Condoms
Overview
The use of a condom is one of the most effective ways of preventing HIV infection, and other sexually transmitted diseases, by creating a barrier that prevents the transfer of bodily fluids. A condom is also commonly used to prevent a woman from falling pregnant.
Definitions (American Heritage Dictionary)
A male condom is a flexible latex or rubber sheath, designed to cover the penis during sexual intercourse.- A female condom is a loose-fitting polyurethane sheath that is closed at one end and inserted into the vagina before sexual intercourse.
If a condom is not used properly, HIV prevention is compromised considerably. However, even in cases of irregular usage which causes breakages and slippages, the risk of HIV infection, sexually transmitted infection and pregnancy is far lower than if the condom is not used at all.
History of Condoms
Condoms have been traced back to ancient Egypt where a linen sheath was used as a protection against disease.
The first published text on the condom was authored by Italian atomist Gabrielle Fallopius in the 1500s. He claimed his invention, a medicated linen sheath, prevented syphilis — a disease that was epidemic in Europe at the time.
But the earliest recorded use of the word condom (or "condum") only came in a 1706 poem, a reference some suggest to the doctor of Charles II, Dr Condom, who might have wanted to help the king prevent the conception of more illegitimate children.
By the mid 1800s, the invention of vulcanised rubber — a process where rubber is heated and elasticised — enabled the production of a cheap and more effective mass-produced condom.
The next major technical advance occurred in the 1930s when condoms were created with liquid latex.
Condoms were first used as protection against sexually transmitted diseases, then grew to prominence as a contraceptive device. By the 1960s, the use of the condom declined as "the pill", the coil and sterilisation became more popular. But condom use and access has dramatically increased since the advent of HIV/AIDS.
The Female Condom
Also see: Factsheet: Gender and HIV/AIDS
The female condom was developed in the late 1980s.
The female condom is a polyurethane sheath that lines the vagina to create a barrier against the exchange of body fluids. It comprises of an inner and outer ring. The inner ring at the closed end is used for insertion and helps to maintain the device at upper end of the vagina. The larger outer ring remains outside the vagina and anchors the condom so that the sheath covers the external genitalia as well as the base of the penis during intercourse.
In 1998, the female condom was introduced as a South African dual protection option against unintended pregnancies and sexually transmitted infections, including HIV/AIDS.
Female condoms are more expensive than male condoms (e.g. The Global Public Sector Price agreement between UNAIDS and FHI is about $0.58 per Female Condom), but are still viewed as a cost-effective contraceptive especially amongst high-risk groups such as sex-workers.
Key Research
A 2000 study by the Reproductive Health Research Unit on the introduction and use of the female condom in South Africa indicated that, of the females that received female condoms:
- 44% reported continued use after initial experimentation;
- The biggest factor in non-use was partners objecting to it;
- A small minority of respondents found it difficult to insert the device, and reported slippage and noise;
- 90% reported using protection more often after the female condom was made available to them, with 44% of female condom users reported also using male condoms.
The study also found that "many women" found the female condom to be empowering, primarily because it allowed them protection in situations where the male partner refuses to wear a male condom. (The female condom can be inserted up to eight hours before intercourse).
The study found that supply and distribution of female condoms was sometimes haphazard and unpredictable and that health providers lacked time to counsel patients on proper use.
Safe sex without the squeak
Belinda Beresford. Mail&Guardian.
DEC 5, 2005 — With a rustle and a softer squeak, an undercover agent against the HIV epidemic is being relaunched around the world… ... Recently an as-yet unpublished study in South Africa found that 80% of men liked the female condom, and the same percentage of women agreed. The men commented that female condoms did not reduce sensation as much as the male condom, and were preferable and less constricting. There are anecdotal reports that men don’t always know that a Femidom is being used. Read more. Also read: Unexpected thrills.
Condom Reliability
Fast Facts
100% Efficacy of condoms in ideal conditions
85% Effectiveness of condoms in actual conditions
Source: US National Institute of Allergy and Infectious Diseases, 2000
Various terms are used to describe the usefulness of condoms in preventing HIV/AIDS.
