The most effective method to prevent HIV acquisition and
transmission, the condom, is worn by men. Many women do not have relationships
of equality with the men they have sex with, and they can experience
difficulties persuading men to use condoms. This can be particularly difficult
in situations where possible HIV transmission is not a woman’s primary concern
(for example, when the woman experiences violence). However, it is also
problematic for women in more equal relationships, since many men find condoms difficult
to use or dislike them, and as men are less vulnerable to HIV than women from
vaginal intercourse, they may not afford the same priority to condom use.
When it was introduced in 1993, at the height of the
AIDS crisis in the developed world, the world’s first female condom, the Femidom,
was hailed as the first female-controlled barrier method for preventing HIV, sexually
transmitted infections (STIs) and pregnancy. It was forecast that it could make
a significant contribution to HIV prevention.
Over fifteen years later, this, the only new prevention
technology invented and approved since the advent of the HIV epidemic, has yet
to fulfil its promise. Although there are significant female-condom
distribution and education programmes in a number of developing countries,
including South Africa and Brazil, its use has largely remained confined to sex
workers. Just one female condom is used for every 200 male condoms used
worldwide: in 2008, 35 million were available for distribution compared with
six to nine billion male condoms.1
Campaigners at the 2010 International AIDS Conference in
that, despite studies from as early as 1997 showing acceptability rates of 96%
in men and women, it was still regarded with unease.2
“The female condom has been available for 15 years and for 15 years it has been
joked about,” commented Lucie van Mens of the pressure group Universal Access
to Female Condoms (see www.condoms4all.org). In
2004, Population Services International sold two million female condoms through
its social marketing campaign, whereas it sold 867 million male condoms.
Nonetheless, the female condom is still the only
female-controlled barrier method that has been proven to reduce sexually transmitted infections,
and in the current absence of any other methods of proven efficacy,
manufacturers, researchers and prevention advocates continue to promote this
potentially extremely effective intervention tool and develop new versions that
will gain more acceptability.
There are signs that in some populations of women in both
low- and higher-income countries, female condom use is slowly gaining wider
currency, especially since the second-generation FC2 female condom started to be licensed in various countries from
2005 onward. The number of female condoms distributed has tripled since 2005
and since the FC2 was finally
licensed by the US Food and Drug Administration (FDA) in 2009, four years after
it was introduced, there have been a number of promotion campaigns targeting
women, especially from the African-American community, in cities such as New York, Chicago and Washington DC.
It may not be too late for this technology to achieve wider popularity.