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Current status of the female condom in Africa.

Abstract The female condom was developed in the 1980s. It is a contraceptive device used by women that protects against both pregnancy and sexually-transmitted diseases (STDs) including HIV infection. Two studies have investigated the contraceptive effectiveness of the female condom, and it was found to be as effective as other barrier methods. It has been shown to be effective against STD and HIV transmission in vitro but there is only limited evidence of its efficacy in vivo. No serious local side effects or allergies have been reported and the female condom can be used with any type of lubricant, spermicidal cream or foam. The female condom is the only device other than the male condom that has been shown to prevent HIV transmission. The female condom has been marketed in 13 countries since the summer of 1996. Most of these countries are industrialized and the selling price in these countries is too high for developing countries. Sub-Saharan Africa has very high prevalence rates for HIV infection, at least 30% of the general population in Eastern and Central regions. The epidemic is also spreading fast in some parts of the Western region. In Ivory Coast for example, 12 to 15% of pregnant women are infected. African women are subordinate to men in many aspects of their lives, politically, educationally, socially and sexually. This sexual inequality makes them highly vulnerable to STDs, including HIV, and unwanted pregnancies. This paper reviews 10 of the 15 studies carried out in sub-Saharan African countries between 1990 and 1996 and compiled by the World Health Organization. Recruitment methods, education of subjects, methodology and assessment of acceptability differed between studies. Despite these limitations, most studies concluded that the women who participated in the trials generally found the female condom acceptable. Acceptability was established quicker among prostitutes than among other women and men found the female condom less acceptable than did women. However, the sample size is too small to draw any firm conclusions. Commercial sex workers in the studies reviewed were very interested in this new method because it gave them an additional method of safer protection during sex. However, they were occasionally faced with difficult negotiations with some clients, refusal to use the female condom and sexual violence. Reuse of the device was reported in four studies, but the term reuse is seldom defined. In cases where it was defined, the frequency of reuse, with washing of the device, accounted for no more than 1% of the total number of uses. The acceptability of the female condom among women other than prostitutes faces two obstacles, the reaction of the woman's regular partner and attitudes to the device itself (appearance, difficulties or uneasiness concerning its use). However, some women liked it because it provided dual protection against pregnancy and STDs and sexual pleasure. The moderate level of acceptability to male partners may be overestimated because women whose partners disliked the device would be more likely to discontinue its use. The studies of acceptability reviewed here show that use of the female condom in Africa is realistic and that it provides women with more independent protection. Initial negative perceptions of the device are often replaced with a more positive reaction after several uses. The experience gained with use reduces the technical problems. We need to overcome the stereotypes, simplifications and strong opinions that threaten to damage the acceptance of this new method and efforts to encourage women to adopt it. However, we still require further clinical data on the effectiveness of the female condom at preventing pregnancy and HIV transmission. Availability of the female condom is improving in Africa. Pilot marketing studies were launched in 1996 in Guinea, Zambia, South Africa, followed by Uganda and Tanzania. There are local initiatives in Ivory Coast and Zimbabwe. (ABSTRACT TRUNC
PMID
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Authors

