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[Current status of the female condom in Africa].

Abstract

The female condom was developed in the 1980s. It is a contraceptive device used by women that protects against both pregnancy and sexually-transmitted diseases (STDs) including HIV infection. Two studies have investigated the contraceptive effectiveness of the female condom, and it was found to be as effective as other barrier methods. It has been shown to be effective against STD and HIV transmission in vitro but there is only limited evidence of its efficacy in vivo. No serious local side effects or allergies have been reported and the female condom can be used with any type of lubricant, spermicidal cream or foam. The female condom is the only device other than the male condom that has been shown to prevent HIV transmission. The female condom has been marketed in 13 countries since the summer of 1996. Most of these countries are industrialized and the selling price in these countries is too high for developing countries. Sub-Saharan Africa has very high prevalence rates for HIV infection, at least 30% of the general population in Eastern and Central regions. The epidemic is also spreading fast in some parts of the Western region. In Ivory Coast for example, 12 to 15% of pregnant women are infected. African women are subordinate to men in many aspects of their lives, politically, educationally, socially and sexually. This sexual inequality makes them highly vulnerable to STDs, including HIV, and unwanted pregnancies. This paper reviews 10 of the 15 studies carried out in sub-Saharan African countries between 1990 and 1996 and compiled by the World Health Organization. Recruitment methods, education of subjects, methodology and assessment of acceptability differed between studies. Despite these limitations, most studies concluded that the women who participated in the trials generally found the female condom acceptable. Acceptability was established quicker among prostitutes than among other women and men found the female condom less acceptable than did women. However, the sample size is too small to draw any firm conclusions. Commercial sex workers in the studies reviewed were very interested in this new method because it gave them an additional method of safer protection during sex. However, they were occasionally faced with difficult negotiations with some clients, refusal to use the female condom and sexual violence. Reuse of the device was reported in four studies, but the term reuse is seldom defined. In cases where it was defined, the frequency of reuse, with washing of the device, accounted for no more than 1% of the total number of uses. The acceptability of the female condom among women other than prostitutes faces two obstacles, the reaction of the woman's regular partner and attitudes to the device itself (appearance, difficulties or uneasiness concerning its use). However, some women liked it because it provided dual protection against pregnancy and STDs and sexual pleasure. The moderate level of acceptability to male partners may be overestimated because women whose partners disliked the device would be more likely to discontinue its use. The studies of acceptability reviewed here show that use of the female condom in Africa is realistic and that it provides women with more independent protection. Initial negative perceptions of the device are often replaced with a more positive reaction after several uses. The experience gained with use reduces the technical problems. We need to overcome the stereotypes, simplifications and strong opinions that threaten to damage the acceptance of this new method and efforts to encourage women to adopt it. However, we still require further clinical data on the effectiveness of the female condom at preventing pregnancy and HIV transmission. Availability of the female condom is improving in Africa. Pilot marketing studies were launched in 1996 in Guinea, Zambia, South Africa, followed by Uganda and Tanzania. There are local initiatives in Ivory Coast and Zimbabwe. (

ABSTRACT

TRUNC

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  • Authors+Show Affiliations

    Réseau IEC-Population, Abidjan, Côte d'Ivoire.

    Source

    MeSH

    Africa
    Attitude
    Condoms
    Condoms, Female
    Contraceptive Agents, Female
    Costs and Cost Analysis
    Developed Countries
    Developing Countries
    Disease Outbreaks
    Female
    HIV Infections
    Health Services Accessibility
    Humans
    Hypersensitivity
    Male
    Marketing of Health Services
    Patient Satisfaction
    Pregnancy
    Pregnancy Complications, Infectious
    Prevalence
    Sex Work
    Sexual Partners
    Sexually Transmitted Diseases
    Social Conditions
    Spermatocidal Agents
    United Nations
    Women's Health
    Women's Rights
    World Health Organization

    Pub Type(s)

