The lack of political will has long been a barrier to HIV prevention work in South Africa – from the Viramune debacle to a denialist Presidency and two successive incompetent Ministries of Health.

As the AIDS death toll reached an estimated 2 500 000 in June this year, civil society is faced with  what could very well be one of our biggest advocacy challenges of the next few years – that of universal access to the female condom.

The need for a concerted national effort to ensure that this goal is reached, is clearer now than at any other time in our country’s history. Our long term goal to ensure that every woman is able to access the female condom will only be realised with concerted, targeted efforts by donors, civil society and service providers.

In 2007, women represented half of all HIV infections worldwide and 61 percent of HIV infections in sub–Saharan Africa. Eighty percent of all HIV infections are sexually transmitted. Despite this reality, two and a half decades into the pandemic, the disease continues to outpace the global response.

Research findings have shown that for every person who accessed antiretroviral treatment, six people are newly infected. As organisations and groups working at the coal face we cannot afford to overlook the only available HIV protection designed to allow women to initiate protection: the female condom.

The unique nature of female condoms should be reason enough for this method to be at the forefront of prevention programmes, translating ideally into matched support in resources and long term funding by governments and the donor community.

Being a key tool in family planning, superinfection and the reduction of transmission to seronegative partners, the benefits are clear. The usage of the female condom for protection during anal intercourse for both MSM and heterosexuals is an added benefit.

One area that is often overlooked and presents huge potential is that of female condoms being used as preparatory tools for future microbicide use due to the similar programming and marketing requirements.

The perpetual low investment levels in female condoms pose an added advocacy issue that needs to be taken up. In South Africa where female condoms are not easily accessible, there is growing demand for them. However due to the lack of information amongst the majority of potential users, no meaningful estimates of demand exist. What goes without saying is that the female condom is an integral part of achieving the lowest possible number of unprotected sex acts.

So how would we structure advocacy efforts around the issue of female condom provision in South Africa?

Political Will

As with other struggles to access human rights in South Africa, the success of a potential campaign to increase access to the female condom, lies with mobilisation of civil society, donors and government to ensure maximum use of existing structures.

Problematic donor attitudes such as those promoted by PEPFAR and US policy that focus on abstinence and marriage is based on the presumption that condom use encourages sexual activity. Concerted lobbying is required to change these attitudes. Any intervention that aims to lobby for the nationwide roll out of female condoms needs to partner with a donor community that emphasises effective, evidence based prevention with the same amount of energy that we in South Africa have had on treatment.

The National Strategic Plan and Female Condoms

The following extract is from the document entitled “The costs of the National Strategic Plan on HIV and AIDS & STIs 2007-2011, Draft 2, 7 March 2007”.

Condom provision

Condoms have been shown to be highly effective in reducing sexual transmission of HIV and it is therefore crucial that sufficient condoms are readily available in the country to promote their consistent use.

The costs of condoms are a function of the unit cost per condom and the targets of numbers of condoms disbursed per annum. See below for details on unit costs. The national department of health procured 415 million condoms in the 2004/05 financial year, and planned to buy 425 million male condoms and 1.3 million female condoms in 2005/06.

Summarised unit costs of NSP interventions (in 2005/06 prices)

Cost per condom male – 0.22
Cost per condom female – 7.40
Condom mark up – 1.25

Two condom costing scenarios have been created, as shown above. Both start from a baseline of 428 million condoms disbursed in 2007, or 17 per person aged 15 to 49. In the first scenario, provision increases gradually to 505.5 million condoms by 2011 (19 per person). The second scenario models future uptake based on a goal of providing 50 condoms per person to an increasing percentage of people aged 15-49.

The indications are that if the aimed for (2005/6) 1.3 million female condoms are supplied it would represent an estimated prevention of 783 new infections! This is based on the Holtgrave Study that shows that if only 16.6 million female condoms were distributed in South Africa almost 10 000 HIV infections would be prevented. The ensuing total saving to the health sector would be a staggering US$ 5.3 million. The lack of emphasis and content on the provision of female condoms, as well as universal access coupled with the virtually non existent budgeting of training and marketing that would support the role out of the initial batch is unfortunate, and again highlights the need for comprehensive lobbying to ensure that female condoms are not only provided in quantities on par with make condoms but realistic provisions are made for training of caregivers , organisations and communities on the usage of them.

Tian Johnson is the advocacy officer at Thohoyandou Victim Empowerment Trust. More information can be obtained from tian@tvep.org.za 

Civil Societies Betrayal of South African Women.……..The Way Forward in Lobbying for Access.

Thohoyandou Victim Empowerment Trust will, together with its partners, be convening a series of discussions to strategise and plan a way forward in order to formulate a work plan that will culminate in the launch of a campaign to lobby for Universal Access to Female Condoms by all South Africans. Interested individuals can call or email the Trust to be updated on developments in this regard.

Read the declaration from the Thohoyandou Victim Empowerment Programme Female Condom Dialogues