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Siyayinqoba Beat It! 2005 Episode 16 –

Female Controlled Prevention

Globally women are more at risk of HIV infection than men. Women’s position in communities, gender-based violence and the fact that many women are not empowered to negotiate safer sex, make them especially vulnerable to HIV. The Siyayinqoba Beat It! team asked: What preventative methods are available in South Africa to help women protect themselves from infection by HIV and other STIs?

Jason Wessenaar: Kgotsong re ya le amohela mona ho Siyayinqoba Beat It! Support Group. {Sesotho} [Hello and welcome to the Siyayinqoba Beat It! Support Group.] My name is Jason. In the Siyayinqoba Support Group we are all living positively with HIV. Each week we get together to talk about issues that affects our lives with HIV; from overcoming stigma and denial to dental health and HIV. I-Siyayinqoba wuhlelo lwakho lokuphila ncono ne-HIV. {isiZulu} [Siyayinqoba is your guide to living positively with HIV. If you are living with HIV] or you have a friend, a family member or a partner who is HIV positive this program is for you. Globally women are particularly at risk of being infected with HIV. Women are not empowered to negotiate safer sex with their partners. Gender based violence as well as women’s position in the community contributes in making women more vulnerable to HIV infections. The only way for women to protect themselves is to find a preventative method that women can use. You can stop HIV infections more effectively if women had an easy way of protecting themselves before vaginal intercourse. Products that can protect women from HIV infection are called microbicides. Currently non are proving to work but there’s a global effort supported by UNAIDS, the World Health Organisation and our own government to find effective microbicides. We would like to welcome Ntombenhle. Welcome, but first the Siyayinqoba team traveled to Durban to meet Dr Gita Ramjee form the Medical Research Council. Dr Gita is making research on the effective use of microbicides, let’s take a look.

Can we develop effective microbicides?

Durban, KwaZulu Natal

Dr Gita Ramjee: I’m Dr Gita Ramjee and I’m the Director of HIV Prevention Unit of the South African Medical Research Council based in Durban. I’m currently running all HIV prevention programmes and this is mainly focused on women controlled HIV prevention options. The largest number of people infected with HIV/AIDS lives in sub-Saharan Africa. And what we find that in sub-Saharan Africa over 60% of the people infected with HIV are women. And these are young women in the ages of between 15 and 24. Several years ago we saw this emerging epidemic among the women the phase of HIV/AIDS was becoming a phase of a woman. And there was this need to try to find some protective measures for women. And many third world countries, women are economically dependent on their male partners. A lot of them stay at home and look after the children and are doing work at home. And when the woman is economically dependent on the man she’s not gonna jeopardise her daily bread and butter or money for her to look after her children and insist on condom use. And that’s where the problem is. There isn’t a platform where there is equality on sexual negotiations and safe sex practice. So we trying to test products that not only prevent HIV but will also prevent other sexually transmitted infections that will enhance the acquisition of HIV. As a woman and as women elsewhere we realise that there is a need for products that will allow for pregnancy but prevent infections. So we’re trying to look for contraceptive and non-contraceptive products. Microbicides are products that are formulated either as gels or creams and which has an active ingredient which can combat HIV and STIs. The ideal microbicides should be odourless, it should be easy to use, it should be absolutely safe. This microbicides will be packaged in a tube like this, for example. And the woman will twist this, insert the tube in the vagina and then squeese the product into the vagina and line the vaginal wall. Just like microbicides we are looking at all different options for control of HIV infections among women. And another trial that we currently busy with and we’ve completed two years of it is the use of vaginal diaphragm in the prevention for HIV. The trial is being conducted in Zimbabwe and in Johannesburg and at the Durban side here at the Medical Research Council. We’ve almost completed enrollment, infact we have 1460 women on the trial already. And the women are using a vaginal diaphragm.

