Why the condom is losing its lure

Why the condom is losing its lure

MASERU – Listening to public health officer Makhotso Tšotetsi lamenting how an attempt to boost Lesotho’s fight against HIV and AIDS could be backfiring with potentially terrible consequences, one is quickly reminded of the law of unintended consequences.
Long known to social scientists well before it was popularised in the 20th Century by late American sociologist Robert K Merton, it is the concept that one’s actions produce not only the intended results but could also yield other outcomes that one never thought about, anticipated or wanted – the unintended consequences.

Sometimes unintended consequences can be so negative as to make a problem or situation far worse than it was before the intervention.
Well, not quite where the Ministry of Health is with its bid to use voluntary male medical circumcision (VMMC) and the free access to pre-exposure prophylaxis (PrEP) medication to strengthen its campaign against HIV and AIDS.
But still an unwelcome drawback, with some people, according to Tšotetsi, now thinking that with the introduction of VMMC and the ready availability of prophylaxis medication they could as well ditch condoms altogether – a worrying trend that if unchecked could undo decades of effort against the scourge.

Tšotetsi said with VMMC touted as having the potential to reduce the chances of infection by 60 percent some people now think being circumcised is a passport to having unprotected sex.
“Then there is PrEP that allows anyone to collect the pill at any clinic and this is definitely going to reduce the number of people relying on condoms to protect themselves,” added Tšotetsi, who was speaking at an event jointly hosted last week by the ministry and the United Nations

Population Fund (UNFP) to review the government’s National Condom Strategy.
She did not give figures to illustrate how much the ministry thinks the use of condoms may have dropped owing to people preferring circumcision as their only method of protection against the virus.

But she said while the campaign to raise public awareness about the huge advantages of male circumcision coupled with the use of prophylaxis medication – which are drugs taken by people at risk of infection to prevent getting infected – had been effective, it appeared some men may have misinterpreted or misunderstood the message.
Instead of using VMMC and PrEP as additional tools to protect themselves some apparently believe that the two could replace use of condoms, a very dangerous development given that, apart from abstinence and sticking to one partner, the rubber sheath remains the most effective way to avoid infection.

One only needs to take a quick review of the progress Lesotho has achieved against HIV and AIDS over the years on the back of a campaign that relied on condoms and antiretroviral (ARVs) drugs.
From the early 90s the country has promoted the use of condoms and ARVs as the primary weapons against the pandemic that at one time was responsible for sending whole families to an early grave because of the low rate of condom use among people with multiple sex partners, while ARVs were inaccessible to many.

But a concerted effort to raise public awareness of the importance of condom use would soon bear fruit with, for example, the country’s National AIDS Commission (NAC) in 2015 distributing 31 condoms per adult man, above the UNFP’s regional benchmark of 30.50, according to the Global Information and Education on HIV and AIDS.

The study also found that condom use among adults in Lesotho aged 15-49 who had more than one sexual partner in 2016 was at 76 percent.
It also said there had been an increase in condom use among men who pay for sex, with 90 percent reporting using the sheath with a sex worker in 2014, compared to 64 percent in 2009.
It looked like the country was on course to winning the war against the pandemic, with the same study saying by 2017, 80 percent of people living with HIV in Lesotho were aware of their status, with 74 percent of all those living with the virus on treatment.

The percentage of people on treatment who are virally suppressed in 2017 was 68 percent, the study revealed.
But this progress could be undercut if the misguided belief that circumcision and PrEP medication alone can prevent infection were to gain traction and more people stopped using condoms.
But how did we arrive here?
Was it simply a case of an initiative with noble intentions unfortunately yielding an unwanted and ruinous consequence?

Zambian expert Holo Machonda, who is a consultant on the national condom strategy, puts the problem down to a lack of effective coordination among anti-HIV and AIDS campaigners.
He said the promotion of circumcision and prophylaxis medication needed to have been done in a well-coordinated manner that would also simultaneously highlight the importance of condoms and ARVs.

Machonda also appeared to suggest that the early enthusiasm about the condom might have been lost, with the sheath now being gradually relegated to a mere birth control tool instead of the vital weapon against a deadly virus that it is.
“Currently, the condom is a reproductive health commodity. (This) is not enough because it means condoms are treated the same as family planning pills,” Machonda said.
He suggested that condom advertising in the media was not as high as it should be in a country that has the second highest HIV prevalence rate in the world.

Machonda bemoaned lack of accurate data on condom usage in Lesotho and called for the establishment of a special condom unit to promote the use of the protective sheath and to gather information on usage to guide future HIV prevention policies and programmes.
“This way the government will be able to see why there is an understocking and overstocking in other regions. Records and data are important,” he said.

Machonda does seem to have a point if one considers that the latest record on condom distribution dates back to two years ago, when the United Nations Programme on HIV/AIDS (UNAIDS) said in 2016 that Lesotho topped the SADC region in the use of condoms among women aged 15 to 24 years.

The report revealed that 80 percent of women interviewed said they used condoms when they had sex with their non-regular sex partners.
But the report did not say how many condoms were distributed countrywide. Also, it was not clear whether the interviewed women represented the majority of sexually active women in the same age group.

However, the fact that the rate of new infections as well as pregnancy among teenagers were on the rise seems to suggest that condom use might not be as wide as would be desirable, said Tšotetsi.
But Lesotho’s Public Health Director, Dr Thabelo Ramatlapeng, believes the country was not about to throw away the fruits of all the hard work against HIV and AIDS over the last few decades.
She says the new condom strategy will enable the country to build on the success of the past by increasing use of the sheath among vulnerable groups and the population at large.

“Our efforts will contribute to the global goal of reducing mortality due to HIV/AIDS and STI’s, reducing unwanted pregnancies and reducing maternal deaths that occur among adolescents who did not plan their pregnancies,” she said.
The strategy will ensure distribution of condoms is done in a more coordinated manner, while the rate of usage will be tracked, and the information used to guide planners on how best to structure future intervention initiatives, Ramatlapeng said.

“All stakeholders must … effectively promote, procure, distribute, dispense and monitor the use of condoms among those that need them” she added.
And for the sake of all of us one hopes things work out as Ramatlapeng envisions.

Rose Moremoholo

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