How has a new female condom changed the lives of young women in Ethiopia, including sex workers?
A new female condom, FC2, offers the same level of protection as the first female condom (FC1) while eliminating the noise that some users found distracting. Frehiwot Belay, 26, a sex worker in Addis Ababa, Ethiopia, believes the new condom brings “power for women at risk”.
The Wise-Up project, run by a sexual and reproductive health charity DKT Ethiopia, targets sex workers, their clients and intimate partners with HIV prevention activities. The project is raising awareness of the new condom and working to create a demand for it in 28 cities across the country.
Yenenesh Tarekegn, Wise-Up project coordinator, says: “We believe the new female condom could contribute to decreasing the transmission of HIV, and other sexually transmitted infections.”
The organisation is trying to promote the female condom to students in higher education, young people out of school and sex workers. “After we have worked intensively among these groups, we will go to the general public,” she added.
Struggle with “bemelataw” seekers
Before, when only male condoms were available in Ethiopia, it caused problems for sex workers like Frehiwot, as clients would often try to have unprotected sex with them. These men ask for “bemelataw”, an Amharic word which means having sex without a condom.
Frehiwot recalls a night where a man showed her a packet of condoms, turned off the light and tried to penetrate her without putting one on.
“I caught him before he tricked me and asked him to stop. But he promised me that he would pay double if I let him do what he wanted,” she says.
Experience has taught Frehiwot that such promises are not kept once the sex has happened. “Plus it isn’t worth the risk,” she says, adding that two years ago she got pregnant after having sex without a condom with one of her clients.
“Some clients always try to negotiate with us about bemelataw. This can even turn to violence, sometimes to the extent of rape.”
More power to sex workers
According to Yenenesh, there are many men who always find excuses not to use a condom, saying it is not comfortable and holds their body too tight.
Since the male condom is put on the male body, much of the power goes to the client. The female condom helps give women more control over their own bodies.
Of the 300,000 new infections among adolescents aged 15-19 in 2013, there were twice as many new infections among girls as in boys. Women, and particularly young women, are more vulnerable to HIV both biologically and because of their socio-cultural status which often makes it challenging to negotiate safe sex.
Frehiwot said: “If a female condom can be inserted, even a few hours before sex, we will be able to protect ourselves by putting it in before we go with our customers.”
A couple of years ago, FC1 was introduced to Ethiopia but there was a low take up, due to gaps in demand creation activities and the global shift to using FC2.
DKT Ethiopia has recently added FC2 to the list of products it supplies, which include nine types of male condoms and other family planning products.
Through series of awareness creation activities, DKT hopes to increase the demand for the female condom. The United Nations Population Fund (UNFPA) is funding the organisation to carry out female condom training sessions.
Need for more funding
However, there are some concerns over the cost which at USD0.15 per piece is up to three times higher than the heavily subsidised male condoms Hiwot Trust and Sensation.
According to Yenenesh the material used to make the FC2 costs more than the material used to produce male condoms. She said that if more funds were made available, it would be possible to provide female condoms at a lower price.
A report published by the World Health Organization, based on data reported between 2007 and 2011, indicates HIV prevalence among female sex workers in sub-Saharan Africa is 36.9%.
The female condom may be a step in the right direction, but financial insecurity, diverse working conditions and violence are major factors which contribute to sex workers’ vulnerability to HIV – and much more must be done to protect their rights.
Befekadu Beyene lives in Ethiopia and is a member of the Key Correspondents network which focuses on marginalised groups affected by HIV, to report the health and human rights stories that matter to them. The network is supported by the International HIV/AIDS Alliance.