Alex Blaze

Female Condoms Distributed in San Francisco

Filed By Alex Blaze | February 15, 2011 6:00 PM | comments

Filed in: Living, Media
Tags: California, Catholic church, condoms, female condoms, san francisco

Female condoms started being distributed and will be marketed to gay men in San Francisco. Local news was on the scene (text here):

Was there any reason to go to a Catholic teacher to get the "gay sex is bad" quote? Were they just trying to get another opinion on condoms - some people say they keep you safe, others say they'll send you to hell - but the only "fair and balanced" debate here is on whether people will use them, whether they're an effective use of limited resources, etc. That some people hate gays isn't really the story, and the Catholic Church's opinion on condoms isn't much more insightful either.

Also, and people who live in SF can answer, does all local news take an "only in San Francisco!" tone? It seems like it'd get annoying, and people do use condoms outside SF.


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The newscaster wonders where else, but in San Francisco?... -Well, DC for one. For over a year now, the DC Department of Health (DOH) has been distributing female condoms to LGBT venues throughout the city. Although, unlike SF, the DC DOH has not yet produced any media campaigns specifically targeting gay men. Fenway Health, Boston's premier LGBT Health organization, has also been distributing FCs for quite sometime along with information on how to use them for anal sex. Check out this piece from MetroWeekly last year: http://www.metroweekly.com/domestic_partner/sex/?ak=5452

As I posted on Alex's piece on this topic earlier last week, there's a real learning curve when it comes to adopting new public health interventions. In this case, in particular, putting the cart before the horse by handing out loads of FCs to gay men without proper education around their correct use could put them at increased risk for FC failure. -Which raises another issue: there are not yet clearly defined guidelines, as FC use for anal sex has not yet been studied sufficiently. In fact, most studies I've found conclude there is an increased risk of condom failure and rectal bleeding when FCs are used for anal sex.

I'm all for new, creative alternatives for people to protect themselves. And if these work for people who are experienced with them, fine. But imagine... you're a young gay guy in throes of getting it on for the first time, and you're fumbling trying to figure out how to use this cumbersome FC that no one has ever coached you in how to use properly. Chances are you'd screw it up. We already have enough trouble getting gay men to properly use the regular male condoms we've had around for years. Personally, I'd say stay with what works until there's evidence of something equivalent or better that comes along.

At least FCs are finally getting some attention! I'd love someday to see gay men well educated in their safe an effective use. That said, although the reporter said gay men are now "asking for their approval," that approval will come from the FDA depending on what the evidence says is safe and effective, not just because a lot of people feel it's a good idea. So in the meantime, we should encourage further research.

That said, although the reporter said gay men are now "asking for their approval," that approval will come from the FDA depending on ...

Oh, Dan! ... Grow up! ... depending upon when Hell freezes over!

Do you actually believe that the US federal government is going to do anything that directly implies that gay sex is OK and should be "aided and abetted" ... and if they do, exactly how long will it take for a caucus of rabid GOP Congress-critters to cut the FDA budget, and thus the FDA itself, out of existence?

Gay men in SF and DC and everywhere else haven't been asking "for approval" to have sex ... and they shouldn't start now. Furthermore, we can probably figure out for ourselves the best ways to use low-tech gizmos such as FC's ... and we can figure it out a helluva lot faster than the FDA can.

And if you think I'm wrong ... then show me the FDA-approved anti-HIV anal microbicide that we have been waiting for ... for about three decades now.

AJ:

My point was simply that no one asks for interventions to be approved; rather, they are approved for a particular use based on the weight of supporting evidence. I felt the reporter implied that gay men were actively seeking approval out of some sense of entitlement, when the science will ultimately determine that outcome. More accurately, she should have said that gay men aim to include FCs as part of their arsenal to combat transmission of STDs and are supporting local efforts to raise awareness and promote their use for anal sex.

Understandably, the gay community has a rough history with the FDA and NIH, especially when it came to approval of HIV drugs. If the gay community hadn't demanded quicker access to life saving HIV drugs in the 80s/90s, compromises would not have been made for fast-tracking certain drugs or allowing broader access during the approval process. So there's definitely a place for pressuring for approval.

