Anti-AIDS campaigners in Uganda have denounced the government's decision to halt the distribution of female condoms as poorly informed and dangerous.

The Ugandan Ministry of Health announced last week that it would no longer supply female condoms because of poor uptake by women, who complained that it was difficult to use.

"We have halted their distribution because the women who are supposed to use them have complained that they were not user-friendly," said James Kigozi, spokesman for the Uganda AIDS Commission (www.aidsuganda.org). "Many who have used them complain that they make a lot of noise during sexual intercourse," he told IRIN/PlusNews.

Beatrice Were, HIV/AIDS coordinator for the anti-poverty NGO, ActionAid, said the move was "disappointing", and not enough had been done to ensure that all Ugandan women were aware of the benefits of the female condom.

"I would be interested to know how many women they surveyed said the condom was noisy or was not user-friendly," she said. "One prominent woman activist at a recent conference I attended confessed that she had never even seen one, so what about a poor rural woman? How can they stop providing them if people don't even know what they look like?"

The female condom is a 16.5cm long polyurethane sheath inserted into a woman's vagina before sexual intercourse; it lines the vagina and prevents pregnancy and sexually transmitted infections.

Kigozi said hundreds of thousands of the prophylactics were imported between 2002 and 2004, but few women had used them. "Even those few who tried to use them said they were painful during insertion and uncomfortable during intercourse."

Most women also did not have much say over contraception. "Research shows that one of the reasons why the female condoms were not popular is [lack of] women empowerment in society, as their husbands and boyfriends were forcing them to remove them after they had inserted them," he said. "A woman is yet to have the power and courage to say, 'I have to use it'."

However, Were said Ugandan women were not a homogenous group, and the same standard could not be applied across the country. Some women might not have the power to negotiate safe sex or find the condom noisy, but others might find it entirely acceptable, so a blanket decision to halt national provision was unfair.

AIDS campaigners said women-driven initiatives such as the female condom were a vital tool in the fight against the disease. Were said the decision put in question the government's commitment to eradicating the pandemic among women, who carry a higher HIV burden than men. Women make up almost 60 percent of Uganda's one million HIV-positive people.

"Take, for example, male circumcision, a male-driven prevention strategy; since it was recently confirmed as a method of prevention, all roads lead to huge male circumcision programmes, yet they want us to believe that the female condom, which has been scientifically proven for years, is being stopped because it's not user-friendly - I don't think so," she said.
Dr Margaret Muganwa, of the Global Campaign for Microbicides, said the female condom had not been widely distributed as it could have: "The condoms have been made unpopular because they were inaccessible to the users, who could only get them from government stores, compared to male condoms that can be accessed from all outlets, including hotels."

Female condoms had been less accessible and more expensive than the male condom, said Elizabeth Bukusi, of the Kenya Medical Research Institute (www.kemri.org), but complaints about user-friendliness were trivial.

"Some people have said that it [the female condom] is noisy, but who told them that sex has to be a quiet event?" she said at a meeting on gender equity and development in the capital, Kampala.

Uganda's HIV prevention programme is based on the 'ABC' model of Abstinence, Be faithful and use a Condom, but the 'C' has tended to focus on male condoms.

The male condom has also suffered some bad press: in 2004 there was a nationwide shortage after the government imported defective condoms. The situation has since been rectified, and Kigozi said the health ministry and private firms imported at least 120 million male condoms every year, a quantity that is expected to increase.