September 16 is Global Female Condom Day.
Believe it or not, the female condom is a controversial tool in the arsenal against HIV transmission. Donors argue that it’s expensive and not widely used. Women complain that it’s too big and hard to insert. What no one can argue is that it works.
Female condoms are the only woman-initiated method available that offers dual protection from unintended pregnancy and sexually transmitted infections (STIs), including HIV. Studies have shown that the female condom is at least as effective as the male condom in reducing the risk of contracting STIs and can reduce the per-act probability of HIV infection by 97 percent. Studies from Madagascar, Brazil, Kenya, India and the United States demonstrate that female condom promotion and use increases the total number of protected sex acts.
But to provide the dual protection it was designed for, female condoms must be used. And while gaining acceptability and uptake among women is not an easy task, it can be done.
Patience Kunaka first heard about female condoms in Zimbabwe in the early 1990s. “I first thought it might be a good prevention tool. In those days, HIV was taking its toll and antiretroviral therapy was not yet known and available.”
Patience worked then as a midwife trainer for the National Health Ministry. While her training provided her with knowledge of reproductive anatomy, she was still shocked when she saw the female condom. “I wondered how it would remain inside me with the movement of the penis. I thought it would be sliding in and out and become a really messy act!”
Despite her concerns, she attended a female condom training and decided to try one during her menstrual cycle. “It takes a lot of practice to get used to it. But it’s worth it in the end.”
Patience joined Population Services International (PSI) Zimbabwe in 2006 as the training manager and has become an outspoken advocate for female condoms. “It takes time to get used to female condoms but mainly it takes a positive attitude toward trying it. I am a regular user and talk to a lot of women about trying it.”
In the nearly 20 years since it started programming for female condoms, PSI has learned valuable lessons in supporting their uptake. Relying solely on traditional commercial marketing strategies is not effective. PSI targets female gathering places such as hair salons, which allow for prolonged interaction between potential users and promoters to encourage trial and repeat use. Promoters receive intensive training to demonstrate female condom use with interpersonal communication to their female peers. Non-traditional channels also include barber shops and gathering places for men, which can help programs achieve male partner buy-in.
As the international community gathers to celebrate Global Female Condom Day on September 16, it is important to remember that the female condom provides another option for women whose partners refuse to wear a male condom or women who want to take charge of their own reproductive health. As additional female condoms become commercially available, the prices will hopefully reduce, providing access to an even greater number of women. And while programming for female condoms can be complex—just as any behavior change can be—women like Patience Kunaka demand it.
Through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), USAID supports PSI and other implementing partners’ female condom programming in a number of sub-Saharan African countries.