Although I agree it is still more of a challenge than it should be (if not impossible) to fund research for interventions that deal with gay sex; my point had less to do with funding the research and more to do with whether or not such interventions are ultimately approved.

After all, just last month, the FDA approved use of Gardasil, the HPV vaccine, to protect against anal warts and cancer (http://www.aidsmeds.com/articles/hiv_gardasil_anal_1667_19644.shtml). This approval came on the heels of a massive study to test an intervention (previously approved for use in women/girls) in a new population, gay men. I participated as a subject in this large scale, multi-city randomized control trial, designed to determine if the vaccine would have a similar benefit in gay in preventing anal caner and warts as it had in women, protecting them against cervical HPV and cancer. Although largely funded by Merck, Gardasil was shown to be efficacious and was subsequently approved by the FDA for use in gay men.

Research has always moved at a slower pace than we'd like; and you're right that chances of any big advances happening while the Republicans continue to slash and burn (they even put another ban on federal funding for syringe exchange back in the Appropriations bill, on top of everything else) NIH and HIV funding are slim to none. I'm not saying we should stop handing out female condoms and wait for the research (as anecdotally a proof of concept is at least there), but just that we need to be careful in how we do it. That's all.

Two final points:

1) The collective "we" can figure it out before the FDA, doesn't fly in my mind.... since not all of us can. Otherwise, we wouldn't have so many problems using regular condoms. Gay men are not all fortunate to be well educated about FCs or other means to protect ourselves, which may pose a problem if faced with having to use one. Beyond enabling approval, the research would inform us what really is the best way to use the FCs - providing us with guidelines or best practices. Does it make more sense to leave the ring in or out? How long can you place them in the rectum before having sex? Can they be reused? etc.

2) And as for microbicides... again our anatomy is different (it's an open as opposed to a closed tube) and the mechanics of anal sex are different than with vaginal sex; so developing an effective microbicide for anal sex is even more challenging for us than it is for women. Risks of chemicals irritating mucous membranes (as with the nonoxynal-9 issue in years past) are also cause for concern. Research is being done... Could we be doing more? Yes. But as indicated, this challenge is not as simple to solve as it seems, compounded by there being limited research funds and effective alternatives for the time being.

AJ:

My point was simply that no one asks for interventions to be approved; rather, they are approved for a particular use based on the weight of supporting evidence. I felt the reporter implied that gay men were actively seeking approval out of some sense of entitlement, when the science will ultimately determine that outcome. More accurately, she should have said that gay men aim to include FCs as part of their arsenal to combat transmission of STDs and are supporting local efforts to raise awareness and promote their use for anal sex.

Understandably, the gay community has a rough history with the FDA and NIH, especially when it came to approval of HIV drugs. If the gay community hadn't demanded quicker access to life saving HIV drugs in the 80s/90s, compromises would not have been made for fast-tracking certain drugs or allowing broader access during the approval process. So there's definitely a place for pressuring for approval.

Although I agree it is still more of a challenge than it should be (if not impossible) to fund research for interventions that deal with gay sex; my point had less to do with funding the research and more to do with whether or not such interventions are ultimately approved.

After all, just last month, the FDA approved use of Gardasil, the HPV vaccine, to protect against anal warts and cancer (http://www.aidsmeds.com/articles/hiv_gardasil_anal_1667_19644.shtml). This approval came on the heels of a massive study to test an intervention (previously approved for use in women/girls) in a new population, gay men. I participated as a subject in this large scale, multi-city randomized control trial, designed to determine if the vaccine would have a similar benefit in gay in preventing anal caner and warts as it had in women, protecting them against cervical HPV and cancer. Although largely funded by Merck, Gardasil was shown to be efficacious and was subsequently approved by the FDA for use in gay men.

Research has always moved at a slower pace than we'd like; and you're right that chances of any big advances happening while the Republicans continue to slash and burn (they even put another ban on federal funding for syringe exchange back in the Appropriations bill, on top of everything else) NIH and HIV funding are slim to none. I'm not saying we should stop handing out female condoms and wait for the research (as anecdotally a proof of concept is at least there), but just that we need to be careful in how we do it. That's all.

