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Archives for February 2018

Female Condoms: A Woman-Centered Option

In honor of National Condom Month, ASHA asked our colleagues at the Center for Health and Gender Equity (CHANGE) to help us educate about female condoms. Kate Segal (Sexual and Reproductive Health and Rights Policy Analyst, Global Health Corps Fellow) and Beirne Roose-Snyder (Director of Public Policy) share their thoughts on this woman-centered contraceptive option.

When women and girls dictate a prevention agenda, they account for their own unique prevention and pleasure needs that stem from their lived realities. What technologies exist that can both prevent unintended pregnancy and HIV and sexually transmitted infections (STIs)? Are these products easy to access? Do they make sense for women and girls’ bodies? Do they feel good—and maybe even enhance sex?

Woman-centered contraceptive options, which are designed with these questions in mind, promote the right to a safe, full, and enjoyable sex life—one where women and girls can make free and informed decisions about their sexuality without coercion, violence, or discrimination, through access to the information and interventions necessary for their sexual and reproductive health. Plus, sex can be pleasurable. Women and girls want and should have control over interventions that allow sex to be pleasurable for them while reducing unwanted or unintended outcomes.

Female condoms, also known as internal condoms, are one tool that achieves these objectives. They are the only dual-protection method designed for women to initiate that effectively protects against sexually transmitted infections (STIs), HIV, and unintended pregnancy. They can be used by people of all genders who participate in receptive vaginal or anal sex. Studies have shown that female condoms have pregnancy1 and STI prevention2 rates comparable to male condoms.

Female condoms promote safety, particularly for women and girls. Unlike male condoms, female condoms can be inserted hours ahead of foreplay and intercourse. This feature provides women with options when they may not be able to safely negotiate male condom use, such as sex workers who are at risk of violence or whose clients refuse condom use3, or women who experience intimate partner violence.

For women living with HIV, female condoms are vital to their health and the health of their sexual partners, as they protect compromised immune systems from STIs and decrease the per-act probability of HIV transmission by over 90 percent.4

With the spread of the Zika epidemic, U.S. agencies have recommended including female condoms in Zika virus prevention efforts. While many people in Zika-affected countries know that the Zika virus is spread by mosquitoes, fewer are aware that the Zika virus is also sexually transmissible. Female condoms simultaneously prevent the sexual transmission of the Zika virus, including for pregnant women, and unintended pregnancies for women at risk of contracting Zika.

In addition to practical, female condoms are pleasurable. The outer ring of the condom covers the labia, which can lead to extra stimulation while reducing the risk of transmitting skin-to-skin STIs. Female condoms serve as an essential resource for women to plan pregnancies and have safe, healthy, and enjoyable sex.5

While female condoms should be made widely available among a comprehensive array of contraceptive methods, they face multiple barriers to access. Uptake of female condoms can be difficult to generate due to their unfamiliarity and misuse. According to a 2005 study by the Guttmacher Institute, the female condom slipped out the first time for 11 percent of women. Educating women on how to insert female condoms is essential and empowering.

Availability of female condoms in the United States also remains limited. The FC2 is currently the only female condom brand approved by the U.S. Food and Drug Administration (FDA). But this could change soon. In December, the FDA proposed reclassifying the female condom to a “Class II medical device,” the same classification as the male condom. The government agency also recommended changing the name from “female” to “internal.” Proponents argue that this move could broaden access to female condoms because they would not need pre-market approval.

Globally, female condoms are often procured in smaller quantities along with male condoms by ministries of health and donor governments, without the necessary investment in programming and demand creation. Otherwise hindered by much of the same stigma and politicization as other aspects of women’s sexual health, female condoms can thrive in environments with open discussion of their insertion and use, peer education, and ready access. After all, health commodities don’t normalize themselves. With more work and investment in generating excitement around woman-centered options that recognize their diverse needs and experiences, women and girls will be empowered to decide what prevention means to them. Better, safer sex awaits.