Mayor MeshTerms

Condoms, Female

Keywords

Acquired Immunodeficiency Syndrome--prevention and control

Africa South Of The Sahara

Female Condom

Hiv Infections--prevention and control

Literature Review

Method Acceptability

Prostitutes--women

Women's Status

Africa

Barrier Methods

Behavior

Contraception

Contraceptive Methods

Contraceptive Usage

Developing Countries

Diseases

Economic Factors

Family Planning

Sex Behavior

Socioeconomic Factors

Vaginal Barrier Methods

Viral Diseases

Journal Title sante? (montrouge, france)
Publication Year Start
%A Deniaud, F.
%T [Current status of the female condom in Africa].
%J Sante? (Montrouge, France), vol. 7, no. 6, pp. 405-415
%D 11/1997
%V 7
%N 6
%M fre
%B The female condom was developed in the 1980s. It is a contraceptive device used by women that protects against both pregnancy and sexually-transmitted diseases (STDs) including HIV infection. Two studies have investigated the contraceptive effectiveness of the female condom, and it was found to be as effective as other barrier methods. It has been shown to be effective against STD and HIV transmission in vitro but there is only limited evidence of its efficacy in vivo. No serious local side effects or allergies have been reported and the female condom can be used with any type of lubricant, spermicidal cream or foam. The female condom is the only device other than the male condom that has been shown to prevent HIV transmission. The female condom has been marketed in 13 countries since the summer of 1996. Most of these countries are industrialized and the selling price in these countries is too high for developing countries. Sub-Saharan Africa has very high prevalence rates for HIV infection, at least 30% of the general population in Eastern and Central regions. The epidemic is also spreading fast in some parts of the Western region. In Ivory Coast for example, 12 to 15% of pregnant women are infected. African women are subordinate to men in many aspects of their lives, politically, educationally, socially and sexually. This sexual inequality makes them highly vulnerable to STDs, including HIV, and unwanted pregnancies. This paper reviews 10 of the 15 studies carried out in sub-Saharan African countries between 1990 and 1996 and compiled by the World Health Organization. Recruitment methods, education of subjects, methodology and assessment of acceptability differed between studies. Despite these limitations, most studies concluded that the women who participated in the trials generally found the female condom acceptable. Acceptability was established quicker among prostitutes than among other women and men found the female condom less acceptable than did women. However, the sample size is too small to draw any firm conclusions. Commercial sex workers in the studies reviewed were very interested in this new method because it gave them an additional method of safer protection during sex. However, they were occasionally faced with difficult negotiations with some clients, refusal to use the female condom and sexual violence. Reuse of the device was reported in four studies, but the term reuse is seldom defined. In cases where it was defined, the frequency of reuse, with washing of the device, accounted for no more than 1% of the total number of uses. The acceptability of the female condom among women other than prostitutes faces two obstacles, the reaction of the woman's regular partner and attitudes to the device itself (appearance, difficulties or uneasiness concerning its use). However, some women liked it because it provided dual protection against pregnancy and STDs and sexual pleasure. The moderate level of acceptability to male partners may be overestimated because women whose partners disliked the device would be more likely to discontinue its use. The studies of acceptability reviewed here show that use of the female condom in Africa is realistic and that it provides women with more independent protection. Initial negative perceptions of the device are often replaced with a more positive reaction after several uses. The experience gained with use reduces the technical problems. We need to overcome the stereotypes, simplifications and strong opinions that threaten to damage the acceptance of this new method and efforts to encourage women to adopt it. However, we still require further clinical data on the effectiveness of the female condom at preventing pregnancy and HIV transmission. Availability of the female condom is improving in Africa. Pilot marketing studies were launched in 1996 in Guinea, Zambia, South Africa, followed by Uganda and Tanzania. There are local initiatives in Ivory Coast and Zimbabwe. (ABSTRACT TRUNC
%K Africa, Attitude, Condoms, Condoms, Female, Contraceptive Agents, Female, Costs and Cost Analysis, Developed Countries, Developing Countries, Disease Outbreaks, Female, HIV Infections, Health Services Accessibility, Humans, Hypersensitivity, Male, Marketing of Health Services, Patient Satisfaction, Pregnancy, Pregnancy Complications, Infectious, Prevalence, Prostitution, Sexual Partners, Sexually Transmitted Diseases, Social Conditions, Spermatocidal Agents, United Nations, Women's Health, Women's Rights, World Health Organization
%P 405
%L 415
%W PHY
%G AUTHOR
%R 1997........7..405D

