More on the female condom

Anna Forbes, the deputy director of the Global Campaign for Microbicides, responds to my post on the female condom:

I hear your suspicion but I can tell you from first hand experience that you are just plain wrong. Women in Uganda do want female condoms – desperately.  We have met with over two dozen organizations serving women living with HIV and/or at high risk of HIV in eastern Africa in the last year and talked with women in all kinds of settings.  Most of them have heard of female condoms but, as one educator told me, “I have never seen one, and I do trainings on them!”

My colleague and I visited five different pharmacies one weekend trying to buy a female condom, just to see if it was possible.  Only one had them in stock. Suddenly, I had a deeper understanding of why guidelines exist for how often you can wash out and reuse a female condom.  The answer is five times before you start seeing significant damage.  Reuse is not recommended but its better than nothing.  And be sure to re-lubricate it, even if you have to use cooking oil.  Does this suggest to you that women do not want female condoms?

The Ugandan situational analysis released last February shows that 65% of new HIV infections are occurring among married people; 60% of all newly infected Ugandans are women (more like 75% if you look just at the 15-49 age group) and that the rate of extramarital sex between 2001 and 2005 increased from 2% to 3% among women and 11% to 18% among men.  So who do you think is actually bringing HIV into the relationship most of the time?  And what on earth makes you think that women don’t want to protect themselves?

One woman told us, “as a woman, my private part belongs to my husband and he is the decision-maker in the relationship.”  Would you like to be the woman trying to negotiate male condom use in that relationship?  Or getting into bed knowing that you may be infected with HIV before morning, as so many of your friends have been?

Here in Washington DC (during the Bush administration), a Congressional staffer I was lobbying once said to me, “I have no respect for a woman who can’t make her man wear a condom.”  I am sorry to say, Nick, that you sound a lot like that guy when you write, “Do they really think that women need the female condom?”  In speaking to you, I did not get the sense that you are so lacking in compassion.  I wish you had taken my suggestion that you speak to some of the Ugandans I spoke with – as that might have clarified your view of the situation somewhat.

One educator told us about doing a presentation on the female condom from the back of a truck. It was market day and she was explaining the device in the hope that it would someday be available to this community.  At the end of the presentation, she was mobbed by women wanting female condoms.  But she only had her demonstration model, and she couldn’t give it away.

What it the tables were turned, Nick?  What if over 99% of the 10 billion condoms distributed globally each year were female condoms and fewer than 1% were male condoms.  What if you had reason to think you were being exposed to HIV every time you had sex?  Might you be crowding around the back of that truck begging for a male condom when someone finally showed you one?  Or would you still be as inclined to suppose that men in your area didn’t really want male condoms, and that promoting them was just part of someone’s money making scheme?

I slightly resent the remark that I'm lacking in compassion, and I didn't mean to suggest in my previous post that I don't feel compassion for women who want access to female condoms. Otherwise, this strikes me as fair criticism from someone who knows a great deal about the issue.

Comments

[paula]

Hmm, great article Nick. I wonder about the clamour for female condoms ...if the educator was selling them would the interest be as high (reminds me of a recent twitter meme #youknowyourkenyan because you accept anything that's for free). Female condoms are available at Nakumatt in Nairobi in ugly dusty pink and white boxes ....There's nothing inviting on the box - male condoms are glossy, have sexy sweaty semi naked dudes on them ...we need to learn from Durex if we want to effectively market Female condoms

[mark rob]

For our safety,have to wear condoms.From this, we can stop some dangerous diseases also like HIV and etc..

[New female condom]

Female condom is being introduced. It is intended to be introduced within the vagina prior to sex. It also has its pros and cons, but it helps in protecting against STD's. Once used, it can never be used again. It should be cautiously removed from vagina.