Since the beginning of the Aids epidemic, condoms have been the single most efficient available technology to reduce the transmission of HIV and other sexually transmitted infections. Condom use forms one of the three elements of the ABC strategy: Abstinence, Be faithful and Condom use. The National Strategic Plan (NSP) and the United Nations Joint programme on AIDS (UNAIDS) acknowledge that condoms are key to preventing the spread of HIV and Aids. Sonke plays a role in trying to meet some of the objectives of the NSP of halving HIV and Aids by 50% by 2015 through employing various strategies such as condom distribution, community education and training.
In 2010, the Sonke Men’s project distributed over 27 500 male condoms in township communities of Kraaifontein, Khayelithsa, Nkanini and Gugulethu. Selected prisons including Pollsmor, Worcester, Robertson, Ceres, Dwars River, Drunkenstead, Goodwood and Helderstroom where Sonke is currently implementing its programmes were also reached between April and July 2010. What was interesting to note as a matter of concern was the lack of distribution of the female condom.
The female condom was developed in the 1980s as an alternative strategy to the male condom aimed at ensuring a safer sex method for women. To date, studies show that the female condom is the only method that allows women to control and protect themselves and their partners against HIV and various other sexually transmitted infections.
Women represent half of the 40 million people currently living positively with HIV and Aids in Sub-Saharan Africa, and nearly 60% of those newly infected are women and girls. Many African women still remain subordinate to men in various aspects of their lives socially, politically and economically. Women find it difficult to negotiate for safer sex practices with their partners due to toxic and negative cultural beliefs and practices that many African societies’ embraces. Women are denied the right to negotiate on sexual matters. It is women’s’ sexual inequality that makes them highly vulnerable to sexually transmitted infections (STIs), including HIV and unplanned pregnancies. Women are also often unable to negotiate the use of the male condom and hence the introduction of the female condom hoped that it would give women some control in sexual relations as the number and relative proportion of women infected with HIV rises rapidly and as women become more vulnerable to the epidemic, access to protection has become increasingly urgent, especially in Sub-Saharan Africa (UNAIDS/WHO, 2008).
The female condom has been demonstrated to be highly effective in preventing pregnancy, HIV transmission and other viral infections such as herpes and hepatitis by providing safer protection during sex. Although there are case studies that show the acceptability of the female condom, further studies show the challenges that come with this new method (Ajwang, 2009). In October, Faith Chirinda, Sonke’s intern conducted a survey research to find out the perceptions and concerns around the female condom and she interviewed fifteen women from East and West Africa at the Cape Town craft market. The research which was conducted during a condom distribution activity with Sonke’s Refugee Health and Rights indicated that women face several obstacles. Several women interviewed expressed concerns around the condom appearance urging that it is not user friendly. Moreover, some women reflected that the female condom is too long and thus they experience difficulties and pain inserting it into the vagina. Further responses from some of the women indicated that they welcomed the female condom because it provided dual protection against pregnancy and STIs without sacrificing sexual pleasure. A great concern raised was the lack of its availability which leaves women with little or no choice when it comes to protecting themselves. Other responses eluded the fact that female condom carry the stigma of being used only in short term, casual relationships for disease and pregnancy prevention, and hence is associated with promiscuity. Other barriers to the effective use of the female condom as identified include the lack of access from health delivery service centres, insufficient promotional materials, lack of understanding, bias among health workers, lack of knowledge among women about their physiology well being as linked to cultural and social barriers.
Valuing the female condom
The cost price tagged on a female condom is a barrier. The government is distributing less female condoms as compared to male condoms. In South Africa, the female condom costs thirty six times more than the male condom. The question that then arises is that ‘If the government is serious about women’s empowerment and giving women choices and more options to protect themselves, why should the cost be a problem?’ At the moment, the fact that the government is taking costs into account is an indication of how government does not seriously value women’s empowerment because the protection of one’s life should never be quantified. It is worth noting that the lack of acceptability of female condoms by health care workers has been reported in several studies in South Africa, Kenya and the USA. A lack of capacity, lack of support or training to offer female condoms among health providers and inconsistency of supply has stifled promotion of the product. On the other hand, some health care workers’ own inhibitions about sexuality, social ideas about appropriate female behaviour and the fact that the intricacies of female bodies still remains a forbidden topic among most African health personnel remains a challenge. It is high time that health practitioners start seeing the promotion and distribution of the female condom as an integral part of their responsibility too. Drawing from the writings of Hoffman, Mantell and Exner (2004), the fact that female condoms were first targeted at sex workers might have led to stigmatisation rather than normalisation of the female condom. NGOs and government still have a lot of work to do to destigmatise the female condom.
A major recommendation that can be drawn from the analysis is that the introduction and acceptance of the female condom does not mean simply putting the female condom on the pharmacy shelf. Rather for South Africa to achieve effectiveness its NSP goal of prevention through the use of condom distribution strategies, it requires proactive, well-planned strategies to integrate the female condom into the country’s contraceptive method mix. It also requires ongoing monitoring systems, well-designed impact studies and appropriate revisions and applied changes where necessary. Government and NGOs need to step up campaigns that educate people about female condoms. There were concerns that at the moment there is very little advertisement of female condoms in the media and that government needs to make use of media to reach out to many women on the importance of the female condom. It is critical that government and aid organisations ensure a sustainable supply of both female and male condoms. Widespread promotion of the female condom will help destigmatise the method and normalise it as a potential method of safer sexual practice for all sexually active women and men, not just those who engage in high risk behaviours or are living with HIV and Aids.