Mixed Reception for Condom in Latin America

By Patricia Grogg*

HAVANA, Dec (IPS) - The use of condoms is key to preventing the spread of HIV/AIDS, although many people in Latin America and the Caribbean who should be using them fail to do so due to cultural, social and financial hurdles.

Health experts underline that used correctly, condoms are highly effective in preventing unwanted pregnancies and protecting men and women from the spread of sexually transmitted diseases, including HIV (human immunodeficiency virus), which causes AIDS.

But in many countries in the region, the use of the condom runs up against prejudice, ignorance or a lack of awareness of the risk of contagion.

Sexual transmission has become the main route for the spread of AIDS (acquired immunodeficiency syndrome) in the region. Health authorities say blind trust in the faithfulness of one's partner and the widespread belief that condoms diminish sexual pleasure conspire against ''safe sex.''

''Many of my friends say their girlfriends are 'clean', and that they don't need to use condoms, which reduce their pleasure,'' Alberto Flores, a 32-year-old Cuban musicologist, remarked to IPS.

In Cuba, 0.03 percent of the population of 11.2 million is living with HIV -- the lowest rate in Latin America and the Caribbean, according to the joint United Nations programme on HIV/AIDS (UNAIDS).

Local health authorities say condoms are readily available in this Caribbean island nation, and can be purchased, as in the rest of the region, in local pharmacies at modest prices.

But they acknowledge that greater consciousness-raising efforts are needed in order to increase the use of condoms. A nationwide survey carried out last year among Cubans aged 15 to 49 found that only 53 percent said they had used condoms in their most recent sexual encounter.

''We must be systematic'' in our efforts, said María Gattorno, director of a cultural centre for rock music lovers in Havana. ''We need to hand out up to 1,000 free condoms at each rock concert, and we don't always have that many.''

Some countries, like Brazil, see the distribution of free condoms as a key part of the strategy to curb the spread of HIV/AIDS. During the country's Carnival season, in February, 28 million free condoms were handed out.

As part of that policy, Brazil's public health system also provides the antiretroviral drugs needed to prevent or delay the onset of full-blown AIDS free of charge to all people living with HIV.

In 1992, the World Bank predicted that 1.2 million people would be living with HIV in Brazil, a country of 170 million, by 2002. But thanks to the public health measures adopted, the number stands at just 215,000 today, and AIDS-related mortality has been cut in half.

The United Nations Population Fund (UNFPA), the world's leading supplier of condoms, provided a total of 109 million condoms to 18 Latin American countries last year.

The region should earmark 51.5 million dollars a year to cover the need for condoms, UNFPA recommended in 2000.

Of that total, 14.5 million dollars are needed to furnish family planning programmes with condoms, and 37 million for efforts to curtail the spread of HIV and other sexually transmitted diseases.

However, international donors only provide the region with five million dollars towards that end, leaving a deficit of 46.5 million.

UNFPA promotes the use of condoms as the best alternative for sexually active individuals, although it also supports voluntary abstinence or stable monogamous relationships as routes for preventing infection with HIV/AIDS.

UNFPA also included female condoms in the shipments of condoms sent to Bolivia, Cuba and Haiti.

The female condom is a loose-fitting polyurethane sheath with two flexible rings at either end. One ring lies at the closed end of the sheath and serves as an insertion mechanism and an anchor against the cervix. The other ring remains outside the vagina, protecting the vulva and the base of the penis, in addition to the areas of contact covered by the male condom.

Although equally safe and effective and offering the advantage that it leaves the decision of using condoms up to the woman, the female condom, which is more expensive, hardly appears in prevention campaigns in the region, where few are sold.

Chile is one of the exceptions. The National Commission on AIDS (CONASIDA) and the Vivo Positivo (I Live Positive) umbrella group linking 30 non-governmental organisations, have begun to promote the female condom.

In that Southern Cone nation of 16 million, the women most likely to use female condoms are those who already test positive for HIV, and who defend their right to an active sex life.

Several women's groups in Mexico, a country of 100 million, have created a national network to promote the female condom and distribute them through social marketing strategies, with the support of the local UNFPA office.

However, some men find it hard to accept ''sexual novelties introduced by women,'' said Beatriz Pacheco, the coordinator of the Red Ciudadana Positiva (Positive Citizen Network) in southern Brazil, which represents women living with HIV.

Pacheco, who has special training in promoting HIV/AIDS prevention methods, got around the problem by distributing female condoms to men, which led to wider acceptance of the relatively new method.

The secret to her success, she says, is her argument that inserting the female condom does not require ''a full erection.''

But many initiatives have run up against opposition by the Catholic Church and conservatives in this heavily Catholic region, whose protests, for example, led the government of the Brazilian city of Rio de Janeiro to suspend the inclusion of condoms in the basic basket of essential items handed out to low-income families.

According to the statistics, the epidemic is growing mainly in the most impoverished segments of the population of Brazil, and at an especially fast pace among women.

In Argentina, a Southern Cone country of 37 million, the severe economic crisis has driven up the price of condoms by as much as 50 percent over the past few months, and sales have gone down, according to pharmacies.

In some places, purchasing condoms still makes people blush. ''Take off your embarassment, put on a condom,'' was the slogan of a campaign launched in late October by Vivo Positivo in Chile.

The Central American country of Costa Rica, population 3.8 million, has a strong public health response to people living with HIV/AIDS, although prevention efforts fall short. In fact, there is currently no awareness-raising and prevention campaign in the media or schools.

But most countries in the region promote the use of the condom as a prevention strategy, through media spots, community prevention programmes or school fairs.

The campaigns urge more open communication between parents and children, and try to raise awareness on the fact that all sexually active people face the risk of being infected with AIDS.

''You cannot always be with your daughters and sons. The condom can'', states one publicity spot in Mexico, where nine out of 10 cases of HIV/AIDS are the result of sexual transmission.

Meanwhile, AIDS continues to claim victims. This year, 3.1 million people have died of the disease worldwide, and five million were infected with HIV, according to the latest UNAIDS report issued ahead of World AIDS Day, which is observed on Dec 1.

A total of 42 million people are living with HIV/AIDS worldwide, said the report.

UNAIDS reports that there are 1.9 million adults and children testing positive for HIV in Latin America and the Caribbean, including 210,000 who were infected this year.

Studies warn that in this region, where adolescents comprise more than 20 percent of the population, and over 40 percent of the population lives in poverty, HIV is becoming one of the most pressing public health problems, especially among the young.

* Article produced by IPS on the occasion of World AIDS Day, observed on Dec 1, with contributions from the following correspondents: Mario Osava (Brazil), Gustavo Gonzalez (Chile), and Nefer Muñoz (Costa Rica). (END/IPS/LA/HE/TRA-SO SW/PG/DCL/02)