Female Condom A Boon For Female Sex Workers In India The contraceptive could also help sex workers keep AIDS at bay
The possibility of contracting sexually-transmitted diseases and AIDS always haunted Bidu during encounters with drunkards and goons. “How can one tell a drunkard or a thug to use condom?’’ she asks. Instead, she now carries a packet of female condom to protect herself.
Historically, the AIDS epidemic in India was first identified amongst sex workers and their clients, before other sections of society became affected. High HIV infection rates among sex workers continue to be detected in India. The government estimates that 5 per cent of sex workers nationally are infected with HIV, which is fifteen times higher than the overall HIV prevalence. What is more, sex workers in some areas have a much higher HIV prevalence, such as 18 per cent in the state of Maharashtra, and 13 per cent in Manipur. Commercial sex workers in Kolkata during a three-day training programme were shown how to use female condoms to prevent HIV transmission. Under the programme, sex workers were able to purchase female condoms which normally cost about $1, for about six cents each. Hindustan Latex agrees that the cost is the major issue which is around Rs 50 in Indian currency; they want to make it to Rs 23. Under social marketing programme sex workers will buy now female condoms for Rs 3, instead of Rs 5, they spent on it last year.
Says Anne Philpot, international programme manager of Female Health Company, which manufactures the condoms: “The objectives are to look at it as a protection against STD and HIV infections, and a spacing method for married couples.” Sex workers in Hyderabad, amongst whom the female condom was extensively tested, know that using it is their safest bet to prevent getting HIV/AIDS or sexually-transmitted infections (STIs).
The advantages of using female condom
■ It provides an opportunity for the women to share the responsibility with their partners.
■ The female condom will protect against STD and pregnancy if used correctly.
■ The condom can be inserted in advance of sexual intercourse.
■ The FC2 female condom is made of nitrile, which can be used with oil-based as well as water-based lubricants. No special storage requirements are needed because nitrile is not affected by changes in temperature and dampness. In addition, nitrile conducts heat well, so sensation is preserved.
The study found that some of the homosexuals and sex workers already knew about it. “It is a woman-initiated method, leading to their empowerment. Some of them found it and want more of them. Experts do not advocate re-use of it because they fear it will not be cleaned properly. Manju, a sex worker, felt that the female condom had several features in its favour. “Some clients felt its lubrication helped in enhance pleasure. It also provided an effective barrier against the drunken clients who refuse to use condoms.” Radhya, a sex worker, feels safe when she uses a female condom. “There are no more needless arguments with clients about using condoms. I have just learnt to protect myself,” she says.
A pilot project was carried out among the six states; it was most successful in Andhra Pradesh, Maharashtra, Tamil Nadu and West Bengal, the first three being high HIV-prevalence states. Sex workers say although condom used with clients has increased in recent years, there is still the odd client who refuses to use one. Also, condom use is low with regular partners. Possible condom use rates for all female sex workers (FSWs) sex acts ranged from 3 per cent—36 per cent in 2004 to 56 per cent—96 per cent in 2008. The two most realistic scenarios that discounted the number of private sector condoms that might have been bought for sex acts other than with FSWs showed that 16-24 per cent of FSW sex acts could have been protected by condoms in 2004 rising to 77-85 per cent in 2008.
“Regular and timely counselling on potential problems is a must in order to ensure regular usage,” says Patturi (national programme manager, Hindustan Latex Family Planning Promotion Trust (HLFPPT), who admits that wherever outreach workers were able to provide effective interventions, barriers such as discomfort and pain were easily overcome. The female condoms do have some drawbacks, as it requires time and privacy to insert, and these are not always available. But Jayamma, who has helped 1,500 sex workers come together to form a Hyderabad-based cooperative called Chaitanya Mahila Mandal, says: “Prior to the female condom we used to be stigmatised for spreading HIV. That situation has now changed.” A government study has shown that 14 per cent of India’s 5.1 million HIV-positive people are sex workers; female condoms are aimed specifically at them
WHO and UNAIDS are encouraging wider access to the female condom as a method of preventing both pregnancy and sexually-transmitted infections. Many governments and non-governmental organisations provide female condoms for free or at subsidised prices as part of their HIV prevention and family planning programmes.
The HIV epidemic in southern India is thought to be a concentrated epidemic, driven to a large extent by heterosexual sex between female sex workers (FSWs) and their male partners, who then transmit infection to their spouses and other partners. The Bill & Melinda Gates Foundation launched the India AIDS Initiative (Avahan) in Karnataka and five other states in 2004 to scale up targeted HIV preventive intervention programmes for key populations most at risk of acquiring and transmitting HIV, particularly for FSWs in Karnataka. The Avahan state implementing agency is the Karnataka Health Promotion Trust (KHPT).
By Sonali Chakraborty