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HEALTH: Female Condoms Gain Acceptance as Safer Option for Women

Marwaan Macan-Markar

MEXICO CITY, Apr 20 2001 (IPS) - Should more women be encouraged to use female condoms to curb the spread of sexually transmitted diseases? Public health workers seem to think so in the face of mounting evidence from studies conducted in a number of countries.

Researchers reveal, for instance, that women who use female condoms in addition to male condoms are less likely to be infected with sexually transmitted diseases (STDs) than women who depend only on the male condom for safe sex.

A select number of sex workers in Thailand who were encouraged to use female condoms, “experienced a 34 percent decrease in the number of new sexually transmitted infections”, an independent study found.

Likewise, in countries such as Brazil, the United States and Zambia researchers have established that female condom use has had a public health impact – “an increase in the number of protected sex acts”.

“Acceptability of the female condom as an option for prevention is quite good,” admits Michael Fox, senior technical advisor in the Department of Policy, Strategy and Research at the Joint United Nations Programme on HIV-AIDS (UNAIDS). “A significant number of women, and also men, find that use of the female condom is a satisfactory method of protection.”

What is more, says Fox, women can have more control over the use of the female condom as a method of prevention than they do over the use of its male counterpart. “It is a method which women can choose and initiate more easily than the male condom.”

Such reasons, in fact, have played a large part in swaying more women toward using the female condom since its introduction in 1992 by the Chicago-based Female Health Company.

Currently, the female condom is available in over 60 developing countries, says Mitchell Warren, director of International Affairs at the Female Health Company. Last year, for instance, some 45 countries distributed over 4.5 million female condoms, pushing the total number sold over the last eight years to over 35 million.

Nevertheless, affirms Warren, female condom availability in the developing world is still largely tied to special health programmes, like those focused on reproductive health and those attempting to curb the spread of HIV-AIDS.

“Many of the programmes have been small pilot activities,” adds Warren. In Ghana, for instance, the programme began in 1999 with 75,000 female condoms, and increased to 420,000 in 2000 and to one million this year.

But there are other countries that are moving from the experimental phase to “large-scale expansions”, like Brazil, Namibia, South Africa, Uganda and Zimbabwe. “The growing sales volumes in these countries implies an increase in user demand and actual use of the product,” says Warren.

According to UNAIDS, the female condom can contribute significantly to combating AIDS. And in an effort to drive home that message, this UN programme teamed up with the US supplier of the female condom in 1996 to distribute it through public sector groups and non-governmental organisations (NGOs).

“UNAIDS has a long-standing commitment to the promotion and use of both male and female condoms in the struggle against the spread of HIV-AIDS and sexually transmitted infections,” says Fox. “Condoms are an indispensable part of prevention.”

The UN body is emphasising female condom use because women bear the burden of STD infections. “The global burden of infection by HIV (and STDs) among women is very high and is increasing, especially in sub-Saharan Africa and Asia,” confirms Fox.

This is borne out by a World Health Organisation (WHO) study, which reveals that nearly half of the 36.1 million people living with HIV or AIDS are women. On the entire African continent, for instance, there are 12-13 women infected with the deadly disease for every 10 men. And “55 percent of adult infections in sub-Saharan Africa are in women”.

Three factors have contributed to such a high infection rate among women, adds the WHO. They are biological, economic and social and cultural issues.

Regards the biological reasons, for instance, the WHO states that “microlesions which can occur during intercourse may be entry points for the virus”, and adds that very young women are even more vulnerable in this respect.

And the likelihood of such mircolesions are great given the number of women forced into having sex, adds the WHO. “Coerced sex increases risk of microlesions.”

Furthermore, declares the WHO, there are more viruses in sperm than in vaginal secretions. Consequently, as with STDs, “women are at least four times more vulnerable to infection”.

Despite such realities, which underscore the importance of female condoms for women, public health experts like Fox do not expect the female condom to reach the high usage level of the male condom, because the price difference between the two.

The price of the female condom “is still very high and this is a major obstacle to wider acceptance and use particularly in developing countries”, says Fox. In some countries, he reveals, it is “up to 10 times the price of a male condom”.

That has not been lost on the Female Health Company. According to Warren, the programme UNAIDS has with the company includes distributing the female condoms to over 60 countries at the reduced price of 55 cents. The female condom is sold in developed regions such as the United States, Europe and Japan for two dollars each.

“Some of these countries then make the female condom available free in public health programmes and others sell them at very low, subsidised prices that are below the cost of the actual product,” reveals Warren. In South Africa, for instance, the condoms are available free in some clinics and sold in pharmacies for about 30 cents each.

But even if the female condom is sold at the same price as its male counterpart, public health activists do not see the female condom replacing the more used male condom. “The female condom is not envisaged as a panacea or a replacement for the male condom,” says Patrick Freil of the UN Population Fund (UNFPA).

“It is another choice that adds to those few currently available to women in developing countries,” he adds. “Where it is available, accessible and properly promoted, it does increase barrier protection.”

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