The female condom - the step-child in HIV prevention

The female condom – currently the only female-controlled method of preventing HIV - is rarely available to women who need it. Blaming poor marketing and insufficient investment, activists at the International AIDS Conference in Mexico City said failure to promote the female condom had hurt global HIV prevention efforts.

"When the female condom first came to us, it was marketed to sex workers, women in bars, and other women thought to be at high risk of HIV or to have loose morals," said Gladys Chiwome, of Zimbabwe's Women and AIDS Support Network, which promotes the use of the female condom in the southern African nation. "As a result, women who thought they were safe, such as married women, were, and still are, reluctant to use it."

Farah Karimi, director of Oxfam-Novib, the Dutch arm of the UK-based international charity, told a press conference that 28 million female condoms were distributed worldwide in 2007, compared with 11 billion male condoms. The unit cost of a female condom, she added, was 18 times higher than that of the male condom.

"Even here at the conference, the bag supplied by the conference organisers to all delegates contained five male condoms but only one female condom," she said.

While policy makers and donors continued to believe that lack of investment in the female condom was driven by low demand, Karimi said the reverse was true: if more governments bought more female condoms, promoted more female condom programmes, and invested more in the development of a lower-cost version of the prophylactic, demand would shoot up.

"The male condom was promoted so hard in advertising, through school education and advocacy – we need the same effort for the female condom," she said.

The male condom was promoted so hard in advertising, through school education and advocacy - we need the same effort for the female condom

According to Chiwome, lack of access to female condoms meant that women were sometimes advised to wash and re-use them, a practice that had worrying implications for health and hygiene, particularly in rural areas where clean water was not readily available.

The few women in Zimbabwe who had managed to get their hands on female condoms had expressed satisfaction with it. "They have felt more confident, assertive and fulfilled in their sexuality," Chiwome said.

In a society where gender power dynamics often give women little say in their sexual relationships, Chiwome pointed out the need to equip women, not only with female condoms, but with the skills to negotiate their use.

"Girls and women need the skills to say, 'if you're not going to use yours then I'm going to use mine' to their sexual partners," agreed Mary Robinson, former President of the Republic of Ireland and honorary president of Oxfam International.

Describing the provision of an affordable and easily accessible female condom to women as a human rights issue, Robinson said: "It is about the right for women to have access to protection and their right to make choices for themselves. Schools should be teaching boys and girls about the female condom but, sadly, most of them are not."

Karimi said, "Investment in prevention for women is focused on vaccines and microbicides, which are not available now and may not be available for several years. Women cannot wait for them – they need protection now."

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See also: MALAWI: High hopes for female condom