Female condoms have been slow to gain popularity in the United States, although they are more widely used elsewhere, including Europe, Brazil and South Africa, experts said.
The District began its program two years ago to fight a disease that is at epidemic levels. At least 3 percent of Washington residents have HIV or AIDS, a prevalence rate that is the highest of any U.S. city. In a study, health officials found that large numbers of African American heterosexuals engage in risky sexual behavior that could easily lead to infection. Many heterosexuals think they are not at risk for HIV. Officials turned to female condoms to give women more power to protect themselves from HIV and sexually transmitted diseases, especially if they cannot get their male partners to use condoms.
In the first year, the District gave away 200,000 female condoms at beauty salons, convenience stores, community clinics and other locations. After two years, nearly half a million have been distributed, health officials said. The project also trained peers, including hairstylists at beauty salons, to make it more comfortable for women to talk about sexual health.
“We found the D.C. program was practical and doable,” said David Holtgrave, a co-author and chairman of the Department of Health Behavior and Society at Johns Hopkins Bloomberg School of Public Health. The training increased acceptance among women, and surprisingly, some men.
“When we think about what it means for a city or state to have a comprehensive HIV program, this study really says you ought to include female condoms as one element of a comprehensive program because it’s acceptable, effective and cost-saving,” Holtgrave said.
Although the 23 HIV infections prevented in the first year may seem like a small number, costs mount quickly. The lifetime HIV medical-care cost is $367,134, a figure widely used by AIDS researchers. Averting 23 infections translates to more than $8 million in savings, even after deducting the $414,186 for the overall cost of the female condom program, according to the study.
Of the 200,000 condoms distributed in the first year, the authors assumed that only 65 percent, or 130,000, were used during sex. Based on the prevalence rate of HIV and sexually transmitted disease, they calculated the probability of infection, and effectiveness of female condoms in protecting against infection.
“I think this is a really big deal,” said Greg Pappas, senior deputy director at the D.C. Department of Health and a co-author.
“We’re finding very good use and uptake for it,” he said. For women who are HIV-positive, he said, “they’re saying, ‘I can have sex again.’ ”
Although New York was the first city to use female condoms on a large scale when the product was introduced, the District was the first city to make a big public health push with the second-generation female condom, known as the FC2.
The use of the first-generation female condom in the United States was limited and ineffective because women complained that it was too expensive and unsatisfactory. The second-generation female condom, made by Female Health, is priced at $6.49 for a box of three, about the same cost as male condoms.
The new version is made of a synthetic rubber polymer called nitrile. It is a softer material that conducts heat and enhances sensation. Women — and men — have found it more satisfactory, health officials said.
The District’s project was a public-private partnership funded through a $500,000 grant from the MAC AIDS Fund, a subsidiary of MAC Cosmetics. The grant helped the city buy the condoms at wholesale prices from the manufacturer and provide them for distribution by social service organizations. CVS was the first pharmacy to sell the new condom in the city.
District officials plan to continue the program and distribute between 250,000 and 300,000 female condoms a year.
Funding for the study was provided by the condom manufacturer directly to Hopkins, not to the individual investigators.