HIV/AIDS: Female Condoms Slowly Gaining
Popularity
PlusNews
August 11, 2011
Long seen as the ugly step-child of HIV
prevention, the female condom seems to be
gaining popularity through grassroots campaigns,
according to a new report by the UN Population
Fund (UNFPA).
"For the fourth consecutive year,
access to female condoms has increased
dramatically, reaching a record number of 50
million... in 2009," the report states.
The female condom is a 17cm-long
polyurethane sheath with a flexible ring at each
end. It provides about the same protection from
sexually transmitted infections - including HIV
- and unwanted pregnancy as the male condom, but
unlike the male condom, can be used with oil-
and water-based lubricants without the risk of
breakage.
The organization credits successful
partnerships between governments and technical
agencies for helping to increase access to
female condoms. In 2005, UNFPA launched the
Female Condom Initiative in 24 countries to
ensure that female condom programming was
integral to national AIDS policies and
reproductive health programmes.
Creative approaches
"In a number of countries,
governments... are applying highly creative
approaches to educating the public about condoms
and to overcoming the stigma and taboos
sometimes associated with them," the report's
authors said. "In the process, they are
discovering that the female condom is a tool for
women's empowerment, enabling women and
adolescent girls to take the initiative to
protect their own and their partners' health."
In Zimbabwe, billboards, radio spots
and TV adverts helped boost female condom
distribution by the public sector from about
400,000 in 2005 to more than two million in
2008, while the sales of female condoms went up
from 900,000 in 2005 to more than three million
in 2008.
Programmers in Zimbabwe used
hairdressers to market the female condom, which
proved highly successful.
"Often the hairdresser will work
from a chair in her back yard. Such improvised
salons stay open at all hours, so women can have
their hair done – and discuss personal matters –
in privacy," the authors reported.
UNFPA's partner, Population Services
International (PSI), provides day-long training
workshops around the country for the 2,000
hairdressers and 70 barbers who act as sales
representatives for the female condom. PSI also
employs 20 female condom promoters who
distribute the condoms to hairdressers and
barbers and spread the word about the training.
For the fourth consecutive year,
access to female condoms has increased
dramatically, reaching a record number of 50
million... in 2009
This approach was also used
successfully in Guyana and Malawi.
In Ethiopia, the programme used
coffee ceremonies, an age-old social custom, to
reach married women. Because condoms - perceived
to be used by promiscuous people and sex workers
- are highly stigmatised in Ethiopian society,
programmers highlighted the family planning
benefits of the female condom.
In Myanmar, efforts targeted
high-risk female sex workers and men who have
sex with men, with PSI rebranding the condoms
"Feel for Men" to make them more appealing to
MSM.
Although not recommended for anal
sex by the UN World Health Organization, some
health authorities have opted to market it for
use by MSM. In a 2002 US study, men reported
more frequent problems with female condoms than
male latex condoms, particularly slippage,
discomfort and rectal bleeding; the authors
recommended more research on the safety of
female condoms for anal sex.
Lagging behind the male condom
Despite these gains, the female
condom still lags behind the male condom in
popularity; according to UNFPA, more than 10
billion male condoms are used every year
globally.
In Kenya, female condoms are part of
the country's broader HIV and family planning
programmes, but women have shown little
interest. The country recently received three
million female condoms from UNFPA and
distributed them.
"We do not have reliable data on
acceptability but we know that among sex workers
there is a high demand," said Peter Cherutich,
head of HIV prevention at the National AIDS and
Sexually transmitted infections Control
Programme. "Overall, the demand is low mainly
due to general unavailability and [lack of]
information.
"It is still more expensive [than
the male condom] and we are yet to be confident
that it is as widely popular as the male
condom," he added. "Except for female sex
workers and highly empowered women, most other
women do not have the capacity to demand safe
sex... the majority of women depend on their
sexual partners to protect them."
The UNFPA report noted that female
condoms can cost as much as US$1 each while male
condoms are often distributed free of charge. In
pharmacies in Nairobi, a pack of three male
condoms costs from about $0.20 to just over $1.
Challenges
"In 2009, only one female condom was
available for every 36 women worldwide," the
report states.
One of the major complaints women
had about the original FC1 female condom was
that it was noisy during sex. The newer FC2
female condom is quieter and less expensive to
produce but many women still feel it is more
complicated than the male condom.
"We are trying to popularize it
among sex workers, but they say if you have five
or 10 customers in one night, the male condom is
more convenient - with the female condom, it
takes time to put on, then it has to warm up to
your body temperature and the guy knows it's
there," said Macklean Kyomya, executive director
of the Ugandan NGO, Women's Organization Network
for Human Rights Advocacy, which represents sex
workers.
Lillian Mwamba, who lives in
Nairobi, says she would use the female condom
more often if it were more widely available.
"I have used a female condom on
certain occasions but my partner and I prefer
the male one because they are easy to come by
and you can walk into any shop, even a kiosk,
and get it; female condoms are very rare and
expensive," she told IRIN/PlusNews. "But on the
occasions I have used it, I can't say it was bad
- it gives me as a woman some control."
Ignorance persists
Conversations with other Nairobians
reveal that ignorance about the female condom is
still widespread. "From the demonstrations I
have seen, the female condom is inserted inside
and your penis too goes inside. Now I am
thinking to myself, what if I push it deeper
inside and the woman gets hurt?" said Paul
Mayaka. "And where do you get it even if you
wanted your woman to have it?"
Mayaka added that he couldn't "trust
my life with something that is washed like a
cloth", referring to the practice of washing the
female condom for reuse, which is not
recommended by the UN World Health Organization.
NASCOP's Cherutich said the Kenyan
government would need to market the female
condom in new ways to increase use. "We have not
placed the female condom as a family planning
tool, which if we had, would make FC less
stigmatizing since family planning is now an
accepted concept within family settings," he
said.
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