Man: Yiyona i-diaphragm ke le. Bese uphuthuzela la ngaphakhathi nendawo lapha kwi-diaphragm. Bese uyayigqoba ngaphambe yokuthi uyifake, bese uyayigqoba gqoba. Mawuqeda lapho uzoyibamba kanje ingalingani uze ukwazi ukuyishotheka ngaphakathi. Uma uyishotheka, uyishotheka ngathi uyiyisa ngaphantsi. {IsiZulu} [This is a diaphragm. You put this gel in the center of a diaphragm. Then you spread the gel evenly around it before insertion. Once you’ve done that, you squeeze like this for easy insertion. When you insert it you do so in a downward motion.]

Dr Gita Ramjee: Well, the only one’s that are are the microbicides that I talked about, the vaginal diaphragm and the female condoms. So those are the three options. One of the issues around female condoms is that a lot of couples don’t like it because of the noise it makes during the sexual intercourse. And secondly, it’s not always, some woman complain that, it’s not that comfortable. You can’t sort of insert it and walk around or something like that. But I think we shouldn’t say that it’s not a positive thing, people need to have options. And there’s a female condom, some couple may like the female condom some people may like vaginal microbicide. But what will be great it will have a combinations of products to enhance the preventative measure.

Support Group

Jason Wessenaar: It seems to me that microbicides will give women a lot of power, in terms of sexual reproductive rights. But do you guys think women will welcome microbicides, they’ll use them?

Busisiwe Maqungo: Mna Jason, ndicinga bangayamkela kakhulu ngoluhlobo izabanika i-independence ebantwini abangamadoda, abazuxhumela kubantu bamadoda into yoba basebenzise i-condom, ngoku it’s something made for bona bangaxhomekekanga kubo. {IsiXhosa} [I think women will happily accept them because they will not be dependent on men, it’s a product made for them.]

Prudence Mabele: As an HIV positive woman it doesn’t mean that ha ke batle go etsa ngwana. Ha o ka sheba hore ha o etsa tshepetso ya kemariso ya maikeketso, ho a tura hona jwale ke bo R15 000. So ela e tlabe fela e le jele ebile o kgona le ho thola ngwana, hobane re na le balekani ba bangata ba bang ba nale HIV, ba bang ha bana yona ebile ba batla ho etsa bana. E tlo thusa ntho tseo tsa reproductive health. {Sesotho} [I don’t want to have children. And if you look at the artificial insemination process, it’s very expensive right now, it costs around 15 000. So you can just use this gel and still have a baby, because in many couples one person can be HIV negative, and the other HIV positive and want children. So this will help with reproductive health issues] and that to me is excellent.

Ntombenhle: Abanye abantu besilisa bayathanda ukuthi ama-condom mancane. Babe ne-excuse ukungawasebenzisi. Avele umuntu athi incane, uma uthi usebenzisa leyabantu besifazane athi heyi iyaraas, manje ngiyacabanga ukuthi manje le-gel izobamba ichiza ilekhulu,abaningi bazoba right ngoba hey. {isiZulu} [Some men say they won’t use condoms because they are too small. When you use a female condom, they say it makes a noise, so I think the gel will play a huge role, most people will want to use it.]

Busisiwe Maqungo: Abantu bazakuza naso i-story nalapha kwi-gel, bazenazo izitory kwi-male condom, baze nazo kwi-female condom, nakwi-gel bazoza nazo. {isiXhosa} [People have come up with excuses for male condoms and female condoms, so they will probably also make excuses about using the gel. Something is gonna come out.]

Jason Wessenaar: But the thing is everybody comes up with a story. Even women come up with stories that you know, they allergic to condoms or they don’t want to use condoms. So I think we need to find a balance.

Busisiwe Maqungo: Ja, I think that is why kufanele kubene-microbicides so that bazoba necontrol over i-sexual life abantu abangomama. {isiXhosa} [So I think that is why the microbicides should be available, so that women have control over their sexual lives.]

Prudence Mabele: So how do they test this product? Haeba tshwanetse ba sebedisa khondomo, hobane le ha o kare mo basading ba phelang ka HIV, kenya gel o sebedisa le khondomo o kase kgone ho ba le di ditholwana tse. {Sesotho} [If they are supposed to use condoms, because if an HIV positive woman uses the gel and condoms you will not get conclusive results.]

