Talk:Safe sex/Archive 3

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First safe sex guidelines written in 1983

The following sentence (which was recently added to the Focus on HIV section) is dubious and at the least misleading.

Indeed, the first safer sex guidelines appeared in the 1983 booklet How to Have Sex in an Epidemic: One Approach, written by Michael Callen, Richard Berkowitz and Dr. Joseph Sonnabend in response to the emergence of AIDS among gay men in America.

While the reference does appear to say what the sentence claims, it does not appear to be a highly reliable source for such a claim about history (extraordinary claims require high quality sources). Since practices for prevention of STDs go back for centuries, the claim that this is the first safer sex guidelines needs better documentation, and possibly clarification (i.e. was this the coining of the term "safer sex?"). Zodon (talk) 05:53, 21 October 2008 (UTC)

I suggest the book "Safety in Numbers" by Edward King (available through Google book search), which says, "It was How to Have Sex in an Epidemic: One Approach which pioneered the approach to safer sex which we recognise today. It was virtually the only safer sex publication which proposed a specific theory of what caused AIDS, on which its advice about specific sex acts were based." A recent article in the Lancet cited this book to support a similar statement. Trezatium (talk) 08:43, 22 October 2008 (UTC)

So it apparently marked the application/adaptation of safer sex techniques to HIV/AIDS. Much more plausible than the claim that there were no such techniques before then. (Might be worth noting what sorts of changes were made in safe sex.) Thanks. Zodon (talk) 07:55, 24 October 2008 (UTC)

As I understand it, the booklet was the first attempt to promote risk reduction (as opposed to risk avoidance) as a method of preventing STI infection, which would make it the first set of "safe sex" guidelines ever written. But I could be wrong. It might be best to wait and see if anyone more knowledgeable speaks up here. Trezatium (talk) 17:08, 25 October 2008 (UTC)

What is the difference between "risk reduction" and "risk avoidance"? (e.g. are those terms for something like condom use vs. something like abstinence?)

The use of condom type devices in attempts to prevent STI have been documented back to at least 1564. While condom use for STI prevention has gone out of popularity in some places and times, for instance in the U.S. the Comstock laws of 1873 were partly responsible for a decrease in knowledge of contraception and a rise in STIs; but condoms have also had advocates and increases in popularity as disease prevention (e.g. German military pre-WW1, US military starting in 1930s through WW2, etc.). More recently various factors, such as more effective treatments for various STIs, lead some to view STIs less seriously, for instance going back to historically less effective methods of prevention, such as promoting abstinence (e.g. US military 1947 through Vietnam war). Then HIV/AIDS prompted many to again advocate safer sex practices.

If you look at it in terms of STD prevention, the History of condoms seems to give an example of "those who forget history are condemned to repeat it." The use of safer sex practices may seem new if compared to what was done immediately before, but not so new if looked at in historical perspective.

Certainly there have been advances in understanding and new devices and techniques, but are a lot of similarities also. Zodon (talk) 07:52, 26 October 2008 (UTC)

Aids in Pakistan

how many Aids patient in Pakistan —Preceding unsigned comment added by 203.223.164.70 (talk) 13:05, 8 February 2009 (UTC)

The correct term is always... Safer

The correct term is always... Safer
There's never zero risk.
   -- thezak (talk) 8 March 2009

Agree: The only "safe" sex is no sex at all and there's no other ways to be 100% safe.

NetDoctor.co.uk: "You could say that the only totally safe form of sex is masturbation. " [1]

PlannedParenthood.org: "Even though a lot of people say "safe sex" instead of "safer sex," there is no kind of skin-to-skin sex play with a partner that is totally risk-free. But being "safer" is something all of us can do." [2]

etc.

es_uomikim (talk) 15:09, 26 August 2009 (UTC)

Abstinence as a remedy

The author writes:

Some groups, notably some American evangelical Christians and the Roman Catholic Church oppose sex outside marriage,

Afaik, most of Christianity and good many other religions do. 'Some Swedish athletes and teachers and the Seven-Imams-Shia Islam oppose excessive drinking', don't they? But that's beside the point: Whatever the merits or demerits of sexual abstinence, abstaining from sex without marriage is NOT sexual abstinence. To a literate reader, this passage looks very funny. 78.55.129.12 (talk) 21:11, 26 November 2008 (UTC) Wojciech Żełaniec

How is abstaining from sex when not married not abstinence? Is somebody who abstains from sex when they are married more abstinent in some way? What is "funny" about it? You seem to agree with what it says. (Unclear what you find unclear/funny/objectionable about it, so can't suggest way to help resolve.) Thanks. Zodon (talk) 01:04, 27 November 2008 (UTC)

---

The author writes:

This can place some teenagers at higher risk of unintended pregnancy and STDs, because about 60 percent of teenagers who pledge virginity until marriage do engage in pre-marital sex and are then one-third less likely to use contraceptives than their peers who have received more conventional sex education.

If abstinence promised 100% protection from pregnancy yet delivered, say, only 30% protection, one might accurately say that promotion of abstinence places some teenagers at higher risk. But that is not the case. In fact, what places some teenagers at higher risk is lack of commitment to their pledge of abstinence. This is due to lack of maturity and a variety of other factors.--Kerry (talk) 19:26, 6 August 2009 (UTC)

The actual use effectiveness of long term abstinence at preventing pregnancy has not been well studied, but it is not thought to deliver 100% protection. If you are considering abstinence as a public health/educational option, then you have to include those who attempt to use the method, but fail to do so correctly, just as is done with other contraceptive or STD prevention methods. Consider Heads I Win; Tails Don't Count: The actual value of abstinence and this Journal of Adolescent Health editorial Zodon (talk) 06:59, 6 September 2009 (UTC)

New picture

Condom protected sex image

Editors keep adding and removing File:Penetración realizada con peservativo.jpg without comment. I haven't done either so far, but I'd like to get a consensus on any additional picture(s). I don't like this picture: it has little artistic/decorative merit and I'm not sure that it's even a particularly good illustration of what it depicts, a close up shot of genitals, but confusing to any viewer who doesn't know what's happening and adding no additional information. Do we need a further focus on condoms? How a bout a picture of pegging or dildo use instead or a picture of non-penetrative sex to illustrate that section. --Simon Speed (talk) 14:32, 29 May 2009 (UTC)

This very photo was discussed in Talk:Sexual intercourse with the consensus being that it appeared more pornographic than educational (certainly a difficult and subjective determination). The photograph's proponents should seek consensus here before returning it. Relevant guidelines include WP:NOTCENSORED and WP:Pornography, in particular:

• Words and images that would be considered offensive, profane, or obscene by typical Wikipedia readers should be used if and only if their omission would cause the article to be less informative, relevant, or accurate, and no equally suitable alternatives are available. Including information about offensive material is part of Wikipedia's encyclopedic mission; being offensive is not.

