By Yelibenwork Ayele

The female condom was introduced in Ethiopia 9 years ago with the help of United Nations Population Fund (UNFPA) and DKT, a social marketing organization.

During that time, the Medio Socio Development Assistance Ethiopia (MSDA) conducted a study on volunteer sex workers as a preventive method because they were the ones believed to be spreading the virus. "First we taught them about the female condom. After a seven-day training, a focal person was assigned and supervisors and peer educators from among the sex workers themselves," said Dr. lyasu Haileselasie, director of MSDA Free female condoms were delivered everywhere sex workers were active. Delivery work was done by peer educators who taught the other sex workers how to use the female condom.

From the outset, everybody was interested in female condoms. They wanted to see what it looked like and how it worked. Twenty years have elapsed since the invention of the female condom in Europe, but it came to Ethiopia not more than ten years ago. The UNFPA and the MSDA did the promotion of female condoms in Ethiopia in four regions to health workers.

The use of the female condom is believed to empower the sex workers to protect themselves. "For one thing, the women are sure they are going to use it. They can protect those clients who do not want to use the male condom." The female condom is only a substitute for female condom, but not a replacement, Dr lyasu explained.

In Ghana, Zimbabwe and South Africa, the use of the female condom is not a new phenomenon as it is in Ethiopia. But here, there are even medical doctors who have never seen it and do not know what it looks like.  

"The reason we lagged behind other African countries in the use of the female condom is the reluctance of doctors in introducing and promoting it and pushing it through the Ministry of Health. The first information we had about female condom focused on how expensive it was and that it could be imported only from England or the USA.  That was a bit discouraging.”

No matter how expensive the female condom might be, the lives saved by its use are more valuable than the money paid for to import it, says Dr. Iyasu. "We get it from the UNFPA and give it to peer educators in Addis Ababa, Dukem, Modjo and Adama, and the peer educators distribute it for free to sex workers."

It is still being used as promotion only in limited regions in the country. The trial stays for five years. "Until now we have been doing only observations and promotions for the last five years.

When it comes to sex workers and transmission of HIV/AIDS most people think sex workers are all HIV-positive and they are the ones who are spreading the virus, said Dr. Isyasu. "In fact, we found that there are fewer HIV positive women among sex workers than the non-high risk groups. Sex workers are very careful. They know the dangers of sex work and are more careful than other groups of people." Now, with the availability of the female condom, they are safer than before. When their clients are reluctant to use the male condom they can use the female condom and the men may not know it at all. Or, they can offer their clients choice of which condom to use.

A controlled study of HIV/AIDS and other sexually transmitted diseases transmission among sex workers in Addis Ababa, Dukem, Bishoftu, Modjo and Adama has found that with the availability of female condoms the rate of transmission was lower than that in a sex workers group with access to the male condom only.

The female condom is not a replacement for the male condom but an addition to barrier method options. Results of research interventions indicate that there is an increase in the number of protected sexual acts when female condom is available. Sex workers say that their partners respond positively to female condom use comparing it favourably with the male condom.

The female condom is not yet registered by the Ministry of Health as it is still being tested in the Addis-Adama high risk corridors. After the period of observation is completed and the condom proven to be effective and affordable, then it will be registered. Then the UNFPA in cooperation with the Ministry will allocate money for it just like they do for the male condom.

The MSAD has produced a documentary video on using female condom and has been using it for tutoring purposes. It has presented the video to sex workers in the different sub cities in Addis Ababa.