Thursday, March 12, 2009

The Real Problem With Female Condoms

Few HIV prevention tools have generated more hype and less demonstrated success in Africa than the female condom. The Chicago Tribune reports in a blog today about a new one approved by the FDA that is made from a different material (synthetic rubber instead of polyurethane) and hence is cheaper to make. For those who want to use the female condom, this obviously is good news.
But who are these people? In four years in Africa, I never met a single woman who said she regularly used this device. The cheaper, easier and vastly more plentiful male condoms had at least become routine (if not always consistently used) for bar hookups or encounters with sex workers. But the female condom has not yet caught on. The Tribune article blames this on price. My gut is that different problems are at play: Those who have tried them say they are uncomfortable and also squeak during sex. One woman compared it to stuffing a garbage bag into her body. The Tribute article doesn't address these issues, though other reports suggest that the newer generation of female condoms are indeed less squeaky, if not less like bags. (Here's a nice piece from the NYT on newer female condoms:
But remember that a woman using a female condom is still taking a stand, and risking a fight or abuse from her husband or boyfriend, because he surely will know that it's there. Many will perceive this as a sign of distrust, which has been a key barrier in keeping male condoms from being used more widely, and hence more effectively, in long-term relationships. In the end, are the dynamics so different between male and female condoms?
No one doubts the need to give women more control over their sex lives, especially in African societies where they don't traditionally have much. And we've all heard story about faithful wives getting HIV from their unfaithful husbands. But is the best answer a new product?
Let's remember that the core issue here is the nature of loving relationships, and the disastrous disruptions in traditional sexual rules wrought by colonialism and its aftermath. This is surely a tricky subject, but in societies where multiple sexual relationships are widely accepted, maybe more energy needs to go into making women feel like they have the right to demand mutual fidelity from their husbands or boyfriends. Or better yet, more energy could go toward helping men see that having lots of sex partners is deadly, as South Africa's Soul City soap opera recently has tried to do. Even more direct is this add from Mozambique. It's in Portuguese, but the message is clear enough...

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