As this article discusses Safe sex in general, it seems strange to include a photograph considerably more explicit than any currently in Condom, Sexual intercourse, or Human sexual behavior. -- 58.147.52.240 (talk) 05:16, 6 June 2009 (UTC)

This photo was tagged as a likely copyright violation and subsequently deleted. -- 58.147.53.179 (talk) 01:44, 24 July 2009 (UTC)

Non-penetrative sex image

I've added PeterJohannNepomukGeigerEroticWatercolor04.jpg to the non-penetrative sex section. What do other people think? --Simon Speed (talk) 12:42, 10 June 2009 (UTC)

Caption should say what it depicts. For the purpose of this article, the artist and when it was painted are less relevant than a brief statement of what it shows. (Provide enough information so that if one couldn't see the picture one could still understand what is being portrayed.) Zodon (talk) 07:10, 6 September 2009 (UTC)

Partner selection

The statistical relevance of various attributes of a partner may be a fact, but I'm not sure where they fit in a safe sex regime. Is this ever included in medical advice? I've shifted all this information to "other precautions" next to monogamy and reducing the number of partners. --Simon Speed (talk) 23:11, 5 September 2009 (UTC)

It's not advice as a single practice but combined. Other sources: [3][4][5]--Nutriveg (talk) 00:11, 6 September 2009 (UTC)

Condoms, HPV protection and HPV cancer relevance.

The text "Condoms offer low protection against HPV, a cause of many cancers", was removed with the following justification "caption was misleading (condoms provide reasonable protection against HPV, HPV only causes small proportion of cancers". One HPV transmission method is skin contact, including by fingers[6] and foreplay, condoms provide only "some" protection[7]. HPV is the main cause of cervical and anal cancer and if that wasn't relevant the UK wouldn't be spending £100 million a year vaccinating the young population.[8]--Nutriveg (talk) 21:32, 7 September 2009 (UTC)

It isn't clear what the relevance of the chart (which showed percent of a few cancers that are associated with HPV) [File:Cases of HPV cancers graph.png] is to safe sex.

As the only mention of HPV in the article, the coverage in the caption was so incomplete as to appear misleading. Confusion over the various viral acronyms (HPV, HSV, HIV, ...) is not uncommon, and the epidemiology of HPV is different from many of the others.

Almost everyone who has sex will be infected with HPV (e.g. 75-80% of sexually active individuals in US by age 50). The vast majority of those infected with HPV never have any signs or symptoms (i.e. in most cases it causes no disease). So condoms provide moderate protection - but so what. If get HPV infection it isn't particularly serious (unlike HIV or HSV).

Yes, HPV is cause of Cervical cancer, most anal cancers, and a few other relatively rare cancers. But most cancers are not caused by HPV, or even by (as far as we know) viral causes. (The article on Cancer says viruses responsible for about 15% of cancers worldwide. (of which HPV only a portion)) So saying "many cancers" seems like overstating the case. (Another way of looking at Worldwide in 2002 - Cancers overall caused 12.49% of deaths, cervical cancer caused 0.42, and the other HPV cancers are considerably rarer.)

So problem with the caption was mostly one of balance and not providing enough information to give perspective.

At this point I don't see that the graph adds anything to the article. I am not quite clear why coverage of HPV is desirable in the article, is it as a more concrete example of a counterpoint to HIV/AIDS? (Rather like the difference between the common cold and the plague.) Not that I oppose covering HPV, as long as it is balanced. Perhaps you could explain why think HPV should be covered here and what want to convey. Zodon (talk) 06:28, 8 September 2009 (UTC)

I used that image to illustrate a relevant virus, HPV, not because of the relevancy of that chart. Mention of that virus was relevant because that section was a critic about the single focus on HIV prevention. If you can find a more relevant pathogen more transmissible than HIV we can cite it instead, but I believe HPV is the most dangerous than the others.

It's not because, nowadays, in the US, most people are contaminated by some type of HPV, that the virus doesn't represent a concern or that situation is accepted, as we can see by the UK government actions spending hundreds of millions to prevent it. Beyond that cancers are associated with specific HPV types, not "any type".

Condoms provide limited protection as we can see by the sources provided and the high number of general HPV infections, that's the purpose of the section: "sexual pathogens that aren't protected by the simple use of condoms". This is not an article about "HIV safe sex" but STI in general, so all relevant STIs should be mentioned. If you have an alternative way to present that example that please provide it.--Nutriveg (talk) 17:36, 8 September 2009 (UTC)

Thanks. That makes it clearer.

Looking over the article, you are right, it is weak in mentioning STIs other than HIV. I don't see adding a catalogue of STIs as helpful (the article on Sexually transmitted disease has that). But mentioning a few others in appropriate places would help.

I added immunization to the "Other precautions" section (surprising it wasn't mentioned in the article). So that brought in mention at least of HPV and Hep B.

As to the significance of HPV versus other more transmissible STIs - what other pathogens do you have in mind? Without knowing that, I couldn't comment. In some ways I think HPV might be a poor choice for "pathogens overshadowed by HIV," just because with the recent development and marketing of the vaccine, people may be more aware of HPV than of some of the others.

