D.C. Aims to Increase Female Condom Use

Today health officials announced a $500,000 grant from the MAC AIDS Fund to promote and distribute female condoms in Washington, D.C. The announcement marks an ambitious collaboration of private and public organizations: CVS, which is distributing the condoms; the Female Health Co., which manufactures them; the District of Columbia; and the MAC AIDS Fund, the philanthropic wing of the cosmetics company. All this comes at a time when rates of HIV in D.C. area women are dangerously high, and when women's roles in AIDS prevention are often overlooked. It's a big investment in a bold plan—but can female condoms really make a difference?

The female condom was introduced in 1995, but despite initial optimism, use of the product never took off. The last study, done in 2002 by the Centers for Disease Control, showed that only 2 percent of American women had ever used the female condom, a number experts say hasn't changed much in the following years. "Female condoms are sort of an oddity. I don't know if it's the female part or the condom part or a combination," says Nancy Mahon, director of the MAC AIDS Fund.

And yet the female condom remains the only way for women to initiate protection against sexually transmitted diseases. "It's very difficult for many women to negotiate condom use with a partner," says Dr. Vanessa Cullins, the medical director for the Planned Parenthood Federation of America. The female condom, which can be inserted several hours before intercourse, allows a woman to protect herself without having to persuade the man with whom she's sleeping to change his behavior.

Empowering women to take control of their own health and safety is the theory behind today's rollout in D.C. HIV is the leading cause of death for African-American women between 24 and 39, and women in poor areas of the District are at an especially high risk: the average rate of HIV infection in the U.S. is 0.7 percent, but 3 percent of black women in D.C. have HIV. While that number is less than the 7 percent of African-American men in D.C. with the virus, it's still indicative of a crisis that needs attention. "People continue, I think sadly, to think that AIDS is a gay man's disease," says Mahon. "Even though it remains a big issue for men who have sex with men and for gay men, it's a bigger issue for women than people understand." That's why this year the MAC AIDS Fund made prevention among women a priority. And so far, female condoms have proved to be one of the best ways of reducing HIV transmission among women. A meta-analysis of female-condom research showed that they have similar efficacy when compared with male condoms, and another study reported a 24 percent drop in STDs among sex workers who had access to both male and female condoms. But that same meta-analysis reported multiple cases of reluctance and resistance to the female condoms, many of which had to do with cost and ease of use.

Those studies, however, dealt with the condom's original version. The latest version of the female condom, FC2, was approved by the FDA last summer and offers several advantages over the original. For one, it's markedly less expensive—about 82 cents apiece. "That reduced the wholesale prices to about a third of the initial price, which made it feasible to add onto our condom-distribution program," even after the MAC grant ends, says Shannon Hader, director of the HIV/AIDS administration within the D.C. Department of Health. She notes that the new condom is also quieter; the original female condoms were made from a polyurethane material, which more than one researcher compared to the sound of "two sandwich bags rubbing together." The new material, which is more latex-like, has one more advantage: "It's not cold; it immediately warms to the body," says Mary Ann Leeper, founder and president of the Female Health Co.

Female condoms had been available in Washington prior to this partnership on a smaller scale, and evidence indicates that women who do use them like them. "We've always had the female condoms available to our partners, and we've had targeted places and groups that have used them," says Hader. "Our partners, health clinics, and community-based organizations have never had any problem getting rid of female condoms. We have anecdotal evidence that if they're there, with the right support, women want them and they use them."

And though female condoms may still be a novelty for many couples, researchers who have studied the FC2 note that there's little resistance to their use from men. "Men seem to be quite happy with it," says Mags Beksinska, technical advisor to the Reproductive Health & HIV Research Unit at the University of the Witwatersrand in Johannesburg, who researched the efficacy of FC2 before it received FDA approval. "It's because they don't have the responsibility of using it. It's loser, so they're not constricted. It's warmer. A woman can insert it an hour beforehand, so it doesn't disrupt."

Still, just making the condoms accessible is not enough. "More than likely, giving out the condoms and making them easily available is not going to be enough for a lot of people," says Cullins of Planned Parenthood. "Some people will take advantage of the fact that the condoms are easily available, but others will need to have a conversation, not only with partners and potential partners, but also with friends about female condoms—how they get used, when they get used, how they can be used in such a way as to not detract from the sexual encounter, or what that person thinks that sexual encounter should be." That's why a portion of the grant from MAC will be used to educate women about female condoms and to produce marketing tools to complement their existing sex-education materials.

It won't be immediately apparent as to whether this partnership will lower HIV rates in the District, though Hader's team has established some short-term benchmarks of progress. "We hope by adding yet another tool, not just more people will be using female condoms, but that people will become more regular users of any condom in general," she says.