Alex Blaze

San Francisco to Advertise Female Condom to Gay Men

Filed By Alex Blaze | February 10, 2011 9:30 AM | comments

Filed in: Living
Tags: bisexual, condoms, female condoms, HIV prevention, HIV/AIDS, men, MSM, san francisco, std prevention

The ads themselves haven't been released yet, but the Bay Area Reporter is reporting that the city of San Francisco will start a campaign for the female condom female-condom.gif(also known as the Reality condom) for men who have sex with men.

In 2009 the FDA approved a new version of the condom that was cheaper, thinner, and better-designed, and promoted it for use in vaginal sex. Such ads aren't likely to get men who have sex with men to use it since they might not know that it works for anal sex or how to use it (video after the jump - it's different from the other condoms you've met). Plus, if they keep on referring to it as the "female condom," it might make it hard to get men to use it.

That's only a year and a half after the new one was approved and over a decade after the old version was approved - you can feel the pressure to prevent an epidemic. My guess is that promoting the female condom will provide more protection than promoting, say, circumcision, but the latter gets debated back and forth and back and forth... while the former is forgotten.

It's not for everyone, some people will prefer it and some people will like the old-school condoms better, but the more effective choices for STD prevention there are out there, the better.


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An expert on this female condom answered all my dumb gay-guy questions about it and how to use it for anal sex. You can see the video of my interview with her at http://marksking.com/my-fabulous-disease/aids-2010-opening-day-sex-drugs-and-annie-lennox/.

Still looks kinda, ummm, bulky to me.

Mark

Yeah and it has that seam on the side! Unless they got rid of it in the redesign?

This particular photo might not be the best. I feel certain that that white line is a fold, not a seam -- and the samples I have of the original design do not have any seams, they are smooth all the way around just like a regular male condom.

Maybe they should call it the Bottom Condon instead of the female condom...

I think they're going to go with "reality condom," but that's just confusing. Is the other condom for fantasy?

My guess would be that they picked 'reality condom' because the reality is that if you are the one getting penetrated, you are prolly the one who is going to have to be responsible for protection (esp when talking about women who have sex with men).

The opposite of reality is not necessarily fantasy -- too often, the opposite is delusion or denial.

My partner works doing hiv testing and prevention and they call it the "bottom condom."

Well, duh!

Both this and anti-HIV microbicide should have been championed years ago -- and the GLBT community is to blame for this failure to educate, probably more than the NIH or FDA or any govt agency.

I'm glad to see someone finally promoting this.

Thanks for the post, Alex. Exactly as you say, the more options we put out there, the higher the chances that everyone will find one that they are willing to use.

Oh, and even though I am not male, I am guessing that you are right in that marketing it as something for women isn't going to help it get accepted in the gay male community.

Have any guys on here actually tried to use it? I'm curious as to the feel, etc.

No ... but I'd love for a hunky volunteer to contact me!

wow, you *are* such a dirty old man! ;)

While volunteering at the Whitman-Walker Clinic several years ago, I first heard about gay men using female condoms with some success - along with the benefit of them being hypoallergenic and their tendency to generate a warming sensation. However, these positive anecdotal reports were all from individuals who were experienced in using FCs. In truth, FCs are designed for use in the vagina - not the rectum. So although it seems like FCs could easily be used for anal sex, in reality the mechanics may not work out the same.

I recently had a conversation with Dr. Manya Magnus at the George Washington University School of Public Health, the principle investigator for the DC MSM National HIV Behavior Surveillance Study published earlier last year, and she also seemed concerned about the lack of data on the use of FC in MSM. Importantly, of the studies that do exist on the subject, there seemed to be increased risk of "rectal bleeding" and other problems, like slippage, discomfort, and bunching up, etc.

Anyway, the most recent study I was able to find when looking into the matter a year ago was from 2003 (Renzi C, et al. "Safety and acceptability of the Reality condom for anal sex among men who have sex with men." AIDS. 2003 Mar 28;17(5):727-31.) The study concluded, "Design modifications, training, and research on the clinical significance of safety outcomes are needed for use of [Female] condoms with anal sex."

