Global access and availability of female condoms have increased dramatically in recent years, but with rates of HIV, sexually transmitted infections (STIs) and unwanted pregnancy among women still high, providers of female condoms may need to consider marketing them more to couples and men to increase uptake.

While there is no deliberate bias to focus HIV prevention programmes on women, there is widespread acknowledgement that women are among the worst affected by HIV and therefore require tailored programmes and products to help them beat the pandemic.

According to the United Nations Population Fund (UNFPA), more than half of the 33.3 million people living with HIV around the world are women and many of them were infected through unprotected sex with their husbands, boyfriends or long term sexual partners. In sub-Saharan Africa, the UN agency says this percentage is much higher, approximately 60 percent.

“There really has been a concerted effort by the global community to try to ensure that women are provided firstly with the knowledge and information they require to protect themselves from HIV, STIs and unwanted pregnancies and secondly, with the specific tools they require, such as female condoms and other contraceptives,” says Agai Jones, project director for Population Services International’s Results Incubator (RI) in Johannesburg.

Access to female condoms more than quadrupled between 2006 and 2009, rising from 11.8 million condoms distributed globally in 2006 to 50 million in 2009. Female condoms are now also available in about 114 countries and the number is growing every year.

The increases in availability and use of the female condom as a prevention method have largely been driven by the combined efforts of several stakeholders in the public health, nonprofit sector, private sector and the donor community. However, with the exception of a few countries, it has been difficult to get female condom use above a small percentage of the population, or out of high-risk groups such as commercial sex workers or men who have sex with men.

In many countries, women face the added burden of violence and sexual coercion, and their taking the lead in condom use challenges cultural norms, beliefs and practices that often overwhelmingly favour men.

A major challenge has therefore been the fact that women in many countries do not feel they are able to control decisions about contraception and protecting themselves from HIV and STIs.

Over the past six years, the female condom has been at the centre of the global effort to help women overcome the triple threat of HIV, STIs and unwanted pregnancies by putting the ‘power’ in their hands. This initiative has seen many successes thus far, but there is little doubt about the need to increase the number of women and their partners using female condoms.

“With the female condom, women are able to initiate condom use and take responsibility for protecting themselves and their partners, so that gives them a level of control,” says Jennifer Christian, PSI’s global social marketing advisor.

However, this is still no guarantee that men will agree to using female condoms. In addition to targeting women with social marketing of the female condom, Christian believes social marketers and other advocates of the female condom need to focus more on couples and creating a situation where the man will be more receptive to trying out the female condom.

“Women are obviously the ones who have to be willing and able to insert it, but I think there is a growing realisation that use will not grow beyond a small percentage of the population unless we encourage the consent of their partner. For this reason, it is critical that marketing efforts create awareness among men about the benefits of the product and its differences to a male condom,” she explains.

“For example, few programmes highlight the fact that female condoms can provide a more natural feeling for both partners. This would not only be a great selling point to a partner, but it also takes the discussion away from one of disease – which can breed distrust in a couple – and back to the point of sex in the first place – we do it because it feels good,” she adds.

A crucial point in getting more women to use female condoms is encouraging women to use them correctly as this is more likely to ensure the best experience and that they continue to use them. Experts say one way of achieving this is by encouraging women who have never used female condoms to practice inserting them on their own before they use them for the first time with their partner.

If the successes of the male condom in HIV prevention are anything to go by, the potential benefit of achieving results with female condom initiatives, along with other measures, is great.

A study conducted by experts at the University of Cape Town, Imperial College of London and the Human Sciences Research Council in South Africa recently showed that increased condom use was the main reason behind the decline in HIV incidence in South Africa since the year 2000.

The study, titled ‘The Effect of Changes in Condom Usage and Antiretroviral Treatment Coverage on Human Immunodeficiency Virus Incidence in South Africa’, found that antiretroviral therapy (ART) also had an impact on the reduction in HIV incidence.

“Both of the models considered in this analysis suggest that adult HIV incidence in South Africa has declined significantly since the year 2000. In addition, both models suggest that most of this decline can be attributed to the effect of increased condom usage, and that some of the decline may be attributable to the impact of ART on the infectiousness of individuals with advanced HIV disease,” it said.

If we can enable one more alternative, and one that arguably feels even better than a male condom, the potential for success is very exciting indeed.

– Muchena Zigomo is Communications Officer at Society for Family Health.