-Caveat Lector- Faulty Condoms Thwart AIDS Fight in Africa By DONALD G. McNEIL JR. JOHANNESBURG, South Africa -- Out of the depths of the AIDS epidemic sweeping Africa, an ugly truth is emerging: Some condom makers have been dumping their substandard wares here and Africans have been risking their lives on brittle, leaky or ill-fitting condoms. The problem has been particularly bad here in South Africa, where, until last August, government officials were using a procurement system that almost invited manufacturers to ship their castoffs here. There is no question that a scarcity of condoms and the refusal of many men to use them are to blame for far more of Africa's 23 million HIV infections than faulty condoms are. And experts say most condoms are perfectly good and that the influx of bad ones may finally have been stemmed. But the deviousness or sloppiness of some manufacturers and the failure of inspectors to catch them have contributed to the disease's spread. As a result, couples who do practice safe sex have been left helpless. Elizabeth Chidonza, an AIDS-education worker in Cape Town, said she has twice had condoms break during sex. Her boyfriend is not infected with the AIDS virus, but she is. She is both afraid of infecting him and afraid he would beat her if she did. In the West, condoms are not necessarily thought of as life-saving medical devices. Here, however, infection with the human immunodeficiency virus, which causes AIDS, is rampant, and virtually everyone infected will die of it because almost no one in Africa can afford thousands of dollars for AIDS "cocktails" that enable people to live with the disease. Condoms also prevent the spread of venereal diseases and urinary tract infections, which can produce sores that speed HIV transmission. Hundreds of millions of condoms are handed out free on this continent each year, paid for -- and tested -- by international aid agencies. Even now, though, more than 4 million Kenzo brand condoms from Polo Latex Co. of Calcutta are on their way back to India. They were not tested before distribution, and complaints from Cape Town prostitutes flooded in to SWEAT, the Sex Workers Education and Advocacy Task Force, a community aid agency, which had handed thousands out free. When they were checked, the results were shocking: As many as 48 out of 200 in some test batches broke. "Some of them had sand inside the foil packets," said Andrew Crichton, a national Health Department consultant. "How do you even do that? You practically have to have a guy inside the factory throwing dirt into the machine. The cartons had water marks and were disintegrating. They looked like they'd been around the world twice." Thiru Moopen, assistant director of Inbeco, a Pretoria company that imported the condoms, said her "fingers were burnt" in the deal. Polo Latex "claimed its factory was sabotaged," she said, but it agreed to replace the goods. A consignment of Twin Lotus condoms from China is also being recalled, and there have been problems with other brands. There has been no worldwide study of faulty condoms, said Bunmi Makinwa, a distribution expert for UNAIDS in Geneva, but anecdotal reports crop up. There have been occasional problems in Zimbabwe, Cameroon, Rwanda, Zambia and Malawi. In 1993 in Zimbabwe, 24 million condoms made in Malaysia by Dongkuk Techo Rubber and paid for by the British government failed tests. Fortunately, the results came in before any were distributed, but fearing they would be stolen and end up on the black market, Zimbabwe burned them. In a country where 25 percent of adults are now infected, it took 18 months and $157,000 to replace them, even though Durex, a London-based company making a high-quality, slightly more expensive brand, sent "emergency shipments." Dongkuk later said its goods were rejected only because the standards were raised after they were made. A British Embassy AIDS educator denied that, calling it "an excuse," but acknowledged that Dongkuk now sells condoms elsewhere without problems. The incident was so embarrassing -- British aid officials were "nearly court-martialed" by Parliament, one expert joked -- that the British aid agencies adopted far stricter testing rules, which are now used in the many English-speaking countries for which they buy condoms. Condoms are made all over the world, but most factories are in India, Malaysia, Thailand and China, where latex rubber and cheap labor are available. Dennis Blairman, a British condom-quality consultant, has toured dozens of factories. "The industry is a jungle," he said. "Some makers have very science-based companies with excellent laboratories, and others are awful, staggering along with broken-down machinery. Latex goes in one end, something comes out at the other, and the buyer doesn't know the difference." As a result, he said, "I don't think there's a plot to dump substandard goods on Africa, but I'm sure there are individuals planning to dump their bad merchandise anywhere they can get away with it." Paradoxically, South Africa became a dumping ground because it was rich enough to buy its own condoms. Its procurement officers used an ineffective