District of Columbia To Offer Free Female Condoms

Jodi Jacobson

The District of Columbia will begin distributing free female condoms in an effort to reduce HIV infections.  The new program will make 500,000 female condoms available in beauty salons, convenience stores and high schools in parts of the city with high HIV rates. DC is the first city in the nation to make female condoms available for free.

The District of Columbia will begin distributing free female condoms in the next few weeks, in an effort to reduce HIV infections.  The new program will make 500,000 female condoms available in beauty salons, convenience stores and high schools in parts of the city with high HIV rates.  This makes DC the first city in the nation to make female condoms available for free.

“Anywhere male condoms are available, female condoms will be available,” Shannon Hader, director of the D.C. HIV/AIDS Administration, told the Washington Post. “We’re trying to make every effort count to build on what already exists . . . to expand options rather than limit them.”  The program will focus not only on making the female condom more accessible, but also on teaching correct use.

Female condoms offer dual protection from infection and pregnancy and may therefore also be useful in reducing high rates of unintended pregnancy.

High rates of HIV infections, a lack of ability by some women at risk of infection to negotiate male condom use, and a study showing that large numbers of African American heterosexuals are engaging in risky sexual behavior prompted the program. 

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Seventy-five percent of participants in an HIV behavioural study said they were in committed relationships. But nearly half, 46 percent, said they thought their last sexual partner had had sex outside the relationship. And nearly half, 45 percent, said they had had sex outside the relationship. More than 70 percent said they didn’t use condoms, and only 60 percent said they had been tested for HIV.

The Post notes that HIV/AIDS infection is the leading cause of death for black women ages 25-34 nationwide. A 2008 report showed the District’s HIV infection rate at 3 percent, or about 15,100 adults, a major epidemic. Some think the rate may be as high as 5 percent.

According to Post article, “the [female condom] project is funded through a $500,000 grant from the MAC AIDS Fund, a subsidiary of MAC Cosmetics, which contributes to numerous city programs, including two of the city’s needle exchange programs. The grant helped the city buy the condoms at wholesale prices from the Female Health Co. and provide them for distribution by social service organizations, including Planned Parenthood, the Community Education Group and the Women’s Collective.”

The move is an official acknowledgment by the city of the futility of relying solely on the use of male condoms, which have been distributed citywide for nearly a decade, to stem the District’s epidemic of HIV and AIDS. Officials said they are turning to female condoms to give women more power to protect themselves from HIV and sexually transmitted diseases when their partners refuse to use protection.  As is true in throughout the world, low-income women often are reluctant to protest when their husbands and boyfriends refuse to use male condoms because they may be dependent on the man’s income or may be physically abused or blamed for the suggestion of infidelity within the relationship. Moreover, women can’t always predict when their partners will demand sex and are not always able to refuse.  Studies have shown that female condoms, which can be inserted well in advance of sexual intercourse, can be part of a larger plan of self-protection in such relationships.

The female condom has been available in Europe for nearly two decades and was first approved for use by the FDA in 1993. Its use in the United States was limited and ineffective.   Last year the Federal Drug Administration approved an improved version, FC2, with a thinner polyurethane that conducts body heat and enhances sexual sensation for men and women, according to its designers at the Female Health Co. The new condom was developed in 2005 and became widely used in South Africa. It is now in use in nations such as Indonesia and Brazil.

Commentary Sexual Health

Building Solidarity to Overcome Invisibility: Sex Workers and HIV-Focused Activism

Anna Forbes

Even as federal agencies and public health organizations have taken steps to address HIV in vulnerable populations, sex workers have been left out of the conversation.

Researchers from the Centers for Disease Control and Prevention (CDC) in February published a study of HIV rates among female sex workers in the United States. The authors of the review—which was limited to female sex workers because research on genderqueer, transgender, and male sex workers in the United States is almost nonexistent—acknowledged that the prevalence of HIV in this group is high. They also noted, however, that they had little material to work with: The paper reviewed 14 studies, of which only two were done in the last decade. Thus, the authors note, “The burden of HIV among this population remains poorly understood.”

