The 16th Annual AIDS conference ended on Sunday and HRW has a brief summary of the event at the Eliminate AIDS blog. Demonstrations and protests against multinational drug companies also continued throughout the conference. Although prevention was one of the main topics of the conference, there was little mention of the female condom. Kristin Palitza, South Africa of the Global AIDS Programme blog believes the female condom like abstinence is a non-starter for most women of the world because they are not in a position to “negotiate sexual relationships with their partners”. In the case of abstinence – well you cant be astinent forever. And as the interview with Masias Cowper shows, many women are contracting HIV from their husbands and partners in what they thought were safe relationships. The latest research development in the treatment of HIV is through microbicides which can be applied topically by women without the knowledge of partners thereby making them a far better prevention alternative.
One has to look at the alternatives available to women before dismissing female condoms outright. Male condoms have been around and in many African communities for years but still men are refusing to use them even as a protection against HIV contraction. Would these same men now accept women using female condoms? Prevention Now is launching a global campaign to encourage the use of the female condom. They claim that the female condom has a higher acceptance rate amongst women in 40 countries because “it gives them greater control in negotiating safer sex” and that the main obstacle to increased access and use is cost. I would add that an additional issue for young women and girls would still be the matter that they do not have the power within their relationships with men to negotiate whether to use a male or female condom. Although it may be slightly easier to use a female condom in that situation. A further issue with the female condom is that it is not that simple to use as a male condom. Women need to be taught how to use it and it requires considerable practice. Even assuming that the use of female condoms would be easier to negotiate there still needs to be some basic changes. Changes in attitudes towards women, in understanding how STDs and HIV are contracted and the availability of free or very cheap condoms whether female or male. With these three components, the campaign has a much better chance of succeeding.
In Nigeria “Journalists Against Aids” (JAAIDS) recently published an article on traditional forms of female contraception and hygiene —the use of Lime and Lemon juice, in some regions of Africa as protection against contracting HIV. JAAIDS together with Professor Solomon Sagay who is leading a “Lime Juice” research project at the Jos University Teaching Hospital (JUTH)organised a roundtable event to “examine lime juice as a potential microbicide”. A questionnaire of female sex workers (FSW) and attendees at a family planning clinic (FPC) found that 80% of FSW used lime juice as opposed to only 4% of those at the FPC. The FSW also used a number of other products such as dettol, TCP and drinks with lemon juice as protection against STDs including HIV.
The concern here is that although the users claim lime/lemon juice is effective as a contraceptive there does not seem to be any scientific proof as yet. However it is a huge leap from believing that lime/lemon juice or any of the above products, are effective as contraceptives to the idea that they could be effective in preventing the contraction of HIV. This leap shows a lack of understanding of STDs in general, HIV in particular and that both are, medically at least, unrelated to getting pregnant. The message that using a condom is the only appropriate protection against HIV is clearly not getting through even now in 2006 amongst an extremely vulnerable group, female sex workers. The question is why? Is it just a matter of lack of education on how STDs and HIV are transmitted? Or is it pressure from clients to have unprotected sex with the FSW?
Staying with Nigeria, the BBC has a report on the treatment of people living with HIV in Nigeria. Maryam Tamakloe echoes the experience of Masias Cowper when she speaks of the stigma and ostracisation by her community and family.
I’m a mother of two living with HIV and Aids. I got to know my HIV status three years ago when I was four months pregnant. When I discovered this, it felt like the end of the world for me because being a person living with the virus in Nigeria is a terrible thing. I felt like going in front of a car so it could smash into me or going to Lagos’s beach to fall in the water. When I went to tell my family that I was HIV positive, I had to first explain to my mother what HIV was. She said to me that she did not care if I was HIV or not. With my husband, it was more difficult. He tried to chase me out of the house. But I have a little boy and there would have been nobody to take care of him. “You have to sit and take care of your child,” he said. After that I kept going to the clinic and bringing back leaflets for him explaining what HIV was all about. Thank God, now he knows.
When people know that you have HIV it is very difficult to get a job. Your colleagues, your landlord and your people stop having anything to do with you. Your family may even build a separate room for you and leave you there to die. When I went to have my baby I was supposed to have a caesarean section, but the staff refused to do the operation because I was HIV positive. The folder at the end of my bed was marked “WXYZ” in large letters – a euphemism meaning that you’re HIV positive and on your way out. I was in the ward for three days before the labour came, but the nurses were not there for me. They were just looking at me and then passing by. A doctor came by at last and saw I was in terrible pain and helped me. Thank God my baby was born HIV negative. …………
I recently lost a friend whose husband was HIV positive. He had been going to the clinic to collect his drugs but he refused to tell his wife at home that he had Aids. At the end of the day she died and he’s still alive. She left behind a four-year-old daughter. It is difficult in our society for women to protect themselves against the virus. If a woman talks about a condom people will think she is a prostitute. If you tell your husband to use a condom he will ask you, “Did I marry you for you to give me an order?
For me taking ARVs (anti-retroviral drugs) is difficult because it is for a lifetime. You have to take them according to the time, you can’t miss one day or else you’ll get complications. But without free treatment I would not be here today; my boy would not have been born negative; my husband would have no wife and my son would have no mother.
I have been helped by a non-governmental organisation in the city. However, millions are not as lucky as me for them tests and drugs cost money. What about the ones in the village? Death is the only escape from the shame they are made to feel. Right now what I want from the conference in Toronto is for them to stop speaking too much – they need to act fast because there are a lot of people out there dying. HIV has turned into a business here. People are using us to collect money from donors but at the end of the day it is not used for us. Nothing is done. As a basic health right we need free voluntary counselling and testing, free monitoring and free ARV drugs. Without free testing and treatment we have no future and our children have no hope. Do not let us die like dogs in the streets.
The inteview seriously questions Nigeria’s HIV programme that was announced some months ago which was supposed to provide free ARV treatment – obviously it is not working at this time. I will be talking to a Nigerian LGBT and HIV activist and someone in the medical profression hopefully next week to find out more about how that programme is working and if it is filtering down outside of major cities centers. For the millions of women in Nigeria and elsewhere in the South who are not yet able to get ARV treatment, even when microbicides are available it will still be a long time before they have access to the treatment and meanwhile death is knocking on the door.
Links: Report from Uganda : HIV: Women get hope in Microbicides by Gracia Machel