Although the female condom has been heralded as a way for women to protect themselves from HIV and STI infections, its impact has been severely limited due to several reasons including its design, cost, access, stigma, and lack of political will.
Given the fact that women are the most affected and infected by HIV (in 2007, women represented half of all HIV infections worldwide, and 61% of HIV infections in sub-Saharan Africa) it is an imperative that evidence-based measures be undertaken to reduce their vulnerability.
The female condom is an essential sexual reproductive health tool that women can control but, disappointingly, it remains confined to the fringes of the response to the global AIDS epidemic.
According to a report by the Center for Health and Gender Equity titled “ Saving Lives Now: Female Condoms and the Role of US Foreign Aid” the US has an important role to play in the procurement, distribution and programming of female condoms.
As a leading provider of funding for HIV and AIDS prevention, treatment and care, and reproductive health supplies worldwide, the US can promote the wider use of the female condom, including reducing the cost which is beyond the reach of many of the affected women.
The report notes that there is little knowledge among policy makers and advocates about what the current US role is and, thus, a lack of understanding of what more the US should do.
“Bureaucratic obstacles, funding restrictions, and a lack of high level commitment to female condoms have significantly hindered the expansion of U.S.-funded female condom distribution efforts,” says the report.
“The U.S. government has no policy guidance encouraging missions or contractors to promote female condoms, which has meant that female condom procurement is dependent on a few field-level champions who are committed to the method,” adds the report.
Currently, international donors and government are investing millions of dollars and energy into promoting initiatives such as male circumcision, and little attention is being paid to promoting female condoms which allow women to initiate protection.
“While the unique nature of female condoms in providing women with their own source of protection should be reason enough for donors and governments to promote the method, female condoms hold other advantages as well. They fill their own niche, as consumers often alternate their use with that of male condoms, thus increasing the total number of protected sex acts,” states the report.
“They can be used by women living with HIV who do not wish to become pregnant, to protect against superinfection and to reduce the chance of HIV transmission to seronegative partners.”
In addition, female condoms also provide an additional option for protection during anal intercourse for men who have sex with men and heterosexuals, says the report.
In spite of the apparent benefits of the female condom, there are still major challenges in promoting its use.
Apart from the fact that female condoms are prohibitively expensive in many parts of the world, users find them noisy, physically unappealing, or difficult to use.
“However, female condoms are a cost-effective mechanism for HIV prevention when measured against thevcosts of potential HIV infections or other HIV prevention mechanisms. Also, as more and more female condoms are produced and purchased, their cost will drop,” states the report.
With greater financial investment and commitment, the design of the female condom can be improved increasing the likelihood of uptake by women.
Furthermore, there is need for educational and social marketing programs aimed at reducing the stigma associated with use of the female condom as well as improving consistent and accurate use.
According to the report, civil society groups can be extremely valuable in developing effective programming because of their access to populations vulnerable to HIV infection and their experience working with these groups.
The report makes the following recommendations to improve US’s role in the distribution and use of female condoms:
- USAID and OGAC should issue policy guidance promoting female condom procurement and programming within US-funded development programs, including PEPFAR. As a signatory of ICPD, the US should promote female condoms as a vital tool to prevent both pregnancy and HIV infection.
- The US should expand technical assistance for female condom logistics and procurement to additional countries to increase HIV prevention efforts.
- The US should apply intensive programming efforts to an additional three countries for scale-up and replication. These efforts could be used to create a more realistic assessment of global female condom needs for scale-up.
- The US should increase HIV prevention efforts by expanding the scope of female and male condom promotion to encompass the general public. Programming for female condoms will depend on each area’s epidemiological profile, and should be free of messages and attitudes that stigmatize condom use.
- The US should invest more funds in female condom promotion and programming. The US should subsidize female condoms for PEPFAR-funded programs.
- At the country level, the US should include civil society, especially women’s health and rights groups, in stakeholder meetings and encourage financing mechanisms that increase government-civil society collaboration in female condom programming.
- Congress should remove all earmarks and funding directives for abstinence-only, abstinence-until-marriage and fidelity prevention programs and fund comprehensive, integrated, and evidence-based HIV prevention programs that include female condoms and that promote and protect women’s health.