This shocking paucity of recent data is a result, in large part, of the withdrawal of federal funds for research on “prurient” topics imposed during the George W. Bush administration. That shift to the right had a chilling effect on the federal HIV response as a whole—an effect that has been most enduring with regard to sex workers. Overwhelmingly, even as federal agencies and public health organizations have taken steps to address HIV in other vulnerable populations, sex workers have been left out of the conversation. This omission is one that HIV-focused activists, at the urging of sex worker rights organizations, are starting to notice.

Most countries recognize men who have sex with men (MSM), people who inject drugs, and sex workers as their primary “key populations”—defined, in United Nations terms, as “groups of people who are more likely to be exposed to HIV… and whose engagement is critical to a successful HIV response.” The U.S. government, however, recognizes the first two, among others, as key populations, but not sex workers. Virtually no federally funded HIV prevention and care services are targeted specifically to sex workers in the United States, although, ironically, U.S. funding does support some good HIV prevention programming for sex workers overseas.

Here at home, they remain largely overlooked. The CDC’s HIV Behavioral Surveillance System (HBSS) only alludes to sex workers indirectly as a subgroup of “heterosexuals at risk of HIV infection” who “exchange sex for money or drugs”—a designation that, obviously, ignores their diversity on multiple levels.

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Meanwhile, the National HIV/AIDS Strategy Update, a federal blueprint for our national response written by the Department of Health and Human Services’ Office of National AIDS Policy, mentions gay and bisexual men 35 times, youth 23 times, transgender people 19 times, people who inject drugs 18 times, and incarcerated people twice. It does not mention sex workers—as such or by any euphemism—even once.

This virtual invisibility was reflected at this year’s National HIV Prevention Conference in Atlanta, billed as the “preeminent conference for scientists, public health officials, community workers, clinicians, and persons living with HIV.” Of the hundreds of abstracts presented via panels, posters, and roundtable discussions, only four mentioned sex workers as a distinct and relevant population to consider at this conference.

At a “listening session” on the NHPC’s third day, I asked Conference Co-Chair Jonathan Mermin—the director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention—about the lack of data on sex workers and HIV. He acknowledged that the CDC has not collected the kind of data on HIV vulnerability among sex workers that it collects on other key groups.

This lack of inclusion is nothing new. In 2012, when the massive bi-annual International AIDS Conference took place in Washington, D.C., many foreign attendees with sex work or drug-using histories couldn’t get U.S. visas to attend.

Four blocks away from the two adjacent luxury hotels where NHPC was held, the HIV Prevention Justice Alliance (HIV-PJA) convened a free “People’s Mobilization on the National HIV/AIDS Strategy Counter Conference.” Nearly 100 participants signed in at its meeting space—some of them unable to afford NHPC registration and some dividing their time between the two conferences.

In the middle of the NHPC’s opening plenary, AIDS Foundation of Chicago organizer Maxx Boykin walked unannounced onto the stage, along with seven other Counter Conference participants, to protest the omission of sex workers from the National HIV/AIDS Strategy Update. “At this conference we talk about getting to zero new infections and ending the epidemic,” he said, “but we will never get there without tackling sex workers’ rights.” The group left the stage to substantial applause.

In contrast to the NHPC, the Counter Conference offered a striking example of HIV-focused advocacy groups joining sex worker rights organizations to address this exclusion. In the process, the collective also examined how structural factors such as housing, gentrification, and displacement affect people’s HIV risk and their HIV prevention and treatment choices.

Rather than choosing among hundreds of presentations, Counter Conference attendees met in plenary with experts leading discussions on topics that included the intersections of HIV criminalization, mass incarceration, and the war on drugs; the barriers to reproductive and sexual health care facing youth and women living with HIV; the escalating difficulty of getting HIV prevention and care in southern states without Medicaid expansion; the links between unemployment, economic injustice, and disparities in HIV-related outcomes; the health care and quality-of-life challenges faced by transgender people; and the need to develop solidarity between HIV and sex worker rights advocates.

