Media images of men in northern Kenya washing condoms for re-use have underscored the need to improve HIV communication and close gaps in the supply of condoms in rural areas.
Local TV channels recently showed images of men in Isiolo, in rural northern Kenya, washing condoms and hanging them out to dry; the men said the price of condoms meant they could not afford to use them just once. Other men in the village said when they had no access to condoms, they used polythene bags and even cloth rags when having sex.
Male condoms are intended for single use; washing and re-using them weakens the latex, increasing the chances of breakage and in turn, the risk of unwanted pregnancy and sexually transmitted infections, including HIV. Washing condoms in dirty water may also carry additional disease risk.
Condoms are free at government health centres, but in rural Kenya these are few and far between and supplies unreliable.
"Many rural areas in the country are inaccessible due to the poor road network and this makes distribution of condoms difficult and challenging," said Peter Cherutich, head of prevention of the National AIDS and Sexually transmitted infections Control Programme, NASCOP. "Because government condoms are mostly made available at health facilities and there are not many in rural areas, this creates another challenge in distribution."
Cherutich said condom re-use showed that the government had to be more creative in raising awareness about their proper use.
Hosea Motoro, 37, knows he risks infecting his wife of seven years with HIV if he does not use a condom. "I know I am positive but I don't want to give my wife HIV and I know if I use a condom, she is safe. We also don’t want any children because we already have five and that is enough for us," he said.
Motoro usually walks the 5km to his nearest health centre for condoms, but on occasion finds them out of stock.
"When you go and you are lucky to get [condoms], you use, then you wash and use another time," he added. "But the washed one is very difficult to put on and I don't know if it protects like the new one."
His wife Josephine says sex with a used condom is unpleasant, but believes it is better than no condom at all. "It feels rough but what do you do when you know he is positive - you don't want to get HIV and you also have to give him sex," she said.
The Ministry of Health recently said the country faced an acute, nationwide shortage of condoms; it has appealed to the US President's Emergency Plan for AIDS Relief, PEPFAR, to supply 45 million condoms.
According to Shahnaaz Sharif, director of public health at the Ministry of Health, the ongoing condom shortage can be blamed partly on procurement bottlenecks.
"We seriously need to improve the procurement of health commodities such as condoms to reduce cases of shortages that put people's lives at risk," he said. "We have started to strengthen procurement systems and put in place commodity projection plans to stem unnecessary shortages."
|The washed [condom] is very difficult to put on and I don't know if it protects like the new one|
Julia Naselenko, coordinator of the Pastoralist Communities Network, a community-based organization in Isiolo, says the recycling of condoms shows how desperate people are to have safer sex. She said the government needed to be innovative in getting condoms to the most remote villages.
"Buying vehicles might not help because there are [areas] that even vehicles cannot access," she said. "I wish they could use bicycles to distribute condoms, and then there are respected community leaders whose homes could be used as points of distribution and access."
Demand for condoms has more than doubled over the past seven years from eight million to 20 million per month, the Ministry of Health reports. However, estimates from the Kenya Modes of Transmission Analysis 2008 show that in 2006 and 2007, about seven million condoms were distributed monthly, reaching 10 million or more in only six of the 24 months.
Under the Kenya National AIDS Strategic Plan 2009-2013, the government aims to reach a distribution target of 28 million condoms per month by 2013.