African Alliance sits down with Griel Dawid Howard – he prefers to go by Dawid – to speak about the inner condom in South Africa.
This article is part of an African Alliance series celebrating 25 years of the inner condom in South Africa and the people who helped to establish the world’s biggest state-funded inner condom project.
Griel Dawid Howard is known in the district hospital of the Emadlangeni sub-district, Amajuba District, KwaZulu-Natal as the manager everyone wants to work with – and not because he says yes to everything. Rather than focus on individual issues, he tries to improve the system to fix problems.
Howard works at the district hospital, as the operational manager of the HAST unit, the HIV and AIDS, STIs, and TB operation of the hospital.
He speaks to African Alliance with the heat of summer not dampening his enthusiasm for public health and condom distribution and use.
Public health at your cervix
So, how does Howard take on improving systems rather than focusing on individuals?
Not so long ago, the Department of Health delivered a truckload of condoms, mostly consisting of the external (male) condoms. They realised that the system meant they focused on areas men frequented; taverns, pool halls, sports recreation centres. This meant that more external condoms were being delivered – a reinforcing loop.
“We’ve sort of had to dial back a little bit and say, you know what team, let us try and activate more sites where women can access condoms, and even if the distribution does not match the male condom – but at the very least, let us put it out there as an option for them, so that they can engage it at their leisure, instead of it being something that we bring into a community when we are not really residents of that community.”
From a passive marketing point of view, he says they distribute the inner condom, waiting to see if there is a market for the product. Then, if the condoms are being picked up, they go into the community and engage with people to see if it’s being used for its intended purpose.
Howard is all about new conversations, pushing the agenda of development, for his staff and the community he works in.
“[The inner condom] empowers the women to be able to take charge of how they want things to happen and things are not left to chance, if they have that option,” Howard says. “When she has to rely on the opposite sex to come with the condoms, they sometimes very conveniently, ‘forget’ to bring them.”
It’s a gamechanger, Howard says, because women and men who are receptive partners are not at the mercy of a partner who may or may not use external or ‘male’ condoms.
From support to prevention and treatment
As a newly graduated professional in the early 2000s, his first allocation was in a medical ward where HIV positive people had to be prepared to get healthcare at home.
“You could see the detrimental effects of what HIV has been doing in the community, because we discharged individuals that you would otherwise prefer to keep in the unit,” he recalls. “But because of the influx of patients that needed to be attended to, you had to decide ‘Okay, this one is better than what he was when he came in.’ We can take a chance, send them to home based care, and so forth.”
In the midst of rampant AIDS denialism, he was one of the clinicians who saw first-hand the devastating effects of untreated HIV.
In 2012, he made the move from inpatients to join primary health care and became more involved in the prevention of mother to child transmission of HIV.
“As I grew in the programme, I realised that I was catching it at the wrong end of the stick, where we were saying we tried to prevent new infections, but the game changer really was making sure that a number of people were on the programme and taking the treatment properly.”
From concealed to commonly-used
Howard says he would love to see better marketing of the inner condom – something that’s been largely left to the public sector in South Africa, as well as distribution.
“It’s always left up to us on the ground to figure out how we are going to be engaging those parts of the population where we are, in essence, asking them to change their behaviour, to change the way in which they see the female condom.”
He points out that he doesn’t see the private sector market the inner condom with as much fervour as the external, ‘male’ condom. The external condom is in every private pharmacy, usually found in bigger quantities than the inner condom.
In the public sector, both kinds of condoms are found in facilities like clinics, or facilities that have ties to the government, such as social development. It’s always found in the bathrooms, while the private sector displays external condoms at the tills, openly.
Because of this shroud of secrecy, or even just difference in how the two condoms are treated, women have been less likely to use the inner condom or ask questions about it openly.
When it comes to delivery of the inner condoms, he’s found that they are not picked up on par with the external, ‘male’ condoms, something that has been more widely accepted.
“It should be something that individuals are able to access where and when they need it. It shouldn’t be something that is only restricted to certain institutions linked to the Department of Health.”
If you go to a private pharmacy, they should be as visible as the lubricants and external condoms – not hidden, or unavailable.
“It’s very difficult for us to market it, because even the contraceptives that we are using to try and make it seem user friendly; from the get go, you can see by the frowns on people’s faces that say, ‘this one has got a bit more of a technical aspects’ to it. And this is not just from the male side, this is also from the female side.”
He adds that people would much rather rely on their male counterparts to shoulder the responsibility of protection. And that is in part due to how widely educated people are on how to use external condoms.
“I really like to see the female condom being one of the conversation, not just from the public healthcare sector point of view, but also getting it onto the shelves, different packaging, because I’m struggling with distribution to pinpoint where it is [most needed], where are people are using condoms for its intended use?”
In KwaZulu-Natal, he reports that people believe the inner condom can be rubbed on the knees if someone wants to treat their arthritis. The condom does come pre-lubricated, but it has absolutely no benefit for treating aching bones and muscles.
He’s worked in the public sector since 2005, and spent a combined time of 13 years at the district hospital in Emadlangeni.
Howard briefly ventured out of the public sector to be a clinical mentor for WITS RHI, at a school-based STIs/HIV prevention programme in 2020, in Empangeni, Richards Bay.
The Howard family is all about health; his wife of 12 years also worked in public health, and recently started her own primary healthcare clinic. They have three kids together and live in Utrecht, situated about 55km outside of Newcastle. The town is inside a game reserve, with game roaming freely – the only one of its kind in South Africa.
Have you encountered myths about the unproven benefits of the inner condom? Let us know! Get in touch with us on X and Instagram. We’re at @Afri_Alliance on both platforms.