A BIRTHDAY CELEBRATION AND A CALL FOR REPRODUCTIVE JUSTICE!

21 years of female condom programmes and working for SRHR.

BY TIAN JOHNSON & TAMBU MUZENDA

The 9th South African AIDS Conference was hosted in Durban in June of this year and came to a close with over 3000 delegates in attendance. The much anticipated conference brought with it a few highlights, one of which was the release of results of the Evidence of Contraceptive Options and HIV Outcomes (ECHO) study. The groundbreaking study of 7,829 women ages 16-35 in East and Southern Africa found no significant difference in risk of HIV infection among women using one of three highly effective, reversible contraceptive methods and showed that each method had high levels of safety and effectiveness in preventing pregnancy, with all methods well-accepted by the women using them. The results strengthen a decades old case for increasing availability of and access to a broad choice of effective contraceptive methods that empower women to make informed decisions about their own bodies – including if and when to have children.

Another exciting finding was from a Doctors Without Borders/Medecins Sans Frontieres study to measure whether it was possible for South Africa to attain the much hyped UNAIDS 90 90 90 targets. They answered this question in the KwaZulu Natal district of Eshowe where 90% of participants living with HIV know their status, 94% are taking antiretroviral (ARV) treatment and 95% of those on treatment have a suppressed viral load.

The SA AIDS conference also became the prime space in which to commemorate 21 years of Female Condom programming in South Africa. The programme – which in many ways speaks to the two major announcements as they relate to awareness, access and agency – was launched in 1998 with  growth in leaps and bounds. The Female Condom (FC) remains the only available method for the recptive partner to use to protect themselves from STI’s, HIV and unplanned pregnancy. In 2012, the World Health Organisation cited the female condom  as an essential strategy for pregnancy and HIV/STI prevention.

In 1998, the National Department of Health piloted the FC programme with support from the manufacturer, the Female Health Company which saw a steady growth over the two decades. The manufacturer’s injection of more than 21 million rands  supported the programme nationally over that time, providing a range of free multi lingual technical, capacity and social marketing support on the product to raise awareness of the  female condom. The need for locally relevant training resulted in over 630 000 trained people to educate, supply and strengthen advocacy on the product and its use. In addition, the Global Female Condom initiative launched in 2005  saw a growing support of the female condom in more than 23 countries in the region by UNFPA. As the new generation female condom – FC2 – became available, South Africa played a critical role in scaling up the female condom programmes with strategies that saw the condom being integrated into sexual and reproductive health services. The demand for the female condom gave the Female Health Company, the manufactures, an opportunity to expand its reach to communities through offering technical and marketing support to the Department of Health. This public private partnership complimented the Departments efforts to increase the footprint of community health workers equipped with SRHR information.

Training is largely focused on shifting the mindsets of front line health workers and strengthening prevention to provide  education to communities. It was also a recommendation made by the authors of the  20th South African Health Review (Health Review) [1] which recommended that “provider training should focus on ongoing myths and problems related to FC use and include values-clarification exercises that address provider attitudes.”

For South Africa, female condom promotion and its launch in more than eight provinces in 1998 showed commitment to promoting women’s health. The targeted female condom distribution at family planning centres, and via outreach commercial sex workers sites and establishments, evidenced more than 1.4 million condoms distributed through government programmes and research showed that female condom recipients were in their 20s and were also using oral contraceptives. In South Africa, the female condom not only made strides in HIV prevention, but also broke barriers in access and promoted women’s rights around decision making and HIV prevention. In fact, South Africa turned the tide by providing education to both men and women on the female condom. It also exposed how cultural attitudes towards women and sexual health need to be considered, especially in considering gender balance of distribution of male and female condoms.

In August of 2016,  President Cyril Ramaphosa, then Deputy President and head of the country’s  National AIDS Council introduced the strawberry, grape and vanilla scented male condoms called Max, to the country’s parliament. The video became viral and in that same year, the City of Cape Town distributed 50 million male condoms and more than 1.5 million female condoms in the 12 month period. For every man in Cape Town there were roughly 25 free male condoms and roughly one female condom for every woman. The discrepancy caused an uproar and highlighted the gender inequalities reproduced within government structures, and failure to acknowledge not only the population of women, but the burden of HIV in the country.

According to the Health Review, eighty per cent of women who participated at one month felt that FC use placed the woman in charge and the level of unprotected sex (no MC or FC use) declined from 43.3% at baseline to 8.4% at 12 months. At the 12-month interview, over half (53%) of the male partners reported that they were interested in and willing to try FCs when initially introduced to them by their partners and just over half (57%) said that FCs did not change their sexual experience. At their one- month interview, 58% of men said that the FC was ‘better or much better’ than the MC, and at 12 months this rose to 74%.

