Awareness of and experience with the female condom among patients attending STD clinics.

Abstract

To the Editor: To the extent that it is a female-controlled method, the female condom has the potential to empower women to protect themselves simultaneously against both conception and sexually transmitted diseases (STD)/ human immunodeficiency virus (HIV).1,2 Yet, relatively little data have been published concerning awareness and use of the female condom among high-risk populations. In 1996, as an adjunct to Project RESPECT, a multisite HIV/STD prevention intervention among heterosexuals attending STD clinics in five cities,3,4 a subset of 413 study participants (196 women and 217 men) was surveyed at a final study visit 12 months after enrollment for familiarity and experience with the female condom. Although the intervention promoted male condom use, no emphasis was placed on female condom use. Of the 413 respondents, 77% had heard of the female condom but only 2.7 had ever used it and only 5.6% knew someone who had used it (Table 1). By chi-square analysis, awareness was higher in women than in men (p < .01), higher in adolescents than in adults (p < .01), and higher in whites than in other ethnic groups (p < .001). Awareness was higher in Long Beach (90%) and Denver (85%) than in San Francisco (73%), Baltimore (69%), and Newark (57%) (p < .001). Among those aware of the device, the primary reasons for nonuse included insufficient knowledge about the device itself and where to obtain it.TABLE 1: Experience With the Female Condom Among Project RESPECT ParticipantsComment Contraception studies show that the female condom performs reasonably well in the prevention of pregnancy with failure rates as low as 2.6% with perfect use and 12.4% with typical use over 6 months.5,6 Although studies of the effectiveness of the female condom in STD/HIV prevention are more limited, in vitro data indicate that the device is an effective barrier for sexually transmitted viruses, including HIV,7,8 and a small clinical trial indicated benefit in prevention of trichomoniasis among consistent users of the method.9 Although no large trials of the benefit of the female condom for the prevention of STD/HIV have been performed, one estimate based on contraceptive failure data suggested a potential effectiveness rate of 94% with perfect use and of 46% with a 50% use rate.5 In our survey of heterosexuals participating in an HIV/STD prevention intervention, awareness of the female condom was generally high, especially among adolescent females who are at greatest risk of STD and unplanned pregnancy. However, despite high levels of awareness, reported use among our subjects (presumably interested in prevention given year-long participation in Project RESPECT) and their network of acquaintances is disappointingly low and consistently so across gender, geographic, age, and ethnic groups. Such limited use may be owing to the novelty and relative newness of the female condom (FDA approved in 1993).1 In our survey, lack of product familiarity was a major issue cited by nonusers who were aware of the product, and, although levels of acceptability have varied across studies, some studies have reported a high level of acceptability among females after specific introduction to the method.10,11 It is encouraging that expense, believed to be a potential barrier12 because of the substantially higher cost of the female condom than the male condom, was an infrequent concern, although cost may not have yet appeared as an issue among our subjects given the low usage. In conclusion, despite the potential advantages offered by the female condom as a female-controlled method for prevention of pregnancy and STD/HIV, we found limited use in high-risk heterosexuals. Greater use may be enhanced by studies documenting field effectiveness in both STD/HIV and pregnancy prevention, as well as by more proactive advocacy among health care providers and public health programs, analogous to efforts to promote the male condom in the 1980s.13