Perhaps some research indicating relative protection of condoms against various STIs would be helpful. (e.g. a table or graph indicating how effective condoms are against various genital STIs). It would probably need accompanying explanation to note that some STIs are transmitted other ways than sexually, etc. Something like that would serve the purpose of mentioning the relevant STIs. (Or even indicating the relative transmissability of the various pathogens.)

Another way of doing it would be coverage of other safe-sex measures recommended for protection against other STIs (and the STIs they help prevent).

Perhaps noting other epidemic level STIs (e.g. Chlamydia) in the "it isn't all HIV" section would also help. (e.g., Along the lines of "we have these other epidemics, but they get overshadowed by HIV" - if that is what sources indicate.) Zodon (talk) 20:37, 8 September 2009 (UTC)

I was talking about a specific section already present in the article specific about the limitation of the HIV prevention methods in relation of other STIs. There's no research "indicating relative condom protection" since ethical concerns make those studies hard to make so risk is approximate by combination of other available data (like skin-to-skin contamination, genital contamination with non penetrative sex and finger contamination of genital infected people). I don't have any other more significant example otherwise I would have used it instead. Assumption of knowledge of the reader is not a justification to remove the content and the vaccine campaign is country/social specific since price is prohibitive for most.

Your suggestions for the general article don't justify the exclusion of the example in that section. Please propose a better one if you didn't like the previous, otherwise I'll put it back.--Nutriveg (talk) 21:29, 8 September 2009 (UTC)

For example, "The correct and consistent use of latex condoms reduces the risk of sexual transmission of HIV by about 85%."HIV#Sexual I don't know if comparable data exists for other diseases. However, if, as you suggest, such evidence does not exist, then it becomes hard to justify claims that HIV prevention methods do or don't work well for preventing other STIs. (Evidence doesn't have to be a prospective trial to be comparable.)

I don't understand what mean by "assumption of knowledge of the reader not being justification ..." (Problem was that addition didn't provide enough information, either to figure out why the chart was there, or to give a balanced perspective on the subject.) Lack of clarity, lack of sources, lack of balance are reasons for removal or revision.

I don't understand what saying about vaccination. Certainly vaccine availability varies with national, economic, etc. factors. Just as is the case with STD tests, condoms, or soap. (I heard a news item about a study showing how infant dehydration through diarhea in ghettos someplace could be prevented by hand washing. Unfortunately the cost of the soap made it prohibitively expensive in that population.) Vaccines against some STDs are recommended as part of STD prevention by some, so seem apropos for the article. Economics of safe sex could be interesting material to add. (Of course some AIDs drugs are even more prohibitive in cost.)

Just "putting it back" without addressing the concerns raised doesn't seem helpful. Since we agree that the chart is not relevant, would suggest not using it. It would help in drafting coverage for that section if you indicate the source(s) that support the claim that condoms provide less protection against HPV than HIV. (The references above do not appear to support this assertion. Sonnex et al. suggest finger to genital transmission as "possible"; Moscicki says "Condom use remains important in the control of HPV infections and HPV-disease progression, and thus should be recommended to all sexually active adolescents.", neither one gives comparison between condom effectiveness at preventing HPV and HIV.) Difficult to suggest what to say when don't know what the evidence is. Zodon (talk) 05:56, 9 September 2009 (UTC)

I said there's no comparative of that level (with numbers) because virus are generally not well tracked as HIV, because there are different level of concerns, detection methods and number of people examined. Even in the case of HIV I would say that number is bullshit because it's hard to control if all the partners of those subjects were infected or not. Studies genreally only give statements like: "there was no consistent evidence that condom use reduces the risk of becoming HPV DNA-positive", "Always using male condoms with a new partner was not protective." and "The available scientific evidence is not sufficient to recommend condoms as a primary prevention strategy for the prevention of genital HPV infection".

My mention of "assumption of knowledge of the reader not being justification to remove the content" was because you said "people may be more aware of HPV than of some of the others". The removed phrase included links to the specific article section where the issues are further discussed, so it was contextualized. The image was just a thumbnail, a small illustrative image, and yet I don't see much problem with that data. So far you didn't propose a better phrase or image and I'm impressed how you make so much noise (without proposing a better solution) for such small things. There are plenty of sources on the subject and many of them were presented.

Making general statements, just to object, without proposing a better solution don't help at all. Condoms offer limited protection, that was what the phrase said, that means there's some protection so it's better than not using it, in the sense it may reduce some infections, specially if (only) the penis itself is contaminated, but you won't find (prevalent) sources saying it's effective to protect HPV while you can find plenty saying condoms are effective to HIV protection (as you said with your 85% number). You're now simple Moving the goalpost by requesting those both statements on the same phrase but I got that for you "It is unlikely that condoms offer the same level of protection against genital HPV infection as they do for HIV".--Nutriveg (talk) 12:21, 9 September 2009 (UTC)

(Outdent) I have proposed other solutions - whether they addressed the problem as you see it is a different matter. When you made it clearer that you were looking for how to add HPV to that particular section, I noted that the sources mentioned did not seem to support any statement about the relative protection of condoms for HPV vs. HIV. Lacking a single source that makes such a comparison, any such comparison would be original research. Not a case of discounting previously presented evidence, since no such evidence had been presented.

Thank you for providing references. I am out of time at the moment - will get back with a suggestion shortly. Zodon (talk) 19:19, 9 September 2009 (UTC)

You didn't propose an example for that section but only added original research to it, in a interesting lack of rigor for sources that contradicts your expressed motivation so far.

The phrase you removed mentioned the "limited protection of condoms", not the "relative protection of condoms for HPV vs. HIV". Sources supporting that mentioned statement have been available in the article section linked by that phrase since the time I included it and since the start of this long discussion.--Nutriveg (talk) 19:50, 9 September 2009 (UTC)

I made other suggestions for that section in my post of 20:37, 8 September 2009, above.

Here is a more specific suggestion for addition to the section.

It is unclear how much protection condoms offer against infection with genital Human Papillomavirus (HPV).(cite CDC2004, Cite Manhert & Koutsky) However Condoms reduce the risk of developing diseases (genital warts, cervical cancer) caused by HPV. (Cite Manhert & Koutsky, CDC2004).

