Female condom makes its mark at home and abroad
If policy-makers and program officials are interested in the female condom, how can their interest be turned into safer sex for both men and women?
Interest in the Reality female condom, marketed by The Female Health Co. of Chicago, has indeed grown in the last year, according to Mary Ann Leeper, PhD, company president. The product was launched in Japan and Ghana this spring, and the company has been working with the Joint United Nations Programme on HIV/AIDS (UNAIDS), based in Geneva, to make it more available and affordable in developing countries.
American sales of the Reality condom increased 16% over the same quarter in 1999, and the company anticipates figures around 20% for the year, says Leeper. Most U.S. sales are to city and state public health clinics, family planning facilities, Planned Parenthood centers, and AIDS outreach agencies, she confirms.
What has prompted the increase in U.S. sales? Leeper attributes it to an aggressive step-by-step plan to help facilities implement use of the female condom in their prevention programs. The company has developed a resource list of potential grant and fund sources and works closely with participating agencies in obtaining funding for female condoms. (See resource listing, p. 123, for contact information.)
The female condom, like its male counterpart, must be presented as part of a total prevention program if it is to be used on a consistent basis, advocates Leeper. "To us, it is a total program; it is not just a product. If you deal with it just as a product, it is not going to work; you have to have it in its total context of prevention programming."
Condoms prevent infections and pregnancy, but only when people use them correctly and consistently, according to a 1999 Population Report published by the Population Information Program at the Johns Hopkins University School of Public Health in Baltimore.1 Reproductive health programs must address the issues of trust, negotiation, and communication between partners that are important to condom use and essential to safe sexual relationships, the report states.
To help developing countries introduce and implement female condom prevention programs, the Female Health Co. worked closely with UNAIDS in developing The Female Condom: A Guide for Planning and Programming. Reflecting field experiences from projects all over the world, the guide demonstrates how to integrate the female condom into existing reproductive health programs, including information on training health care providers, communicating to women and men about the product, and facilitating its use. Geared for developing countries, the guide was introduced at the recent XIII International AIDS Conference in Durban, South Africa.
Helping patients build communication skills around use of the condom is important, especially when it comes to teen-age users, says Leeper. The Female Health Co. has developed a program for adolescents to help them communicate with their partners and understand their own sexual health, she notes. (See resource listing, p. 123, for contact information.) An ongoing research program at Columbia University in New York City is using teen focus groups to better understand the communication tools needed to discuss female condom use. "For adolescents, the issue is for them, from the female condom perspective, is How do I talk about this? How do I deal with this with this guy?’" says Leeper. "That is part of the program, to help them set up a dialogue and to help them understand about their own sexual well-being and why it’s important to take care of themselves."
Research presented at the Durban conference indicates that use of the female condom will increase with better education, counseling, availability, and training on how to use it properly.2-6
Brazilian investigators reported results of their study analyzing the widespread introduction of the female condom.2 At their most recent visit to the health services facility promoting the method, about 40% of women said they had used the female condom the last time they had sex. Use was highest in services that emphasized intensive education and conducted community education about condom use.
Because services had been randomized as to their practices, the paper is particularly important in showing the role of health workers in influencing women’s use of the female condom, says Zena Stein, MB, BCh, professor of public health and psychiatry at Columbia University and co-director of the HIV Center for Clinical and Behavioral Studies, both in New York City. Stein served as co-chair of the Durban session on female condom use.
Mary Latka, PhD, an epidemiologist with the New York Academy of Medicine, shared results from a Philadelphia-based randomized clinical trial of the female condom’s effectiveness in prevention of sexually transmitted diseases (STDs).5 Women were assigned to one of three STD small-group prevention education sessions and given free condoms in accordance with their group: male condoms only, female condoms only, or a hierarchy of prevention methods. The post-intervention incidence rates of STDs were determined in the three groups after 12 months. Both arms showed a decrease in STDs, with women in the female condom group faring just as well as those in the male condom group, says Latka.
When women are given good information on the female condom, researchers have found they can and will use the method, says Ida Susser, PhD, professor of anthropology at Hunter College/City University of New York. Susser participated in anthropology field studies in which the female condom was demonstrated and discussed. The studies included women who felt they could not propose the use of male condoms to their partners. Those women greeted the information about the presence of a female condom with enthusiasm and maintained adamantly that they could and would use them.7
"I like to call it the woman’s condom,’" says Susser. "That makes it sound less clinical."
References
1. Gardner R, Blackburn RD, Upadhyay UD. Closing the condom gap. Population Reports. Series H, No. 9. Baltimore: Johns Hopkins University School of Public Health, Population Information Program; April 1999.
2. Kalckmann S , Barbosa RM, Berquó E. How health care providers and health services influence the acceptability of the female condom: The experience in Brazil. Presented at the XIII International AIDS Conference. Durban, South Africa; July 10, 2000.
3. Mobley S, Fisher A, Rutenberg N. The female condom: Dynamics of use in Zimbabwe. Presented at the XIII International AIDS Conference. Durban, South Africa; July 10, 2000.
4. Jivasak-Apimas S, Saba J, Chandelying V, et al. Acceptability of the female condoms among sex workers in Thailand. Presented at the XIII International AIDS Conference. Durban, South Africa; July 10, 2000.
5. French P, Latka M, Gollub E, et al. Female versus male condom in preventing STDs. Presented at the XIII International AIDS Conference. Durban, South Africa; July 10, 2000.
6. Marseille E, Kahn JG, Billinghurst K, et al. Cost-effectiveness of the female condom in preventing HIV and STDs in commercial sex workers in rural South Africa. Presented at the XIII International AIDS Conference. Durban, South Africa; July 10, 2000.
7. Susser I, Stein Z. Culture, sexuality, and women’s agency in the prevention of HIV/AIDS in Southern Africa. AJPH 2000; 90:1,042-1,048.
For more on the Reality female condom, contact:
• Jaimin Chung, Sales and Education Representative, The Female Health Co., 875 N. Michigan Ave., Suite 3660, Chicago, IL 60611. Telephone: (800) 635-0844 or (312) 280-1119, ext. 222. E-mail: [email protected].
The Female Condom: A Guide for Planning and Programming is geared for developing countries. For more information or to order, contact:
• Mitchell Warren, Vice President, International Affairs, The Female Health Co., One Sovereign Park, Coronation Road, London NW 10 7QP, UK. E-mail: [email protected]. Web: www.femalecondom.org.
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