@Article{Deniaud1997,
author="Deniaud, F.",
title="[Current status of the female condom in Africa].",
journal="Sante? (Montrouge, France)",
year="1997",
month="Nov/Dec",
volume="7",
number="6",
pages="405--415",
keywords="Africa",
keywords="Attitude",
keywords="Condoms",
keywords="Condoms, Female",
keywords="Contraceptive Agents, Female",
keywords="Costs and Cost Analysis",
keywords="Developed Countries",
keywords="Developing Countries",
keywords="Disease Outbreaks",
keywords="Female",
keywords="HIV Infections",
keywords="Health Services Accessibility",
keywords="Humans",
keywords="Hypersensitivity",
keywords="Male",
keywords="Marketing of Health Services",
keywords="Patient Satisfaction",
keywords="Pregnancy",
keywords="Pregnancy Complications, Infectious",
keywords="Prevalence",
keywords="Prostitution",
keywords="Sexual Partners",
keywords="Sexually Transmitted Diseases",
keywords="Social Conditions",
keywords="Spermatocidal Agents",
keywords="United Nations",
keywords="Women's Health",
keywords="Women's Rights",
keywords="World Health Organization",
abstract="The female condom was developed in the 1980s. It is a contraceptive device used by women that protects against both pregnancy and sexually-transmitted diseases (STDs) including HIV infection. Two studies have investigated the contraceptive effectiveness of the female condom, and it was found to be as effective as other barrier methods. It has been shown to be effective against STD and HIV transmission in vitro but there is only limited evidence of its efficacy in vivo. No serious local side effects or allergies have been reported and the female condom can be used with any type of lubricant, spermicidal cream or foam. The female condom is the only device other than the male condom that has been shown to prevent HIV transmission. The female condom has been marketed in 13 countries since the summer of 1996. Most of these countries are industrialized and the selling price in these countries is too high for developing countries. Sub-Saharan Africa has very high prevalence rates for HIV infection, at least 30\% of the general population in Eastern and Central regions. The epidemic is also spreading fast in some parts of the Western region. In Ivory Coast for example, 12 to 15\% of pregnant women are infected. African women are subordinate to men in many aspects of their lives, politically, educationally, socially and sexually. This sexual inequality makes them highly vulnerable to STDs, including HIV, and unwanted pregnancies. This paper reviews 10 of the 15 studies carried out in sub-Saharan African countries between 1990 and 1996 and compiled by the World Health Organization. Recruitment methods, education of subjects, methodology and assessment of acceptability differed between studies. Despite these limitations, most studies concluded that the women who participated in the trials generally found the female condom acceptable. Acceptability was established quicker among prostitutes than among other women and men found the female condom less acceptable than did women. However, the sample size is too small to draw any firm conclusions. Commercial sex workers in the studies reviewed were very interested in this new method because it gave them an additional method of safer protection during sex. However, they were occasionally faced with difficult negotiations with some clients, refusal to use the female condom and sexual violence. Reuse of the device was reported in four studies, but the term reuse is seldom defined. In cases where it was defined, the frequency of reuse, with washing of the device, accounted for no more than 1\% of the total number of uses. The acceptability of the female condom among women other than prostitutes faces two obstacles, the reaction of the woman's regular partner and attitudes to the device itself (appearance, difficulties or uneasiness concerning its use). However, some women liked it because it provided dual protection against pregnancy and STDs and sexual pleasure. The moderate level of acceptability to male partners may be overestimated because women whose partners disliked the device would be more likely to discontinue its use. The studies of acceptability reviewed here show that use of the female condom in Africa is realistic and that it provides women with more independent protection. Initial negative perceptions of the device are often replaced with a more positive reaction after several uses. The experience gained with use reduces the technical problems. We need to overcome the stereotypes, simplifications and strong opinions that threaten to damage the acceptance of this new method and efforts to encourage women to adopt it. However, we still require further clinical data on the effectiveness of the female condom at preventing pregnancy and HIV transmission. Availability of the female condom is improving in Africa. Pilot marketing studies were launched in 1996 in Guinea, Zambia, South Africa, followed by Uganda and Tanzania. There are local initiatives in Ivory Coast and Zimbabwe. (ABSTRACT TRUNC",
issn="1157-5999",
url="http://www.ncbi.nlm.nih.gov/pubmed/9503499",
language="fre"
}

