When AIDS first emerged in the 1980s, it mainly affected men.
Today, according to UNAIDS figures, women account for about half
of the 33 million people living with HIV worldwide, and 60 per
cent of those infected in sub-Saharan Africa. Most of these women
acquired the virus through heterosexual intercourse, often
through unprotected sex with their husbands or long-term primary
"Women think marriage is a safe haven," says Beauty Nyamwanza of
Zimbabwe's National AIDS Council. "They think that when you're
married, you don't have to worry about HIV."
But what the AIDS-prevention team in the country found out is
that marriage can actually increase the risk of HIV among young
women. According to research carried out in Kenya and Zambia in
2004 , marriage increases the frequency of sex and hinders a
woman's ability to negotiate condom use or abstain from sex.
Married women are often afraid to ask their husbands to use a
condom � or to use one themselves � since this implies that they
suspect their husbands of infidelity.
Thanks to the efforts of Ms Nyamwanza and others, Zimbabwe is one
of a handful of countries that has taken advantage of the female
condom and made major inroads in promoting its use. The latest
device, the FC2, is a strong, flexible, nitrile sheath, about 17
centimetres (6.7 inches) long, with a flexible ring at each end.
The closed end is inserted into the woman's body, and the open
end remains outside during intercourse. Like the male condom, it
offers dual protection against unintended pregnancy and sexually
transmitted infections, including HIV. But it has one critical
advantage: it is the only available technology for HIV prevention
that women can initiate and control.
Condom promoters in Zimbabwe suggest that married women can
present the female condom as a means of child spacing. In this
way, the issue of a woman appearing to accuse her husband of
having other partners and putting her at risk need not arise.
Zimbabwe introduced the female condom in 1997, but acceptance was
slow. Eventually, the Government requested support from the
United Nations Population Fund (UNFPA) to scale up promotion of
both male and female condoms through the public sector. Beyond
training condom promoters, highly creative ways to educate the
public about condom use were employed. Billboards, radio spots
and TV commercials helped break down taboos against talking about
condoms, and thus helped overcome the stigma sometimes associated
with them. In the process of implementing the strategy, the team
� which included the Ministry of Health and Child Welfare, the
Zimbabwe National Family Planning Council, the National AIDS
Council and Population Services International (PSI) � discovered
that the female condom can be a tool for empowerment, enabling
women and adolescent girls to take the initiative in protecting
their own reproductive health and that of their partners.
From 2005, when the strategy was launched, to 2008, female condom
distribution by the public sector in Zimbabwe increased
five-fold, from about 400,000 to more than two million. Sales of
female condoms through social marketing rose from some 900,000 to
more than 3 million, and sales of male condoms also increased.
One person who has seen the change coming is Langton Ziromba. He
owns a small, outdoor barbershop in the Budirio section of
Harare. In addition to haircuts, shaves and chats about football
and women, Mr Ziromba provides another service to his male
customers: information about female condoms, how they are used,
and the advantages to both partners. He is one of about 70
barbers and 2,000 hairdressers in Zimbabwe who have been trained
to promote the female condom. He sells Zimbabwe's most popular
brand, called Care, and makes a small commission on the highly
"Our research shows that for this product to be accepted and used
by women, we also need to involve men," says Margaret Butau of
the National Family Planning Council. "We customise the benefits
of the female condom according to the target group we are
addressing." Specific points highlighted for men include the fact
that the female condom is not constricting like the male condom,
it is even less prone to breakage, its use does not require an
erection and it can enhance pleasure for both partners. Moreover,
it is not necessary to withdraw immediately after ejaculation.
And, finally, it could be seen as the woman's responsibility.
"When we point all this out, we find that men become curious
about having their partners try the product."
Providing a model for other countries
The Zimbabwe campaign created by PSI that uses hairdressers to
market condoms has served as a model for a similar programme in
Malawi. Some 2,400 Malawian hairdressers now sell, and serve as
advocates for, the female condom in the country. Their numbers
are growing as word spreads. Sandra Mapemba, a national programme
officer in the UNFPA office in Malawi, says the impact has been
dramatic. "The female condom is actually empowering women to
become more assertive and to stand up for their own health
issues," she says. "That's the most exciting thing for me. Women
who are in discordant relationships or women who are HIV-positive
come and tell me that now they can actually insist on condom use.
Before, their partners would refuse."
The response has been so positive that UNFPA Malawi is now
providing training in condom programming to some 35 international
and local NGOs working on HIV-prevention in the country. Over the
course of three years, female condom distribution through the
public sector alone in Malawi increased from 124,000 in 2004-2005
to nearly a million in 2008.
Programming challenges persist
The success of UNFPA and its partners in promoting the female
condom in Zimbabwe, Malawi and also in Zambia has prompted other
countries to seek similar assistance. Though global distribution
of female condoms nearly tripled from 2004 to 2008 � to a total
of 33 million in 90 countries � they still represent only 0.2 per
cent of condom use worldwide. Key barriers are cost and
availability. Not only are female condoms more expensive than
male condoms � they cost as much as $1 per unit in some countries
� they are still far less widely available. Through an initiative
called comprehensive condom programming, UNFPA is helping
countries address these and other issues. The programme is also a
platform from which other female-initiated prevention
technologies still in development, including cervical caps and
microbicides, will be launched.
"Giving women the power to protect themselves could turn the tide
of the AIDS epidemic," says Bidia Deperthes, who leads the
comprehensive condom programming initiative for UNFPA. "But we
still have a long way to go." The largest obstacle, in her view,
is funding for programming. While the majority of donors
willingly contribute essential commodities, including male and
female condoms, little money is allocated to laying the
groundwork needed to create awareness and demand, and to train
women to use condoms correctly and consistently. "It's all part
of one comprehensive package."
This article was adapted from an upcoming UNFPA publication
"Prevention Gains Momentum: Successes in female condom
Key populations: women and girls -
HIV Prevention -
Sub-Saharan Africa -
United Nations Population Fund (UNFPA) - http://www.unfpa.org/
Population Services International (PSI) - http://www.psi.org/
The Global Coalition on Women and AIDS -
Barber Shops and Beauty Salons promote HIV education in Guyana
(26 March 2009) -
Commission on the Status of Women opens with call for action to
achieve universal access and gender equality (02 March 2009) -
ICASA 2008: Addressing the vulnerability of young women and girls
to HIV in southern Africa (03 December 2008) -
UNAIDS Technical Meeting on Young Women in HIV Hyper-endemic
countries of Southern Africa (pdf, 11.3 Mb.) -
2008 Delegates Guide to Women and AIDS: All Women, All Rights
(pdf, 506 Kb.) -