A new report warning that nearly half of the commercially-available condoms in Vietnam are of poor quality has health officials worried the country’s tenuous gains in safer sex habits could be at risk.
“Anyone who buys condoms in the private market now faces the risk of using low quality condoms. It affects sex workers and their clients, but also [the public in general],” Arthur Erken, the United Nations Population Fund (UNFPA) Vietnam representative, told IRIN.
Vietnam has made substantial gains in making condoms available to the public in recent years. They are free in clinics, or sell for as little as two US cents at kiosks, cafes, massage parlours and hotels.
The most recent data show that new HIV cases decreased rapidly between 2007 and 2009 and held steady at about 14,000 reports per year in 2010 and 2011, and adolescent fertility rates decreased from 31 births for every 1,000 youths under the age of nineteen in 2009 to 29 in 2013 - considerably lower than neighbouring Laos (65) and Thailand (41).
However, a March 2014 UNFPA report revealed that Vietnam is flooded with poor quality condoms - and oversight mechanisms have failed to catch the influx.
“If the condoms available to users are not of high quality, even if people use them consistently and correctly they may become infected, or pass on infection to their partners,” said Kristan Schoultz, the Vietnam country director for Joint United Nations Programme on HIV/AIDS (UNAIDS).
Experts say standardizing and enforcing condom quality is urgently needed to contain Vietnam’s HIV epidemic. They warn the erosion of condom credibility could undermine years of work in encouraging safer sex.
Condoms supplied at hospitals and clinics are procured by the Ministry of Health, which certifies they meet international standards. But the UNFPA report found that roughly 85 percent of Vietnam’s condom supply comes from the private sector, and 47 percent of these fail quality control tests, typically those imported from China.
Condom quality is measured by the “Acceptable Quality Limit” (AQL), which sets thresholds for temperature endurance, shelf life, and strength to hold liquid or air pressure. Condoms that meet AQL standards are 90-95 percent effective in preventing the transmission of HIV, and reduce the risk of gonorrhoea and Chlamydia by 62 and 26 percent, respectively, notes the UN World Health Organization (WHO).
Condoms that do not meet AQL requirements can contain microscopic holes, which cause them to pop easily when filled with small amounts of water or air. “Low quality rubber is being used, and its elasticity is compromised quicker than it should be,” Erken explained.
“To identify such a high level of failure could be considered very serious,” said David Whybrew, the technical manager for Crown Agents, the consulting firm that led the UNFPA study.
What is worse, many of the poor quality condoms are counterfeit, marketed as Durex or other reputable commercial brands, duping consumers.
While genuine brands cost up to one dollar per condom, counterfeit condoms are sold at rock bottom prices — as low as two US cents each. “This [situation] is tricky because people think they are buying Durex, which is good quality,” said Erken.
Durex claims its condoms can hold up to 40 litres of air without exploding (more than double the AQL test amount), and tests its products regularly.
“If [any condom] does not pass the rigorous testing of the product, the [whole batch] will not be shipped,” the company notes on its Vietnam website.
Anti-stigma victories could be lost
People who inject drugs, sex workers, and men who have sex with men havedisproportionately high HIV infection rates, at 13.4 percent, 3 percent and 16.7 percent prevalence respectively— much higher than the national average of 0.45 percent, according to UNAIDS and government data.
In the recent past, sex workers were reluctant to carry condoms for fear of being arrested, fined, and forced into “rehabilitation centres”.
The sex worker arrest policy has since been abolished, softening that barrier to condom use. However, Schoultz warned, “If people can’t trust the quality of condoms, then they will probably be less likely to use them.”
According to the Ministry of Health, general perceptions of condoms remain precarious due to the population association of condoms with infidelity or sex work.
Presenting a government survey of youth reproductive health attitudes, Nguyen Duc Vinh, the vice director of the Maternal and Child Health Department at the Ministry of Health said a third of under-eighteen Vietnamese believe using condoms amounts to “improper conduct” and 16 percent say condoms are only for sex workers or unfaithful partners.
One study found that only one-third of unmarried youth use condoms. For many, purchasing them at shops and kiosks instead of asking at clinics provides a welcome degree of privacy and anonymity.
“They think it's just embarrassing if someone knows about their personal life, it's just too personal to let anyone know, even a doctor,” explained Nga, the teacher.
Until 2010, aid agencies procured all of Vietnam’s condoms. However, once the country gained “middle income” status, procurement funding ended “virtually overnight,” according to Erken.
“We are confident that government procured condoms [meet international standards] but the private market is a different animal in that sense,” he said.
Nguyen Dinh Tai, the director of the Central Institute for Economic Management (CIEM) in the Ministry of Planning and Investment warned health officials in a March 2014 presentation that the regulation of consumer products in Vietnam has had a history of failure.
In response to the UNFPA report, the government plans to introduce stricter quality assurance by shifting condoms from being a “consumer product” to “medical equipment,” bringing Vietnam in line with WHO and UNFPA condom procurement guidelines.
“It is vitally important that condoms are subject to standardized regulatory testing for quality assurance,” said Schoultz.