Barrier Methods for the Prevention of Infectious Diseases: Decades of Condom Research can Inform the Promotion of Face Mask Use

Abstract

Let's consider two seemingly unrelated protective behaviors: using a condom to interrupt the transmission of HIV and wearing a mask to prevent the spread of SARS-CoV-2. At first blush, these two activities would seem to have very little in common. Not only do they involve distinctly different features of the human anatomy but the latter (i.e., mask wearing) is a practice typically adopted in public venues, while the former takes place in the most private of settings. Yet, on closer consideration, there are discernable similarities between these two practices. Both actions are often perceived as inconvenient or troublesome, fettering as they do, natural biologic activities. Furthermore, despite documented efficacy, the prevention effectiveness of both requires ready access to the needed gear along with the knowledge and skills of how to properly and consistently use said gear. Just as there are incorrect ways to don and doff a condom, masks, too, can be worn in a fashion that defeats their intended purpose. And finally, the uptake of both of these prevention practices can be significantly influenced by our own attitudes as well as the attitudes and practices of our peers and other, so-called, opinion leaders. This rather metaphorical comparison is offered not as an exercise in intellectual calisthenics, but to assert that efforts to promote the consistent and proper use of face masks to prevent the spread of SARS-CoV-2 will require the same breadth of scientific underpinning that went into our national efforts to promote condom use during the first decades of the AIDS epidemic. Currently, much of the discussion surrounding mask wearing as a strategy to prevent the further spread of SARS-CoV-2 has focused on the need for mandatory regulations to enforce consistent use [1]. While we * Ronald O. Valdiserri

Evaluating Masks Through the Lens of Evidence-based Medicine

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