One could go on to say that

Most people who have sex become infected with genital HPVs, but only rarely do those infected develop disease. (CDC2004)

Zodon (talk) 20:18, 10 September 2009 (UTC)

It's a good start, I would change, by the CDC source: "Condoms are not recommend as a primary prevention strategy of Human Papillomavirus (HPV) infection, but condom use has been associated with lower rates of the HPV-associated diseases of genital warts and cervical cancer"

About the second phrase, it's an interpretative number, an actual number is "15% of the (US) population are currently infected with HPV", it's time specific, since "Progression from cervical cancer precursor lesions to invasive cancer is a slow process, estimated to take 10–15 years" and "and 5.5 million people are infected every year", so it refer to a unknown number of infections at least 10 years ago (not the current), the number of those with high-risk types is lower and imprecise (50–75%), it's not gender adjusted (low risk for men, high for gay and women), even a small percentage of large number become a significant number of a serious disease "12,200 women/year" (unbalanced) and it's country specific.--Nutriveg (talk) 21:49, 10 September 2009 (UTC)

The phrasing "condoms are not recommended" sounds like they are ineffective or discouraged (which is not the case), primary prevention may be too technical a distinction for lay audience. The point is that condoms help prevent disease caused by genital HPV, although they may or may not significantly reduce the rate of infection. Especially since this has been an area of controversy in the United States, with political pressures to discredit condoms, it is important to maintain a neutral phrasing.(Markus J. Steiner and Willard Cates, Jr. (2006). "Condoms and Sexually-Transmitted Infections". N. Engl. J. Med. 354 (25): 2642–3. doi:10.1056/NEJMp068111. PMID 16790696.[9])

Also, important to keep "genital" in there when talking about the HPV infections, since not talking about other types of warts, etc.

I don't understand what you are saying about the second phrase. I was trying to keep this brief, and generally applicable, so didn't see going into detail on the statistics (which are more germain to the articles on HPV, cervical CA, etc.). While the statistics above appear to mostly be country specific, the statements apply to the general population of most areas that I am aware of where this has been studied. The point of the later part is that disease is what we care about, not infection (yes, the disease can be fatal, but the infection in most cases does nothing.)

How would you suggest improving the second part? Or could you explain what your reservation is in another way to help me understand. Zodon (talk) 21:17, 11 September 2009 (UTC)

"Condoms are not recommend as a primary prevention", it's not my words but CDC's, the remaining of the phrase is clear they "reduce the rates". They are effective to reduce, not to prevent.

The word genital is present where appropriate.

The second phrase is innacurate, specially when using words that don't reflect to a number (15% percent of US population, 12,200 US cancer cases/year), it's desinformative (depends on HPV type, gender, and takes 10 years to develop symptoms) and is country specific, so I keep not supporting it's inclusion.

By the way I was wondering these phrases we are discussing are not very illustrative as an example for that section (focus on condoms that are not so effective to other diseases). So I come out with another, sourced from the CDC website: "Although condoms, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV, they may only reduce the risk for genital human papillomavirus (HPV) infection and HPV-associated diseases, e.g., genital warts and cervical cancer."[10]-- —Preceding unsigned comment added by Nutriveg (talk • contribs)

I'm not sure what the relevance of HPV is to the article. Condoms don't stop it, but neither do other safe sex precautions. Focusing on condoms and underlining this with official statements and statistics makes condoms seem bad, but this is just an artifact of how the information is presented. --Simon Speed (talk) 23:46, 11 September 2009 (UTC)

Response to Nutriveg -

Part of the problem with using the "Condoms are not recommend as a primary prevention" phrase is that then you have to go and explain what that means (that there is insufficient evidence to recommend for or against their use to prevent infection, at that time). Which is fairly close to what I had suggested, and makes the whole thing longer. Rather than using the jargon and then having to explain it, it makes sense to just say what it means in more accessible terms to start with.

Here is a simplified version of the first part of the suggestion, based on more up to date sources.

For women, condom use by their partners reduces the risk of infection with genital Human Papillomavirus (HPV)(cite steinger & cates), and reduces the risk of developing diseases (genital warts, cervical cancer) caused by HPV.(Cite CDC2004, Manhert & Koutsky, ).

The second phrase is not inaccurate. As noted above, 75-80% of sexually active individuals in US will be infected with HPV by age 50. (Sources in HPV article). I think that qualifies as most, though saying "the majority of" would also work. (As you note, the 15 or whatever percent is at a given time, whereas the statement I drafted says for given person (i.e., over a lifetime).)

Nor is it country specific. (The data mentioned above is, but the observations are not, though citations to support that would of course be apropos.) The specific probability of getting infected may vary some by country, but HPV remains very widespread. Although there is some geographic variation in HPV type prevalence, and various types are more or less likely to transition to cancer/warts, it remains that most people who are infected with HPV don't develop disease. Zodon (talk) 08:08, 12 September 2009 (UTC)

Simon, this an example for a section that talk about the limitations of the "Focus on condoms and HIV control", to point that condoms can not be used as a single method of prevention of that diseases as it is by HIV. There are other safe practices in this article that increase the protection of that diseases like partner selection.

Zodon, it's clear for me what "primary prevention" means, and as I said above I proposed a better phrase for that section comparing condom effectiveness for both diseases:

"Although condoms, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV, they may only reduce the risk for genital human papillomavirus (HPV) infection and HPV-associated diseases, e.g., genital warts and cervical cancer."[11]

As you said above, "75-80% of sexually active individuals in US", so it's country specific, you also point to the future and age factor, "will be infected with HPV by age 50", that is not an actual number (but a prediction based on current infection rates) and implies the exposure to a higher number of partners, which is by the way a predictor for STDs. The major diseases are mentioned in my proposed phrase, "genital warts and cervical cancer", which are mostly, 90% and 85% respectively, caused by HPV, so the reader can check those diseases severity and incidence in their community to determine if it deserves concern or not.--Nutriveg (talk) 17:49, 13 September 2009 (UTC)

Problems with the article

There are various problems with the article (which I became aware of via AN/I).