At the latter panel, four leaders in sex worker rights organizations recommended that HIV activists learn more about their local and state laws on sex work. Magalie Lerman, representing the Sex Workers Outreach Project, observed that “the political and social environment in the [United States] contributes to negative outcomes for people in the sex trade” in all kinds of ways.

It is not unusual, for example, for police and prosecutors to use the possession of multiple condoms as evidence of someone’s intention to sell sex. This practice has been exposed and subsequently prohibited in a few cities, but is still a common practice elsewhere. It both discourages condom use—thus heightening HIV risk—and provides another tool for unjustly arresting marginalized people, including sex workers and those profiled as sex workers, which frequently includes transgender women of color.

Lack of funding for sex worker-specific HIV prevention and outreach work is another issue where joint advocacy is needed. Lerman urged HIV-focused organizations to “deal us in on HIV prevention funding streams” and collectively demand resources to support local, peer-led empowerment programs that have proven effective in reducing HIV rates. Such projects received less than 1 percent of all HIV prevention funding worldwide in 2009, the most recent year for which data is available. Domestic data on funding for this is, of course, nonexistent.

Another high priority was staff training and program adaptations to make HIV service agencies more accessible to sex workers. Panelist Deon Haywood represented Women With a Vision, a New-Orleans based organization providing harm reduction and HIV prevention services to Black women since the 1980s. She mentioned the need to “make the people running the organization look more like the people coming through the door.” She said this could be done by hiring peer counselors with lived experience in the sex trade and ensuring that their jobs were designed with room for advancement.

Panelist Cassie Warren from Chicago’s Howard Brown Health Center, meanwhile, talked about how agencies could expand their hours, locations (using mobile van services), and strategies to reach street-based youth engaged in survival sex. While the process of investigating and resolving existing barriers to care is labor-intensive, she said, HIV-focused service providers can’t expect to engage with high-risk youth without doing such work.

Building cross-sectoral communication and trust is another major challenge. Panelist Stella Zine, founder of the peer-driven support group Scarlet Umbrella Southern Art Alliance, pointed out that sex work can be a “heavy term” for some people. She urged participants to learn how to talk about HIV and sex work carefully, using language acceptable to people who need services but do not self-identify as sex workers.  

When working with organizational partners rather than clients, on the other hand, Haywood cited a willingness to name the issues on the table explicitly—and to point out incidents where issues are misnamed or avoided—as essential to solidarity building. For example, Haywood commended the Counter Conference for bringing an explicit racial analysis to its discussions, an aspect she found missing at the NHPC.

The central theme of the session was “nothing about us without us.” Having been ignored and forcibly silenced in so many other settings, the panelists emphasized that sex worker rights advocates will partner with allies willing to ensure that sex workers are at the table whenever funding, policy, and strategy decisions affecting sex workers are under discussion.

After the sex workers panel, some of us walked back to the NHPC to attend the “listening session” mentioned above, where I raised the issue of sex worker invisibility. Dr. Mermin responded by acknowledging the gap and advised us of the CDC review published in February. He warned us, however, that this new paper would not contain the kind of key population data on sex workers that is being collected in other countries.

Indeed, the CDC’s website currently states that “there are few population-based studies of sex workers in the United States or globally” (emphasis added) due to their illegal status. In international terms, that assertion is badly outdated. A plethora of studies on sex workers and HIV have been published in the last five years, showing clearly that punitive approaches to sex work exacerbate HIV spread. Public health and rights-based approaches, on the other hand, not only reduce HIV rates substantially, but are cost-saving to boot.

Silencing groups by excluding them from pivotal conferences and omitting them in national strategic planning are forms of overt discrimination, as is simply refusing to include them accurately in population surveys. If uncounted, they do not officially exist and do not have to be served. This political decision results in an absence of much-needed evidence.

Dr. Mermin added, however, that we don’t have to wait for solid numbers or data to increase national efforts to deliver services successfully targeted to sex workers. Was he signalling a federal shift, at last, toward the public inclusion of sex workers in our national HIV response? Hard to tell—but the odds of that occurring are undoubtedly better if pressure for such inclusion escalates.  

