Barrier contraception

Zena Stein, Ida Susser and Marion Stevens report from Mexico on the diaphragm: inexpensive a single purchase may last for years easy to use and virtually hidden from the partner. Would it give harm reduction to HIV, as it did for pregnancy?

The diaphragm contraceptive device does not help to prevent HIV infection, according to the results of a three-year trial published in the Lancet today.

A sharp cut in the price of female condoms should promote their use in Gabon, one of the Central African countries most affected by HIV/AIDS, medical workers said.

The high cost of the female condom has led to the controversial practice, particularly in developing countries, of reuse. But soon-to-be launched World Health Organisation (WHO) programmatic guidelines for reuse will provide helpful information to programme managers who need to make decisions regarding reuse. In July 2002 WHO published a clinical protocol which stated that a new condom is always preferable. But in situations where they are not available or affordable, evidence suggests that the female condom can be used safely at least five times if the WHO guidelines are followed. Many HIV/AIDS advocacy groups see female condoms as a significant new alternative women can use to better protect themselves against infection. The challenge will be to make sure that information on correctly reusing them reaches women the hardest-hit population group. The use of the female condom was still not widespread enough. Part of the reason was its limited appeal. To support the WHO guidelines, the Female Health Foundation has launched a website to assist programme managers in deciding whether or not to support reuse of the female condom in their programmes. (Source: IRIN, 29 July 2003 www.reusefemalecondom.org)

National Condom Week kicked off in South Africa with an announcement that the government had distributed one million female condoms at 200 sites last year. A social marketing campaign for the product, which has been running for the past two years, has been hugely successful, Society for Family Health (SFH) marketing manager David Nowitz told PlusNews. As a result, we ran out of stock in July 2002, he added. SFH has been working in partnership with the national health department to distribute the condom through pharmacies at a subsidised price. But the FC is also available free of charge at selected national sites, which are part of a collaborative project between the Reproductive Health Research Unit (RHRU), the Planned Parenthood Association of SA and the health department. Selected pharmacies are now selling the FC under the brand name Care, at under R5 (US $0.5) for two. Nowitz agrees that these numbers are still relatively small, and attributes this to confusion about the size and shape of the condom. According to Nthuthu Manjezi, a project manager at the Planned Parenthood Association of South Africa, the FC is not popular among young people aged between 15 and 21 and is seen as this big thing, which is not sexy or attractive. But it has proved popular and is used more regularly by older women in stable relationships, as they are able to better negotiate its use. This is why advertising campaigns have targeted urban females aged between 24 and 30 who are established in their careers and have confidence in their relationships to insist on safer sex, Nowitz noted.(Source: Integrated Regional Information Network, 11 February 2003)