In a month when the internal divisions in the Women’s Sector of the National AIDS Council became public, the Department of Health, National Treasury and Female Condom Manufacturers were back in court wrangling, yet again, over the shady area of female condom procurement. A balancing act that was on the verge of seeing 11 million unqualified female condoms being distributed by the Department of Health and the final tender being awarded to Sekunjalo Investments for the supply of the FC2 Female Condom, all in a competition vacuum that continues to put women’s lives on the line.
FACT: The Female Condom has been around for decades now. FACT: It works. FACT: It can protect women and men from HIV. FACT: Because of differences in physiology, women are twice as likely to contract HIV as men, when exposed to it. FACT: Women are often less able to protect themselves. FACT: Most primary modes of HIV prevention require the cooperation of the male partner. FACT: Inequality and violence also limits women’s options and ability to protect their own health. We also know that at every conference and meeting we hear laments of ‘HIV being a feminised epidemic’ we hear that we need to ‘protect the women’, ‘keep women and girls at the centre of our response’ yet why do our responses remain so male-centric?
So why don’t we see female condoms everywhere we see male condoms in equal (no pun intended!) quantities? Well, haven’t you heard? The female condom is big, noisy, expensive, and painful, it’s generally an all-round problem and why the fuss don’t we have male condoms that are cheaper and widely available? There’s also medical male circumcision and the good old faithful, abstinence! A rule of thumb to use when assessing if an issue is pro-women is asking ‘have the same questions been asked/demands made of men?’ Would the procurement of male condoms be as effective (in most cases) as it is today if ‘men liking it’ or ‘demand’ was used as criteria for procurement? The simple truth is that we knew there was a virus that caused a disease that could be prevented if men used a rubber. Why then are we still stuck in the patriarchal mud, after close onto a decade of female condom programming in South Africa prescribing to women what they should feel/desire/want/try when it pertains to their sexual health?
So now, in a world where the HIV sector is recharged with increasingly promising evidence of a microbicide for women coming to market, why should we be excited about the Female Condom? But first the not so encouraging news…
In 2010, more than 16 million female condoms did not get into the hands of women, and men who rely on government to provide them with this life saving tool. A tool they could use to protect themselves from HIV. The only female initiated tool for HIV prevention and unplanned pregnancy. A tool that we know works.
The basic tender process requirement is that applicants need to prove that their product has undergone studies in accordance with international standards and are recognised by the World Health Organisation (WHO) and/or the FDA. This year, the Department of Health awarded an 11 million piece female condom tender to a Chinese manufacturer, Tianjin, through local KwaZulu-Natal based partner Siqamba Medical for the Phoneurse Female Condom, a condom not yet approved by the WHO. This month, however, North Gauteng High Court Judge, Sullette Potterille, set aside the decision to award the tender to Tianjing for the supply of female condoms on the basis it was not yet qualified according to WHO standards and awarded the tender to Sekunjalo Investments to supply the FC2 Female Condom made by the United States-based Female Health Company.
So why the initial was tender awarded to Tianjin? The Finance Minister, Pravin Gordhan, says he did not have to supply reasons as the ministry had already agreed that the process was flawed. The Judge said when an organ of state took a decision it contended was flawed, but flippantly refused to give reasons, it was presumed to be for no good reason and not in accordance with a system that was fair or transparent. Why is the procurement of female condoms in South Africa perpetually dogged by scandal, inefficiency and unanswered questions? In a world where global distribution of female condoms has more than tripled from 2005 to 2009, we need answers and we need them sooner rather than later.
Why do we never seem to be able to get over the hurdle of female condom procurement in South Africa? Why is there no competition in a country that consistently claims its resources for health are stretched? The main ‘hurdle’ to competition appears to be lack of WHO qualified female condoms.
Who is WHO accountable to?
Manufacturers of ‘new’ female condoms urgently need support and guidance to enable them to undertake the required research, quality assurance testing and clinical trials required to produce quality products and compile the required documentation needed for country regulatory and bulk procurement approvals. The WHO agrees with this. But why do we, all these years later, still only have one female condom that has been qualified for public procurement?
Questions about the length of time that the WHO takes to pre-approve female condoms for public procurement should be asked. Advocates need to start asking these questions as a matter of urgency. Surely if the end goal is that of preventing new HIV infections, especially in resource limited settings, whose interests does lack of competition serve? The WHO needs to answer these questions, too often hidden under the cloak of confidentiality, which fall away when we live in a world where 33.3 million people are living with HIV and for every two receiving treatment, five are newly infected.
The table below makes a simple but fundamental point, just like in the case of antiretroviral (ARV) drugs we need to open the market to female condom manufacturers. We simply no longer have the luxury of sitting back while it takes years for the WHO to qualify lifesaving technologies. There is simply no excuse. None.
I am in no way implying that the task the WHO Technical Review Committee has is an easy one, but, if there is a common understanding of what is at risk, truly at risk, by not aggressively supporting female condom manufacturers, to reach recognised levels of safety, then the onus is on us as activists to make that link clear and ensure that the funding that the WHO needs to create a supportive environment for manufacturers is provided as a matter of urgency.
|Brand||Price Per Unit||WHO Recognition|
We should be excited about the female condom for many reasons. It adds to the basket of effective HIV prevention tools available, it gives women another option to use an existing, safe Sexual and Reproductive Health and Rights (SRHR) tool, its sexy (can be used by women to reach a more intense orgasm and men to maintain an erection for longer) and half of the infections that are currently projected to occur by 2015 could be averted if HIV prevention was brought to scale.
Most importantly, political will and accountability from our government, the South African National AIDS Council and the WHO Technical Review Committee is key to not only “walking the talk” to keep women and men alive but viewing efficient, accountable and competitive female condom programming as the basis of efficient, accountable and effective microbicide programming.
The lives of those we love depend on it and it is up to all of us to speak truth to power in a country where misogyny reigns, the women and children’s ministry has a budget less than most average size NGOs and decisions regarding women’s access to sexual and reproductive health rights remain in the hands of a few. The lives of those we hold dear depend on it.
- Tian Johnson is a Development Activist and founder of the African Alliance for HIV Prevention (firstname.lastname@example.org).