In just under three years, the government has distributed one million female condoms, free of charge. Between February 2006 and January 2007, a half million female condoms were distributed, translating to 41,000 condoms a month.

Majority of these women have turned to the condom as they are able to use it without the knowledge and consent of their partners, according to Godfrey Maina, a Programe Officer at the National Aids and STDs Control Porgramme (Nascop), 

Maina, who is in-charge of the female condom programme, says they are also receiving information that the gadget has become a protective tool in the eventuality of rape. 

Because it can be worn up to eight hours before sex, some women are said to insert it in the evenings before driving off, particularly at this time when there are increased cases of carjacking and rape. 

The condoms are being distributed free of charge by the government in popular outlets such as bars and restaurant, family panning clinics, and through women and youth groups. They can also be accessed in the market at not less than Sh 100 a piece. 

But due to this high price, commercial sex workers are forced to lean heavily on those being provided by the government. And once the free ones are over, they revert to washing and re-using the ones they have after every sex act, against the manufacturers warning of “one time use only”. 

“The condoms are procured at high price, making retails to tag prices that are high than what an ordinary person can afford,” says Maureen Kuyoh, Project Director at Family Health International. 

She adds: “Reuse has been shown to work where sanitation is good and proper detergents are sued in cleaning the condom. But due to lack of these things in resource poor settings, women are advised to use the condom once.” 

According Maina, a pilot study done in Nairobi, Coast, Western, and Nyanza provinces proved that when women are educated and trained on how to use the condoms, the uptake increases significantly. 

“The reach is still limited because enough personnel to instruct women on how to use the condom have not been trained. Funds towards female condoms are also small compared to those for male condoms,” he adds. 

Advocates of female condoms complain that while women are showing increased willingness to use the tools than was the case in the past, donors and governments are not putting enough resources to help in their procurement and distribution. 

“While Female condoms have been shown to work, they have not received much attention in funding,” says say Jodi Jacobson, the Executive Director of the Centre for Health and Gender Equity (CHANGE). 

“This means we need to dramatically increase funding to buy and distribute female condoms, a method that has been deemed safe and effective by the World Health Organization and Food and Drug Administration (FDA).” 

According to Kuyoh, while the acceptability of the gadgets is good, demand for the condoms has not been created at the community level to help women appreciate their usefulness. 

This year, for instance, the country is going to get 600,000 female condoms using funds from the Global Fund and UNFPA, who are sharing equally the cost of the condoms. 

This is however a drop in the ocean compared to 52 million male condoms to be procured using the Fund’s money and 120 million male condoms to be purchased through World Bank funding, for the same year. 

Campaigners of female condoms now want their availability to match the immense interest in the male condoms. 

The debate around providing female condoms to all women especially the rural and urban poor intensified last week after one of the microbicides candidate gels, which have been receiving handsome attention it terms of funding, was stopped. 

A group of women, like CHANGE disillusioned by a streak of failures being registered by these trials want female condoms to be given priority and availed to all women at subsidized prices. 

The women are putting pressure on donors and governments to put money in procurement and distribution of the tools than investing only in microbicides studies. 

But those who advocate for microbicides argue they need more resources than ever before in order to build on the lessons learnt in the failed trials, to accelerate studies on finding a safe and effective microbicide. 

“We appreciate the role of the female condom, but it is not the right time to abandon microbicides because people need different tools to protect against HIV infection and cannot substitute one tool with another,” says Pauline Irungu of Global Campaign for Microbicides. 

“Frustration with what is happening is understandable, but we need to do several trials before we get a safe and effective microbicide,” she adds. 

Since 2003, over US$300 million (Sh 20 billion) have been put in microbicide research by donors such as Bill and Melinda Gates Foundation, with a fraction or nothing going into purchase and distribution of female condoms. 

But studies on three microbicides trials have returned disappointing results on a safe and effective gel that could be used by women to protect themselves from HIV and other Sexually Transmitted infections. 

The latest case is the stoppage of trials on the Ushercell also known as Cellulose Sulphate, a microbicide that was found to increase the chances of HIV infection among women volunteers who were using the microbicide compared to those were not using it (the placebo group). 

Terminated this January, trials on this microbicide were being conducted by Conrad in Uganda, Benin, South Africa and India since 2005, while Family Health International (FHI) was carrying similar trials in Nigeria since 2004. 