%0 Journal Article
%T [Current status of the female condom in Africa].
%A Deniaud, F.
%J Sante? (Montrouge, France)
%D 1997
%8 Nov/Dec
%V 7
%N 6
%@ 1157-5999
%G fre
%F Deniaud1997
%X The female condom was developed in the 1980s. It is a contraceptive device used by women that protects against both pregnancy and sexually-transmitted diseases (STDs) including HIV infection. Two studies have investigated the contraceptive effectiveness of the female condom, and it was found to be as effective as other barrier methods. It has been shown to be effective against STD and HIV transmission in vitro but there is only limited evidence of its efficacy in vivo. No serious local side effects or allergies have been reported and the female condom can be used with any type of lubricant, spermicidal cream or foam. The female condom is the only device other than the male condom that has been shown to prevent HIV transmission. The female condom has been marketed in 13 countries since the summer of 1996. Most of these countries are industrialized and the selling price in these countries is too high for developing countries. Sub-Saharan Africa has very high prevalence rates for HIV infection, at least 30% of the general population in Eastern and Central regions. The epidemic is also spreading fast in some parts of the Western region. In Ivory Coast for example, 12 to 15% of pregnant women are infected. African women are subordinate to men in many aspects of their lives, politically, educationally, socially and sexually. This sexual inequality makes them highly vulnerable to STDs, including HIV, and unwanted pregnancies. This paper reviews 10 of the 15 studies carried out in sub-Saharan African countries between 1990 and 1996 and compiled by the World Health Organization. Recruitment methods, education of subjects, methodology and assessment of acceptability differed between studies. Despite these limitations, most studies concluded that the women who participated in the trials generally found the female condom acceptable. Acceptability was established quicker among prostitutes than among other women and men found the female condom less acceptable than did women. However, the sample size is too small to draw any firm conclusions. Commercial sex workers in the studies reviewed were very interested in this new method because it gave them an additional method of safer protection during sex. However, they were occasionally faced with difficult negotiations with some clients, refusal to use the female condom and sexual violence. Reuse of the device was reported in four studies, but the term reuse is seldom defined. In cases where it was defined, the frequency of reuse, with washing of the device, accounted for no more than 1% of the total number of uses. The acceptability of the female condom among women other than prostitutes faces two obstacles, the reaction of the woman's regular partner and attitudes to the device itself (appearance, difficulties or uneasiness concerning its use). However, some women liked it because it provided dual protection against pregnancy and STDs and sexual pleasure. The moderate level of acceptability to male partners may be overestimated because women whose partners disliked the device would be more likely to discontinue its use. The studies of acceptability reviewed here show that use of the female condom in Africa is realistic and that it provides women with more independent protection. Initial negative perceptions of the device are often replaced with a more positive reaction after several uses. The experience gained with use reduces the technical problems. We need to overcome the stereotypes, simplifications and strong opinions that threaten to damage the acceptance of this new method and efforts to encourage women to adopt it. However, we still require further clinical data on the effectiveness of the female condom at preventing pregnancy and HIV transmission. Availability of the female condom is improving in Africa. Pilot marketing studies were launched in 1996 in Guinea, Zambia, South Africa, followed by Uganda and Tanzania. There are local initiatives in Ivory Coast and Zimbabwe. (ABSTRACT TRUNC
%K Africa
%K Attitude
%K Condoms
%K Condoms, Female
%K Contraceptive Agents, Female
%K Costs and Cost Analysis
%K Developed Countries
%K Developing Countries
%K Disease Outbreaks
%K Female
%K HIV Infections
%K Health Services Accessibility
%K Humans
%K Hypersensitivity
%K Male
%K Marketing of Health Services
%K Patient Satisfaction
%K Pregnancy
%K Pregnancy Complications, Infectious
%K Prevalence
%K Prostitution
%K Sexual Partners
%K Sexually Transmitted Diseases
%K Social Conditions
%K Spermatocidal Agents
%K United Nations
%K Women's Health
%K Women's Rights
%K World Health Organization