Lihle Dlamini: Ama-studies siyazi ukuthi anamaphases ahambe ngawo. It could be bakwi-first phase were they are checking i-safety yayo i-microbicide ukuthi is it safe yini makungabe ingenile kuwe ngaphakathi ayiyenzi amanye ama-infections. {isiZulu} [The studies have different phases. It could be that they are in the first phase where they check safety of microbicide reactions in the body, like secondary infections.]

Ricardo Moses: I think the microbicide will be a good solution because you get people which is on ARV treatment, both the man and the husband is on ARV treatment. And they think they not gonna use condoms. You get that people out there who’s not using condoms. So I think that maybe the microbicide will be a solution for re-infection.

Jason Wessenaar: Do you guys think {Sesotho} [the microbicides if they were there then they would’ve changed your situation?]

Prudence Mabele: They could’ve changed my life instead of talking about a condom. You know in the early days before I got infected I spoke to, you know, my partner and I said: “Can we use a condom”, but then condoms were not like everywhere. But I knew a condom as a rough rider; I remember I said: “Can we use a rough rider.” And you know that didn’t happen he’s response was: “There’s a morning after pill, so don’t worry about pregnancy.” They will just be fine, you understand.

Anthony Fernandes: I believe that if they successful by getting these microbicides down by getting them to what it needs to do it will be forever life changing for the whole idea of how we perceive safe sex to responsibilities and the convience. I mean just that whole thing of somebody like me who is HIV positive and I’m constantly thinking is the condom on, is the condom right, is it ripped off, is it ripping, you know, that playing policemen the whole time at the back of my mind. As to having this odorless gel that you can’t even tell most likely it will be there protecting you against STIs, protecting you against HIV hopefully against pregnancy. I mean there is so many cons and conveniences and I think it’s the most fantastic thing that can possibly, possibly happen. I’m excited.

Jason Wessenaar: Our discussion on microbicides continues after this short break. Stay tuned.

Jason Wessenaar: Mmuhi re ya ho amohela hape mona ho Siyayinqoba Beat It! Support Group {Sesotho} [Welcome back to Siyayinqoba Beat It! Support Group] – the program for everyone infected and affected by HIV. We are talking about female controlled prevention. The microbicide will be a solution for women to protect themselves, but what we have right is female condom. Government distributes female condoms in limited numbers .But is it something that many women could be using right now. The Siyayinqoba team traveled to Tzaneen to speak to women who use female condoms. Let’s check this out.

Using female condoms to prevent HIV

Tzaneen, Limpopo

Agnes Mhlari: Vito ramina iAgnes Mhlari ndzitsama la aMahwelereng, ni HIV positive. And ndzitirisa tifemale condom, kuze ndzi tirisa tifemale condom imakha yakuri athindzi khoma kahle, nakhuri vavanuna avalavi khutirisa ticondom. So lokho vanga tirisi ticondom nitwa kahle kuvamehe. Ndzivona kuri botomibye mehe byitakota kuyamahlweni ndzi savheka yimaka yacondom leya. Condom yaswinunu loko utlele navona utaku condom umbarile kari unwanyana ayitsema ungaswivonangi utibyela kuri umbarile condom, kari inwanya ukuma kuri upregnant uhlamala kuri why uripregnant kube andzitirisa condom. Se ashisati kahle wehemunhu watibarisa umaker sure kuri condom yashisati ubarile loko uyibarile, loko ifika laround le ngamahlweni ufanele ukukhoma kuri ingena athlele ifanele yingena straight ifanele ingena inonweni wacondom. That is why ndzihlohlothela babasati kuri batirisa condom yabasati condom yavasati ikahle ngopfu. {Tsonga} [My name is Agnes Mhlari and I stay in Mahwelereng. I am HIV positive. I use female condoms during intercourse, because there is a tendency amongst some men not to use condoms, and this compromises my health. The importance of using a female condom is that it protects me from sexually transmitted infections. Often when I meet pregnant women and I ask them how they fell pregnant they tell me that it was a mistake, the male condom had burst. So I also recommend using a female condom to avoid unplanned pregnancy, as they are safer because they are less likely to burst.]

