.

10% Annual Increase

New statistical evidence, Perlman said, shows that in groups with HIV infection rates comparable to those of gay men in Los Angeles, a 10% annual increase in those rates can result in as much as a 1-in-50 chance that a man using a condom will be exposed to the virus in any given sexual encounter. Among gays who practice anal sex in the Los Angeles area, he said, the infection rate has been increasing as much as 20% a year.

Perlman emphasized that the problem is primarily the statistical likelihood of being with an AIDS-infected partner when a condom happens to fail. “It is not the condoms that are at fault, it is the degree of absolute risk,” he said.

Dr. Martin Finn, medical adviser to the AIDS program office of the Los Angeles County Department of Health Services, said he still believes that condoms may offer some protection against AIDS infection.

Blanket Recommendation

But the odds of infection suggested by the government and other research have prompted him to issue a blanket recommendation against anal intercourse. “I am to the point that I advise anyone that if they are going to do anything,” Finn said, “do not have anal sex.”

NIH’s conclusions about condom use in high-infection areas appear to conflict with earlier policies advocated by Surgeon General C. Everett Koop, who has consistently urged condom use for people unwilling to abstain from sex entirely.

A spokesman for Koop said he was on vacation and unavailable, but Koop has been apprised of the new NIH conclusions, Perlman said.

The NIH conclusions and the UCLA funding cutoff caused alarm Tuesday in local AIDS organizations. A spokesman for AIDS Project Los Angeles, the largest local group, said discontinuation of the research was a significant concern. The spokesman, Andy Weisser, said the 600 men who would have been recruited for the test are among those not availing themselves of any means of protection against AIDS and are among the highest-risk members of the local gay community.

Still Interested in Study

Among such men, Weisser said, even highly unreliable protection from condoms would be better than unprotected, high-risk sex.

Perlman said the federal government is still interested in a test of condom effectiveness, but that such a study would have to be done in some part of the country where HIV infection rates are still low and would have to include heterosexuals.

The NIH funds cutoff is the latest in a series of controversies to hit the pioneering UCLA study. In late June, The Times published results of the project’s ranking of condom brands in terms of their ability to prevent leakage of HIV. That story has resulted in separate internal investigations of the unauthorized release of the rankings at the NIH and at UCLA.