October 2001

Acceptability of the Female Condom After a Social Marketing Campaign in Campinas, Brazil

Key Findings

The number of ever-users of the female condom increased significantly. At baseline, 17 percent (34/204) of the sex workers reported ever use of the female condom. This climbed to 51 percent (109/214) of the women interviewed in the final survey (p < .001). As shown in Figure 1, there were variations in ever-use of the female condom among the sites. For example, the proportion of women from Site C who had tried the female condom rose from five percent to 61 percent. The high proportion of women in Site D interviewed at baseline who had tried the female condom was likely the result of an earlier acceptability trial that distributed free female condoms via a local health post. The main reasons given for initial use were curiosity, prevention of HIV/STIs, and partners’ or clients’ unwillingness to use the male condom.

The female condom offers some advantages over the male condom. Sex workers perceived a number of benefits to the female condom: the ability to have sex in any position without the device breaking or slipping, greater lubrication than the male condom (especially valued by women with several clients per day), and the ability to use it during menstruation and when the man is not fully erect. A few noted that the female condom could be used if the client does not like male condoms. According to a street-based sex worker, “I go to the bathroom and insert the female condom without him noticing it. And I do not lose money and at the same time I protect myself.” Sex workers said they introduce the female condom by highlighting its advantages over the male condom, such as its loose fit, that the man doesn’t have to do anything, and that it can give them both pleasure.

Sex workers are more likely to use a female condom with a regular client than with a new or occasional client. Findings from the final survey show that nearly three-fourths (72 percent) of women who used a female condom within the last six months reported using one with a regular client, compared to 14 percent who used the female condom with a client they either didn’t know well or not at all. More than a third (35 percent) said they used a female condom with a boyfriend. Some sex workers mentioned that they felt more comfortable using it with someone they trust rather than with a stranger.

Practice increases sex workers’ comfort with the female condom. When consistent users were asked how many times it took to feel comfortable using the female condom, most said between two and five times. Comfort involved learning how to insert it correctly and overcoming embarrassment due to its size and shape. According to one sex worker, “In the beginning I was ashamed because of the size and to have to insert it in front of the client. It was terrible…I think by the fifth time I was not ashamed anymore.”

The majority of initiators are not currently using the female condom. Thirty-five percent of final survey respondents who had ever used the female condom claimed to be a current user. The largest proportion of women who reported current use was from Site D, the street-based sex workers (17/29 or 58 percent). This again may be due to previous exposure to an earlier intervention trial. About a fourth (29/109) of ever-users from the four sites said they had used the female condom at least once during their previous five sexual encounters, and 20 percent (21/109) reported using it more than ten times during the last six months. Major complaints were difficulty of insertion and aesthetics (e.g., ugly appearance, noisy during use).

The intervention did not affect male condom use with new clients. About 97 percent of women in both the pre- and post-intervention samples reported that they always used a male condom with a new or occasional client. However, there was a significant decrease in consistent condom use with intimate partners: 53 percent of the pre-intervention sample who had a boyfriend or spouse always used a male condom compared with 37 percent of the post-intervention sample (p < 0.01).

Reported levels of protected sex did not improve between baseline and final results. When asked about protected vaginal sex in the previous two weeks, 83 percent of the women in the baseline survey said they always used either a male or female condom with all of their partners. In the final survey, a significantly smaller proportion of women (69 percent) reported that they always used protection
(p < .001).

Less than a fourth (24 percent) of users actually bought a female condom. Most women reported using condoms they received for free. All of the women who purchased the female condom were willing to pay at most US$1.32 for each one; this dropped to 40 percent when the hypothetical price rose to US$1.70. In contrast, the price of a male condom at the time of the study was US$0.22.

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This page updated on
19 Oct 2007