For women in the developing world, few public health strategies have the potential to be as transformative as increasing the rate of male condom usage.
This truth—more controversial than it sounds—is hammered home today by a New York Times report on a new study that found injectible hormonal birth control, such as Depo-Provera, can double a woman’s risk of contracting HIV from her male partner, even as it prevents pregnancy. This catch-22 is unacceptable. Expanding women’s economic and political power means empowering girls and women to avoid three all-too-common fates: early marriage, unintended pregnancy and HIV infection.
It would be great if women and girls could accomplish some of this without the cooperation of male partners. That’s why so much hope has been poured into the development of microbicides—vaginal foams that, theoretically, could prevent both pregnancy and HIV transmission, without men having to do anything at all. But the fact of the matter remains that an effective microbicide has never been developed; that male circumcision, while effective at tamping down on female-to-male HIV-transmission, has far fewer benefits for women and gay men; and that a number of studies now show that hormonal birth control can increase women’s HIV-infection rate.
The problem, of course, is that increasing male condom usage requires massive public education efforts, since cultural attitudes remain a powerful barrier. In Uganda, for example, only 30 percent of people who know they are infected with HIV consistently use condoms, and usage has actually gone down in recent years. Some men in the developing world resist condoms for the same reasons some Western men do: they don’t feel as good, and then there’s plain old misogyny. And over the past decade, all around the world, increasingly effective HIV-treatment methods—as well as hype about the possible benefits of circumcision—have convinced some men (and women) that it isn’t as important to use condoms as it once was.
The problem is that women are left out of the equation when men make this choice uniltaterally, or pressure women for condom-free sex. This new study confirms that the World Health Organization, NGOs, and philanthropists should keep their focus on the only gold-standard method of both pregnancy and HIV-prevention: the male condom.