Female condoms: Shifting the burden of safe sex to women?

Female condoms: Shifting the burden of safe sex to women? http://www.infochangeindia.org/features457.jsp
By Rashme Sehgal
Hindustan Latex is all set to market the female condom, particularly to sex workers. NACO is partnering with 61 NGOs across six states to reach out to 60,000 female sex workers. Sex workers in Hyderabad, where the condom was tested, say it gives them a sense of control over their bodies The onus of responsibility for safe sexual behaviour has now shifted squarely onto the shoulders of women. NACO (National Aids Control Organisation) and the Hindustan Latex Family Planning Promotion Trust (HLFPPT) have joined hands to promote the female condom as an alternative to the male condom, especially since there are innumerable cases being cited by housewives, sex workers and single women of male partners refusing to use condoms.

Hindustan Latex Ltd (HLL), a State-owned condom manufacturing company, is all set to market a female condom called ‘Confidom passion rings’. The 17 cm female condom is the same size as a male condom, but two flexible rings at both ends give it the appearance of a “basketball net”. That is how it was described by a sex worker in Hyderabad, who when she first saw it complained that the polyurethane condom with its large, lubricated pouch that is fixed to the vagina seemed much “too big and unwieldy”. Once the women were shown how it worked, however, they realised that it was not as difficult to use as it appeared.

Sex workers in Hyderabad, amongst whom the female condom was extensively tested, know that using it is their safest bet to prevent getting HIV/AIDS or sexually transmitted infections (STIs). Lakshmiamma, a sex worker, feels safe when she uses a female condom. “There are no more needless arguments with clients about using condoms. I have just learnt to protect myself,” she says.

In 2006, HLFPPT, the Chicago-based Female Health Company (FHC) and NACO carried out a social acceptability study on the use of condoms in Andhra Pradesh, Kerala and Maharashtra, among three sets of target groups namely female sex workers, men who have sex with men (MSM) and eligible couples. The total sample size of users was 717, of which 337 were female sex workers.

The objective of the study, which was spread over a period of two months in 2006, was to analyse perceptions and initial acceptability of the female condom in terms of efficacy, reliability and ease of use. It was important also to identify enabling factors affecting initiation and negotiation, and to find out whether the condom helped foster communication between partners.

Some sex workers who were part of the sample study spoke candidly about their experiences with the female condom.

Pushpamma, who works in the old city of Hyderabad, pointed out that she was happy to use it because it helped protect her from HIV/AIDS. She said: “The main reason for using a female condom is disease-prevention rather than as a means of contraception.”

Rosy, another sex worker, felt the female condom has several features in its favour. “Some clients felt its lubrication helped enhance pleasure. It also provided an effective barrier against drunken clients who refused to use condoms.”

Married women responded in much the same way. The female condom, they said, was an alternative when their husbands refused to use condoms. But a Delhi-based teacher felt that the large size of the condom and the hardness of its inner ring caused too much discomfort during insertion.

Kavita Patturi, NACO’s national programme manager, admits that use of the female condom between eligible couples dropped from 94% to 89% during the final week of the survey, while for MSM it dropped to 94% in the eighth week. Problems cited in using it included its large size, slippery nature, and the fact that privacy was required in order to insert it.

“Regular and timely counselling on potential problems is a must in order to ensure regular usage,” says Patturi who admits that wherever outreach workers were able to provide effective interventions, barriers such as discomfort and pain were easily overcome.

But the majority of women covered under the study said they were willing to use the product as it was seen as being woman-initiated and would lead to their empowerment. Many MSM had even switched to the female condom because of its reliability. Unlike the male condom, it does not tear easily, thereby increasing safety.

G Manoj, CEO of the Hindustan Latex Family Planning Promotion Trust, says: “Women have to be taught how to use it. Demonstrations on its use were first conducted on vagina moulds by outreach workers associated with different NGOs working in the area of HIV/AIDS. Female condoms can succeed only as part of a social marketing campaign, not if they are sold as mere condoms. This has been the experience around the globe.”

The female condom does have its drawbacks however. It requires time and privacy to insert, and these are not always available to a sex worker. But Jayamma, who has helped 1,500 sex workers come together to form a Hyderabad-based cooperative called Chaitanya Mahila Mandal, says: “Prior to the female condom we used to be stigmatised for spreading HIV. That situation has now changed.” A government study has shown that 14% of India’s 5.1 million HIV-positive people are sex workers; female condoms are aimed specifically at them.

Female condoms were introduced in India after two years of research and test-marketing. Confidoms are being given to NGOs for Rs 3; they are then sold to sex workers for Rs 5. Although the price is higher than that of a male condom, female respondents of the survey said they did not mind spending more because of its reliability.

Jayamma said: “If we can spend money every day on biryani and a gajra, we can also spend on a female condom.”

Patturi says NACO is partnering with 61 NGOs across six states in order to reach out to 60,000 female sex workers. NGOs with whom partnerships have been forged include SAATHI, Sapid, Vimochana, Changes, Jawahar, KAWW, RCTC, SARANG, Sex Workers Forum, Saheli, Sambhavan, Udaan, Vijay Krida Mandal and Yuvak Pratishtan. “So far we have not come across a single case of a customer rejecting a sex worker because she is using a female condom,” Patturi points out.

The female condom is not expected to replace the male condom. Presently, the male condom programme in India extends to over 1.5 billion male condoms. NACO imported 500,000 female condoms in 2006; the figure has gone up to 1.5-2 million pieces in 2007-08.

“We would like to adopt a cafeteria approach to contraception, with the male and female condoms playing complementary roles,” says Manoj.

The Indian market holds the key to the success of the female condom. HLL is presently in talks with FHC for transfer of technology to indigenise production of the female condom to help bring down the retail price.

Infochange News & Features, November 2007