Mmakole (Choice Trust, Tzaneen): {Sepedi} [I find that most people are interested in the female condom, but complain that it is not easily available. I get a lot of female condoms because I show women how they work. If only they were easily available, because male condoms are available in clinics everywhere.]

Eva (Department of Health): Ene di tliniki tsa rona kaofela di nale list ya di tliniki tse e leng hore di nale stoko tsa di khondomo tsa basadi, mo e leng hore motho ebeng o nale thahasello ya ho e sebedisa a ka kgona ho ya tliniking eno. Engwe ya lebaka le e leng hore e etsa hore bomme ba seke ba ba kgutla hotla lata di khondomo tsa basadi hape, ho santse ho nale me nyenyetsi e mengata ya hore thobalano ke qeto ya bo ntate.Bo mme ha ba kgone ho buisana le bo ntate hore ba ba hlalosetse molemo wa khondomo ya basadi, mo nale hore ba shebe di tletlebo tse ding tse e leng hore bo ntate batla ka tsona. {Sesotho} [We have a list of all clinics that offer female condoms, so if people want to access those condoms, they can be referred to those clinics. There is still the belief that sexual agreements are made by men only and this prevents women from coming to get female condom. Women are unable to talk to men about the benefits of female condoms instead they listen to what the men have to say.]

Agnes Mhlari: Before ata itsama eight hours eza kamirhi wamina, then yiteka kuhisa wamirhi wamina. Yivuyelela ifana nakuri andzifakangi condom, nakuhisa kwamirhi wamina kufana nakuri ipart yamehe yashisati. Se lokho atlela na mina, yikuva mina ndzimubyerile yiswi status swamina, utwa afila kahle and hayi enjoya hicondom yaswisati yikuva seyitholoverile. Condom yavasati yandzi durela hiku ndziteka taxi la ndzi yadorobeni ndzishaba kaluband ticondom tamina edorobeni I fourteen rand something no fifteen rand then taxi kuya edorobeni kuya naku vuya itwenty rand. Lokho yikuma ticondom aticlinic kuri yikota kutirisa tona. {Tsonga} [I normally take about eight hours to prepare for having sex, to ensure that the female condom is properly inserted. I don’t think it’s easy for anyone to feel the condom during sex. I have used female condoms for a while, I also used them with my previous partner and have had no complaints. I enjoy using the female condom. But for me the female condoms are expensive. I buy them in town and I pay R14, no R15 for a packet of two, and then R20 for a return taxi. So I would prefer it if the clinics would issue female condoms for us.]

Support Group

Jason Wessenaar: Joining us to answer some of our questions is Katy Pepper, African Programme Director for the Female Health Foundation; an NGO that aims to improve women’s health. Welcome Katy. Katy can you please do a demonstration, a female condom demonstration.

Katy Pepper: Sure. This is a female condom. If you just turn the flap over you can see it has an expiry date there. To open it follow this arrow at the top and pull it down, and you take out the condom. You spread the lubricant slightly and hold the condom like this. You’ll see it’s got two rings, the other one is for insertion and the other is the ring that stays outside to keep the condom in place. To insert it you can squeeze the condom either in to the figure of eight or just squeeze the two sides together. You need to find a comfortable position to put it in. You can choose three positions. One is lying down flat and putting it like that. The other is to put your leg up on a table or the other one is to squat. So you take it, it’s very slippery, it’s quite difficult to hold on to and it takes lots of practice to do this. You can’t expect to do it the first time. You squeeze it together and you push it into your vagina or into the anus.Push it in as far as it goes like this, then use your middle finger, push it further in. As far as you can comfortable make that, push. And then it goes over the top through the vagina, and then should line the neck of the cervix. So it goes over the pubic bone, you may feel the pubic bone as you push it in. And then the condom looks a bit like this, when it’s in. When intercourse starts, when the penis enters that flap really will pull against the clitoris of the vagina. To remove it you just turn it around and pull it out, put it back in the packet.

Vuyani Jacobs: I swim in this, and the reasons that I felt so small.

Lihle Dlamini: It doesn’t mean ukuthi if ufaka i-female condom iya-expanda no my virgina stays, kusho ukuthi wena {isiZulu} [He say’s that it’s big and you feel like you swimming in this, it doesn’t mean that if I use a female condom my vagina expands. No my vagina stays still that you are small.]

