Musa Chauke, Deputy Director of HIV&AIDS Prevention in the Free State, speaks to African Alliance about the history of the inner condom and what he wants for the uptake to increase.
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.
The Female Condom, or inner condom, was introduced to South Africa in 1998. It’s been 25 years of promoting them in the country.
So, where are we now?
Musa Chauke, a nurse and public health academic who has worked as the Deputy Director of HIV&AIDS Prevention at a provincial level for the Free State since 2018, speaks to African Alliance on how the uptake of the inner condom has gone for the province.
“I think the female condom is very good because it capacitates women in decision-making regarding their sexual health, and breaks the stereotypes of men deciding when to use condom,” says Chauke.
The history of getting jiggy with the inner condom
He’s been working in public health for two decades – from a clinic in Limpopo from 2004, to the Tlokwe Youth Centre in the North West from 2007, then as a deputy director for HIV&AIDS at a district level in the North West, and now provincially as Deputy Director of HIV&AIDS Prevention since 2018 in the Free State.
When Chauke started working with inner condoms, there was a lot of misinformation flying around and not a lot of awareness.
People didn’t like them for various reasons, he says, such as the mistaken belief that they were not safe, or they just did not know how to use them.
Back in 2004, female condoms or inner condoms were not as accessible as male condoms, Chauke explains. As the years went on, the inner condom started to become more available.
In 2016, Chauke says, when training on how to use the inner condom began more fervently, the use of inner condoms started to improve.
Where are we at, stat?
Twenty seven million inner condoms were distributed in South Africa in 2015/2016, exceeding the country’s National Strategic Plan (NSP) target of 25 million annually by 2016.
Now, the health department has peer educators, trained as ambassadors to explain how to use inner condoms, going into harder-to-reach communities to increase visibility of the female condoms.
While uptake of inner condoms is not where they want it to be, it’s still improved, he adds. At clinics, he’s observed that male condoms fly off the shelf faster than the inner condom. But the inner condoms do get taken and the box gets emptied too.
From 2014-2016, an evaluation of the FC was done by the Health Systems Trust. While 90% of men and women had heard of the inner condom verbally by providers, only 20% had ever used it – according to a survey. Though inner condoms were available at almost all sites included in the evaluation, only two thirds surveyed knew they were at healthcare facilities.
While inner condom distribution has doubled since 2008, there are still differences across provinces. Provider interviews showed that three-quarters of providers had been trained in FC provision, but most sites lacked information, education and communication (IEC) materials and demonstration models.
The FC2 is a multipurpose prevention option for unintended pregnancy, HIV and STIs, and is still the only female-initiated HIV, STI and pregnancy prevention method. Inner condoms protect against pregnancy 95% of the time during perfect use, and 79% of the time during typical use.
In the 2017–2022 South African Strategic Plan for HIV, TB and STI’s a target of 40 million FCs was set for the financial year of 2021–2022, a reasonable jump from the goal of the 2015/2016 financial year.
Despite these goals, uptake has been low – a recent review of the FC in South Africa found that FC use ranged between 2.9% and 38.7%, despite having one of the strongest FC programmes in the world.
It shows inner condoms need to be mainstreamed, the same way ‘male’ or external condoms were when they came out.
“My hope for the future is that community acceptability to the female condom will increase and more designs for packaging to continue to address the social needs – for example smaller packaging,” he says.
He also wants the outer package design itself to be updated with a flashier design, so young people are more likely to pick them up.
If more young people get curious and decide to use them, the FC2 is more likely to be normalised as an option.
Are you a young person with an idea about getting the word out about inner condoms? Get in touch with us on X and Instagram. We’re at @Afri_Alliance on both platforms.