Of the 1,333 women who participated in the Conrad studies, 35 got infected with HIV. 

This number was too high than expected, forcing an independent Data Safety Monitoring Board to advice the termination of the studies and order a detailed investigation conducted to establish why women were getting infected. 

FHI had to also stop the Nigeria study as a precautionary measure, although a higher rate of HIV infection had not been observed by the time the Conrad studies were being halted. 

It is however emerging that of the 1,644 women who participated in the Nigerian study, 21 were infected with the virus. Whether these women were those given the microbicide or in the placebo group is yet to be explained.
 

There are however suspicion some of these women might have been sharing the gel or engaging in several sexual encounters believing the gel would protect them. All those who participated in the studies have now been asked to return all the gels they had been given. 

A microbicide is gel or cream inserted in the vagina or rectum to prevent the transmission of HIV and sexually transmitted diseases. Others also act as contraceptives by immobilizing or killing the sperms. 

Before the Cellulose Sulphate microbicide failure, other two microbicides trials: the Nonoxynol-9 or N9 microbicide and Savvy microbicide trials had been stopped. 

The N9 was stopped after it was found to be ineffective in protecting women from HIV infections. It irritated the vaginal lining and caused lesions when used in higher doses; factors that facilitated HIV entry. 

In one of the studies, 15 percent of HIV negative female sex-workers who received the N-9 gel became infected with HIV compared to 10 percent of those who did not receive it during the study. 

FHI studies on SAVVY microbicide in Ghana were also stopped after a review of interim data indicated that the study was not likely to provide convincing evidence on the efficacy of the gel. 

Only two microbicide gels, Carraguard and PRO2000 are in advanced stages of studies.

A phase III data from the Carraguard that will provide information on the efficacy and safety of the microbicide is expected later this year, with the one for PRO2000 expected next year. 

Advocates of microbicides have crossed fingers, hoping these studies will not disappoint them once again. 

While those who are involved in microbicide research say this failures are normal in scientific research before an effective microbicide is found, advocates of female condoms think otherwise. 

They argue these stoppages indicate that an effective microbicide is far away from being found, and resources should be put in increasing procurement and distribution of female condoms. 

“It is clear that access to an effective microbicide remains some years away, and the rapid spread of HIV among women and adolescents underscores the fact that we must do everything in our power to make prevention methods available and affordable to who need them,” say Jodi Jacobson. 

Indeed, the female condom has been celebrated as a tool that gives the women the power to control safer sex, especially in cases where men refuse to use the male condoms. 

Some women who participated in previous studies done in Kenya on the female condoms said it increased sexual pleasure if inserted few hours before the act. 

Others said they were able to insert it secretly without their partners knowledge and get protected from a wide spectrum of sexually transmitted infections and unwanted pregnancy. 

While advocates like Jacobson espouse these as strong points to why female condoms should be given more funding, there are numerous challenges they have to surmount to make many women use it. 

Recent studies on the acceptance of female condoms among Kenyan women of social classes have shown that the acceptability may not be easy even if made available at affordable prices. 

Majority of the women who participated in these studies said the condom was difficult to insert and remove. Their male partners on the other hand rejected it even when women had inserted it long before sex. 

“My partner asked me to remove it before we had even finished having sex. He said it was making him feel uncomfortable,” says Janet Aketch, trader in town. 

When Horizon interviewed ordinary women on the condom usage, many seemed not know what it was all about. Those had some idea said they would be reluctant to use it because of what they have heard about it. 

“I heard it makes a lot of noise when people are having sex, something not good when you are sleeping in the same room with your children,” say Beatrice Mueni, a resident of Dandora Estate in Eastlands. 

For others, the look of the female condom is not exciting. “I saw it once during a conference on HIV/AIDS and I did not like how it looked,” says Margaret Nduta with contorted expression. 

Women have also complained of the cumbersomeness as they have to constantly hold the condom in place while having sex. 

Another challenge is the price of the condoms, which locks out even those who want to use them. 

A spot check in the chemists and supermarkets indicated that the prices of the female condoms are over Sh 100 a piece. 

Yet the male condoms sell for Sh 10 or are given for free by the government. Unlike the male condoms which can be accessed in any shop even the kiosks in villages, female condoms remain urban based and found only in specific places. 

To help solve this problem, advocates of female condoms want the government to budget for them in the national budget and donors to start funding or increase funding for the same.