Regardless of whether new information on the topic has come out since, I imagine that any issues that emerge around the appropriate use of the FC for anal sex may be solved through a simultaneous, strong education effort. Unfortunately, that doesn't seem to be happening at this point in time.

Also, it's worth mentioning that FC should NOT be used simultaneously with a male condom. Using the two together will likely result in failure of both. At the end of the day, if gay men are going to use them, they need to at least be educated on how to use them properly. Otherwise, they may put themselves at more risk.

At the end of the day, I'm all about risk reduction. So, if gay men are going to use FCs because they feel they provide a better alternative to regular male condoms; then great. People just need to know that the evidence - as far as I can tell - isn't quite there yet.

I am a little surprised that there isn't much information on anal use. There are actually a lot of women who like anal sex, so I would have thought that at least there would be data on that? Some bias among researchers, perhaps? My guess is that it is much harder to apply rectally, but I don't know, not using any kind of condom in any hole...

Neither the medical industry nor culture at large wants to admit to the fact that many women (straight and queer) actually enjoy anal sex. It's the reason why the uninformed but highly regarded quack Drew Pinsky can run around claiming that anal sex will just cause "leakage" in women - and why women won't rise up and tell him to shut up.

Given the phobia around anal sex and the fantasies we nurture about "what women want," I'll be surprised if we get any reliable data about it.

Yes, that was kinda my point! :)

Personally, I don't mind telling anyone who is interested that I like it up the ass, or anything else I like, but i know what you mean!

If this country can ever get over its sexual hangups, it will be a much better place, and a much healthier one, too.

"If this country can ever get over its sexual hangups, it will be a much better place, and a much healthier one, too." So true.

Although, I suspect that you and I, Carol, will be standing at the edge of hell, admiring the beautiful, vast sheets of ice when that happens :-D

(laughs)

Yes, and this wouldn't be the only thing we be standing there together for... :)

It'd be great to have more information out there about this. Unlike some methods of STD-prevention, we really hear nothing about this when it comes to MSM.

I'd imagine that with the redesign of the FC that the discomfort, etc., might be reduced. Do you know if there are any numbers out there about how much this is being used for anal sex, either male or female?

I didn't notice if any of the video's or comments mentioned this but the inner ring should be removed for anal intercourse.Due to the differences between a Vagina and an anus the inner ring could cause discomfort during intercourse.

Thanks! ... That, I'm sure, is a small but important detail.

It's great that we are having this dialogue about condom use. If the female condom is truly a better alternative than a regular condom for those of us who might enjoy anal sex; then we need to delve deeper into this conversation and get more, solid information.

The Health Department at Binghamton ought to be applauded for having had the sense and the sensitivity to produce this video. The "stars" are terrific, and I'd hope that it will reach a larger audience.

Thanks, Alex - we needed that.

George,

I am very iignorant of MSM needs, but I do know a lot of the background for the use in women. It isn't that the 'female condom' is better than the regular one, it is that the woman can control the use of it much better than she can control the use of a regular one by a male partner.

So really, I don't think the benefit is that it is better than a regular condom, the benefit is that it is better than *nothing*! PLEASE educate yourself about the risks and benefits before you make any changes to your practice, ok? :)

And if you are using nothing, I hope you are having sex with someone/ppl you really know well and can trust! :)

Carol, I meant to address the use of the female condom in place of a regular condom for anal usage. I've never taken the risk of enjoying anal sex without a condom, and never would. I don't think it'd be wise in any event. If my current partner (he won't, but...) were to penetrate me, I'd absolutely require that he wear a condom, no matter how confident he and I are about his health and cleanliness.

Thanks for the encouragement to be safe. As for "changes" I'd make in practice, well let's just say it's been awhile since I enjoyed a man fully.

Sorry if I came off preachy, George. I just am sick over all the ppl we have lost to AIDS, and I'd like to never see another case. When I think of the waste and tradgegy, of all the ppl who died and are sick b/c of indifference in the medical community and the government, it blows my mind.

Not that he was worth any more as a human being than anyone else, just that I see him a lot of tv, and of course listen to his music, but that Freddie Mercury had to suffer and die, and not know why, and the loss the world has suffered because of all the hate and lack of compassion, really keeps it in my mind (I don't personally know anyone infected, though do know several who have died, so I can kinda need something to keep this in the front of my mind, and Freddie does that for me).

