Marcela Valente *

Dr. Mabel Bianco shows a female condom to three young women on a street in Buenos Aires. Credit: Juan Moseinco/IPS

BUENOS AIRES, Nov 30 2011 (IPS) – In spite of the growing spread of HIV/AIDS among women in Latin America and the Caribbean, the female condom, which could put them in charge of their health, is not readily available.

Dr. Mabel Bianco shows a female condom to three young women on a street in Buenos Aires. Credit: Juan Moseinco/IPS

In Argentina, a country of 40 million people where the state distributed 39 million contraceptives of various kinds in 2010 alone, , which prevent pregnancy as well as and other sexually transmitted infections in women, are not offered as a choice, nor can they be purchased in pharmacies.

In Brazil, with its nearly 200 million people, a state initiative was launched in 2006 to give out female condoms, but the programme has declined since 2010.

Mexico, with a population of 112 million, is also battling rising prevalence of HIV. But only now is the state planning small-scale distribution of female condoms.

This is the scenario in the three Latin American countries with the largest populations and economies, while in Peru, with 29 million people, there is so far only a pilot plan for distributing the condoms to sex workers.

The situation in the region is not very different from what is happening in the rest of the world. According to the international (UAFC) campaign, barely one percent of all condoms used worldwide are specially designed for women.
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The campaign is active in a score of countries in Africa, the Americas, Asia and Europe, and is steered by over 40 NGOs whose efforts are directed to disseminating female condoms in order to empower women and reduce their vulnerability.

Polls carried out by the campaign found that 215 million women living in developing countries would like to use female condoms if they had access to them.

Fifty percent of people living with HIV worldwide are women or girls, according to the (UNAIDS).

The highest proportions of HIV-positive women are in sub-Saharan Africa (59 percent of all people living with the virus) and the Caribbean (53 percent), UNAIDS reported on the eve of World AIDS Day, Thursday Dec. 1, which this year marks the 30th anniversary of the first AIDS diagnoses.

The epidemic has plateaued in Latin America, where 36 percent of the 1.5 million people living with HIV are women. However, in the 15-24 age range the proportions of men and women are about equal, indicating a tendency towards feminisation of the epidemic.

Why, then, is the female condom not a more popular choice? Is it uncomfortable or awkward to use? Or is price a limiting factor? Women experts interviewed by IPS said female condoms are a good product, but expensive, perhaps because states are not prepared to buy them in bulk.

An Argentine doctor, Mabel Bianco of the (FEIM) an organisation that forms part of the universal access campaign said there are three models on the international market today, one of which is more widely available than the others.

Female condoms consist of a sheath attached to a flexible inner ring which is inserted in the vagina, and an outer ring that covers the labia and vulva. According to Bianco, the new model is a great improvement on the previous one, which could be uncomfortable and made distracting crinkling sounds.

The new material is nitrile, which can be used by people who are allergic to latex. The female condom warms to body temperature, provides enhanced sensation for both men and women, and can be inserted hours before intercourse, Bianco said.

The former head of Argentina s National AIDS Programme said women living with HIV were requesting female condoms. For the last three years the state has been promising to carry out testing; instead, they keep changing the heads of the programme, and nothing has been done, she complained.

In her view, if the state does not purchase large quantities of the condoms, it is unlikely that companies will risk manufacturing them. On the other hand, if the state purchased them on a large scale, it would enable increased dissemination, create greater demand, and eventually drive prices down.

The fact is that at present, male condoms on the market are dazzling in their variety and low in price, while female condoms are expensive, costing up to 30 times more, and there is little variation.

Male condoms now come in up to seven sizes and different thicknesses, textures and flavours. Some are fruit flavoured mango, banana, or watermelon; others are mint, coconut or vanilla flavoured. There is even a model that helps delay ejaculation.

Yet female condoms come in just three different types of materials and designs.

In Mexico, a country which is behind in terms of sexual health services and contraceptive supplies, the state promised to begin distributing female condoms this year, starting with a first purchase of 400,000.

In Brazil, awareness of increasing HIV transmission to women prompted the state to take steps to distribute free female condoms. According to the Health Ministry, in 2006 they distributed 1.3 million (compared to 230 million male condoms).

This caused Brazil to be hailed as a shining example at international forums. But the programme could not be sustained in the long term.

In 2008 a larger quantity of female condoms were distributed, three million, but in 2009 the number fell to two million. By 2010 the total had shrunk to 379,000, compared to 327 million male condoms. In 2011 no female condoms have been distributed at all.

According to Jo Meneses of , an organisation working with HIV-positive people that is another member of the global campaign, female condoms costs 10 times more than male condoms in Brazil, because of shortage of suppliers and lack of competition.

Alessandra Nilo, also of Gestos, said: There s only one company in the country that sells them, and their price is just too high. Brazil cannot afford them.

However, Nilo said the Health Ministry has promised to make a regular practice of buying stocks of female condoms. According to Meneses, 40 million female condoms are to be procured, for distribution over the next three years.

* With additional reporting from Fabiana Frayssinet in Rio de Janeiro.