Lauren Sisson's blog

Female Condoms: Freedom Doesn't Come Free

2008-04-28T09:24:21-04:00

"...Capital gets its first Female Condom Machine - an effective step towards women's emancipation...freedom of protection, freedom from STDs and, above all, freedom from embarrassment."

-- Times of India, "Female condoms - freedom at last?"

Most would consider female condom vending machines in bars and night clubs a positive step toward increased access to safe sex technologies. But others would question the professed "emancipatory" qualities of the female condom. Over the last six months, the Center for Health and Gender Equity has interviewed experts involved in various aspects of global female condom availability, and several expressed skepticism regarding female condoms as a "liberating" tool for women.

They have reason to be skeptical. With roughly one female condom available for every 100 women in the developing world, and only five cents spent on female condom procurement for every U.S. dollar spent on male condom procurement, female condoms will not be freeing women from the risk of HIV infection, unintended pregnancy, or male-dependant prevention methods any time soon.

Lack of product investment, however, cannot be confused with product failure.
As the host of the Prevention Now! campaign, CHANGE regularly receives emails from organizations abroad requesting supplies of female condoms. Rather than suggesting product failure, these requests are evidence that an obvious need is not being met. Why do these organizations want female condoms?

Female condoms are the only approved and available HIV prevention method designed for women to initiate and control.
Studies have shown that making female condoms available in the same market as male condoms increases the overall number of protected sex acts and reduces the rate of STIs.
In situations where one or both partners refuse to use a male condom, female condoms provide an additional, and sometimes preferred, prevention option.
Female condoms can increase sexual pleasure: the non-latex products can be used with oil-based lubricants and massage oils; the fact that they can be inserted up to eight hours prior to intercourse means their use does not have to interrupt foreplay; and men have reported that its one-size-fits-all design increases pleasure and some women have found that the outer ring adds to their sexual stimulation.

If the problem is not the product itself, what will it take to ensure that female condoms provide women with freedom of self-protection as described in the Times of India article? This is one of several questions CHANGE sets out to answer in its new publication Saving Lives Now: Female Condoms and the Role of U.S. Foreign Aid. In particular, Saving Lives Now seeks to answer what more the U.S. government, as the largest donor to the global fight against HIV/AIDS and international contraceptive and condom supplies, should do to ensure that female condoms reach their full prevention potential.

Saving Lives Now does not assert that increased global access to female condoms alone will simultaneously empower the world's women to take control of their sexuality and end the global AIDS crisis. As the report points out, female condoms are not the perfect method for everyone. But as we develop programs that provide women with information about female condoms, how they work, and how to negotiate their use, we take an important step toward guaranteeing comprehensive, good quality reproductive and sexual health services that foster human rights, empowerment, and a full range of prevention choices for every woman.

Saving Lives Now documents the political and financial roadblocks preventing female condoms from achieving their full potential as a tool for women's empowerment and a method for curbing HIV infections.

For example, since 2002 USAID missions have been able to access male and female condoms for HIV prevention at no cost to mission budgets. However, since 2006 U.S.-funded HIV prevention programs in the 15 PEPFAR focus countries have not been eligible for no cost male and female condoms. Given that female condoms can cost as much as U.S. $0.80 per unit compared to male condoms that cost roughly U.S. $0.035 per unit, there is a severe disincentive for missions within PEPFAR focus countries--the countries most heavily impacted by HIV--to incorporate the higher-priced female condom into prevention programs.

Successful female condom marketing and programming is essential to the product's acceptability among users. Experts interviewed for the report acknowledge that while PEPFAR has provided essential support to combating global AIDS, the program's prevention policies have stifled efforts to normalize female condoms. While the U.S. has increased procurements of female condoms nearly eight fold since 2003, PEPFAR's emphasis on abstinence and fidelity has divested programs of funds necessary to market and promote female condoms to the general public. As a result, female condoms are being shipped to countries but not used.

While male condoms are familiar to large portions of the general public, female condoms are not, and their acceptability will remain tragically low as long as this is the case. U.S. global HIV prevention policy is not simply siphoning money away from programming and advertising for female condoms. It stigmatizes their use by targeting messages around male and female condoms to sex workers, men who have sex with men and intravenous drug users--already highly stigmatized populations in many societies--while excluding condoms from prevention messages aimed at youth and married couples.