• Various statements read like a medical how-to guide - this is prohibited via the general disclaimer and needs to removed/rewritten.
• Various unsourced medical statements - these need sourcing or removing.
• Various weird uses of italics as part of the medical guide. --Cameron Scott (talk) 21:13, 20 September 2009 (UTC)

Which disclaimer exactly are you referring to? I checked the appropriate page, and there is nothing that suggests this: Wikipedia:Medical disclaimer Mish (talk) 21:25, 20 September 2009 (UTC)

Must have changed that - it's covered by WP:NOT anyway - not a guidebook. --Cameron Scott (talk) 21:31, 20 September 2009 (UTC)

Rewritten: I checked the appropriate pages, and there is nothing that suggests Wikipedia:General_disclaimer or Wikipedia:Medical disclaimer prohibits this. It does not appear to be a how-to-guide, but an article about safe-sex and its practice, as part of WP:MEDICINE. If you look at Influenza, this has sections on 'Signs and symptoms', and 'Prevention' - it seems pretty standard stuff for medical articles. As this a medical article, these tend to take a slightly different format from other articles, so if you are concerned, I would refer it to that project, as many of their articles read like medical texts.

Your second and third point are fairly bog-standard and should be easily addressed. Mish (talk) 21:25, 20 September 2009 (UTC)

• My apologies, I hadn't realized this had already been to ANI, but I've fully protected it for three days to stop the edit warring, and I think I'll leave it protected despite the forum shopping. I encourage all involved parties to use this time to resolve the disputes here on the talk page. Beeblebrox (talk) 23:19, 20 September 2009 (UTC)

Mish, there's an important difference between "Washing hands reduces cases of diarrhea" and "People should wash their hands to prevent diarrhea." This article has certainly contained some inappropriate advice statements. If you'll search the article for the word should I think you'll see several examples of statements that, while true, are written as practical applications/advice instead of simple statements of the facts. WhatamIdoing (talk) 01:04, 21 September 2009 (UTC)

I take your point, and these should be reworded either in a way that states the facts as drawn from reliable sources, or as recommendations for practices as cited from reliable sources, leaving the reader free to draw their own conclusions about their own sexual hygene - you will note that I did not take issue with any of Cameron's specific edits, and while I may not always like the way he edits, I have learned to trust that his edits do tend to improve the quality of the material targeted. Mish (talk) 01:30, 21 September 2009 (UTC)

Condoms reduce risk of STD infections

There was question raised in this edit summary about the level of reliance that can be placed on the cited source. Markus J. Steiner and Willard Cates, Jr. (2006). "Condoms and Sexually-Transmitted Infections". N. Engl. J. Med. 354 (25): 2642–3. doi:10.1056/NEJMp068111. PMID 16790696.

It is not OR, since the sentence being supported is almost verbatim what the authors said. One of the authors of the reference in question is Willard Cates, Jr., a widely respected authority on STDs (he is one of the author/editors of Contraceptive Technology, among other works.) So while the item cited is a Perspective piece, it is a perspective by an authority in the field. It also cites review articles, etc. published in well regarded journals as basis for their summary. I added the subsidiary citations to the sentence to help make the support clearer. Zodon (talk) 18:48, 13 September 2009 (UTC)

You should not make your own conclusions from the article, but cite the article conclusions, that article is lower quality since it's a commentary, you can cite the conclusions of the reviews it cites though.--Nutriveg (talk) 19:05, 13 September 2009 (UTC)

I took conclusions directly from the secondary source, by "authors ... generally regarded as trustworthy or authoritative in relation to the subject at hand.", per WP:RS Zodon (talk) 09:35, 16 September 2009 (UTC)

"You taking conclusions from source" is different from "citing authors conclusions", it's original research.--Nutriveg (talk) 09:36, 18 September 2009 (UTC)

No, that's one of the things we use secondary sources for, making any other conclusions with the help of a primary source is original research. --Simon Speed (talk) 13:20, 18 September 2009 (UTC)

The NEJM article says "Six years later, we have strong evidence that condom use reduces the risk of transmission of HIV,2 gonorrhea and chlamydia,3 and herpes simplex virus4 in both women and men; in this issue of the Journal, Winer et al. (pages 2645–2654) present evidence that it also reduces the risk of HPV infection in women." Simon is entirely right that this source can be used to support a statement that "There is strong evidence that condom use reduces the risk of transmission of HIV, gonorrhea, chlamydia, and herpes simplex virus in men and women, and the risk of human papillomavirus (HPV) infection in women." You simply cannot violate SYNTH when you're copying a single sentence from a single source so nearly verbatim that we have to worry about WP:COPYVIOs. WhatamIdoing (talk) 22:11, 20 September 2009 (UTC)

It looks like you're late here, that sentence is already in any version of this article, but only in a different section, the condom section.--Nutriveg (talk) 22:53, 20 September 2009 (UTC)

WhatamIdoing - I was also concerned about copyright when I wrote that, but I hadn't come up with a clear way of either using a quotation, or better words of my own to say the same thing. Do you think it is okay as it stands, or needs rephrasing to more clearly avoid copyright violation, or to make it a partial quotation?

As it stands now:

1. There is strong evidence that condom use reduces the risk of transmission of HIV, gonorrhea, chlamydia, and herpes simplex virus in men and women, and the risk of human papillomavirus (HPV) infection in women.

An attempt at quotation:

1. There is "strong evidence that condom use reduces the risk of transmission of HIV, gonorrhea and chlamydia, and herpes simplex virus in both women and men, ... [and the risk of human papillomavirus ](HPV) infection in women."

Or rephrasing:

1. Condom use reduces the chance of transmitting HIV, herpes simplex virus, gonorrhea and chlamydia for both women and men, and the risk of human papillomavirus (HPV) infection for women.

Which do you like better? (Or does somebody have another phrasing?) Thanks.