References
  1. James Trussell, Contraceptive Efficacy, in CONTRACEPTIVE TECHNOLOGY 747, 750 (19th rev. ed., Robert Hatcher et al., eds., 2009). See also Julia Matthews & Teresa Harrison, An Update on Female-Controlled Methods for HIV prevention: female condom, microbicides, and cervical barriers, 7 S. AFR. J. HIV MED. 7, 7 (2006)
  2. P.P. French et al., Use Effectiveness of the Male Condom in Preventing Sexually Transmitted Disease in Women, 30 SEXUALLY TRANSMITTED DISEASES 433, 433 (2003); Paul Feldblum et al., Female Condom Introduction and sexually transmitted infection prevalence: results of a community intervention trial in Kenya, 15 AIDS 1037, 1043 (2001); Arnaud Fontanet et al., Protection against sexually transmitted diseases by granting sex workers in Thailand the choice of using the male or female condom: results from a randomized control trial, 12 AIDS 1851, 1858 (1998)
  3. Holly Swan & Daniel O’Connell, The Impact of Intimate Partner Violence on Women’s Condom Negotiation Efficacy, 27 J. INTERPERSONAL VIOLENCE 775, 788 (2012); Thulile Mathenjwa & Pranitha Maharaj, ‘Female condoms give women greater control:’ A qualitative assessment of the experiences of commercial sex workers in Swaziland, EUR. J. CONTRACEPTION & REPROD. HEALTH CARE 383, 389-90 (2012).
  4. James Trussell, Contraceptive Efficacy, in CONTRACEPTIVE TECHNOLOGY 747, 750 (19th rev. ed., Robert Hatcher et al., eds., 2009). See also Julia Matthews & Teresa Harrison, An Update on Female-Controlled Methods for HIV prevention: female condom, microbicides, and cervical barriers, 7 S. AFR. J. HIV MED. 7, 7 (2006)
  5. Alice Welbourn, Sex, life and the female condom: some views of HIV-positive women, 14 REPROD. HEALTH MATTERS 32, 32 (2006).

HSV Rates Dropping

Rates of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) dipped between 1999 and 2016 according to the Centers for Disease Control and Prevention (CDC).

Among those in the U.S. ages 14-49 the prevalence of HSV-2 in 2016 (all of those with HSV-2 in the age range being studied) was 12%, down from 18% in 1999. Approximately 1 in 8 individuals in this age group have HSV-2, which is almost always experienced as a genital infection. Most individuals with genital herpes are undiagnosed and not aware they have the virus.

HSV-1 prevalence also dropped during the same period, from 59% in 1999 to 48%. HSV-1 is typically experienced as an oral infection (cold sores) but research suggests HSV-1 is found with nearly half of all new genital herpes infections.

The data were collected as part of the National Health and Nutrition Examination Survey (NHANES) and reported in Prevalence of Herpes Simplex Virus Type 1 and Type 2 in Persons Ages 14-49: United States, 2015-2016 (McQuillan et al). NHANES is a series of continuing studies assessing the health of adults and children in the U.S.

For more on HSV including testing and prevention visit ASHA’s Herpes Resource Center.

February 7th

HIV stands for Human Immunodeficiency Virus. It is the virus that causes AIDS. AIDS stands for Acquired Immune Deficiency Syndrome. HIV can be transmitted through the blood, sexual fluids, or breast milk of an HIV-infected person.

Over time, infection with HIV can weaken the immune system to the point that the system has difficulty fighting off certain infections. These types of infections are known as opportunistic infections. These infections are usually controlled by a healthy immune system, but they can cause problems or even be life-threatening in someone with AIDS.

A blood test can determine if a person is infected with HIV. Too many people don’t know they have HIV. In the United States, nearly 1.1 million people are living with HIV, and almost one in five don’t know they are infected. Getting tested is the first step to finding out if you have HIV. If you have HIV, getting medical care and taking medicines regularly helps you live a longer, healthier life and also lowers the chances of passing HIV on to others.

If a person tests positive for HIV, it does not necessarily mean that the person has AIDS. A diagnosis of AIDS is made by a physician according to the CDC AIDS Case Definition. A person infected with HIV may receive an AIDS diagnosis after developing one of the CDC-defined AIDS indicator illnesses. A person with HIV can also receive an AIDS diagnosis on the basis of certain blood tests (CD4 counts) and may not have experienced any serious illnesses.