Roundups Sexual Health

This Week In Sex: Middle Schoolers Get Condoms, Some University Students Don’t Use Them

Martha Kempner

This week in sex, the San Francisco School Board voted unanimously to approve condom availability for middle school students, agencies provide new advice on Zika virus, and a survey of University of Minnesota students found fewer of them are using condoms these days.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

San Francisco School Board Votes to Make Condoms Available in Middle School

The San Francisco school board voted unanimously to make condoms available to middle school students despite opposition from some parents. The proposal was put forth by the district’s superintendent after a survey found that while 5 percent of middle school students are sexually active, fewer than 40 percent of those students are using condoms. Board Member Rachel Norton told the San Francisco Chronicle“This is not a giveaway program. They are going to be in a private, controlled space with an educator. This policy really is about the handful of students that really need it.”

Some parents and community members, however, argued that this would encourage sexual activity in other young people. Victor Seeto, issues chairman of the Chinese American Democratic Club, said, “The program’s message says sex is normal, is acceptable, but disease is bad. Let us strengthen the family and not weaken it.”

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Nikkie Ho, a parent in the district, told local media, “We’re talking about between 11 and 14 years old. And they are not ready for it, so I don’t think this is appropriate.”

Others were supportive of the plan. One mother pointed out, “It’s latex; it’s an inanimate object. It’s not going to tell my kid what to do. I don’t see what the problem is.”

District officials believe this is an opportunity to engage students in discussions about their reproductive health. They are so committed to making condoms available that parents are not allowed to opt out of the program.

Research shows that allowing students access to condoms does not increase sexual behavior but does increase condom use. The American Academy of Pediatrics believes that schools are an important place to make condoms available.

Advice Differs on Zika Virus Found in Sperm and Breast Milk 

Zika virus is mainly spread by mosquitos but, as with other viruses, it has been found in both sperm and breast milk of infected people. As of now, however, only sperm is considered a possible route of transmission and breastfeeding women in affected areas are being told to continue.

The Centers for Disease Control and Prevention (CDC) is investigating 14 cases in which the Zika virus appears to have been sexually transmitted. All of these cases involve possible infections in female partners of men who recently traveled to areas with Zika outbreaks. Several of the women are pregnant.

Zika virus is usually mild with symptoms that last about a week, such as fever, joint aches, and a rash. The virus, however, may be linked to a condition known as Guillain-Barré syndrome, an auto-immune disorder that can cause temporary paralysis. In addition, researchers are trying to determine what link, if any, Zika has to an alarming number of babies born in Brazil with microcephaly, a birth defect in which the head is much too small.

The CDC is advising that men who have traveled to regions affected by Zika either abstain from sex or use condoms during sex with pregnant partners.

In contrast, the World Health Organization urges women in infected regions to continue breastfeeding despite evidence of the virus in the breast milk of at least two mothers. The WHO said that scientists still don’t know how much of the virus is present in breast milk and for how long it might remain there. Researchers also question whether mothers who have had Zika can pass along protective antibodies through their breast milk.

Despite these unknowns, the WHO says that for babies exposed to Zika after birth, there have been no reported cases of brain damage or neurological problems. Therefore, the agency believes that the benefits of breastfeeding outweigh the risks and is encouraging women in Zika-affected areas to continue.

Condom Use at All-Time Low for University of Minnesota Students

The University of Minnesota wants its students to use condoms to protect themselves from unintended pregnancy and sexually transmitted infections (STIs). Like many schools, it makes condoms available free of charge at various places around campus. But a survey says that condom use among students is down and, not surprisingly, STIs are up.

The survey was done with about 2,000 students, none of whom were married or in long-term committed relationships. It found that only 52 percent used a condom the last time they had sex. This is down from 60 percent just five years ago. The number of students reporting an STI diagnosis is, in contrast, up from 6 percent in 2013 to 9 percent this year.

On-campus health center officials do not know for sure what has prompted the drop in condoms use, but speculate that increased access to other forms of birth control (such as the IUD) and a decreased sense of urgency about HIV may be part of the cause.