%U http://www.ncbi.nlm.nih.gov/pubmed/9503499
%P 405-415

PT Journal
AU Deniaud, F
TI [Current status of the female condom in Africa].
SO Sante? (Montrouge, France)
JI Sante
PD Nov/Dec
PY 1997
BP 405
EP 415
VL 7
IS 6
LA fre
DE Africa; Attitude; Condoms; Condoms, Female; Contraceptive Agents, Female; Costs and Cost Analysis; Developed Countries; Developing Countries; Disease Outbreaks; Female; HIV Infections; Health Services Accessibility; Humans; Hypersensitivity; Male; Marketing of Health Services; Patient Satisfaction; Pregnancy; Pregnancy Complications, Infectious; Prevalence; Prostitution; Sexual Partners; Sexually Transmitted Diseases; Social Conditions; Spermatocidal Agents; United Nations; Women's Health; Women's Rights; World Health Organization
AB The female condom was developed in the 1980s. It is a contraceptive device used by women that protects against both pregnancy and sexually-transmitted diseases (STDs) including HIV infection. Two studies have investigated the contraceptive effectiveness of the female condom, and it was found to be as effective as other barrier methods. It has been shown to be effective against STD and HIV transmission in vitro but there is only limited evidence of its efficacy in vivo. No serious local side effects or allergies have been reported and the female condom can be used with any type of lubricant, spermicidal cream or foam. The female condom is the only device other than the male condom that has been shown to prevent HIV transmission. The female condom has been marketed in 13 countries since the summer of 1996. Most of these countries are industrialized and the selling price in these countries is too high for developing countries. Sub-Saharan Africa has very high prevalence rates for HIV infection, at least 30% of the general population in Eastern and Central regions. The epidemic is also spreading fast in some parts of the Western region. In Ivory Coast for example, 12 to 15% of pregnant women are infected. African women are subordinate to men in many aspects of their lives, politically, educationally, socially and sexually. This sexual inequality makes them highly vulnerable to STDs, including HIV, and unwanted pregnancies. This paper reviews 10 of the 15 studies carried out in sub-Saharan African countries between 1990 and 1996 and compiled by the World Health Organization. Recruitment methods, education of subjects, methodology and assessment of acceptability differed between studies. Despite these limitations, most studies concluded that the women who participated in the trials generally found the female condom acceptable. Acceptability was established quicker among prostitutes than among other women and men found the female condom less acceptable than did women. However, the sample size is too small to draw any firm conclusions. Commercial sex workers in the studies reviewed were very interested in this new method because it gave them an additional method of safer protection during sex. However, they were occasionally faced with difficult negotiations with some clients, refusal to use the female condom and sexual violence. Reuse of the device was reported in four studies, but the term reuse is seldom defined. In cases where it was defined, the frequency of reuse, with washing of the device, accounted for no more than 1% of the total number of uses. The acceptability of the female condom among women other than prostitutes faces two obstacles, the reaction of the woman's regular partner and attitudes to the device itself (appearance, difficulties or uneasiness concerning its use). However, some women liked it because it provided dual protection against pregnancy and STDs and sexual pleasure. The moderate level of acceptability to male partners may be overestimated because women whose partners disliked the device would be more likely to discontinue its use. The studies of acceptability reviewed here show that use of the female condom in Africa is realistic and that it provides women with more independent protection. Initial negative perceptions of the device are often replaced with a more positive reaction after several uses. The experience gained with use reduces the technical problems. We need to overcome the stereotypes, simplifications and strong opinions that threaten to damage the acceptance of this new method and efforts to encourage women to adopt it. However, we still require further clinical data on the effectiveness of the female condom at preventing pregnancy and HIV transmission. Availability of the female condom is improving in Africa. Pilot marketing studies were launched in 1996 in Guinea, Zambia, South Africa, followed by Uganda and Tanzania. There are local initiatives in Ivory Coast and Zimbabwe. (ABSTRACT TRUNC
ER