The freedom to make decisions about safe sex remains elusive for the majority of the world's women. Female condoms will not and cannot be used by everyone, but for some they are the ticket to safe sexual practices. However, until national governments and donors, particularly the U.S., remove restrictive and ideologically driven policies preventing access to female condoms, the freedom to make such decisions will continue to evade women. Eliminating obstacles within prevention policies is only the first step. Donors and governments must demonstrate increased political will for providing women with access to an HIV prevention method designed for their use by significantly increasing financial investments for female condom procurement, programming and reliable distribution networks. The cost of ensuring that women and their partners enjoy the benefits of female condoms greatly exceeds current commitments, but the price of inaction, paid in lost or debilitated lives, is many times more costly.

Female Condoms: The Missing Prevention Method

2007-02-14T08:00:00-05:00

In 2006, only one female condom was available for every 100 women worldwide. This disturbing fact won't surprise anyone who's ever tried to locate female condoms. My first attempt to purchase them resulted in a confused pharmacy technician showing me various spermicidal gels, vaginal sponges and a male condom marketed for women. Before traipsing to pharmacies across DC, I decided to call around. Of the 22 locations I called, 12 of which were pharmacies, only five carried female condoms: two Planned Parenthoods, two student health centers, and an HIV/AIDS clinic. None of these locations were open after business hours and the closest provider was a 20-minute metro ride from my office.

The fact that I had to traverse the city to find a female condom points to greater problems than those presented for sexual spontaneity. This experience starkly highlights a failure to market and distribute one of the most effective prevention methods, and the only available female-controlled method, against the sexual transmission of HIV.

When used correctly and consistently, the female condom is as effective as the male condom in preventing HIV. Additionally, the female condom remains the only new form of STI prevention developed since the advent of the AIDS epidemic. Since that time, the world has experienced a feminization of the disease: worldwide, 17.3 million women over 15 are infected with HIV, and 76% of HIV-positive youth in sub-Saharran Africa are female. While the majority of new HIV infections occur in developing countries, women in the United States are not exempt from the scourge of this disease: AIDS is the leading cause of death for African American women aged 25-34. Such conditions demand a female-controlled prevention method.

To address this demand, public and private entities like USAID and the Bill and Melinda Gates Foundation have begun investing millions of dollars into research on microbicides—undetectable gels and creams that women could apply vaginally to protect themselves from the sexual transmission of HIV. Because they are undetectable and could be applied prior to intercourse, microbicides present distinct advantages for women with partners who oppose protection. However, UNAIDS estimates that a microbicide won't be ready for general use for another five to seven years. Additionally, the recent halting of two phase III microbicide trials due to product failure reminds us that these yet-to-be-developed technologies are still a promise of the future and further underscores the immediate need to enable women to protect themselves with prevention technologies currently available.

The unit cost of female condoms—approximately $0.60—is often cited as a barrier to distribution. However, estimates predict that increasing female condom distribution from the present 20 million-per-year to 200 million-per-year would decrease their cost by two-thirds, making them cost-competitive with male condoms. To date, donors have spent $163 million on microbicide research. According to a study published by Johns Hopkins University, one-fifth that amount could purchase over 50,000,000 female condoms and prevent as many as 32,000 new HIV infections in South Africa. Imagine the savings to South Africa's healthcare system if the country had 32,000 fewer HIV cases. Imagine the savings for human life.

This is not a matter of pitting research budgets against procurement budgets, but rather of doing everything in our power to fund the distribution of an effective HIV prevention method that women and men worldwide can start using now.

Female condoms provide an alternative to the male condom and allow women to bring a protection option to the table (or bed, if you will). Additionally, research has shown that couples' ability to switch between male and female condoms leads to an increase in the total number of protected sexual acts. Most importantly, female condoms are available now—they can start curbing the spread of HIV and saving lives today.

Organizations and communities must demand access to female condoms. Zimbabwe only began importing female condoms after women's groups presented their government with 30,000 women's signatures demanding access to them. Such grassroots and community action needs to take place around the world. PreventionNow is an international campaign to ensure universal access to female condoms led, in the United States, by the Center for Health and Gender Equity. You can join this network of thousands of people and more than 175 domestic and international organizations committed to building grassroots and donor support for female condoms at PreventionNow.net. By enabling and empowering women to protect themselves and their partners with female condoms, we can begin saving lives and curbing the spread of HIV today.