Sex workers, such as María, manifested a strong interest in using the female condom. Most of them suggested this would be a great opportunity to empower themselves. Nevertheless, they were not familiar with the product and wanted to learn more about it. In a study made with Family Health International (A study on the acceptability of the female condom by low class sex workers) women indicated their willingness to use it. Once they tried it, they reported that many clients did not even notice they had it on. 351 They thought the female condom made safe sex much easier for them and that 349 Johnny Madrigal and Jacobo Schifter, Encuesta Nacional de Sida, San José: Asociación Demográfica Costarricense, 1990.
350 Ibid.
351 Johnny Madrigal, Jacobo Schifter, and Paul Feldblum, "Female Condom Acceptability Among Sex Workers in Costa Rica," AIDS Education and Prevention 10, no. 2 (1998): 105-13
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it provided them with more security. This data suggests it is more viable to promote the female condom among sex workers who cater to tourists than those that work in the lower-income sector since they have the available income to afford the product, which is twenty times more expensive than the male condom.
The female condom is important because women are biologically more vulnerable to transmission from an infected partner than men are. More important, economic, social, and cultural disempowerment means that the current HIV prevention strategies of abstinence, monogamy, condom use, fewer partners, and treatment of sexually transmitted infections (STI‘s) are not feasible for many women, since they often lack the ability to negotiate safe sex.352 Therefore, there is an urgent need for HIV
prevention strategies that give women greater control to protect their bodies. The female condom is the only female-controlled safe-sex method available. While this method is effective and relatively well accepted by women; costs, men‘s negative attitudes, its contraceptive properties, and practical aspects of its use limit its usefulness.
Studies have shown that there was a 24 percent reduction in the rate of new STIs in groups of Thai sex workers who were given the choice of using either the male or female condom, compared with groups offered only the male condom.353 There have been many studies of the use of the female condom in developing countries. Many have involved commercial sex workers who generally accept the device more quickly than other women. Most studies have shown high or moderate acceptability among sex workers, including those in China, Costa Rica, C™te d'Ivoire, Thailand, and Zimbabwe.354 But these studies also revealed a number of barriers to the use of the female condom, including clients' distrust of unfamiliar methods, inconvenience, insertion difficulties, discomfort or pain from the inner ring, and itching.
These obstacles can be overcome by the introduction of condoms, technical support and counseling.
Women who have experience with the male condom or who receive more intensive training with the female condom generally find the device easier to use. Research in Zambia showed that the addition of female condoms with counseling on the barrier method mix could reduce unprotected sex among couples at high risk of HIV infection.355 Marketing Strategies Social marketing has been used widely in the promotion of the male condom in developing countries and this strategy is now being applied to the female condom.
352 World Health Organization (WHO), Women and HIV/AIDS, fact sheet no. 242 (Geneva: WHO, 2002) 353 A.L. Fontanet et al., "Protection Against Sexually Transmitted Diseases by Granting Sex Workers in Thailand the Choice of Using the Male or Female Condom: Results from a Randomized Controlled Trial," AIDS 12, no. 14 (1998) 354 A.L. Fontanet et al., "Protection Against Sexually Transmitted Diseases by Granting Sex Workers in Thailand the Choice of Using the Male or Female Condom: Results from a Randomized Controlled Trial," AIDS 12, no. 14 (1998): 1851-59. 16.
Francois Deniaud, "ActualitÎ du prÎservatif fÎminin en Afrique," SantÎ 7, no. 6 (1997): 405-15. 17. C.
Yimin et al., "Introductory Study on Female Condom Use Among Sex Workers in China," Contraception 66, no. 3 (2002): 179-85. Johnny Madrigal, Jacobo Schifter, and Paul Feldblum, "Female Condom Acceptability Among Sex Workers in Costa Rica," AIDS Education and Prevention 10, no. 2 (1998): 105-13. Francois Deniaud, "Dynamiques d'acceptabilitÎ du prÎservatif fÎminin chez des prostituÎes et des jeunes femmes Âbidjan, C™te d'Ivoire," Migrations SantÎ 94-95 (1997): 111-37. 20.Sunanda Ray et al., "Constraints Faced by Sex Workers in Use of Female and Male Condoms for Safer Sex in Urban Zimbabwe," Journal of Urban Health 78, no. 4 (2001): 581-92. United Nations Population Fund (UNFPA),
"Condom Programming for HIV Prevention," HIV Prevention Now, Programme Briefs (New York: UNFPA, 2002).
355 Sohail Agha, "Intention to Use the Female Condom Following a Mass-Marketing, Zambia," American Journal of Public Health 91, no. 2 (2001): 307-10.
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