PMID- 9503499
OWN - NLM
STAT- MEDLINE
DA  - 19980421
DCOM- 19980421
LR  - 20061115
IS  - 1157-5999 (Print)
IS  - 1157-5999 (Linking)
VI  - 7
IP  - 6
DP  - 1997 Nov-Dec
TI  - [Current status of the female condom in Africa].
PG  - 405-15
AB  - The female condom was developed in the 1980s. It is a contraceptive device used
      by women that protects against both pregnancy and sexually-transmitted diseases
      (STDs) including HIV infection. Two studies have investigated the contraceptive
      effectiveness of the female condom, and it was found to be as effective as other 
      barrier methods. It has been shown to be effective against STD and HIV
      transmission in vitro but there is only limited evidence of its efficacy in vivo.
      No serious local side effects or allergies have been reported and the female
      condom can be used with any type of lubricant, spermicidal cream or foam. The
      female condom is the only device other than the male condom that has been shown
      to prevent HIV transmission. The female condom has been marketed in 13 countries 
      since the summer of 1996. Most of these countries are industrialized and the
      selling price in these countries is too high for developing countries.
      Sub-Saharan Africa has very high prevalence rates for HIV infection, at least 30%
      of the general population in Eastern and Central regions. The epidemic is also
      spreading fast in some parts of the Western region. In Ivory Coast for example,
      12 to 15% of pregnant women are infected. African women are subordinate to men in
      many aspects of their lives, politically, educationally, socially and sexually.
      This sexual inequality makes them highly vulnerable to STDs, including HIV, and
      unwanted pregnancies. This paper reviews 10 of the 15 studies carried out in
      sub-Saharan African countries between 1990 and 1996 and compiled by the World
      Health Organization. Recruitment methods, education of subjects, methodology and 
      assessment of acceptability differed between studies. Despite these limitations, 
      most studies concluded that the women who participated in the trials generally
      found the female condom acceptable. Acceptability was established quicker among
      prostitutes than among other women and men found the female condom less
      acceptable than did women. However, the sample size is too small to draw any firm
      conclusions. Commercial sex workers in the studies reviewed were very interested 
      in this new method because it gave them an additional method of safer protection 
      during sex. However, they were occasionally faced with difficult negotiations
      with some clients, refusal to use the female condom and sexual violence. Reuse of
      the device was reported in four studies, but the term reuse is seldom defined. In
      cases where it was defined, the frequency of reuse, with washing of the device,
      accounted for no more than 1% of the total number of uses. The acceptability of
      the female condom among women other than prostitutes faces two obstacles, the
      reaction of the woman's regular partner and attitudes to the device itself
      (appearance, difficulties or uneasiness concerning its use). However, some women 
      liked it because it provided dual protection against pregnancy and STDs and
      sexual pleasure. The moderate level of acceptability to male partners may be
      overestimated because women whose partners disliked the device would be more
      likely to discontinue its use. The studies of acceptability reviewed here show
      that use of the female condom in Africa is realistic and that it provides women
      with more independent protection. Initial negative perceptions of the device are 
      often replaced with a more positive reaction after several uses. The experience
      gained with use reduces the technical problems. We need to overcome the
      stereotypes, simplifications and strong opinions that threaten to damage the
      acceptance of this new method and efforts to encourage women to adopt it.
      However, we still require further clinical data on the effectiveness of the
      female condom at preventing pregnancy and HIV transmission. Availability of the
      female condom is improving in Africa. Pilot marketing studies were launched in
      1996 in Guinea, Zambia, South Africa, followed by Uganda and Tanzania. There are 
      local initiatives in Ivory Coast and Zimbabwe. (ABSTRACT TRUNC
FAU - Deniaud, F
AU  - Deniaud F
AD  - Reseau IEC-Population, Abidjan, Cote d'Ivoire.
LA  - fre
PT  - English Abstract
PT  - Journal Article
PT  - Review
TT  - Actualite du preservatif feminin en Afrique.
PL  - FRANCE
TA  - Sante
JT  - Sante (Montrouge, France)
JID - 9212437
RN  - 0 (Contraceptive Agents, Female)
RN  - 0 (Spermatocidal Agents)
SB  - IM
SB  - J
SB  - X
MH  - Africa/epidemiology
MH  - Attitude
MH  - Condoms
MH  - *Condoms, Female/adverse effects/economics
MH  - Contraceptive Agents, Female/therapeutic use
MH  - Costs and Cost Analysis
MH  - Developed Countries
MH  - Developing Countries
MH  - Disease Outbreaks
MH  - Female
MH  - HIV Infections/epidemiology/prevention & control/transmission
MH  - Health Services Accessibility
MH  - Humans
MH  - Hypersensitivity/etiology
MH  - Male
MH  - Marketing of Health Services
MH  - Patient Satisfaction
MH  - Pregnancy
MH  - Pregnancy Complications, Infectious/epidemiology
MH  - Prevalence
MH  - Prostitution
MH  - Sexual Partners
MH  - Sexually Transmitted Diseases/prevention & control/transmission
MH  - Social Conditions
MH  - Spermatocidal Agents/therapeutic use
MH  - United Nations
MH  - Women's Health
MH  - Women's Rights
MH  - World Health Organization
RF  - 25
OID - PIP: 132104
OID - POP: 00275792
OAB - PIP: This work discusses the female condom and the context of women's lives in
      sub-Saharan Africa, analyzes results of studies on acceptability conducted in
      Africa, and assesses the prospects for future use of the method in Africa.
      Studies have been conducted throughout the world on the efficacy, tolerance, and 