Anthony Fernandes: This is the second time I see a female condom and we said earlier on the outer rims are so exposed outside of the vagina. Don’t you find that ugly first of all? And secondly men complain about it ’cause they haven’t seen it themselves or they find: “Oh, what is this?” I mean from face value it’s kind of not very attractive. Is that the kind of feedback that you get or is just something that you get used to?

Katy Pepper: I mean I don’t think male condoms are really that attractive either. But I mean we have to use them. And I think female condoms sure, they not attractive. And it’s, I mean certainly when you see the size of them as you were saying: “My word look at the size of that”. And many of the comments that we get particularly from men when they first see them is: “Gosh do we have to fill that.” So there’s a sort of understanding that really they’re still wearing a condom but it isn’t really.

Lihle Dlamini: I think with ama-male condoms ngeke kuze kubenzima as much as ama-female comdoms, also ama-male condoms they are cheaper than ama-female condoms. {isiZulu} [I think male condoms are used more than female condoms because the male condoms are cheaper than female condoms.] You know that.

Katy Pepper: Sure, I think there are two or three issues there. I mean the company that does produce them have been producing them for the last seven years. The material they made out of, polyeurophane, is very expensive material and unfortunately these condoms are produced in the U.K. where it’s expensive to produce anything really. So if you producing something out here in South Africa or any other country it will be much much cheaper. You could then do away with the transportation charges and all the different things that are incredibly expensive.

Jason Wessenaar: What is the organisation doing? What can we do to make sure that these are accessible at affordable prices?

Katy Pepper: This is the second generation female condom, it’s made out of polyeurophane, it’s made out of synthetic latex, which is the same material that surgeon gloves are made of. It has a slight odor and it’s slightly colored but essentially it’s the same product. It has the same design, it’s inserted the same way and has the same protection but it’s a cheaper process.

Lihle Dlamini: We had that belief that ukuthi if usebenzisa this old one [if you are going to have sex using the older version] you have to put it in two hours up until eight hours before you have sex and lena ke uyifaka nini? [And is it the same with the new one?] {isiZulu}

Katy Pepper: It is the same. The reason why people suggest that you put it in before hand is its heat seeking material. So if I was to hold a condom for long a long enough up to 20 minutes you’d find that it would stick to the sides of my hand. That’s what happens in the vagina.So you should really put it in 20 minutes before, not two hours not three hours. The same as polyeurophane the same with latex. So if you put it in up to 20 minutes before then the experience is likely to be better.

Prudence Mabele: Ntho e nketsang hore ke makale ke hore khondomo ya basadi e tsebisitswe kgetlo la pele mo Afrika Borwa re etsa dithuto ko diporofensing tse kaofela ha tsona, e ne ele ka 1996.Ntho eng makatsang ke hore e patehile.O kase o e bone le ko ditleniking kae kapa kae. Ntho e e thusa basadi kaofela ba Afrika Borwa. {Sesotho} [What surprises me about the female condom is that it was introduced in South Africa in 1996, and there was training in all the provinces. So it surprises me that no-one knows about it. You don’t see them in clinics or anywhere. This will help all women, it should be available all over South Africa.]

Katy Pepper: I think the government is beginning to address this now. It’s actually made sure that the province now takes control of the distribution of within the provinces; before it was a national distribution program which was very well done in the first part. A lot of people were trained, there was a lot of demands in for it, but really in the last seven years nothing’s happened. People have lost their experience, have lost their expertise but I think we need to put pressure on government to make sure that people, though I’m put in that position, that there are always new condoms available.

Jason Wessenaar: Thank you Katy, Ntombenhle the support group and the viewers at home. Today we learnt that the only products designed for women, to protect themselves against HIV infections, is the female condom. In three to five years there will be microbicides for women to use, to protect themselves from HIV infection. We hope you had enjoyed the show today and that you’re feeling the Siyayinqoba Spirit. If you have any questions, comments or views about the show please contact us on the numbers below. Till then, stay healthy, stay positive.

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