‘Uncomfortable and disgusting’: Uganda’s 1.2m unwanted condoms. The government has spent hundreds of thousands of dollars on female prophylactics, but poor take-up is sparking concerns of a rise in HIV infections
Uganda has been left with a mountain of unused female condoms after spending hundreds of thousands of dollars buying in more than a million of the unpopular contraceptives.
The low take-up, particularly among sex workers, is sparking concern that it could lead to a rise in HIV infections.
Last year, the Uganda Health Marketing Group (UHMG), which distributes contraceptives on behalf of the government, said 1.2m condoms were procured at a cost of $600,000 (£460,000), and it expects 3m to be sourced this year. The contraceptives are funded through grants from the UN population fund (UNFPA).
But campaigners say the majority of the condoms are left unused, adding that action needs to be taken to promote greater awareness of the benefits or to find new designs.
The findings come as New Vision newspaper reports that Uganda is facing a shortage of 150m male condoms this year.
Dinah Apio, HIV programme officer at Action Group for Health Human Rights and HIV/Aids (Agha), said money was being spent on sourcing the condoms at the expense of other essential supplies such as drugs to treat sexually transmitted infections (STIs).
“Unfortunately, uptake of female condoms remains low among women in the general and most at-risk populations,” Apio said. “This directly compromises efforts towards HIV prevention among key populations.
“One would rightly consider it a waste given other unfunded priorities in HIV response such as co-morbidities [additional diseases] and opportunistic infections like STI.”
Rogers Sebukyu, warehouse and operations manager at UHMG, defended the decision to buy in female condoms, saying their improved design and awareness campaigns had generated more demand.
“With the proposed improvements, branding and different flavours to address the challenges that users expressed in surveys regarding the low uptake, the product should be able to do better,” he said.
Female condoms offer women protection against HIV and other STIs, as well as pregnancy. They are one method among a range of contraceptives available in Uganda, the most popular of which are long-term injectables and implants.
Women who have used condoms complain they are hard to use and uncomfortable. They can also be expensive if bought privately.
Research conducted between January and March on the use of female condoms in districts including the capital, Kampala, found only a 2% demand for them, compared with 98% for male condoms. The groups most at risk are female sex workers, men who have sex with men and injecting drug users.
“If not addressed, the issue of low utilisation of female condoms is likely to contribute to new HIV infections among young women in Uganda, more cases of other STIs among female sex workers and unwanted pregnancies,” said Apio.
Vastha Kibirige, from the Ministry of Health, said: “It’s a new method and people have a negative attitude about the product. We need to do a lot of education and promotion for female condoms.
“It takes time and money to create uptake and use. It’s not something that you can broadcast on radio and TV. We need to train health workers and educate people … But we don’t have money to do it.”
According to baseline research by UNFPA and UHMG in 2011, lack of information was the biggest hindrance to female condom take-up, with only a small minority of those interviewed having seen or used one.
“Myths and misconceptions are still rife among sex workers, with concerns around the time it takes to insert the female condom and fear of alienating or angering sexual partners,” said Sarah Nakku Kibuuka, country community mobilisation and networking adviser at the UN programme on HIV and Aids (UNAids).
Shifa Nalubega, a sex worker in Kampala, is not a fan: “It’s uncomfortable, stressful, disgusting and not user-friendly. It requires a lot of monitoring during sex. You have to hold the condom throughout the sex until the client finishes.”
Another sex worker, Sophie, said it’s about business. “The more clients you serve the more money you make. Who would want to waste time to go the whole process of opening and inserting Femidom?”
Angella Ankunda, a sex worker in Wakiso, about 10km from Kampala, said that at 17cm long with two flexible rings, the condom was “too big and scary”.
The female condom was introduced in Uganda in 1998, but was never popular. In 2007, the government was forced to stop importing the original brand because women complained they were noisy during sex. Barely two years later, the government introduced a new variety through a pilot initiative in four districts and rolled it out nationally in 2012.
“We have tried to promote the use of female condoms among sex workers, but demand and uptake has remained low,” said Daisy Nakato, executive director at Wonetha, an organisation that promotes sex workers’ rights in Uganda. “Few sex workers use them. There was not enough promotion of female condoms like the male ones. So many people don’t even know what it looks like, and men don’t trust [it].”
Some of those interviewed in Kampala opt for unprotected sex, for which they can earn around 30,000 Ugandan shillings (£6.40) compared with 5,000 shillings with a condom.
“Poverty and the struggle to pay school fees, treatment, buy food and provide basic necessities, and pressures from landlords over rent, forces many to have live [unprotected] sex. It pays more,” said Nakato.
Anthony, a sex worker, said: “Ladies no longer want to use condoms. Many of them prefer pills to stop unwanted pregnancies. The ladies say they’d rather have HIV and Aids than pregnancy, which is visible, hence killing or tarnishing their market.”
According to the national HIV strategic plan 2015-20, HIV prevalence among sex workers is 37%, and among gay men 13%, and as high as 40% among fishing communities, compared with the national prevalence of 7.3%.