Marriage increases the frequency of sex and impedes a woman's ability to negotiate condom use or abstain from sex.
24 August 2011
"WOMEN think that when you're married, you don't have to worry about HIV. They think it is a safe haven,"said Beauty Nyamwanza of the National Aids Council.
But marriage can actually fuel the risk of HIV among women, particularly the young.
Research has shown that marriage increases the frequency of sex and impedes a woman's ability to negotiate condom use or abstain from sex.
In essence, married women find it difficult to request their husbands to use condoms, even to use one themselves as this would be seen as if they are promiscuous.
When Aids first struck in the 1980s, it mainly affected men. Now, globally about half of the 33,3 million people infected with HIV today are women, and in sub-Saharan Africa, the share rises to 60 percent.
The large majority are infected through unprotected sex with their husbands or long-term primary partners.
Nyamwanza recently told a media seminar in Kadoma: "Marriage, once thought to protect women from sexually transmitted infections, puts many girls and women, especially those who marry much older and more sexually experienced men, at risk."
But with interventions of Nyamwanza and others, Zimbabwe is one of the countries that has made impact with the female condom and has made great strides in promoting its use.
The latest device, the FC2 is a strong flexible nitrile sheath, about 17 centimetres long, with a flexible ring at each end.
The closed end is inserted into a woman's body, and the open end remains outside during intercourse.
Like the male condom, it offers dual protection against unintended pregnancy and sexually transmitted infections, including HIV.
Also, it has a key advantage, it is the only available technology for HIV prevention that women can initiate and control.
Zimbabwe is cited as a success story in female condom use and has the highest distribution and sales of the condom in the world, according to the United Nations Population Fund.
"This is as a result of strong civil society participation, innovative social marketing, comprehensive condom distribution mechanisms, capacity building of service providers in the public, private and social marketing sectors as well as sustained political will, financial and technical support from the Government and funding partners respectively," says Sinokuthemba Xaba, the National Condom
Programme Co-ordinator in the Ministry of Health and Child Welfare.
He also says, "Our case provides important insights for female condom introduction, effective distribution and programming and high rates of acceptability."
Considering that choices to prevent HIV are limited, the female condom is the only available method which offers some degree of control to women who wish to protect themselves and their partners from the risk of sexually transmitted infections(STIs)/HIV and unwanted pregnancy.
The female condom is a tool that women can use to negotiate for safer sex as well as to facilitate communication with their partners about other reproductive health issues.
"The female condom is a tool that women can use to negotiate for safer sex as well as to facilitate communication with their partners about other reproductive health issues," Xaba says.
Women's rights and reproductive health organisations played a vital role in bringing female condoms to the country through identifying a need for the product and advocating Government's support in procurement.
First, an acceptability study on a small sample of family palling participants in rural areas and sex workers was conducted in 1995.
The results of this study found female condom acceptability to be over 50 percent among all categories of women, according to the Ministry of Health and Child Welfare.
Consequently, the Women and Aids Support Network mobilised 30 000 people, most of whom were women, to petition Government to introduce the female condom.
The Ministry of Health and Child Welfare responded and the female condom was brought into the country.
"Women and Aids Support Network (WASN) organised a successful, nationwide petition drive in support of female condoms that coincided with the government's efforts," says Mary Sandasi, WASN Executive Director.
In 1997 the female condom was made widely available through public sector outlets.
Soon after this launch, the female condom public sector programme conducted a pilot study in 30 districts (six of which were urban and 24 of which were rural). This study lasted for approximately one year and its results indicated 74 percent and 91 percent acceptability levels in men and women respectively.
At first, acceptance of the female condom was low due to policy and programmatic constraints; especially limited stock availability made it impossible to meet the demand that had been created and a general lack of strategic direction and coordination marked the erratic nature of the public sector programme.
In 2002, new attempts were made to develop a targeted female condom strategy, but efforts again came to a standstill due to the inability to secure regular supplies.
Despite significant envisaged potential, the public sector programme failed to maintain a high degree of coverage.
On the other hand, as initial curiousity and interest drove people to try this new product, the social marketing programme experienced a sudden increase in sales soon after introduction of the female condom in 1997.
This later stabilised.
In response to this, the Government requested support from UNFPA to enhance the promotion of both the female and male condoms through the public sector.
Population Services International (PSI) adopted a targeted marketing approach to the female condom in 2001 and has since expanded the social marketing programme to married women, women living with HIV and Aids, women in discordant relationships, and young females (aged 19-25).
Annual distribution increased steadily between 2001 and 2005.
In 2005, PSI expanded its channels to include groups of sex workers, groups of People Living with HIV and Aids, Care and Support Organisations and tertiary institutions.
Currently, sales continue to thrive.
Recognising the need for a more strategic urban/rural and public/social marketing approach in Zimbabwe, UNFPA facilitated and supported Government in forming a Technical Support Group on condom programming.
The TSG, comprising of representatives from the Ministry of Health and Child Welfare, the Zimbabwe National Family Planning Council, PSI, civil society organisations and donors, assisted the government in undertaking a Female Condom Research review as well as a situation analysis to provide evidence for the development of a national female condom strategy for 2006-2010.
In addition to training condom promoters, PSI used various ways to educate the public about condom use.
Langton Ziromba is one person who was trained in the promotion of female condoms.
He lives in Budiriro where he owns a small, outdoor barbershop. Ziromba provides information about female condoms to his clients, the advantages to both partners and how they are used.
He is one of 70 barbers and 2 000 hairdressers in Zimbabwe who were trained to promote the female condom.
Ziromba sells one of the country's most popular brand, the Care condom.
One of the partners in this programme is the Zimbabwe National Family Planning Council (ZNFPC).
Margaret Butau, of the ZNFPC says her organisation's research shows that for this product to be acceptable and used by women there is a strong need to involve men.
"We customise the benefits of the female condom according to the target group," she says, adding that specific points highlighted in this education drive aimed at men include the fact that the female condom is not constricting like the male condom, does not break easily, its use does not require an erection and it enhances pleasure for both partners. Even better: it is not ideal to withdraw immediately after ejaculation. Above all, she says, it is the woman's responsibility.
"When this is discussed with the men, we find that men become curious about having their partners try the product."
Most women interviewed had a lot of praises for the female condom. But they said it was difficult to make their husbands use it at first. They laughed about its size and shape, about their partners' first reaction to it, and about the changes it had brought to their relationships.
"When I took it home for the first time, my husband quarreled with me, saying he would never eat a sweet with its wrapping on," said a 35-year old women from Dzivaresekwa. Most of the women said that using the female condom had given them courage to discuss sex with their husbands and boyfriends.