      acceptability of the female condom. The two studies of contraceptive
      effectiveness, carried out in England, the US, and Latin America, showed it to be
      about as effective as other barrier methods. Both studies had high dropout rates.
      The female condom has been demonstrated to be effective in vitro against
      transmission of HIV and sexually transmitted diseases, but evidence of efficacy
      in vivo remains limited. The high prevalence of HIV infection in eastern and
      central Africa and its rapid spread in parts of western Africa, and the growing
      desire of African women to space or limit births, indicate a need for protection 
      that could be met by the female condom. The subordinate position of African women
      at all levels limits their ability to negotiate on sexual topics, including
      contraception. 10 of the 15 studies of acceptability of the female condom,
      carried out in 9 sub-Saharan African countries between 1990 and 1996 and compiled
      by the World Health Organization, were reviewed. The studies were limited by
      small sample size, selective recruiting, lack of consistency in methods and
      analysis, and a tendency to ignore dropout rates and motives. Despite the
      limitations, the studies found female condoms to be acceptable to certain groups 
      of women, especially prostitutes. Acceptability was established more rapidly
      among prostitutes, although large proportions reported the method to be
      unacceptable to some of their clients. Results of acceptability studies were more
      variable among non-prostitutes. Acceptability among men has been insufficiently
      documented. Stereotypes and oversimplifications must not be allowed to hamper
      promotion of the female condom. It is recommended that further study of the
      contraceptive and disease prevention efficacy of the female condom be conducted
      and that availability and accessibility of the method be increased for African
      women.
OABL- eng
OTO - PIP
OT  - *Acquired Immunodeficiency Syndrome--prevention and control
OT  - Africa
OT  - *Africa South Of The Sahara
OT  - Barrier Methods
OT  - Behavior
OT  - Contraception
OT  - Contraceptive Methods
OT  - Contraceptive Usage
OT  - Developing Countries
OT  - Diseases
OT  - Economic Factors
OT  - Family Planning
OT  - *Female Condom
OT  - *Hiv Infections--prevention and control
OT  - *Literature Review
OT  - *Method Acceptability
OT  - *Prostitutes--women
OT  - Sex Behavior
OT  - Socioeconomic Factors
OT  - Vaginal Barrier Methods
OT  - Viral Diseases
OT  - *Women's Status
GN  - PIP: TJ: SANTE
EDAT- 1998/03/21
MHDA- 1998/03/21 00:01
CRDT- 1998/03/21 00:00
PST - ppublish
SO  - Sante. 1997 Nov-Dec;7(6):405-15.
TY  - JOUR
AU  - Deniaud, F.
PY  - 1997/Nov/Dec/
TI  - [Current status of the female condom in Africa].
T2  - Sante
JO  - Sante? (Montrouge, France)
SP  - 405
EP  - 415
VL  - 7
IS  - 6
KW  - Africa
KW  - Attitude
KW  - Condoms
KW  - Condoms, Female
KW  - Contraceptive Agents, Female
KW  - Costs and Cost Analysis
KW  - Developed Countries
KW  - Developing Countries
KW  - Disease Outbreaks
KW  - Female
KW  - HIV Infections
KW  - Health Services Accessibility
KW  - Humans
KW  - Hypersensitivity
KW  - Male
KW  - Marketing of Health Services
KW  - Patient Satisfaction
KW  - Pregnancy
KW  - Pregnancy Complications, Infectious
KW  - Prevalence
KW  - Prostitution
KW  - Sexual Partners
KW  - Sexually Transmitted Diseases
KW  - Social Conditions
KW  - Spermatocidal Agents
KW  - United Nations
KW  - Women's Health
KW  - Women's Rights
KW  - World Health Organization
N2  - The female condom was developed in the 1980s. It is a contraceptive device used by women that protects against both pregnancy and sexually-transmitted diseases (STDs) including HIV infection. Two studies have investigated the contraceptive effectiveness of the female condom, and it was found to be as effective as other barrier methods. It has been shown to be effective against STD and HIV transmission in vitro but there is only limited evidence of its efficacy in vivo. No serious local side effects or allergies have been reported and the female condom can be used with any type of lubricant, spermicidal cream or foam. The female condom is the only device other than the male condom that has been shown to prevent HIV transmission. The female condom has been marketed in 13 countries since the summer of 1996. Most of these countries are industrialized and the selling price in these countries is too high for developing countries. Sub-Saharan Africa has very high prevalence rates for HIV infection, at least 30% of the general population in Eastern and Central regions. The epidemic is also spreading fast in some parts of the Western region. In Ivory Coast for example, 12 to 15% of pregnant women are infected. African women are subordinate to men in many aspects of their lives, politically, educationally, socially and sexually. This sexual inequality makes them highly vulnerable to STDs, including HIV, and unwanted pregnancies. This paper reviews 10 of the 15 studies carried out in sub-Saharan African countries between 1990 and 1996 and compiled by the World Health Organization. Recruitment methods, education of subjects, methodology and assessment of acceptability differed between studies. Despite these limitations, most studies concluded that the women who participated in the trials generally found the female condom acceptable. Acceptability was established quicker among prostitutes than among other women and men found the female condom less acceptable than did women. However, the sample size is too small to draw any firm conclusions. Commercial sex workers in the studies reviewed were very interested in this new method because it gave them an additional method of safer protection during sex. However, they were occasionally faced with difficult negotiations with some clients, refusal to use the female condom and sexual violence. Reuse of the device was reported in four studies, but the term reuse is seldom defined. In cases where it was defined, the frequency of reuse, with washing of the device, accounted for no more than 1% of the total