FAQs

Where did HIV come from?
There are many theories about the origin of HIV. The first known case was found in a blood sample collected from man from Kinshasha, Democratic Republic of Congo in 1959. Genetic analysis of this blood suggests that the origin of HIV came from a single strain of HIV-1 in the 1940s or 1950s. In the U.S. the virus is known to have existed since the mid 1970s. Symptoms of rare types of what are now known as opportunistic infections began manifesting themselves between 1979-1981. HIV was first isolated by scientists in 1983. The virus was at first called HTLV-III/LAV (human T-cell lymphotropic virus-type III/lymphadenopathy- associated virus) by an international scientific committee. This name was later changed to HIV (human immunodeficiency virus).
What is AIDS?
A diagnosis of AIDS (acquired immune deficiency syndrome) is made by a physician. An HIV-infected person may be diagnosed with AIDS if he or she meets certain clinical criteria. Criteria include becoming sick with an illness defined by the Centers for Disease Control and Prevention (CDC) as an AIDS-indicator illness (illnesses that take advantage of the body’s weakened immune system) and/or by taking a blood test that shows that the person’s immune system is severely damaged.
What are the symptoms of HIV?
Most people infected with HIV do not know that they have become infected, because they do not feel ill immediately after infection. However, some people do experience a illness with fever, rash, joint pains and enlarged lymph nodes. If an immune reaction to HIV occurs, it usually takes place between 1 and 6 weeks after HIV infection has happened. A person with HIV may look healthy and feel good, but they can still pass the virus to you, especially during the initial infection period. You cannot tell if someone has HIV by just looking at them. The only way to determine whether HIV is present in a person’s body is by testing.
How does HIV become AIDS?
AIDS is a disease caused by HIV. HIV infects cells of the human immune system and destroys or impairs their function. Infection with this virus leads to slow destruction of a persons’ immune system making them more susceptible to many kinds of infections. Once a person with HIV develops any one of a number of rare infections or cancers – tuberculosis, pneumonia, candidiases or tumors – they are said to have AIDS. This most often occurs 10-15 years after a person becomes infected with HIV.
How long does it take for HIV to cause AIDS?
According to the Centers for Disease Control and Prevention (CDC), prior to 1996, scientists estimated that about half the people with HIV would develop AIDS within 10 years after becoming infected. This time varied greatly from person to person and depended on many factors, including a person’s health status and their health-related behaviors.

Since 1996, the introduction of powerful anti-retroviral therapies has dramatically changed the progression time between HIV infection and the development of AIDS. There are also other medical treatments that can prevent or cure some of the illnesses associated with AIDS, though the treatments do not cure AIDS itself. Because of these advances in drug therapies and other medical treatments, estimates of how many people will develop AIDS and how soon are being recalculated, revised, or are currently under study.

How common are HIV and AIDS?
According to the Centers for Disease Control and Prevention (CDC), approximately 1 million persons in the United States are living with diagnosed or undiagnosed HIV/AIDS. CDC estimates there are over 41,000 new HIV infections in the United States each year.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that, since the beginning of the epidemic, almost 60 million people worldwide have been infected with HIV and 25 million people have died of HIV-related causes. UNAIDS estimates that about 33.4 million people worldwide were living with HIV in 2008.

Who does HIV affect?
There are various risk factors that make some people more at risk for contracting HIV than others. Most people, however, run some risk of contracting HIV as they share in one or more of the following risk factors:

