Female condoms

The most effective method to prevent HIV acquisition and transmission, the condom, is worn by men. Many women do not have relationships of equality with the men they have sex with, and they can experience difficulties 'persuading' men to use condoms. This can be particularly difficult in situations where HIV is not the priority concern (for example, when the woman experiences violence). However, it is also problematic for women in more equal relationships, since many men find condoms unpleasant, and as women are more vulnerable to HIV than men from vaginal intercourse, they may not afford the same priority to condom use.

When it was introduced in 1993, at the height of the AIDS crisis in the developed world, the world’s first female condom, the Femidom, was hailed as the first female-controlled barrier method for preventing HIV, STIs and pregnancy. It was forecast that it could make a significant contribution to HIV prevention.

Today, this – the only new prevention technology invented and approved since the advent of the HIV epidemic – has yet to fulfil its promise. Although there are significant female-condom distribution and education programmes in a number of developing countries, including South Africa and Brazil, its use has largely remained confined to sex workers. Just one female condom is used for every 500 male condoms used worldwide: in 2004, 14 million were available for distribution compared with six to nine billion male condoms.

Nonetheless, it is still the only female-controlled barrier method that has been proven to reduce STI infections, and in the current absence of any other methods of proven efficacy, manufacturers, researchers and prevention advocates continue to promote this potentially extremely effective intervention tool and develop new versions that will gain more acceptability.