Two final points:

1) The collective "we" can figure it out before the FDA, doesn't fly in my mind.... since not all of us can. Otherwise, we wouldn't have so many problems using regular condoms. Gay men are not all fortunate to be well educated about FCs or other means to protect ourselves, which may pose a problem if faced with having to use one. Beyond enabling approval, the research would inform us what really is the best way to use the FCs - providing us with guidelines or best practices. Does it make more sense to leave the ring in or out? How long can you place them in the rectum before having sex? Can they be reused? etc.

2) And as for microbicides... again our anatomy is different (it's an open as opposed to a closed tube) and the mechanics of anal sex are different than with vaginal sex; so developing an effective microbicide for anal sex is even more challenging for us than it is for women. Risks of chemicals irritating mucous membranes (as with the nonoxynal-9 issue in years past) are also cause for concern. Research is being done... Could we be doing more? Yes. But as indicated, this challenge is not as simple to solve as it seems, compounded by there being limited research funds and effective alternatives for the time being.

To respond briefly to just one of your points, Dan, specifically 1):

The failure of gay men to use condoms, or to use them properly, is not because of the unavailability of information about how to use them correctly (whether that info comes from govt or some NGO source) -- it is largely a matter of simple inattention or blatant unwillingness.

To me, this renders moot your perception of the FDA as the center of the information universe. My argument is that the LGBT community has the wherewithal, or can find it, to establish and distribute the needed knowledge independent of the govt -- and to do so is to our advantage, since that also circumvents the political barricades that the govt must deal with.

AJ:

Just because you say so, doesn't make it so. Do you really believe inappropriate condom use by MSM is solely because they don't care or are unwilling to learn about how to use condoms properly? If that were the case, why would MSM bother attempting to use them anyway, if they don't care about educating themselves on their proper use? Not every young gay person has ready access to condoms or practice in using them before they need to. I sure didn't; and I'm guessing the numerous young, unassuming gay men who come into Whitman-Walker Clinic regularly for their first HIV test and get broadsided by a positive result didn't either. Moreover, I'm aware of countless sexually experienced gay men that still open condoms with sharp objects, use oil-based lube, and flip the condom over if first donned incorrectly - all improper ways to use them. Also, gay men probably shouldn't use ribbed and studded condoms because they'll likely disrupt the anal mucous membrane - making them more prone to transmission of STDs - but many likely do. These are many questions about regular condom use that gay men should be educated about to diminish risk of condom failure; and the same should be done for FCs. Proven efficacy aside, I don't see what's wrong with at least finding out what works best or how to decrease risk of condom failure.

The female condom opens up a whole new world of questions about their safety and the most appropriate way to use them. Many of these questions we haven't begun to answer. But by all means, let's unleash this untested intervention on gay men and let them figure it out for themselves. Their lives only depend on it.

Secondly, I'm not saying that "the FDA is the center of the information universe;" just that it makes sense to look at this matter through a scientific lens, as opposed to making decisions based on willy-nilly anecdotal reports. Don't you agree? If answers about FC safety come from research before the FDA has any say, I don't care. But I'd rather we take a more prudent look at the many questions around FC use to ensure they are actually safe and that gay men can use them as optimally as possible. To give an example, when women first started using FCs, some used them in addition to having their male partners also don a male condom at the same time - hoping to provide double protection. Makes sense, right? And it likely worked well for some people too. However, after researching this question in a more controlled fashion, it was found that doubling up actually lead to increased condom failure. What we assume is a good idea doesn't always pan out in reality. As such, we shouldn't assume female condoms are safe because they sound like a neat new intervention that work well for some people.

I'll admit that if someone handed me one of those before sex, I'd have no idea what to do with it.

Well, Bil ... I hope you never have to buy "Assembly Required" furniture at Ikea ...

Bil, I already posted a helpful video on how to use it last week. Didn't you memorize it for the next time a rough trick says it's the only thing he has? You never know!