Attitudes Toward the Female Condom  

The female condom is used much less often than male condoms. But the female condom may be another effective strategy in reducing HIV and sexually transmitted disease (STD) transmission and re-infection. Researchers at the HIV Center for Clinical and Behavioral Studies at Columbia University examined attitudes and experiences toward the female condom among HIV-positive men and women to shed light on the issues that prevent more widespread use.

Most studies of female condom use have focused on women at risk for STDs; fewer studies have looked at men and HIV-infected populations. The study by Dr. A. Elizabeth Hirky and colleagues, published in Women & Health, focuses on this population to find out if the female condom is a viable option to help stop the spread of HIV/STDs.

The female condom is as effective as other barrier methods, including the diaphragm, cervical cap, and sponge. It is impermeable to sperm and STD pathogens, such as HIV. Studies also show low rates of breakage and a reduced risk of bacterial and viral infection among women users. So why does female condom use remain lower than rates of male condom use?

Investigating Attitudes

Hirky and her associates conducted in-depth interviews with 152 HIV-positive adults in Los Angeles, Milwaukee, New York, and San Francisco between December 1998 and August 1999. Participants were men who had anal intercourse with another man in the past six months, women who had heterosexual intercourse within the past six months, and male intravenous drug users, all of whom were recruited from primary care clinics and community-based service organizations. However, the analysis was based on only those participants who had engaged in heterosexual intercourse, 89 participants (56 women, 33 men).

Most of the participants lived in New York and ranged in age from late 30s to early 40s. More than half of the women identified as African or Caribbean American, and more than half of the men identified themselves as Latino. Just 34.6% of the women and 41.9% of intravenous drug users had completed high school or its equivalent. More than half of the women (54.6%) and two-thirds of the men (67.7%) depended on Disability benefits for their primary income. None of the men reported having a job as their main source of income. All of the men (100%) and most of the women (92.9%) reported lifetime drug and alcohol use, including IV drugs.

The researchers found that those who had used the female condom had a more positive attitude about it than non-users. This finding is consistent with other research on attitudes among HIV-infected women. However, the number of participants in this study with direct experience of the female condom was relatively low, just 19 respondents. Of those, only 12 (9 women and 3 men) had used the female condom more than once. Among the 58 participants who said they had knowledge of but no actual experience with the female condom, 4 had apparently confused it with a dental dam.

How Does it Feel and Look?

Participants described numerous advantages and disadvantages in using the female condom. Advantages were typically described in relation to problems with the male condom. For example, male pleasure, related to penile blood circulation, sensation, and comfort, was said to be greater with the female condom. Respondents also mentioned increased personal control and protection for the woman, elimination of vaginal irritation from latex, and uninterrupted passion since the female condom can be inserted in advance as other advantages.

Almost all of the women and some of the men considered the female condom to be less than aesthetically pleasing. Women who had seen but not actually used it had some of the strongest reactions to it, calling the female condom "cumbersome and weird,"
"real ugly looking," and "scary looking."

Women worried about how comfortable the female condom would be and how well it worked. They also anticipated difficulty in figuring out how to use one. Not surprisingly, those who had used the female condom more than once viewed it more favorably than those who had not. For women, a favorable or unfavorable view of the female condom was often influenced by their partner's reaction to it.

Based on their findings, Hirky and her colleagues suggest that the female condom could become a more realistic option for couples if they were better educated about its potential advantages and disadvantages and received technical training for proper use. For example, both women and men made clear that they did not immediately know how to use the female condom properly. In fact, misconceptions and misuse added to negative attitudes and experiences.

The researchers note that service providers would be a likely source of education and training in female condom use since they are already in the position to distribute information and materials related to sexual behavior and health. In this study, most of the women who had used the female condom had obtained it free-of-charge from a clinic or other community service program. However, negative attitudes and misconceptions among health providers themselves, documented in other studies, prevent more widespread use of the female condom. The researchers conclude that instruction on using the female condom, and talking about it, could help promote the female condom as contraception and protection against HIV/STDs.

* Tracey Cohen is a Science Writer based in Cambridge, MA.