Also, I found a cleaner way to include the subsidiary citations. Instead of separating them, add the subsidiary citations to the Steiner & Cates citation (..., which cites: then have the citations for Warner; Wald; Winer; etc.), as is done in some of the references in birth control. Zodon (talk) 10:12, 22 September 2009 (UTC)

Once again this item has been removed, with no reason given for the removal.[12] Why was it removed? Zodon (talk) 05:29, 24 September 2009 (UTC)

Basic edit warring. Nutriveg's first action was to revert from m:The Wrong Version to his personally preferred version. WhatamIdoing (talk) 05:38, 24 September 2009 (UTC)

Restoring unjustified reverts

Six days ago Simon Speed reverted a large number of my edits, I've addressed his expressed concerns but he reverted me another time. So far he expressed no arguments addressing my points that content should be improved instead of deleting my contributions. So, since no valid arguments where presented to support that early revert, I'm undoing it, and readding newly added content on top of that.--Nutriveg (talk) 16:34, 20 September 2009 (UTC)

Given the response from AN/I above, I would suggest you desist from multiple edits and reverts, and bring each point to the talk page, and allow for them to be discussed one-by-one, so that the arguments can weighed by other editors, and consensus reached. In ignoring that response, and persisting in reversion etc., you run close to edit-warring. The way to resolve this is to return to the earlier edit so that your proposed changes can be discussed fully before insertion. Mish (talk) 21:40, 20 September 2009 (UTC)

That response was from another editor that, by his own words, refused to discuss content. You must be new here, the article was already reverted to an earlier version, and I started from there, but suddenly Simon deleted all those edits and restored a later version, arguing vandalism. And you started editing from that later version. I'm not seeing the same care you ask for making changes with those you have made.--Nutriveg (talk) 22:11, 20 September 2009 (UTC)

If there was a time when this article had a stable lead that started 'Safer sex...' rather than 'Safe sex', then please provide the diffs to prove that. Mish (talk) 22:51, 20 September 2009 (UTC)

No, there isn't, but based on that earlier stable version, the version before that change is this or another between (13:12, 16 September 2009 and 09:13, 19 September 2009), after that earlier version (7 September 2009) was restored. or yet some earlier than (21:03, 7 September 2009). Not the one you're reverting to.--Nutriveg (talk) 23:25, 20 September 2009 (UTC)

Yes, there is. "Safer sex" was the term of choice from the article's creation in 2001 until this change in March 2004. Early versions of the article actually describe the shorter name choice as being obsolete. WhatamIdoing (talk) 01:28, 21 September 2009 (UTC)

This is the problem with multiple edits that are contested - it is not obvious for a neutral editor to know exactly where to revert back to. I went back to a version immediately before the problematic insertion I refer to above. Mish (talk) 00:01, 21 September 2009 (UTC)

Now you know it.--Nutriveg (talk) 00:08, 21 September 2009 (UTC)

The thing is not whether I know the problem (obviously I knew there was a problem, otherwise I would not have done what I did in the way I did - the problem was your edits), but what is important is whether you understand why it was a problem, and whether this will encourage you to discuss controversial changes you wish to make when they are challenged (rather than jumping in and making multiple changes which include adding contested material, because then the only way to avoid letting the article be wrecked is to revert back to a point before the wreckage began). By all means propose something on how some bodies advocate the use of 'safer sex' rather than 'safe sex' in the body of the article - but there is no justification for replacing the description of an article about 'safe sex' as being about 'safer sex' rather than 'safe sex', or imply that this was what was stated in a previous version, when it wasn't.

So, now we have established that there is no justification for that, would you like to present your reasoning for all the other changes, one at a time, while the page is still protected, please, so we can review them more carefully, each one on its merits. Thanks. Mish (talk) 00:51, 21 September 2009 (UTC)

From "know you know it" I was referring to what version you should revert to.

We are discussing that intro term in the section above.

I don't understand what you mean by "that" in this phrase "now we have established that there is no justification for that"

I'm up to discuss any of those changes made since that baseline version, just let me know what concerns you.--Nutriveg (talk) 01:30, 21 September 2009 (UTC)

By 'that', I was referring to what I said in the previous sentence (in relation to the previous section you refer to). Mish (talk) 01:38, 21 September 2009 (UTC)

My main concern is the substitution of 'safe' with 'safer', although I agree that there is no such thing as safe sex. A proper discussion of instances of the use of 'safer sex', explaining why those sources use that term, should alleviate any concern that we might be misleading people into thinking that any sex is risk free. I cannot dispute the placing of tags for missing sources, although I think it unnecessary to detail which sexual acts are being discussed where you have tagged for expansion. I think your rephrasing of pre-ejaculate is OK, as what was there before was too detailed and as it is unproven, unnecessary, but I think 'may' should be used rather than 'can'. My other concern is the elimination of detail about non-sexual transmission of STDs; although it is not strictly related to safe-sex per se, it is important to be clear that there are other ways of transmitting of STDs, and this is particularly of relevance to the use of hyperdermic needles, which may be shared in some communities which abuse drugs, so, somebody can engage in safe sex, but of they share a hyperdermic syringe with somebody who does not, then they can still be at risk from certain STDs. They will also be at risk of transmission of certain forms of hepatitis, which while not an STD per se, can also be transmitted sexually - so that needs to be included as well. There was at one time a certain relationship between IV drug use and hep C and HIV alongside sexual transmission of these infections - in part because of the relationship between some IV drug users and sex-work. How true that is today I am not sure (it is over twenty years since I worked with IV drug users). Just as I see it important to include things like not having sex at all, even though that is not sex (rather than safe sex), so it is important to include practices that can lead to increasing the risks of infection through safe sex (i.e., in a monogamous relationship). This also applies to other ways STDs and hepatitis can be acquired - because if an STD like HIV, or hepatitis, is acquired through medical application of blood-serum products, or by visiting the dentist or having a tattoo or piercing, then that can put the partner at risk, even when monogamy is practiced as a form of safe sex. It is late here (early in the morning, in fact) and I have an appointment in a few hours, but I will go back over the diff you provided to see if there is anything further I have to add. Mish (talk) 02:06, 21 September 2009 (UTC)

Any response, or do I need to go through this in more detail? Mish (talk) 00:35, 22 September 2009 (UTC)

I'll address those issues later, to don't mix this discussion with that of "safe sex", many of the issues you raised can be easily solved.--Nutriveg (talk) 14:23, 22 September 2009 (UTC)

Still waiting... Mish (talk) 22:39, 23 September 2009 (UTC)

Well, I've been dealing with your main concern and you're still waiting? About your other points, you should proceed with your suggested change in "pre-ejaculate".