    Journal Article
    Review

    Language

    fre

    PubMed ID

    9503499

    Citation

    Deniaud, F. "[Current Status of the Female Condom in Africa]." Sante (Montrouge, France), vol. 7, no. 6, 1997, pp. 405-15.
    Deniaud F. [Current status of the female condom in Africa]. Sante. 1997;7(6):405-15.
    Deniaud, F. (1997). [Current status of the female condom in Africa]. Sante (Montrouge, France), 7(6), pp. 405-15.
    Deniaud F. [Current Status of the Female Condom in Africa]. Sante. 1997;7(6):405-15. PubMed PMID: 9503499.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - [Current status of the female condom in Africa]. A1 - Deniaud,F, PY - 1998/3/21/pubmed PY - 1998/3/21/medline PY - 1998/3/21/entrez KW - Acquired Immunodeficiency Syndrome--prevention and control KW - Africa KW - Africa South Of The Sahara KW - Barrier Methods KW - Behavior KW - Contraception KW - Contraceptive Methods KW - Contraceptive Usage KW - Developing Countries KW - Diseases KW - Economic Factors KW - Family Planning KW - Female Condom KW - Hiv Infections--prevention and control KW - Literature Review KW - Method Acceptability KW - Prostitutes--women KW - Sex Behavior KW - Socioeconomic Factors KW - Vaginal Barrier Methods KW - Viral Diseases KW - Women's Status SP - 405 EP - 15 JF - Sante (Montrouge, France) JO - Sante VL - 7 IS - 6 N2 - The female condom was developed in the 1980s. It is a contraceptive device used by women that protects against both pregnancy and sexually-transmitted diseases (STDs) including HIV infection. Two studies have investigated the contraceptive effectiveness of the female condom, and it was found to be as effective as other barrier methods. It has been shown to be effective against STD and HIV transmission in vitro but there is only limited evidence of its efficacy in vivo. No serious local side effects or allergies have been reported and the female condom can be used with any type of lubricant, spermicidal cream or foam. The female condom is the only device other than the male condom that has been shown to prevent HIV transmission. The female condom has been marketed in 13 countries since the summer of 1996. Most of these countries are industrialized and the selling price in these countries is too high for developing countries. Sub-Saharan Africa has very high prevalence rates for HIV infection, at least 30% of the general population in Eastern and Central regions. The epidemic is also spreading fast in some parts of the Western region. In Ivory Coast for example, 12 to 15% of pregnant women are infected. African women are subordinate to men in many aspects of their lives, politically, educationally, socially and sexually. This sexual inequality makes them highly vulnerable to STDs, including HIV, and unwanted pregnancies. This paper reviews 10 of the 15 studies carried out in sub-Saharan African countries between 1990 and 1996 and compiled by the World Health Organization. Recruitment methods, education of subjects, methodology and assessment of acceptability differed between studies. Despite these limitations, most studies concluded that the women who participated in the trials generally found the female condom acceptable. Acceptability was established quicker among prostitutes than among other women and men found the female condom less acceptable than did women. However, the sample size is too small to draw any firm conclusions. Commercial sex workers in the studies reviewed were very interested in this new method because it gave them an additional method of safer protection during sex. However, they were occasionally faced with difficult negotiations with some clients, refusal to use the female condom and sexual violence. Reuse of the device was reported in four studies, but the term reuse is seldom defined. In cases where it was defined, the frequency of reuse, with washing of the device, accounted for no more than 1% of the total number of uses. The acceptability of the female condom among women other than prostitutes faces two obstacles, the reaction of the woman's regular partner and attitudes to the device itself (appearance, difficulties or uneasiness concerning its use). However, some women liked it because it provided dual protection against pregnancy and STDs and sexual pleasure. The moderate level of acceptability to male partners may be overestimated because women whose partners disliked the device would be more likely to discontinue its use. The studies of acceptability reviewed here show that use of the female condom in Africa is realistic and that it provides women with more independent protection. Initial negative perceptions of the device are often replaced with a more positive reaction after several uses. The experience gained with use reduces the technical problems. We need to overcome the stereotypes, simplifications and strong opinions that threaten to damage the acceptance of this new method and efforts to encourage women to adopt it. However, we still require further clinical data on the effectiveness of the female condom at preventing pregnancy and HIV transmission. Availability of the female condom is improving in Africa. Pilot marketing studies were launched in 1996 in Guinea, Zambia, South Africa, followed by Uganda and Tanzania. There are local initiatives in Ivory Coast and Zimbabwe. (ABSTRACT TRUNC SN - 1157-5999 UR - https://www.unboundmedicine.com/medline/citation/9503499/[Current_status_of_the_female_condom_in_Africa]_ L2 - http://www.jle.com/medline.md?issn=1157-5999&vol=7&iss=6&page=405 DB - PRIME DP - Unbound Medicine ER -