Sexual Health 2.0

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Female Condom Campaigns Ring Out Across the U.S.
by Chael Needle

On March 10, National Women and Girls HIV/AIDS Awareness Day invites communities across the nation to get the word out to a population that has been severely impacted by the disease. When it comes to prevention messages, any campaign, formal or informal, worth its salt would set its sights on the female condom.

The Female Health Company (FHC) introduced the first FDA-approved female condom in the early nineties and, just last year, introduced a second-generation version of the product called FC2 Female Condom, also FDA-approved (and the only one that has been), to the U.S.

FC2 works to prevent unintended pregnancy as well as the transmission of HIV/STIs. Worn by a woman during sex, the FC2 has a flexible polyurethane ring at the closed end of the pouch, which is vaginally inserted, and a soft nitrile ring at the open end of the pouch that remains outside of the vagina. The inside of the condom is lined with a silicone-based lubricant.

As a woman-initiated prevention product, the female condom allows women to have more control over their sexual health—and more options for their sexual pleasure. The female condom can be inserted hours ahead of time, so foreplay need not be interrupted by unsexy fumbling. It doesn’t require an erect penis to work, so male partners need not pull out after ejaculation and can stimulate their partners longer. Also, the outer ring stimulates the clitoris during vaginal sex for some women (while the inner ring stimulates the penis tip).

The potential for women’s empowerment was “why the company started and why it has continued to [promote the female condom] even though it’s been a hard struggle all these years,” shares Mary Ann Leeper, FHC’s senior strategic advisor. “We have a total commitment to helping women stay healthy.”

From one iteration to the next, the safety and efficacy of FHC’s female condom has remained the same, but a change in material and less labor-intensive manufacturing process has lowered the cost and made the product more budget-friendly for public-sector health programs around the world. Approved by the World Health Organization in 2006 and now cleared for purchase by U.N. agencies, FC2 has since been introduced in developing countries and now is being rolled-out in the U.S. through a series of sequential campaigns in major cities like Chicago, New York, Washington, D.C., and San Francisco, where rates of HIV and STIs are highest. Houston’s campaign is underway this March, and Philadelphia is on the horizon.

The social-marketing campaigns, in which FHC collaborates and coordinates with each city’s public-health departments and outreach agencies, are useful because knowledge about the female condom as a sexual health option is “increasing but still minimal,” says Leeper.

“When we introduced the first-generation female condom back in the early nineties, it was perhaps a product before its time in the United States. First of all, people didn’t talk about sex until Seinfeld started talking about it, and this was after we had introduced the female condom,” notes Leeper. “Second, the idea of sexually transmitted infections, including HIV/AIDS, and talking about them—it was just minimal at that time. So, women at risk, living in high-risk areas, were interested in it, but the demand was coming from the developing world.

“Being a small company, we didn’t have the resources to do massive consumer marketing. And we still don’t, we still can’t, we’re still very limited. So our focus has always been on the public sector.”

FHC works closely in each urban community, strategizing with key community outreach organizations and/or public-health departments to tailor the message and materials. Chicago’s campaign cribbed urban slang and centered on the tagline, “Put a ring on it,” a play off of Beyoncé’s hit song. San Francisco’s campaigns had posters that read, “The FC2 for when he’s into you,” and ran bus banners that reminded, “It doesn’t always have to be up to him,” targeting young women, heterosexual couples, and, going off-label, men who have anal sex with men. (Each public health department is free to promote female condom off-label use for men who have anal sex with men and men who have anal sex with women.) Though available at retail venues, FC2s are distributed free-of-charge at participating organizations and clinics.

Despite the different approaches across cities, “there are similarities in terms of what needs to be done, in terms of introducing the product. And a key one is training, which we bring to the cities. We do all of the training. We train the trainers,” says Leeper about the educational programs that FHC provides. “We also share the marketing campaigns that were used in the different cities—what worked and what didn’t work. For instance, we put San Francisco in touch with Washington, D.C.’s ad agency because they did such a good job. The San Francisco folks thought they were really good, so they used the same ad agency, and even some of the materials. They just tweaked it so they didn’t have to reinvent the wheel.”

FHC has learned over the years that, “whether it’s in Paris, France, or Washington, D.C., or Harare, Zimbabwe, the key points that have to be communicated about using the female condom are consistent. How you communicate them differs,” says Leeper.

The response has been excellent, says Leeper. New York City’s program keeps expanding. Washington, D.C.’s goal was to increase awareness and acceptability to 10,000 women, and the campaign ended up reaching 25,000 women and men.

Barriers to reaching women still exist, however. “‘I’m not at risk, but somebody down the road is. It’s not me, it’s them,’” Leeper says, quoting attitudes that some women still have about dismissing risk and safer sex. “The whole issue of prevention is a hard sell. When you are talking about prevention and sex, the most intimate act, it’s very hard. Intellectually it makes sense but in practice, when you’re in the heat of the moment, it’s tough to introduce a new prevention barrier method that you’ve never seen before. You grow up learning what a male condom looks like; you didn’t grow up learning what a female condom looks like.” Another barrier is some women’s lack of knowledge about their bodies and how they work, says Leeper. FHC has also learned that prevention barriers are often eased if men are brought into the discussion about penile-vaginal sex.

One set of barriers—access and education—is steadily being dismantled, but only with the help of others. “We can’t do it by ourselves. So we’ve formed partnerships with community-based organizations within the public sector to do this [work] because we don’t know the nuances in each community and we don’t know how best to reach the woman on the street where she lives. We can’t do that by ourselves. The partnership is absolutely critical to the success in the long-term of getting this product to women who need it.”

For more information about FC2s, log on to www.fc2femalecondom.com.

Chael Needle wrote about Real Stories Gallery in the February issue of A&U.

March 2011