Some parts are used as decorative bangles in certain countries and, at times, it is derisively referred to as a ”fish bag”, but usage of the female condom seems to be rising in South Africa, its second-largest market in the world.
The female condom has been around for nearly a decade, and in South Africa — which globally has among the highest incidence of HIV/Aids with about 5,5-million people living with the disease — it is a focal point of the government’s national HIV/Aids programme.
The female condom is an integral part of the government’s ”ABC” — abstinence, be faithful and condomise — message, with distribution thereof increasing from 1,3-million in 2001/02 to 2,6-million in 2004/05. The target for 2005/06 was to distribute three million female condoms.
”I believe that its phased introduction over the years has gained momentum,” says Mags Beksinska, executive director of the reproductive health and HIV research unit at the University of the Witwatersrand.
Beksinska says measuring the impact female condoms has had in the country is difficult because one needs to measure changes in protected sex acts.
”In South Africa one study is trying to look at this issue, and data will be available soon that looks at these issues. The availability of the device in South Africa is extremely important due to our high STI/HIV infection rates,” she said.
Research suggests that in South Africa one in four women is HIV-positive by the age of 24, twice the infection rate for men. This reflects the changing face of the pandemic, which in its early years predominantly affected men, but today sees women account for nearly 50% of the world’s HIV-positive persons. Sixty percent of those infected with the virus in Africa are women.
Eleanor Sopili, an HIV-positive Cape Town woman, says that when she started using the female condom, it felt a ”little bit funny”.
”But as you continue using it, there is no difference between that and the male condom,” she says, adding that male partners who are reluctant to wear condoms are ”happy” this responsibility is shifted to women. She says the female condom is not very popular among her peers, but feels confident this will change.
Momentum lost
Katy Pepper, African regional programme manager at the not-for-profit Female Health Foundation, says the initial response to female condoms in the country was fairly good. But, gradually, with training skills going and people moving on from the original 214 sites set up throughout the country, momentum was lost.
Existing barriers to the programme include a lack of access, lack of staff training, lack of promotional materials, lack of understanding and bias among medical staff.
Ignorance among women about their physiology adds to the challenge. ”To put it crudely, a lot of woman don’t realise that they have three holes [vagina, urethra and anus] and that’s one of the big issues because women, when they put it [the female condom] in or see them, think they won’t be able to go to the loo to pee,” Pepper says.
The first-generation female condom, FC1, is marketed as a strong, soft, transparent polyurethane sheath that is about 17cm long, the same length as a male condom. The new, synthetic latex FC2 could be in the country by next year.
The FC1, greasy to the touch, has flexible rings at each end and is inserted into the vagina prior to sexual intercourse, providing protection against both sexually transmitted infections and HIV/Aids.
The condoms, currently imported from the United Kingdom where they are manufactured, are also deemed too expensive, costing the government about R5 for one. They are given out free of charge in the public health sector.
”But cost is not the prohibitive factor … access to it is the real problem,” says Pepper, basing her impressions on interactions with women’s groups and clinics throughout the country.
Beksinska confirms the female condoms have not been widely available, saying costs mean they are not found in condom cans like the male version is. She says the number of sites distributing the condoms will increase to about 300 by next year. ”However, this is only a small percentage of facilities and so we need to ensure that referral mechanisms and requests for condoms for clients can be dealt with so access can be increased.”
Cultural barriers
Besides access and cost challenges, Pepper says diverse cultural barriers include the Catholics’ religious edict banning condoms, while men, particularly in Kenya and parts of Zambia, prefer dry sex. The female condom does not provide for this and women are reluctant to use it.
Pepper says the female condom, which can be inserted up to eight hours before intercourse, is a heat-seeking medium that sticks to the walls of the vagina. She defies suggestions that the condom is overly noisy, saying ”sex isn’t silent anyway”.
She says the condom does not inhibit sexual pleasure for either partner, with some men saying it actually heightens pleasure when their glans touches the inner ring.
”It has its problems, such as slippage, and is not the answer to the HIV pandemic. But the intention is to give men and women choices, and women more options to protect themselves,” Pepper stresses.
The female condom is not reusable, although the World Health Organisation has recently developed guidelines for this.
Anecdotal evidence suggests that South African women, concerned over the likelihood of rape, insert the condom as a precautionary measure before going clubbing.
Gay men are also making use of the female condom. ”Anything that we can use to encourage gay men to explore in terms of enjoying safer sex must be promoted. Safer sex is not necessarily boring sex. Sex is about having fun and experimenting and we encourage men to play with female condoms,” says Glenn de Swardt, of the Triangle Project, the oldest gay organisation in Africa.
”Those who have tried it find it fun and we are receiving positive feedback. But one drawback is the cost,” he says. — Sapa