- The term "efficacy" generally describes the protection a condom offers in ideal conditions.
- The term "effectiveness" generally describes the protection a condom offers in actual conditions.
The National Institute of Allergy and Infectious Diseases (NIAID) and other US federal agencies reviewed studies on condom effectiveness in the 2000 Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention report, and concluded:
- In terms of efficacy: "Intact condoms are essentially impermeable to particles the size of STD pathogens (including the smallest sexually transmitted virus, hepatitis B)."
- In terms of effectiveness: "From the two incidence estimates, consistent condom use decreased the risk of HIV/AIDS transmission by approximately 85%."
The Centers for Disease Control & Prevention (CDC) has concluded that: "Latex condoms, when used consistently and correctly, are highly effective in preventing the sexual transmission of HIV, the virus that causes AIDS." (CDC Factsheet)
The female condom is estimated to be 95% effective when used consistently and correctly.
Distribution
- Condom distribution in South Africa has increased from 267-million in 2001 to 346-million in 2004, according to the health ministry. In 2004, 1.2-million female condoms were distributed at 203 sites nationwide. The limited introduction of the female condom in this country is attributed to its higher cost per unit and the education required to ensure proper use by both women and men.
- According to Female Health Company, 12-million female condoms were distributed worldwide in 2004, compared to an estimated six to nine billion male condoms.
Access and Use of Condoms
Fast Facts: Condom use
75.2%of all South Africans aged between 15 and 49, who had more than on partner in the last 12 months, reported the use of condoms during their last sexual intercourse in 2008.
Source: 2008 South African National HIV Prevalence, Incidence, Behaviour and Communications Survey
In South Africa
According to the 2008 South African National HIV Prevalence, Incidence, Behaviour and Communications Survey “there has been a dramatic increase in the number of people reporting using condoms at last sex act” as compared to the findings of the 2005 South African National HIV Prevalence, HIV Incidence, Behaviour and Communication Survey report.
Key findings of the 2008 HIV Prevalence, Incidence, Behaviour and Communications Survey with regards to condom usage in South Africa:
- The greatest improvement with regards to an increase in condom usage was among youth aged 15 to 24.
- Condom usage both among adult males and "females how have traditionally had low rates of reported condom use" has increased.
- Condom usage has increased in all provinces barring the Western Cape.
- While young males have more sexual partners than they female counterparts they report greater condom usage.
Quality Standards
Condom quality in South Africa is tested by the South African Bureau of Standards ( SANS 4074 / 2003 ). All condoms supplied by the government are SABS-approved and comply with World Health Organisation standards.
This was not always the case. In December 1998, the New York Times reported that 4-million Kenzo brand condoms, not tested before distribution, were recalled by the SA Department of Health after sex workers complained about defects.
In 1999, thousands government issued condoms were found to be perforated by staples used to attach anti-AIDS pamphlets. (read Ministry of Health press release)
Faulty Condoms Thwart AIDS Fight in Africa
Donald McNeil Jr. New York Times.
Dec 27, 1998 — Out of the depths of the AIDS epidemic sweeping Africa, an ugly truth is emerging: Some condom makers have been dumping their substandard wares here and Africans have been risking their lives on brittle, leaky or ill-fitting condoms…
... Hundreds of millions of condoms are handed out free on this continent each year, paid for — - and tested — - by international aid agencies.
Even now, though, more than 4-million Kenzo brand condoms from Polo Latex Co. of Calcutta are on their way back to India. They were not tested before distribution, and complaints from Cape Town prostitutes flooded in to SWEAT, the Sex Workers Education and Advocacy Task Force, a community aid agency, which had handed thousands out free…
... When they were checked, the results were shocking: As many as 48 out of 200 in some test batches broke.
Follow-up:
The government responded the next day, saying new tender specifications along internationally accepted principles for the next year would "reduce the possibility of faulty condoms being distributed".