test regimen: Inspectors would visit a factory once a year, test samples chosen by the factory and give it the South African Bureau of Standards seal. Spurred by the Kenzo incident, the country met with a group of consultants last August and then changed its regimen "literally within two weeks," said Margaret Usher, a World Health Organization condom expert. Unfortunately, it had been importing condoms for at least seven years, during which the epidemic here grew from insignificance to 1,500 new infections a day, the fastest rate in the world. South Africa has other problems. KwaZulu-Natal, the province worst hit by HIV, ran out of condoms earlier this year because a local Health Department official simply forgot to order more; a cry for help went out to the country's other eight provinces, which responded by shipping truckloads of expired condoms. A study of the distribution chain found boxes of condoms that had been left for months in overheated storerooms. Under the new standards, the same used by the British, American and other big aid agencies, the purchaser collects about 1,000 test samples at random, right at the factory, from each "batch" of 150,000 to 500,000. They are blown up with air or water until they burst, or partly filled with water, tied and rolled on a blotter to check for leaks. Only the batches that pass are shipped. Then, since condoms can also deteriorate while stacked in the sun or crossing the equator in freighters, more are tested on arrival. Testing can cost up to 10 percent of a contract. As an extra guarantee, manufacturers must post bonds, which often exceed their profit margins. Many factories can pass one South African-style inspection, experts said. But the toughest part of the business is consistency. World Health Organization condom specifications are 13 pages long, and modern condoms must be far less porous than those of 20 years ago, because the size difference between a spermatozoon and the HIV virus "is like a Mack truck versus a Morris Mini," Crichton said. Because latex is tree sap and as unstable as milk, a condom factory is more like an industrial cookie bakery than a bicycle factory, where manufacturing errors are obvious. Small, invisible problems can ruin whole batches. The latex is first vulcanized with sulfur and ammonia. Then molds are repeatedly dipped and dried. The chemicals are leached out, and the condoms are washed, tumble-dried and dusted with cornstarch. Each is electrically tested for invisible holes, visually inspected, then inflated by machine for a burst test. Then each is rolled and sealed into a foil or plastic envelope into which silicon lubricant is injected. Many things can go wrong: curdling latex, dust in the mix, chemistry errors. Poor leaching can leave a rotten egg smell. With too little lubricant, the condom can dry out; too much ruins the packet's seal. Even when condoms are well made, there are problems with promoting their use here. Because the danger of AIDS is so great, there have been few religious objections, even in Catholic countries. But there are other roadblocks. All over Africa, everyone from health officers to women's rights advocates to prostitutes complain that it is very difficult to get men to use condoms. Besides the usual complaints about sensitivity and lack of spontaneity, men argue that they are "not part of African culture." "The men dictate what will be done, and the women have very little power to say no," said Dr. Neil Miller, an AIDS education expert with the British Embassy in Zimbabwe. And, because the vast majority of condoms here are handed out free, no choices of size are offered. The problem may sound silly, but condom distributors say it is not. Too-large condoms slip off, putting the user at risk of infection, while uncomfortably small ones discourage men from using them. In South Africa, for example, 95 percent of the 190 million condoms consumed each year are bought by the government. It only buys the standard 53-millimeter-wide lubricated variety. But that does not fit everyone, and some suppliers have sloppy quality control. For example, youth counselors want the hard-to-find 47-millimeter "adolescent size," Crichton said. Since a recent survey of 18,000 South African teen-agers indicated that 24 percent have sex before they are 14 years old, getting effective condoms to the young is crucial, he said. At the moment, the government has its hands full with purchasing and distribution problems and is barely considering these issues. Experts agree that condoms offer this impoverished continent the one slim hope it has of slowing the AIDS epidemic. "But you need systems for buying them," Ms. Usher said. "Most countries don't know much about these things, so they just go out and buy 6 million condoms thinking they're all the same. They're not." Sunday, December 27, 1998 <A HREF="aol://4344:104.nytcopy.6445375.574106743">Copyright 1998 The New York Times</A> DECLARATION & DISCLAIMER ========== CTRL is a discussion and informational exchange list. Proselyzting propagandic screeds are not allowed. Substance�not soapboxing! 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