As Uganda continues to struggle with condom shortages and inconsistent use, an ongoing campaign hopes to encourage more young people to use condoms and to raise the profile of the little-used female condom.
The multimedia campaign, dubbed "If it's not on, it's not safe", is run by local health group Uganda Health Marketing Group (UHMG) with funding from the UN Population Fund (UNFPA), and is designed to reduce the rate of sexually-transmitted infections (STI) and unplanned pregnancies among people aged 18-34.
It includes broadcasting of radio and TV spots on female and male condoms, DJ mentions, as well as TV talk-show discussions, billboard ads and posters.
Research shows that while high-risk sex is common in Uganda, male and female condom use is fairly erratic. Meanwhile, HIV prevalence in Uganda is rising, going from 6.4 percent in 2005 to 7.3 percent in 2012, making effective HIV prevention campaigns more urgent than ever.
Supply chain problems - including a requirement for post-shipment testing on imported condoms - have led to regular nationwide male condom shortages in the country, which requires some 240 million annually but only receives about half that through the public sector.
Uganda has had numerous condom drives over the past three decades, but according to Daudi Ochieng, head of communications at UHMG, the placement of the female condom at the front and centre of this campaign is what could make the difference.
“The positioning of the female condom is `Power is now in your hands’ and this is intended to portray the woman as having the power to say, `look man, I have a condom too so go away with your excuses of why we can't have safe sex’," he told IRIN. "The other point of positioning is now we have a female condom that can be worn 12 hours in advance of sexual intercourse. This way it doesn't get in the way of the heat of the moment, also... in times of poor negotiating for sex the woman can guard herself from unintended pregnancies and HIV by wearing it in advance."
The female condom is a 17cm-long polyurethane sheath with a flexible ring at each end. It provides about the same protection from sexually transmitted infections - including HIV - and unwanted pregnancy as the male condom, but unlike the male condom, can be used with oil- and water-based lubricants without the risk of breakage.
Since the campaign began in June, more than 10,000 female condoms and 360,000 male condoms have been distributed free of charge, with another 120,000 condoms sold.
A hard sell
Earlier efforts to popularize the female condom in Uganda failed. In 2007, the government stopped distributing the original female condom, FC1, on the grounds that women had complained it was "noisy" during sex. The FC2 was introduced in 2009, but has not, until now, been promoted publicly. While it has done better than its predecessor, it continues to lag well behind the male condom.
Another barrier has been cost - when it is sold, the female condom costs significantly more than its male counterpart.
According to baseline research conducted by UNFPA and UHMG in 2011, myths and misconceptions were the biggest hindrance to female condom uptake, with only a small minority of those interviewed ever having seen or used the condom.
"I see the condom, but even me as a medical doctor I don't know how to use it. I wonder how the ordinary women can insert it in. The condom looks big and scary. I fear to use it," a female doctor at Kampala's Mulago Hospital, told IRIN.
Vastha Kibirige, the national condom coordinator at the Ministry of Health, told IRIN that a study was planned to establish the current use of FC2 in the country.
"The uptake of female condoms has slightly improved. Since people are picking them, we need to have a follow up study to know whether they use it or not," she said. "You can't tell whether they are using it or not. Some people may pick and take them for curiosity."
A 2011 study by UNFPA found that female condoms were slowly gaining popularity around the world, largely as a result of successful partnerships between governments and technical agencies advocating their use and increasing their availability.
Comprehensive HIV prevention
HIV activists have welcomed the campaign, but some warn that other HIV prevention methods - in addition to condom use, Uganda relies on messages of abstinence, faithfulness and on biomedical methods - must remain in the frame as well.
In addition, they say any campaign to boost female and male condom use must be met with a significant improvement in their supply, in order to ensure consistent availability and use.
According to Alice Kayongo, regional policy and advocacy manager at Uganda Cares, a programme of US-based NGO AIDS Healthcare Foundation, there is a need to bring on board non-traditional partners including religious groups, cultural leaders and men to encourage all sections of the population to use both male and female condoms responsibly.
According to Ochieng, campaigns like the current one will help make female condoms a more mainstream part of people's sexual lives. "We need to continue the promotion and demonstration so that we can move this from a trial proposition to a habit."