The removal of "non-sexual transmission of STDs" was from a specific practice/behaviour and I didn't see it much appropriated for the whole article and I don't care very much if they should removed from the article (not from a specific practice) or not, as long it is presented just a introduction to that main article. It seems there's a specific discussion about that in the article page.

Let me know if I missed some point and I'm sorry I made you wait.--Nutriveg (talk) 00:17, 24 September 2009 (UTC)

What is the best way forward? Expert required, or admin input?

The sources suggest that there was a move to replace "safe sex" with "safer sex" in the 1990's, but this was only partially successful. A user has proposed that we replace "safe sex" in the lead with "safer sex", contrary to WP:MOS (the title is "safe sex"). He justifies this by pointing to a few sources from continental and international bodies that still recommend using "safer sex" rather than "safe sex" in the context of HIV. However, a search of scholar indicates that more articles use "safe sex" than "safer sex", especially among more recent papers. A number of editors contest this, and only the proposing editor supports it, and despite this persisted in edit-warring on this, which lead to page protection. He has proposed singling out me to report to WP:NPOV, despite my having no history with this article, and responding to a call to the sexology project as a neutral and uninvolved editor. His discourse is infused with wikilawyer-style threats about sanctions. His actions have already been brought to WP:ANI. I would like feedback on the best course of action, as I would like to place a request for expert advice from somebody in the three covering projects - but it may be more appropriate to raise this again at WP:ANI and seek to have the user bocked from editing, or mediation/arbitrartion - the latter would be problematic, as I am not the only editor he has entered into conflict with, rather I am the latest to attract his hostility. How would other editors like us to proceed? Let the complaint go to the NPOV noticeboard, seeking to have the user blocked at WP:ANI, request the protecting admin to place a call for expertise, or find a way of arbitration between one editor and those who disagree with him? Advice, suggestions appreciated as to how we can stop this persistent disruptive editing, as it is not improving the article, which is unacceptable. Mish (talk) 15:23, 22 September 2009 (UTC)

Don't duplicate discussions to make statements out of context, there's already a section talking about "safe sex" vs "safer sex" awaiting your and "WhatImDoing" answer on weather that later term is or not more appropriate for HIV. Please respond there together with the other comments made about the subject so far.--Nutriveg (talk) 18:14, 22 September 2009 (UTC)

This is about 'weather' (sic) we refer this to an expert or take it to some administrative forum to resolve. If you actually read what other editors say, it would decrease the amount of times we have to repeat ourselves. I have responded to your points, but you must have not read them. I placed this here rather than having this discussion responding to your points scattered all over the talk page. Mish (talk) 18:49, 22 September 2009 (UTC)

Your intro is clear about that term discussion, where you put your arguments out of context.

So far that question is still open waiting a "yes" or "no". Where I expect you to answer in the appropriate place.--Nutriveg (talk) 19:22, 22 September 2009 (UTC)

Mish, the MOS argument is incredibly weak and would be entirely solved by moving the page to Safer sex.

I really think that this is an unimportant fight. The terms are widely used as being interchangeable, although a minority of sources draw a distinction between them. There's a lot of work to do here, and picking over what amounts to "how do we spell this" is silly. Why don't you just stop this discussion entirely, and after we've done the more important work, we can make a choice and fix it all at once?

Here's what this looks like in practice: Both of you quit fussing about the supposed difference between the terms. Both of you quit claiming that your favorite term is the one true term. When you look at a proposed sentence or paragraph, then both of you pretend the other person has typed your preferred term. Both of you assume that whatever the term is, it means "how to reduce the chance of A infecting B with whatever sexually transmissible germs A has." And both of you get back to work on actual content, of the sort that requires more work than an automated search-and-replace to fix. We'll come back to this issue after the entire article has been improved, and decide whether we need an "about this term" section or to pick one spelling or the other. Okay? WhatamIdoing (talk) 20:31, 22 September 2009 (UTC)

You may have different concerns, but I really care about WP:Verifiability and WP:DUE, where I'm just reflecting what (sources provide) major world health organizations have expressed. The definition present in the article introduction is important because that is what will define the article content, whats on topic and what's not. If you just decide to abandon that discussion I'll understand you don't care about the outcome and will accept the achieved result.

User:WhatamIdoing, your answer is also awaited for that question, it's curious how you abandon the defense of that POV when irrefutable sources supporting the other are exposed.--Nutriveg (talk) 21:03, 22 September 2009 (UTC)

I do not have any information that either term is more appropriate with respect to a single STI than with respect to any other STI. "SafeR sex" was at one point certain more fashionable among American HIV prevention workers than among workers with a broader focus, but that's not the same thing.

