Female condom supply would prevent spread of herpes and other std's
Basic maths shows that the department of health's distribution programme falls pitifully short of a meaningful contribution to safe sex November 27, 2005
If women want to live in South Africa, then they shouldn't have sex. Or - if the department of health has its way - they would have safe sex only once every five years.
Although women are 66 percent more likely to be infected than men, according to UNAids, it is almost impossible for them to access female condoms or dental dams to ensure they can practise safe sex.
This week, UNAids released its annual epidemic update in which it referred to the "astonishing speed" of the evolution of the Aids epidemic in South Africa - "a national adult HIV prevalence of less than 1 percent in 1990 rocketed to almost 25 percent in 10 years"
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'Our condom distribution cannot be compared to any in the world' |
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The department of health announced earlier this year that there were 6,57 million HIV-infected people in South Africa in 2004 compared with 5,6 million at the end of 2003.
It said 29,5 percent of pregnant women surveyed in 2004 were HIV-positive, up from 27,9 percent in 2003. In KwaZulu-Natal, the HIV prevalence rate among pregnant women was more than 40 percent.
Last month the department crowed that "our condom distribution programme cannot be compared to any in the world. Public health sector male condom distribution increased by 80 percent from 150 million in 1997 to 270 million in 2003".
That is 270 million male condoms in a population of 44 million, of whom about 20 million are men. The figures seem good, until a little basic arithmetic reveals that this means 13,5 condoms per year for each man.
In a country of 40,5 percent unemployment, few can afford to buy condoms. This either means that South African men need to cut back dramatically on their sex lives or that campaigns promoting safe sex are hypocritical.
The situation is worse for women. The department of health revealed that "more than 1,4 million female condoms were distributed in 2003". There are about 24 million women; the average age of sexual induction, according to the Durex surveys, is 12.
Basic maths shows that 1,4 million female condoms among 24 million women means they should have sex only once every four to five years, because the department is distributing 0,058 condoms for each woman.
And while male condoms are obtainable in public toilets, supermarkets and chemists, it is almost impossible to find female condoms. Supermarkets whose primary clients are women stock none. Dis-chem is the most reliable outlet and sells them for about R27 for three, significantly more expensive than male condoms.
Research in Uganda is broadly applicable across the continent: women in long-term relationships are at very high risk of HIV infection. The Ugandan study quoted by UNAids this week shows that "women's vulnerability to infection in marriage is underlined by the fact that most men with multiple partners are married (45 percent of married men had multiple sex partners compared with 5 percent of women)."
If penetrative sex is dangerous for women, can they at least experience oral sex? No.
Neither the department of health nor any other major organisation distributes dental dams in South Africa - essential for safe oral sex with a woman, whether lesbian or heterosexual. The only outlet for these safe sex tools is Out, an organisation for gay and lesbian people in Pretoria, which sells them for R15 each.
Dental dams are small, thin, square pieces of latex used for oral sex. They reduce the transmission of sexually transmitted infections (such as herpes, genital warts and HIV) during oral sex by acting as a barrier to vaginal and anal secretions that contain bacteria and viruses. They come in a variety of sizes and flavours.
Dr Elna McIntosh, a Johannesburg sexologist, says she is seeing a steep rise among sexually transmitted illnesses among her A-list clientele.
"I recently had a teenager from a prestigious Johannesburg school who had the worst case of genital warts I have seen. It means she isn't practising safe sex."
McIntosh suggests the use of water-based lubricants when using a dental dam or to stop the rustling noise of a female condom during sex. She says the best lubricants to use are KY Jelly or Astroglide, "which, though expensive, is similar to vaginal mucosa. People must not use Vaseline, baby oil or aqueous cream with condoms - they decrease their effectiveness and increase the woman's risk of thrush".
These substances also heighten the risk of breakage. McIntosh suggests that if you cannot obtain a dental dam, "make one out of a male or female condom, latex glove or non-microwavable cling wrap. To make a dental dam out of a condom, simply cut off the tip and cut down one side".
A Johannesburg HIV specialist says the lack of access to female prevention methods is a serious problem.
"I have one couple, as an example, where the man is HIV-positive and the woman is HIV-negative. He doesn't like using condoms and she would prefer to use female condoms, but they are expensive and difficult to obtain."
Although many women complain of the rustling noise of a female condom during sex - making it difficult for them to insert and use without their partner knowing - sex workers in some countries promote it as a sex toy.
The Guardian newspaper reported recently that in Colombo, Sri Lanka, sex workers "marketed it as a toy, allowing the client to insert it - a real thrill, because seeing a vagina up close, or touching one, is a huge taboo in Sri Lanka".
Clients enjoy the way the "plastic ring inside [the condom] rubs against
the tip of the penis during intercourse, intensifying the man's orgasm...
"In Senegal, the condoms are sold with noisy 'bine bine' beads, an erotic accessory that women wear around their hips. The rustle of the polyurethane during sex is now associated with the clicking of the beads - and so, a turn-on.
"In Zimbabwe, where 930 000 of the 1 600 000 adults infected with HIV are women, a new word - kaytecyenza - has entered the vernacular to describe the 'tickle' created by the inner ring rubbing against the penis."
McIntosh says it is important to "eroticise safer sex - people can use different colours, gels that have different tastes. I suggest to clients that they have a basket or drawer next to their bed with different coloured condoms, a variety of lubricants, gloves and toys".