Another key recommendation in the Health Review was a need to have the female condom be rebranded and pre-presented in different colours and scents as the male  condom-Max brand.

The FC should be re-branded to make it more appealing, as was done for the Max male condom, including different colours and scents, and it should be branded to appeal to both men and women.”

“We need to give this (FC2 Maxima) the same high profile platform, the same publicity, the same hype that we gave the scented and coloured male condoms. We have to be consistent, especially when it comes to public support for expanding the basket of prevention options for young women and girls – this is progress”.

Dr Mbulelo Dyasi, SANAC Men’s Sector General Secretary

The 2019 South African AIDS conference celebrated  21 years of female condoms in the country, creating one of the largest government funded female condom programmes in the world. The Department of Health also took the opportunity to launch the new scented and coloured FC2 Maxima Female Condoms in Strawberry and Vanilla.

The introduction of scented and coloured female condoms has the potential to be a game changing move, giving receptive users increased choice. The Government of South Africa and it’s Department of Health have been in the forefront, and continue to show commitment in their responsiveness in listening to the end user by providing choice and quality products. From its growing investments in HIV prevention research, this is a step in the right direction. We have an opportunity to secure and amplify this success. Work towards HIV prevention programming that does not exist in isolation but forms an integral part of reproductive justice programming. So whether it is the struggle to realise public free access to the HIV Prevention pill, PrEP, for years now unjustifiably delayed in the public health sector or the  activism that ensures that HIV vaccine research is funded, supported and held accountable by communities where research happens, these are all part of the same agenda to accelerate, expand and strengthen HIV prevention and SRHR programming if we are ever to reach 90 90 90 – and now we know we can.

This is one Health Review recommendation that we are failing behind on :

  • “With the introduction of new HIV-prevention technologies such as pre-exposure prophylaxis (PreP), condom messaging must be consistently linked with sexual and reproductive health and HIV, that is, the three-in-one package must be reinforced (HIV/ STI/pregnancy prevention). Condoms should be integrated into new prevention services in a similar way to medical male circumcision.”

The rising global tide of anti SHRH sentiment and reduction in funding coupled with the ongoing attacks on women’s bodies and their ability to make decisions about them, not only in South Africa but globally is an afront to the decades of activism that has contributed to women’s liberation and therefore it must be resisted in every corner – from government offices to the streets of Joburg to the bedrooms of South Africa. The female condom remains an icon and symbol of women exercising their power to determine the trajectory of their own lives and has the potential to strengthen her autonomy. We must continue the work to mobilise, agitate and advocate for this tool to be available, accessible and usable in the lives of women who choose to use it. – Tanya Charles, International Gender Expert

So over the next 21 years of FC2 Maxima programming in South Africa there is an urgent need to:

  1. Revive female condom advocacy as a strategic step to agitate for innovation in both product design, marketability and looking beyond disease prevention to pleasure, agency and equity.
  2. Ensure that every single health facility and NGO is trained, aware and empowered to talk about, promote and sustain the distribution of this life saving prevention option.
  3. Ensure that the female condom takes up its historically strategic position in the basket of HIV prevention tools , especially for young women and girls.
  4. Support the media with knowledge, language and context on the importance of the female condom, not only as an HIV prevention tool but also as a strategic opportunity to start closing the critical gap of unmet contraceptive need.

When the conferencing is done, when the training is complete, we all have to, ensure that products like the FC2 Maxima are supported and for each rand we invest in the silky, soft vaginal sheath, stimulating inner ring or clit teasing outer ring, we also invest another rand into the more challenging but essential work of shifting a lifetime of prejudice, bias, misogyny and heteronormativity to put not only the health, but the sexual pleasure, of women and men at the centre of why and how we respond to the prevention of STI’s like HIV and unplanned pregnancies in South Africa.

The excitement generated at conferences such as SA AIDS needs to translate into new and updated research on acceptability studies involving men, youth and under-represented user groups such as men who have sex with men, and sex workers. This excitement too, must surface in our workplans, our budget line items, our community groups, our homes, in the work place and ultimately our bedrooms where we come face to face with the value that we put on our lives and the choices we make to practice autonomy.

We are alone in that moment but the decisions made, the resources allocated and the messaging signed off by those in power are in that room with us as well.

You can learn more at fc2femalecondom.com or request training, materials or technical support for your programme by contacting the writers at info@africanalliance.org.za

[1]https://www.hst.org.za/publications/South%20African%20Health%20Reviews/14_Twenty%20years%20of%20the%20female%20condom%20programme%20in%20South%20Africa_past_present_andfuture.pdf