The lead does not determine the article; the article (always) determines the lead. We need to write the article first, and then construct the lead. WhatamIdoing (talk) 21:26, 22 September 2009 (UTC)

Good grief, leave it a "safe sex" (the common term) and mention the technical distinction in the article. Oh that's the case already. Verbal chat 21:05, 22 September 2009 (UTC)

Please provide the reliable sources supporting your statement.--Nutriveg (talk) 21:55, 22 September 2009 (UTC)

Which statement? WhatamIdoing (talk) 23:37, 22 September 2009 (UTC)

User:WhatamIdoing, well I did present that source, from 2008. And another from 2006 defining the "safer sex" term as in this article content. You provided none. That point in time is pretty updated for me and not limited to "America" since the source provided is from the major world health organization. (and you still didn't answer the question in that section)

The definition in the lead defines the article topic, if one of those definitions of safe sex so far provided that say it means "sex with no risk" is chosen then any practice or behavior that carries some risk would be off-topic.--Nutriveg (talk) 21:55, 22 September 2009 (UTC)

Typical definitions of safe sex do not say "zero risk". Typical definitions are about harm reduction, and never promise infallibility. The fact that a minority of sources use this extreme definition in the process of explaining their preference for the term safeR sex does not mean that this extreme definition is normative. WhatamIdoing (talk) 22:54, 22 September 2009 (UTC)

@WhatamIdoing. This is discussing the issue, not the proposed course of action - lodging a complaint at NPOV, RfC, mediation - as the section title suggests. This reflects the problem with inserting 'safer sex' at the start of the lead, because the article is called 'safe sex'. If the title is to be changed, then that is a different issue, and the request to move the page from 'safe sex' to 'safer sex' needs to be lodged using the appropriate template. If that is the proposed solution, I suggest you do that, and that instead of a discussion about WP:MOS which keeps deviating into sources, this would become a discussion about the merits of re-naming a page with a well-established title.

@Nutriveg. Please provide some direction to the question you posed that requires a yes/no answer. Also, your use of English is very difficult to comprehend. Could you try and make your meaning clearer, because when I don't understand what you are trying to say, I'm afraid I tend to ignore it rather than figure out what you mean. Mish (talk) 23:25, 22 September 2009 (UTC)

@Verbal. I agree with you, unfortunately leaving this as is is a POV, while changing it to 'safer sex' is NPOV, and the only person who wants this seems to insist he is right and the rest of us are all wrong. So, leaving as is will not work, because he wants it changed. Mish (talk) 23:25, 22 September 2009 (UTC)

Finally, what are we going to do to stop this waste of time? Let him rename the article 'safer sex' or seek intervention? Mish (talk) 23:25, 22 September 2009 (UTC)

WhatamIdoing: No one here or in the sources has defined "safer sex" as "harm reduction", no one has described "safer sex practices" as carrying a "high risk of damage", the definition so far is that they're mostly not 100% safe and the safety levels varies according with the practices and behaviors.

MishMich: If the problem is to change the article title or not, if a template was used or not, that won't change the essence of the discussion. Every article needs a title that reflects the article topic, and an introduction that define the article title, that likewise defines the article content. Today's version is a mess: the article title is a deprecated term, the sources define the article title (term) as something else that don't reflect the article content, so someone made up a definition for that term that would better define the article content as it is. So we should fixed it altogether, but I always, since that first change, started from the definition of the source, citing a highly reliable source PAHO/WAS/WHO, but Simon Seed assumed bad faith in that edit and others followed. I wasn't seeking to change the title, I first did search for an updated reliable definition of "safe sex" that reflected this article content, but simple there wasn't, they all contradicted each other and neither represented well the topic, but the PAHO/WAS/WHO definition of "safer sex" was, and is, the one that perfectly defines this article content and deserves a lot of balance because of who authored it, and those who supported it. I'm sorry so many people saw prejudice in that definition or interpreted it someway else.

It looks you figured out what question I was talking about, although you answered it in a dubious way, but we can discuss in that section. Sorry about my bad English, I'll try to improve it, but it's better for the discussion process you try to understand it instead of ignore. --Nutriveg (talk) 02:35, 23 September 2009 (UTC)

Unfortunately, it leads me to suspect that if your English is that bad, you may just not have enough comprehension of the language to engage in discussion. It is not deprecated.

• "Safe sex" –noun

1. Random House Dictionary: Sexual activities in which precautions have been taken, as by the use of a condom, to minimize the chances of spreading or contracting a sexually transmitted disease.
2. American Heritage Dictionary: Sexual activity in which safeguards, such as the use of a condom and the avoidance of high-risk acts, are employed to reduce the chance of acquiring or spreading a sexually transmitted disease. (Usage Note: To emphasize that the probability of acquiring or spreading a sexually transmitted disease is merely reduced and not eliminated when following recommended safeguards, some advocate the use of the term safer sex instead of safe sex)
3. Merriam-Webster's Medical Dictionary: Sexual activity and especially sexual intercourse in which various measures (as the use of latex condoms or the practice ofmonogamy) are taken to avoid disease (as AIDS) transmitted by sexual contact (called also safer sex)
4. The American Heritage Stedman's Medical Dictionary: Sexual activity in which safeguards, such as the use of a condom, are taken to avoid acquiring or spreading a sexually transmitted disease.
5. Oxford English Dictionary: Sexual activity engaged in by people who have taken precautions to protect themselves against sexually transmitted diseases such as Aids.
6. Cambridge Advanced Learner's Dictionary: The use of condoms or other methods of avoiding catching a disease, especially AIDS (= a serious disease that destroys the body's ability to fight infection), from sexual activity with someone else "It's to be hoped that they're practising safe sex."

• "Safer Sex" - zero results apart from,

1. Collins: redirects to "Safe sex" ("Nonpenetrative sex, or intercourse using a condom, intended to prevent the spread of AIDS")

NHS-online uses both terms, e.g.

1. Preventing HIV: "'Safe Sex - Using a condom during sex, including oral and anal sex, is the best way to prevent getting sexually transmitted infections, including HIV". [13]
2. Safer sex and the over-50s [14]
3. NHS-online: Safer sex on holiday [15]

OK? Or are the dictionaries and the NHS all wrong as well - and is using a dictionary WP:OR? Duh? Mish (talk) 22:04, 23 September 2009 (UTC)

Well, since I got to know a specific guideline to deal with this article name issues: Wikipedia:Manual of Style (medicine-related articles)#Naming conventions I will you follow it. If you understand that any of those sources represent a "recognised authority or organisation" support for a specific term, please present it in Title discussion.

When referencing, reference properly like that 1987 dictionary reviewed in 1993.--Nutriveg (talk) 23:29, 23 September 2009 (UTC)

Moved. Mish (talk) 23:44, 23 September 2009 (UTC)