Friday, August 04, 2006

Lime juice or the female condom - negotiating safe sex

As in most of Africa, HIV in Nigeria is feminized. 58% of those with HIV are women. In addition the numbers of girls and women contracting HIV continues to increase. Therefore an essential aspect of any HIV/AIDS policy needs to address this reality.

Nigeria's "Journalists Against Aids" (JAAIDS) recently published an article on traditional forms of female contraception and hygiene –the use of Lime and Lemon juice, in some regions of Africa as protection against contracting HIV. JAAIDS together with Professor Solomon Sagay who is leading a "Lime Juice" research project at the Jos University Teaching Hospital (JUTH)organised a roundtable event to "examine lime juice as a potential microbicide". A questionnaire of female sex workers (FSW) and attendees at a family planning clinic (FPC) found that 80% of FSW used lime juice as opposed to only 4% of those at the FPC. The FSW also used a number of other products such as dettol, TCP and drinks with lemon juice as protection against STDs including HIV.

The concern here is that although the users claim lime/lemon juice is effective as a contraceptive there does not seem to be any scientific proof as yet. However it is a huge leap from believing that lime/lemon juice or any of the above products, are effective as contraceptives to the idea that they could be effective in preventing the contraction of HIV. This leap shows a lack of understanding of STDs in general, HIV in particular and that both are, medically at least, unrelated to getting pregnant. The message that using a condom is the only appropriate protection against HIV is clearly not getting through even now in 2006 amongst an extremely vulnerable group, female sex workers. The question is why? Is it just a matter of lack of education on how STDs and HIV are transmitted? Or is it pressure from clients to have unprotected sex with the FSW?

Babatunde Osotimehin writing in the New York Times (19.08.05) reports that

”Many girls fall prey to sexual violence and coercion. Many others are married off very young, as young as 13 or 14, long before they are psychologically or physically ready. Abstinence is not an option for these girls, nor is getting their partners to use condoms. It is unacceptable for a woman or girl to ask her partner to use one in our part of the world. In Nigeria, only 23 percent of the men and 8 percent of women use condoms regularly, and, as elsewhere, almost none of them use condoms with a spouse or primary partner”.

Male condoms have been around and in many African communities for years but still men are refusing to use them even as a protection against HIV contraction. Would these same men now accept women using female condoms? Prevention Now is launching a global campaign to encourage the use of the female condom. They claim that the female condom has a higher acceptance rate amongst women in 40 countries because “it gives them greater control in negotiating safer sex” and that the main obstacle to increased access and use is cost. I would add that an additional issue for young women and girls would still be the matter that they do not have the power within their relationships with men to negotiate whether to use a male or female condom. Although it may be slightly easier to use a female condom in that situation. A further issue with the female condom is that it is not that simple to use as a male condom. Women need to be taught how to use it and it requires considerable practice. Even assuming that the use of female condoms would be easier to negotiate there still needs to be some basic changes. Changes in attitudes towards women, in understanding how STDs and HIV are contracted and the availability of free or very cheap condoms whether female or male. With these three components, the campaign has a much better chance of succeeding.

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