I apologize if anything I said here was rude or inconsiderate or otherwise offensive. I really don't mean it that way, and am glad to be corrected and educated. :)

Well, it's about darn time! In my little city and other communities across the country (and world) HIV prevention workers have been quietly encouraging reality condom use for gay and bi guys for years. They also have marketed it as the 'bottom condom'.
Since it was first invented in the '90s, research about using FC for anal sex between men has been done (if you don't believe me check out pubmed). Those studies have found that with education and training, FC can be safely used for anal sex between men.
Is more research needed on this product regarding anal sex use? Probably, but larger research institutions, the FDA, and even members of our own community who work in those institutions missed the boat. A perfectly good prevention tool has been denied to many men for over a decade due to this incompetence and homophobia.

Jesse:

I agree with all of your points, except for the assertion that there exists sufficient research to support FC use in MSM. To the contrary, the more recent publications I've come across conclude just the opposite. For example, the article, Mantell, EJ, et al. "Anal use of the female condom: does uncertainty justify provider inaction?" AIDS Care. 2009 Sep;21(9):1185-94 states: "Despite limited safety data and the absence of efficacy data, several studies have reported that the female condom is being used for anal sex by men who have sex with men."

Moreover the above paper concludes, "The dearth of information on female condom use during anal sex could encourage individuals to use the female condom for anal sex, which may increase HIV transmission risk or represent a missed opportunity for protecting non-condom users. There is a need for a series of harm-reduction, acceptability, and efficacy studies and, in the interim, for the development of a carefully qualified safety set of guidelines regarding anal use of the female condom for health-care providers."

Assuming these researchers performed a review of the current evidence base, as that appears to be an objective of their paper, I'm assuming there still remains insufficient data. Anecdotal reports are nice... but that's not science and shouldn't justify Departments of Health going out and distributing them to MSM, especially without appropriate education in place. Otherwise, as indicated in the above article, we may actually put some MSM as INCREASED risk if the FCs are not used properly.

Another recent article, by Kevin, EA, et al. from Am J Public Health. 2009 Jun;99(6):985-7. Epub 2009 Apr 16., concludes: "Although research funding has been available for the development of rectal microbicides, the female condom, which has already been approved for vaginal use, has not been evaluated for anal use. Although there is no evidence that the female condom is safe for anal intercourse, it has already been taken up for off-label use by some men who have sex with men. This demonstrates the urgent need for more protection options for anal intercourse and, more immediately, the need to evaluate the safety and efficacy of the female condom for anal intercourse."

I'm just not finding the studies you're talking about - even after an extensive PubMed search. And I'm not just talking about reviews or meta-analyses... I mean, NO randomized controlled trials or any studies demonstrating basic efficacy with positive findings. Please let me know if you've come across something I'm missing. Sadly, until there's data, we'll continue to lack the guidelines that many sexual health educators are seeking regarding the use of FCs for anal sex. A big hindrance to doing research up to this point has been laws banning sodomy throughout much of the world, including the US until 2003, I believe. Hopefully, the time has come to make some progress on this front, but in my opinion, it doesn't justify putting the cart before the horse when it comes to safety, no matter how great FCs might seem in theory.

Do I think they work as a great alternative to regular condoms for anal sex in some MSM? - Yes. Do I think we're at a point to indiscriminately distribute them? - No; especially, since regular condoms have been shown to work just fine.

I tried commenting a minute or two ago - it's *poof* off into the netherworld, I guess.

Carol, I didn't take offense at all at your commentary; after all, you're just trying to save a life or two and warn people who might otherwise take unnecessary and foolish risks.

Far too many people in this world would sooner say nothing, figuring "it's your life" and that they don't want to be bothered to interfere. I suggest you don't hesitate to chastise those whose behavior is suspect to you.

Keep it up!

Thanks, George! Based on experiences that I have had, I know how it is to have someone who has not much understanding of your community explain yourself to you, and I really want to avoid that, but I hate the thought of another person in the world getting infected. :)