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By Janet Rowe

When we discovered early on in the epidemic that HIV is a preventable disease the solution seemed, if not simple, at least clear: get the message out that HIV can be prevented if condoms are used every time we engage in high risk activities like anal or vaginal sex.

The gay men's community responded swiftly by organizing workshops, community forums, condom distribution and developing educational campaigns promoting condom use as a risk reduction strategy. By the late 80's infection rates had leveled off.

For women it is much more complex. General population campaigns urging heterosexual men and women to use condoms flourished, but failed to recognize the social barriers women face when negotiating safer sex.

Now infection rates have leveled off in gay male communities, while they continue to rise among women. Indeed, infection rates are rising faster among women than any other group.

So why is negotiating condom use difficult for women? Simply put condom use requires a man's consent.

When violence or the threat of violence is used to control women's lives, condom use is dangerous to negotiate for many women, more dangerous than HIV itself.

Women are taught that our sexuality is something that exists for the pleasure of men. To be sexually assertive or self-confident is threatening to many men, and women are punished through derogatory labels, physical violence, or both.

Also, women are biologically more susceptible to HIV infection than men transmission from an infected man to a woman is easier than from an infected woman to a man.

An ideal HIV prevention method would be one women control and can use without their partner's knowledge. Such a method doesn't exist. But there is a new option available to women: the female condom (FC). It is the only woman-initiated HIV prevention method on the market and is now available in Canada.

Marketed under the brand name REALITY, the FC looks like a male condom, only bigger. It is a polyurethane pouch with an inner and outer ring. The condom lines the walls of the vagina and covers the cervix. The inner ring holds the condom in place and the outer rings hangs out of the vagina about an inch.

The condom can be inserted hours in advance. Oil-based lubricants don't break down polyurethane, which is thinner and stronger than latex and conducts heat better. There are fewer complaints of discomfort from male partners, and some women report increased sexual pleasure because the outer ring provides added stimulation to the clitoris.

Drawbacks include: The FC isn't very "sexy". It's quite noisy. And it is visible, so it can't be worn without a partner's knowledge.

Without a doubt, the FC's biggest limitation is its cost. Packages of three cost $12 $15: 3-5 times more than male condoms. This makes it unaffordable for most women.

While sexual health and AIDS educators are excited about the female condom, many are reluctant to promote a method women can't afford. Plus, few community agencies and health clinics can afford to distribute samples even at the reduced rate of $85 for 60.

The makers of the FC insists that the price to the public sector is the lowest they can afford for small orders. In a meeting with the Women's Outreach Network of Toronto, the Female Health Company and their distributors, Pharma Science, said the cost to community agencies could be reduced for large orders. But, until our local public health departments make its distribution a priority, mass orders are unlikely.

The female condom is an important alternative. As infection rates are rising among women, the Public Health departments have a responsibility to make access to the FC a priority.

The development of the female condom is a step forward in the prevention of HIV among women, but the Reality is that the female condom won't be a real option until its an affordable one.

Janet Rowe is Women Outreach Coordinator at the AIDS Committee of Toronto.

Lobby your local health departments to make distribution of the FC a priority.

Lobby government funders to permit the purchase of FC's from program budgets.