Re: HIV in Rural India: On microbicides and female condoms

[Guest guest]

Dear Friends,

My colleague Avni Amin has just replied with an eloquent response to the

issues of sexual negotiation and women's status, the content of which I

will not repeat here. I do want to reply further to Godwin's

posting, however, as I believe the arguments he puts forth are

representative both of a) a bias against female condoms that is not

supported by evidence; and a lack of knowledge about the availability

and efficacy of female condoms in the short run.

First, on the female condom, numerous recent studies show that female

condoms are indeed acceptable to a large share of the women at risk of

infection and unwanted pregnancy in many settings. The key to success

appears to be based on the approach taken in introduction and delivery. In

those places where female condoms are made accessible as part of an

integrated effort to address gender power imbalances and build negotiation

skills, they can be an effective tool in infection prevention/pregnancy

prevention/dual protection. Right now, the downside is that they are not

consistently available in many places, program inputs are not sufficient to

support sustained use, and the price per unit is high. The relatively high

current costs of polyurethane female condoms could be reduced through bulk

purchases by international donor agencies, and more concerted efforts to

address the demand side, but on both counts there is far more talk than

action. Moreover, I am convinced that were we to balance the costs of

publicly subsidized, well-designed and sustained efforts to introduce the

female condom, we would find the costs far lower than those for treatment

and care. Not to take the greatest possible advantage of this method

through well-designed programs to expand its use--as well as that of the

male condom--is morally and ethically unsupportable.

Second, no microbicidal product is yet on the market and widely available;

these are still in various stages of testing. Moreover, the first products

are not likely to have high rates of efficacy, and therefore will only be

100 percent effective when used in tandem with a condom. These too will

have to be subsidized, as the regular use of such a product may well be out

of reach of poor women.

The question is not whether microbicides are needed, as clearly these and

other such technologies are. The issue really is that no matter what the

technology, we can not avoid the social, cultural, and gendered aspects of

power and negotiation in sex and reproduction simply by substituting a

technological fix. We have failed to address sex, sexuality, and mutuality

in any positive way with the male condom and hence have even failed at

getting the best use out of this method. My feeling is there is no time to

wait for the perfect technology, but we rather should begin right now using

the tools we have in the context of integrated efforts to fundamentally

address sex, sexual pleasure, sexual power, and negotiation in people's

lives. Only then will we get at the real issues, and only then will we set

the stage in which technologies themselves can be put to best use.

Best wishes,

Jodi son

Jodi L. son, Executive Director

Center for Health and Gender Equity (CHANGE)

6930 Carroll Avenue, Suite 910

Takoma Park, land 20912 USA

Phone: (301) 270-1182

Fax: (301) 270-2052

www.genderhealth.org

e-mail: jjacobson@...

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