  • Unprotected vaginal, anal, or oral sex
  • Early age of first sexual activity—It is common for youth to engage in sexual activity before receiving information about HIV prevention
  • Heterosexual sex–Women and minorities are particularly vulnerable to HIV infection
  • Men who have Sex with Men (MSM)–Stigma and discrimination make it more difficult for MSM to access testing and counseling services
  • Sexually transmitted infection (STIs)–The presence of other STIs can greatly increase the likelihood of HIV transmission
  • Unprotected vaginal, anal, or oral sex
  • Exchange sex for money
  • Substance abuse—Chronic and intermittent substance users are more likely to engage in high-risk behaviors while using. Injection drug users also run the risk of being infected by HIV while sharing unclean needles.
  • Poverty—Socioeconomic factors can directly and indirectly influence a person’s vulnerability to HIV infection. For many people poverty prevents access to quality health care.
  • Out-of-school youth—Those that drop out of school are more likely to become sexually active younger and less likely to use condoms and other types of contraception.
  • Lack of awareness—Many people, particularly youth, don’t recognize the ways in which they are vulnerable to HIV infection, making them more likely to behave in ways that put them at risk.
How safe is the U.S. blood supply?
The U.S. blood supply is one of the safest in the world. Infection through blood transfusion and other blood products is rare. Since 1985, the blood supply has been ELISA tested for HIV. According to the CDC, an estimated 1 in 450,000 to 1 in 660,000 donations per year are infectious for HIV but are not detected by current antibody screening tests. In 1995, blood banks also began testing with P24 tests along with ELISA, to detect infection with HIV during this window period. As technology advances, the blood supply will become even safer.
How is HIV transmitted?
HIV can be transmitted through the blood, sexual fluids (semen, preseminal fluid, or vaginal fluid) or breast milk of an HIV-infected person. People can get HIV one of these fluids enters the body by way of the mucous membranes (the soft, moist skin found in any opening of the body) or the bloodstream. The virus can be passed during unprotected vaginal, anal or oral sex with a HIV-infected person. An HIV-infected mother can transmit HIV to her infant during pregnancy, delivery or while breastfeeding. People can also become infected with HIV when using injection drugs through sharing needles and other equipment (or works) including cookers and cottons with someone who is infected.

The risk of transmission varies with the type of exposure (e.g. sexual, needle sharing, etc.) The Centers for Disease Control and Prevention offers a table quantifying the this HIV transmission risk that comes from different types of exposures. See the table and explanation at the CDC website.

How effective are latex condoms at preventing HIV?
Studies have been done to test how well latex condoms work for preventing HIV transmission. This research has shown that latex condoms are highly effective at protecting a person from transmitting or becoming infected with the virus. The studies were done on HIV-negative individuals at high-risk for the disease because there partners were HIV-positive. Latex condoms used consistently and correctly were effective 98-100% of the time.

While not having sex or to having sex with a long-term mutually monogamous partner who is not infected with HIV or other sexually transmitted infections (STIs) is the only way to protect yourself completely, latex condoms used consistently and correctly are highly effective in preventing HIV and many other STIs.

Can I get HIV from casual contact?
HIV is not transmitted by day-to-day contact in social settings, schools or in the workplace. You cannot be infected by shaking someone’s hand, by hugging someone, by using the same toilet or drinking from the same glass as an HIV-positive person, playing sports with or by being exposed to coughing or sneezing by anyone living with HIV. There is no evidence that HIV is spread through kissing. So you should not be fearful of interacting with persons who are living with the disease.

February is National Condom Month 

ASHA recognizes each February as National Condom Month. Follow us all month long at #CondomMonth and take advantage of everything we offer:

Female/Internal Condoms

While male condoms tend to get the lion’s share of attention, the female condom is another great alternative to prevent both sexually transmitted infections (STIs) and unintended pregnancy. The female condom—also called the internal condom—offers the additional advantage as a form of contraception and STI prevention that a woman can independently control. Its outer ring also offers better protection from STIs that can be spread from skin-to-skin contact. Another bonus—it stays in place whether or not a male partner maintains an erection.

Learning how to use a female condom might take a little practice, but it’s easy when you learn what to do. The video below offers a step-by-step guide on using female condoms.

Just as with male condoms, and other types of contraceptives, female condoms appeal to people for a variety of reasons. We asked what you guys thought of female condoms and here is some of your responses:

I love using female condoms. They’re nice because you can use them a little before a date so you don’t have to worry about not having one when the time for sex comes! Also, I feel so much more with a female condom, compared to a traditional condom. Definitely recommend! <3

I’ve only used female condoms with one partner, but they worked great. They allowed us to experiment with switching back and forth between penetrative sex and other fun stuff that didn’t involve genitals. He didn’t have to worry about removing and putting on another condom if he didn’t stay completely erect during sexy time, too. Basically, it allowed us to mimic the behavior of non-barrier protected sex more easily than if we had used a traditional condom.

