“At first it was strange, uncomfortable and noisy, but I began to use it as a game and a novelty for my clients”.
“Men often don’t want to use a condom because they say they are allergic, they don’t like them, they are a nuisance – they take them off, but with the female condom I can have control”.
“For the clients it was something new, and for me too. There’s no excuse not to look after ourselves.”
- Sex workers belonging to AMMAR, La Asociación de Mujeres Meretrices de Argentina
The female condom….Cue sniggers and jokes about having sex with a giant plastic bag right? But as the only method to date that women have that enables them to take charge themselves of preventing HIV infection, isn’t it about time we stopped laughing at the back and took the issue just a little more seriously? And there’s no better time to start than today which marks the first Global Female Condom Day!
In theory, the female condom gives women greater control over their own protection although the reality is that for many in the developing countries where the International HIV/AIDS Alliance operates, a power imbalance remains as they still have to negotiate using it with their partner or spouse. Women even purchasing condoms – male or female – also remains problematic in some contexts due to cultural norms around them taking the initiative or their economic situation which may preclude them from buying condoms.
Data shows that female condoms are comparable to male condoms in preventing pregnancy and STIs. Where available however, supply is often limited or too expensive for those most at risk, particularly in the developing world, indicating that there is a general lack of information among decision makers together with low investment. Female condoms currently represent only 1% of all condoms distributed worldwide, resulting in a high cost-per-unit price. Yet the second generation models introduced a few years ago are a cost-effective method of HIV prevention, even at low levels of use and research shows that the cost-effectiveness would increase significantly at higher levels of use.
If governments and donors were to make bulk purchases and to invest in programmes that increase access to female condoms, substantial savings could be made both in terms of lives and also health care costs.
In February of this year the World Health Organization recommended that women living with HIV, or at high risk of HIV, continue to use hormonal contraceptives to prevent pregnancy, but emphasized the need for dual protection. At the Alliance we are highlighting the importance of promoting dual protection in our programmes in order to protect against STIs, HIV and unintended pregnancies. Ensuring that this information is clearly communicated to health care providers and women living with or at high risk of HIV is key to an effective HIV prevention strategy and both men and women being able to take steps to better protect themselves.
One of the earliest initiatives we were involved in involving female condoms was in the English speaking islands of the Eastern Caribbean where a significant number of sex workers are seasonal migrants from the Spanish speaking Dominican Republic with little knowledge of the language and culture and therefore with little access to HIV and AIDS information and services.
Following research in Antigua which found that although there was increasing government interest to promote female condoms, little was happening in the way of promotion or distribution, our linking organisation the Caribbean HIV/AIDS Alliance together with their local partner, worked to produce a comic to promote female condom use. Called Ana descubre sus poderes (Ana discovers her powers), it was designed with female sex workers in mind. The comic presents several different scenarios where female condoms can be an appropriate alternative to the male condom, such as when dealing with a drunk male client, or a client who refuses to wear a condom or offers more money for sex without wearing a condom.
According to UNAIDS, the availability and distribution of female condoms has at least increased in the past few years. In 2009 around 26 million female condoms were provided through international and nongovernmental funding sources, compared to 10.7 million in 2006. Additionally there’s a growing interest in microbicides which offer a potential preventive option that women can more easily control and do not require the cooperation, consent or even knowledge of their partner.
Studies show that providing both female and male condoms as part of a comprehensive prevention strategy increases the overall number of protected sex acts, because people have multiple choices for protection. With women and girls comprising just over half of all people living with HIV worldwide, redoubling efforts to make the female condom less misunderstood and more affordable really could change everything.
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