number of uses. The acceptability of the female condom among women other than prostitutes faces two obstacles, the reaction of the woman's regular partner and attitudes to the device itself (appearance, difficulties or uneasiness concerning its use). However, some women liked it because it provided dual protection against pregnancy and STDs and sexual pleasure. The moderate level of acceptability to male partners may be overestimated because women whose partners disliked the device would be more likely to discontinue its use. The studies of acceptability reviewed here show that use of the female condom in Africa is realistic and that it provides women with more independent protection. Initial negative perceptions of the device are often replaced with a more positive reaction after several uses. The experience gained with use reduces the technical problems. We need to overcome the stereotypes, simplifications and strong opinions that threaten to damage the acceptance of this new method and efforts to encourage women to adopt it. However, we still require further clinical data on the effectiveness of the female condom at preventing pregnancy and HIV transmission. Availability of the female condom is improving in Africa. Pilot marketing studies were launched in 1996 in Guinea, Zambia, South Africa, followed by Uganda and Tanzania. There are local initiatives in Ivory Coast and Zimbabwe. (ABSTRACT TRUNC
SN  - 1157-5999
UR  - http://www.ncbi.nlm.nih.gov/pubmed/9503499
ID  - Deniaud1997
ER  - 
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<b:Tag>Deniaud1997</b:Tag>
<b:SourceType>ArticleInAPeriodical</b:SourceType>
<b:Year>1997</b:Year>
<b:Month>Nov/Dec</b:Month>
<b:PeriodicalName>Sante&#769; (Montrouge, France)</b:PeriodicalName>
<b:Volume>7</b:Volume>
<b:Issue>6</b:Issue>
<b:Pages>405-415</b:Pages>
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<b:Person><b:Last>Deniaud</b:Last><b:First>F</b:First></b:Person>
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<b:Title>[Current status of the female condom in Africa].</b:Title>
 <b:ShortTitle>Sante</b:ShortTitle>
<b:Comments>The female condom was developed in the 1980s. It is a contraceptive device used by women that protects against both pregnancy and sexually-transmitted diseases (STDs) including HIV infection. Two studies have investigated the contraceptive effectiveness of the female condom, and it was found to be as effective as other barrier methods. It has been shown to be effective against STD and HIV transmission in vitro but there is only limited evidence of its efficacy in vivo. No serious local side effects or allergies have been reported and the female condom can be used with any type of lubricant, spermicidal cream or foam. The female condom is the only device other than the male condom that has been shown to prevent HIV transmission. The female condom has been marketed in 13 countries since the summer of 1996. Most of these countries are industrialized and the selling price in these countries is too high for developing countries. Sub-Saharan Africa has very high prevalence rates for HIV infection, at least 30% of the general population in Eastern and Central regions. The epidemic is also spreading fast in some parts of the Western region. In Ivory Coast for example, 12 to 15% of pregnant women are infected. African women are subordinate to men in many aspects of their lives, politically, educationally, socially and sexually. This sexual inequality makes them highly vulnerable to STDs, including HIV, and unwanted pregnancies. This paper reviews 10 of the 15 studies carried out in sub-Saharan African countries between 1990 and 1996 and compiled by the World Health Organization. Recruitment methods, education of subjects, methodology and assessment of acceptability differed between studies. Despite these limitations, most studies concluded that the women who participated in the trials generally found the female condom acceptable. Acceptability was established quicker among prostitutes than among other women and men found the female condom less acceptable than did women. However, the sample size is too small to draw any firm conclusions. Commercial sex workers in the studies reviewed were very interested in this new method because it gave them an additional method of safer protection during sex. However, they were occasionally faced with difficult negotiations with some clients, refusal to use the female condom and sexual violence. Reuse of the device was reported in four studies, but the term reuse is seldom defined. In cases where it was defined, the frequency of reuse, with washing of the device, accounted for no more than 1% of the total number of uses. The acceptability of the female condom among women other than prostitutes faces two obstacles, the reaction of the woman&apos;s regular partner and attitudes to the device itself (appearance, difficulties or uneasiness concerning its use). However, some women liked it because it provided dual protection against pregnancy and STDs and sexual pleasure. The moderate level of acceptability to male partners may be overestimated because women whose partners disliked the device would be more likely to discontinue its use. The studies of acceptability reviewed here show that use of the female condom in Africa is realistic and that it provides women with more independent protection. Initial negative perceptions of the device are often replaced with a more positive reaction after several uses. The experience gained with use reduces the technical problems. We need to overcome the stereotypes, simplifications and strong opinions that threaten to damage the acceptance of this new method and efforts to encourage women to adopt it. However, we still require further clinical data on the effectiveness of the female condom at preventing pregnancy and HIV transmission. Availability of the female condom is improving in Africa. Pilot marketing studies were launched in 1996 in Guinea, Zambia, South Africa, followed by Uganda and Tanzania. There are local initiatives in Ivory Coast and Zimbabwe. (ABSTRACT TRUNC</b:Comments>
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