I sometimes use female condoms for getting myself off alone. They allow me to put a variety of objects inside myself. The continuity of the material from inside to out, along with the outer ring, transfers the pressure of things to a broader area and creates some absolutely exquisite sensations.

Spread the Word

Below are sample Tweets and Facebook posts you can share throughout the month.

  • Wrap it up! February is National Condom Month. Learn more @ http://ow.ly/XOQj8 #CondomMonth
  • Free fact sheet download – Male Condoms & Female Condoms. http://ow.ly/XOR8H #CondomMonth
  • How to Use a Condom animation. http://ow.ly/XORou  #CondomMonth
  • ASHA’s Condomology busts myths & gets out the facts about condoms. Plain language to empower YOU. http://ow.ly/XOQId #CondomMonth

  • February is National Condom Month (#CondomMonth). Visit ASHA to learn more. It’s YOUR health – take charge and be safe!
  • During National Condom Month in January ASHA is offering a free download of the fact sheet Male Condoms & Female Condoms. Get yours at ASHA. #CondomMonth
  • During National Condom Month in February you can download fact sheets and more from ASHA. Get involved, make a difference! #CondomMonth
  • Condomology is an ASHA program to ensure that the facts about condoms are available and understood by all so consumers can make informed choices about their sexual health. FAQs, posters, videos, and more. Get the facts and take control of your sexual health. #CondomMonth

Condoms Unfurled

National Condom Month is always my favorite blog of the year to write. The condom. All sorts of shapes, sizes, colors (even glow-in-the-dark). Ribbed or plain. Lubed or not. Latex or plastic (and natural skin, although that variety isn’t as effective as the others against sexually transmitted infections). Now we even have female condoms, amazing products that are a female-controlled method of contraception one can even insert several hours ahead of having sex.

When I was a teen, my fellow adolescent wise-guys and I were a bit awed by condoms. They were serious business back in the day; simply possessing one conferred a certain level of credibility. They were kind of scary, too, a foil-wrapped reminder that we were taking our first steps into the world of adults and serious stuff. You were never quite sure how to use one, despite the best efforts of the basketball coach who was co-opted into double duty as the generic “health” teacher (which resulted in the Commonwealth of Virginia entrusting him with our school’s fledgling sex ed curriculum for boys. I think he taught driver’s ed one semester, too).

Condoms were exotic, mysterious, and, as I mentioned, a bit intimidating: come on, does anyone really need to unroll one all the way? They were ABSOLUTELY hidden from our parents, too, with the same level of Top Secret access usually assigned to a pack of smokes or a purloined copy of Playboy.

That latter point was a problem, of course, and I suspect it’s not altogether different today. Given how many teens are sexually active (CDC data says 41% of high school students have had sex), how often they don’t use protection (the same data says about 43% of kids who had sex in the last few months didn’t use a condom), and the fact that sexually transmitted infections are rampant in young people (half of all STIs occur in youth….HALF!) it’s important that we put condoms in a distinguished front and center, full-view position.

Condoms are inexpensive, easy to find, not hard to use (a little instruction never hurts, though!) and really, really effective against HIV, chlamydia and a host of other STIs when used – as the public health mantra goes- consistently and correctly. Not a bad choice against unintended pregnancy, either.

Parents: Your kids won’t have sex because they learn about condoms (trust me, they’ll figure out about sex regardless) but with your guidance, they can learn how to protect themselves when they do become sexually active. Sure, you’re nervous, it’s not the easiest thing to discuss, and I get it. Don’t worry – do your best, be genuine, let them know they can talk to you about anything (including sex) and tell them about condoms. ASHA has a parent’s guide to help you have the birds & bees talk, too.

Everybody else: Did I mention condoms work? They do! Use them, admire them, give them to your best buds, and take them seriously.

We have loads of great resources for you during National Condom Month, so visit us for condom do’s and don’ts, videos, talking points if your partner is reluctant, and much more.

–Fred Wyand

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